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Blackwell Science, LtdOxford, UKPPRPain Practice1530-70852004 World Institute of Pain43249266MiscellaneousWhiplash Associated DisordersSIZER Et al.

T UTORIAL

Whiplash Associated Disorders:
Pathomechanics, Diagnosis, and
Management
Phillip S. Sizer Jr, PhD, PT*†; Keith Poorbaugh, MPT†‡; Valerie Phelps, PT†‡
*Texas Tech University Health Science Center, Lubbock, Texas; †InternationalAcademy of
Orthopedic Medicine-U.S., Tucson, Arizona; ‡Advanced Pain Therapeutics of Alaska,
Anchorage, Alaska

Abstract: Whiplash has been defined as an injury mechanism, an injury, a medico-legal or social dilemma, and a
complex chronic pain syndrome. Whiplash associated disorders are frequent in the cervical spine, especially as a result
of a motor vehicle accident. The mechanisms responsiblefor
whiplash-related tissue trauma are complex and a clinician’s
understanding of these complexities lends to a more
complete appreciation for the anatomical structures and
pathological processes that are involved, as well as a
comprehensive diagnosis and appropriate management.
While several classification scales have been developed for
whiplash associated disorders, a thorough andtissue-specific
examination is merited. Management should be directed
toward pain reduction and normalization of mechanics.
While conservative measures can address many of clinical
sequelae of whiplash, both invasive pain management procedures and surgical interventions may be paramount to a
patient’s complete recovery.
Key Words: cervical, disc, trauma, whiplash, WAD,
zygapophyseal

INTRODUCTIONThe incidence of neck trauma related to motor vehicle
accidents is on the rise, due to changes in auto construcAddress correspondence and reprint requests to: Phillip S. Sizer Jr, PhD,
PT, Texas Tech University Health Science Center, School of Allied Health,
Doctorate of Science Program in Physical Therapy, 3601 4th St., Lubbock,
TX, 79430, U.S.A. Tel: (806) 743-3902; E-mail:phil.sizer@ttuhsc.edu.

© 2004 World Institute of Pain, 1530-7085/04/$15.00
Pain Practice, Volume 4, Issue 3, 2004 249–266

tion, traffic patterns, and use of seatbelts.1,2 However,
the mere existence of neck pain after a motor vehicle
accident can conjure doubts regarding the extent of
injury and symptom presentation. Patients often
develop symptoms of neck pain after the accident and
have significantdifficulty in portraying a clear picture
of their symptoms. Rarely is there a complete description of the forces involved in the accident but the pain
can be quite severe, suggesting significant trauma. The
lack of any objective findings on plain radiographs,
combined with vague presentation upon clinical examination, can leave many questions unanswered in
regards to etiology or sources of paingeneration. Often
it becomes evident to the clinician that the case involves
litigation, which could raise suspicion regarding a
patient’s intent toward recovery vs. secondary gain. This
scenario can divide many practitioners into groups supporting either a nonorganic or organic model for the
symptoms associated with whiplash syndrome, presenting little gray area in between the groups.3 Thiscomes
as no surprise, because clinicians are frequently eluded
when attempting to objectively quantify the diagnosis
of this condition.
Whiplash has been defined as an injury mechanism,
an injury, a medico-legal and social dilemma, and a
complex chronic pain syndrome.4 As a result, the understanding of whiplash sequelae has long been a dilemma
for practitioners. The Quebec Task Force onWhiplashAssociated Disorders (WAD) described whiplash in the

250 • s izer et al.

following manner: “Whiplash is an acceleration-deceleration mechanism of energy transfer to the neck. It may
result from rear-end or side-impact motor vehicle collision, but can also occur during diving or other mishaps.
The impact may result in bony or soft tissue injuries,
which in turn may lead to a variety...