This post is password protected. To view it please enter your password below:

Password:

This post is password protected. To view it please enter your password below:

Password:

This post is password protected. To view it please enter your password below:

Password:

James Elliott, PT, MS; Gwendolen Jull, MPhty, PhD, FACP; Jon Timothy Noteboom, PT, PhD, SCS, ATC; Ross Darnell, PhD; Graham Galloway, PhD; Wayne W. Gibbon, MB BS, FRCS, FRCR, FRANZCR

Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia. jelltt@regis.edu

STUDY DESIGN: Cross-sectional investigation of muscle changes in patients suffering from persistent whiplash-associated disorders (WAD).

OBJECTIVES: To quantitatively compare the presence of fatty infiltrate in the cervical extensor musculature in a cohort of chronic whiplash patients (WAD II) and healthy control subjects across muscle and cervical segmental level.

SUMMARY OF BACKGROUND DATA: Magnetic resonance imaging (MRI) can be regarded as the gold standard for muscle imaging; however, there is little knowledge about in vivo features of neck extensor muscles in patients suffering from persistent WAD and how fat content alters across the factors of muscle, vertebral segments, age, self-reported pain and disability, compensation status, body mass index, and duration of symptoms.

METHODS: A reliable MRI measure for fatty infiltrate was performed of the cervical extensor muscles bilaterally in 113 female subjects (79 WAD, 34 healthy control; 18-45 years, 3 months to 3 years post injury). The measure was performed on all subjects for the rectus capitis posterior minor and major, multifidus, semispinalis cervicis and capitis, splenius capitis, and upper trapezius.

RESULTS: The WAD subjects had significantly larger amounts of fatty infiltrate for all of the cervical extensor muscles compared with healthy control subjects (all P < 0.0001). In addition, the amount of fatty infiltrate varied by both cervical level and muscle, with the rectus capitis minor/major and multifidi at C3 having the largest amount of fatty infiltrate (P < 0.0001). Intramuscular fat was independent of age, self-reported pain/disability, compensation status, body mass index, and duration of symptoms.

CONCLUSION: There is significantly greater fatty infiltration in the neck extensor muscles, especially in the deeper muscles in the upper cervical spine, in subjects with persistent WAD when compared with healthy controls. Future studies are required to investigate the relationships between muscular alterations and symptoms in patients suffering from persistent WAD.

Lynn Shaw, Martin Descarreaux, Roland Bryans, Mireille Duranleau, Henri Marcoux, Brock Potter, Rick Ruegg, Robert Watkin, Eleanor White

Faculty of Health Sciences, School of Occupational Therapy, University of Western Ontario, London, ON, Canada.

The literature relevant to the treatment of Whiplash-Associated Disorders (WAD) is extensive and heterogeneous.

METHODS: A Participatory Action Research (PAR) approach was used to engage a chiropractic community of practice and stakeholders in a systematic review to address a general question: ‘Does chiropractic management of WAD clients have an effect on improving health status?’ A systematic review of the empirical studies relevant to WAD interventions was conducted followed by a review of the evidence.

RESULTS: The initial search identified 1,155 articles. Ninety-two of the articles were retrieved, and 27 articles consistent with specific criteria of WAD intervention were analyzed in-depth. The best evidence supporting the chiropractic management of clients with WAD is reported. Further review identified ways to overcome gaps needed to inform clinical practice and culminated in the development of a proposed care model: the WAD-Plus Model.

CONCLUSION: There is a baseline of evidence that suggests chiropractic care improves cervical range of motion (cROM) and pain in the management of WAD. However, the level of this evidence relevant to clinical practice remains low or draws on clinical consensus at this time. The WAD-Plus Model has implications for use by chiropractors and interdisciplinary professionals in the assessment and management of acute, subacute and chronic pain due to WAD. Furthermore, the WAD-Plus Model can be used in the future study of interventions and outcomes to advance evidence-based care in the management of WAD.

KEY WORDS: Pain, neck, treatment, manipulation, assessment

The Association Between a Lifetime History of a Neck Injury in a Motor Vehicle Collision and Future Neck Pain: A Population-based Cohort Study

Work (A Journal of Prevention, Assessment and Rehabilitation) 2010; 35 (3): 369–394

Lynn Shaw, Martin Descarreaux, Roland Bryans, Mireille Duranleau, Henri Marcoux, Brock Potter, Rick Ruegg, Robert Watkin, Eleanor White

Faculty of Health Sciences, School of Occupational Therapy, University of Western Ontario, London, ON, Canada.

The literature relevant to the treatment of Whiplash-Associated Disorders (WAD) is extensive and heterogeneous.

METHODS: A Participatory Action Research (PAR) approach was used to engage a chiropractic community of practice and stakeholders in a systematic review to address a general question: ‘Does chiropractic management of WAD clients have an effect on improving health status?’ A systematic review of the empirical studies relevant to WAD interventions was conducted followed by a review of the evidence.

RESULTS: The initial search identified 1,155 articles. Ninety-two of the articles were retrieved, and 27 articles consistent with specific criteria of WAD intervention were analyzed in-depth. The best evidence supporting the chiropractic management of clients with WAD is reported. Further review identified ways to overcome gaps needed to inform clinical practice and culminated in the development of a proposed care model: the WAD-Plus Model.

CONCLUSION: There is a baseline of evidence that suggests chiropractic care improves cervical range of motion (cROM) and pain in the management of WAD. However, the level of this evidence relevant to clinical practice remains low or draws on clinical consensus at this time. The WAD-Plus Model has implications for use by chiropractors and interdisciplinary professionals in the assessment and management of acute, subacute and chronic pain due to WAD. Furthermore, the WAD-Plus Model can be used in the future study of interventions and outcomes to advance evidence-based care in the management of WAD.

KEY WORDS: Pain, neck, treatment, manipulation, assessment