Whiplash associated disorders (WAD) have been a source of discussion for a long time. Controversy exists between the presence of chronic complaints of the cervical spine and a sustained whiplash trauma with questions about the diagnosis, treatment, and prognosis of whiplash injuries (Yadla S et al, 2008). This controversy is partially due to the lack of a definite proof of injury to the bone, disk, or ligaments (Leidel BA et al, 2008). However, patients with chronic WAD experience extensive complaints and disabilities in daily living and often an extra level of complexity arises with compensation claims. This makes WAD a multilevel source of discussion. One point of discussion is the name and its impact on the prognosis.
One possible explanation for the presence of lasting complaints following a whiplash injury are the cultural expectations of the population in which the injury occurred, engendering the term ‘whiplash culture’ (Haneline MT, 2009). It is known that the incidence of chronic symptoms following a whiplash injury differs between countries. Based on this, a model was proposed in which symptoms are not merely the result of a somatic expression of anxiety or other psychological disorder, but rather of psychosocial factors in those countries with a whiplash culture wherein the occurrence of late whiplash syndrome is common (Ferrari R et al, 2002 & Ferrari R et al, 2005). Expectations about whiplash prognosis were of great interest for the presence of lasting symptoms, but the studies of Ferrari have been criticized. Haneline (2009) concluded in a review on this topic that chronic whiplash symptoms are surely not caused entirely by cultural issues. Yet, they are probably not entirely physical and the answer to the debate probably lies somewhere in the middle.
In the 2016 guideline for treatment of people with neck pain of the Royal Dutch Society for Physical Therapy, it was proposed to abandon the name WAD because of the negative associations with this term and naming it trauma related neck pain instead (Bier JD et al, 2016). Research suggests that causal beliefs may play a major role in the perceived disability and course of neck complaints after motor vehicle accidents, whereas pain catastrophizing is predominantly related to concurrent disability (Buitenhuis J, 2008). People associating their neck pain to ‘whiplash’ possible have a poorer prognosis (Ferrari & Lang, 2005). It was hypothesized that the term whiplash has a negative connotation with all sorts of culturally embedded incorrect associations with its course, such as chronicity, severe disabling complaints or assumptions about desired behaviours such as carefulness with certain movements and especially not moving the neck (i.e. kinesiophobia).
However, the problem remains that the evidence about prognostic factors is not sufficiently robust to confidently make firm recommendations about prognosis (Sterling M et al, 2011 & Ghorayeb JH, 2021). Data is clear that individuals with WAD have various beliefs about pain and recovery, and some of these beliefs may be unhelpful to recovery (Ritchie C et al, 2017). Research suggests adopting a person-centred approach (Juuso P et al, 2020). Therefore, it seems reasonable to consider if it is helpful to use the name WAD or naming it somewhat else. This could be considered in a greater perspective in which we try to discover for each patient what causes the negative beliefs and what strategies are most effective in improving the patient’s expectations (Samoborec S et al, 2018 & Carstensen TB, 2012). In conclusion, there seem to be reasons to change the name WAD, but we need to remember to target all negative beliefs of patients in order to get the most favourable results of rehabilitation.
Erwin Hendriks
Master of Science in manual therapy and sports physiotherapy. Part of the Pain in Motion Research Group. Currently working as a physiotherapist at the Erasmus Medical Centre in Rotterdam (Netherlands) and the Rehabilition Centre Drechtsteden in Dordrecht (Netherlands). Furthermore, Erwin lectures at the Hogeschool Rotterdam.
Pain in Motion, 2024
References and further reading:
Yadla S, Ratliff JK & Harrop JS (2008). Whiplash: diagnosis, treatment, and associated disorders. Curr Rev Musculoskeletal Med, 1 (1),
Leidel BA, Kirchhoff S, Kessler S & Mutschler W (2008). Whiplash-associated disorders: a challenge for the expert in compensation claims and ligitation. Orthopade, 37 (5), 414-23.
Haneline MT (2009). The notion of a “whiplash culture”: a review of the evidence. J Chiropr Med, 8 (3), 119-4.
Ferrari R, Obelieniene D, Russell A, Darlington P, Gervais R & Green P (2002). Laypersons’ expectation of the sequelae of whiplash injury. A cross-cultural comparative study between Canada and Lithuania. Med Sci Monit, 8 (11), 28-34.
Ferrari R & Lang C (2005). A cross-cultural comparison between Canada and Germany of symptom expectation for whiplash injury. J Spinal Disord Tech, 18 (1), 92-7.
Bier JD, Scholten-Peeters GGM, Staal JB, Pool J, van Tulder M, Beekman E, Meerhoff GM, Knoop J & Verhagen AP (2016). KNGF-richtlijn nekpijn. Koninklijk Nederlands genootschap voor fysiotherapie (KNGF).
Buitenhuis J, de Jong PJ, Jaspers JPC & Groothoff JW (2008). Catastrophizing and causal beliefs in whiplash. Spine, 33 (22), 2427-33.
Buitenhuis J & de Jong PJ (2009). De term ‘whiplash’ liever vermijden. Ned Tijdschr Geneeskd, 153, B2.
Sterling M, Caroll LJ, Kasch H, Kamper SJ & Stemper B (2011). Prognosis after whiplash injury: where to from here? Discussion paper 4. Spine, 36 (25), S330-4.
Ghorayeb JH, 2021. The nosological classification of whiplash-associated disorder: a narrative review. J Can Chiropr Assoc, 65 (1), 76-93.
Ritchie C, Ehrling C & Sterling M, 2017. Living with ongoing whiplash associated disorders: a qualitative study of individual perceptions and experiences. BMC Musculoskelet Disord, 18 (1), 1882-9.
Juuso P, Skär L & Söderberg S, 2020. Recovery despite everyday pain: Women’s experiences of living with whiplash-associated disorder. Musculoskeletal Care, 18 (1), 20-28.
Samoborec S, Ruseckaite R, Ayton D & Evans S, 2018. Biopsychosocial factors associated with non-recovery after a minor transport-related injury: a systematic review. PLoS One, 13 (6), eCollection.
Carstensen TB, 2012. The influence of psychosocial factors on recovery following acute whiplash trauma. Dan Med J, 59 12).
Ferrari, R., & Lang, C. (2005). A cross-cultural comparison between Canada and Germany of symptom expectation for whiplash injury. J Spinal Disord Tech, 18(1), 92-97. https://doi.org/10.1097/01.bsd.0000138214.70260.91