An acute whiplash injury results from the sudden hyper-extension, hyper-flexion of the neck with an acceleration-deceleration type traumatic insult, and it is the most common soft tissue injury sustained in motor vehicle collisions.[1] Most cases of whiplash occur after a rear-end motor vehicle collision, and most case presentations include neck pain and stiffness, occipital headache, thoracic back pain and/or lumbar back pain, as well as upper extremity pain and paresthesia.[2] Each year, there are 3 million new whiplash injuries in the U.S. alone.[3] Whiplash is such a significant public health issue that an international consortia of automobile insurers—from North America to Europe, and Japan to Australia—are all actively engaged in whiplash-related research, as are multiple private coalitions, such as the European Whiplash Consortium, International Insurance Whiplash Prevention Group, the Insurance Institute for Highway Safety, and the National Highway and Traffic Safety Administration.
Whiplash injuries can often lead to long-lasting pain and disability and can be costly. When this pain persists over time, whiplash-type trauma can have a psychological component, including post-traumatic fear, anxiety, adjustment reaction, and even depression. A 2001 study confirmed a positive association between whiplash traumas and anxiety disorder and depression.[4]
One very significant risk factor for whiplash is gender. Women are twice as likely as men to suffer whiplash injuries when hit from behind, and studies suggest that this is due to the differences in muscular bulk and the female’s smaller bony structures. These factors likely result in less protection of the cervical spine to certain forces, such as those that occur in a whiplash-type injury.[5] Given their greater predisposition for whiplash injury following a trauma, many medical providers have assumed that women are more likely to suffer from post-traumatic fear, anxiety, adjustment reaction, and/or depression than men who suffer from whiplash. A 2014 published study [6] tested the theory and negated this oft-referenced assumption.
The researchers in this study, from Vrije University and Ghent University in Belgium, looked at 117 patients who all suffered from a whiplash injury, including 24 men and 93 women. They evaluated neck pain, as well as emotional and psychological conditions following a whiplash producing injury. Researchers found no major differences in fear, somatization, bodily pain, disability or overall health between men and women. Interestingly, women in this study actually reported seeking out social support more frequently than men to help cope with emotional dysfunction.
The researchers noted, “This opens the perspective to look for sex differences in chronic [whiplash-associated disorders] in a broader sense.” Researchers concluded that, while psychosocial factors play a role in the development of chronic whiplash, they are “unlikely to be the cause for sex differences in chronic [whiplash.]”
Regardless of the gender of your patient, anyone who is suffering from whiplash and who is dealing with longer-term physical, cognitive, and/or emotional consequences following trauma most definitely needs access to quality health care as well as obtaining second opinions to help assess and treat an injury. Additionally, given the aggressive nature of how insurers deny bills for treatment or outright attempt to block access to appropriate care, it is important to consider having legal counsel assist the patient with insurance-related matters so that the patient can focus exclusively on health and wellness. After all, health is the greatest wealth for any patient and it is our highest goal to assist in that mission.
[1] 4th European Dyna Conference: “Biomechanical Analysis of Whiplash Injuries: Women are Not Scaled Down Men,” Modaka J.
[2] J Bone Joint Surg Br. 2009 Jul;91(7):845-50. doi: 10.1302/0301-620X.91B7.22639 Bannister, G; Amirfeyz, R, Kelley.
[3] Spine Research Institute of San Diego.
[4] J. Psychosomatic Research. September 2002, Vol 53, Iss 3, p. 831-835. “A population study of anxiety and depression among persons who report whiplash traumas.” Wenzel, Haug, Mukletun, Dahl.
[5] http://www.spine-health.com/conditions/neck-pain/what-whiplash h/t: Nordhoff L: “Motor Vehicle Collision Injury for the 1990’s Doctor/Attorney”, Automotive Injury Research Institute, 1994.
[6] See comment in PubMed Commons belowPain Pract. 2014 Sep 27. doi: 10.1111/papr.12244. [Epub ahead of print] Malfliet, A, et a. Sex differences in patients with chronic pain following whiplash injury: The role of depression, fear, somatization, social support, and personality traits. Pain Practice 2014. Doi: 10.1111/papr.12244.
