Whiplash, A Patient Centered Approach to Management


A Patient Centered Approach to Management

By Meridel I. Gatterman, MA, DC, MEd

1. Introduction

"Whiplash" as an Entity

Whiplash: What is it?

The Epidemiology of "Whiplash" Injuries

Patient-Centered Care

The Characteristics of Patient-Centered Care

Emphasis on Self Healing

Holistic Approach to the Patient

A Humanist Attitude

Working with Patients as Partners

Shared Decision Making

Integrative Care

The Paradigm Concept

Clashing Paradigms

What is Integrative Care?

Evidence-Based Care

History of Whiplash


Mechanism of Injury

2. Functional Anatomy of the Cervical Spine

Embryological Development of the Spinal Motion Segments


Components of the Lower Spinal Motion Segments

The Autonomic Nervous System


3. Patient History and Mechanism of Injury

Brachial Plexus



4. Physical Examination

Listening to the Patient

The Pain Drawing

Chief Complaints and General Assessment

Analysis of Cervical Motion

Segmental Cervical Movement

Neurological Evaluation

Sensory Testing


Testing for Muscle Strength

Provocation Tests for Cervical Spine Disorders

Compression Tests

Foraminal Compression

Assessment of Cervical Nerve Function Through Compression

Disc Herniation


Differentiation of Sprain from Sprain

Assessment of Vertebral Artery Function

Cervicobrachial Pain

Outcome Evaluation

Neck Disability Index

5. Imaging

Acute Injury

Chronic Injury

6. Management of Muscle Injury and Myofascial Pain Syndromes

Historical Overview of Muscle Pain Literature

Theoretical Models of Muscle and Myofascial pain

7. Headache in Whiplash: A Comprehensive Overview

Taking a Headache History

Types of Headache That Might be Encountered

Examining the Headache Patient

Deciding What the Diagnoses are

What are Possible Mechanisms of Whiplash-associated Headache?

Managing Headache in the Whiplash Patient

8. Whiplash Associated Disorders of Joints and Ligamentous Structures

Stability of the Cervical Spine and Whiplash Injury

Cervical Joint Sprain

Whiplash Associated Joint Dysfunction

Clinical Indicators of Cervical Subluxation

Palpatory Findings Indicating Cervical Subluxation

Reliability and Validity of Clinical Indicators of Subluxation

Syndromes Associated with Subluxation of the Cervical Articulations

Whiplash Associated Headache Related to Joint Subluxation

Incidence of Post Whiplash Headache

Headache Response to Manipulation

Posterior Cervical Sympathetic Syndrome and the Vertebral Arteries

Cervicogenic Dorsalgia

Cervical-Brachial Syndrome

Conservative Management of Cervicobrachial Pain

Cervical Subluxation Syndromes

9. Epidemiology of Whiplash Injuries

Basic Epidemiological Terms

Frequency of Whiplash

Whiplash Risk Factors

Societal Impact

A Whiplash Culture


10. The Safety and Effectiveness of Common Treatments for Whiplash

Judging Safety and Effectiveness: An Evidence Based Approach

The Quebec Whiplash Task Force

The Bone & Joint Decade Task Force

Comparing Safety and Effectiveness of Common Therapies

Simple Analgesics

Other Drugs

Evidence for Pharmacological Therapies

Conservative Physical Treatments

Non-conservative Interventions

Surgical Interventions

11. Prognosis of Whiplash Associated Disorders

Prognostic Factors

Psychological and Psychosocial Factors That Delay Recovery

In the Patient's Interest