Cervical Whiplash: Assessment, Treatment, and Impairment Rating

Abstract

Abstract Whiplash-associated disorder (WAD) refers to complaints attributed to a shear-hyperextension then hyperflexion cervical injury, typically following a rear-end motor vehicle collision. Research suggests that chronic whiplash symptoms should be the exception rather than the rule, and the surge of chronic whiplash symptoms probably reflects the focus on biological treatment of WAD, ignoring the cultural, psychological, and sociological influences. The physician evaluating and/or treating a whiplash patient needs to have a solid understanding of the complexities and controversies associated with this disorder. Evaluation should be prompt and thorough, but, unless indicated, evaluators should avoid sophisticated diagnostic studies (eg, magnetic resonance imaging studies correlate poorly with whiplash symptoms). Treatment generally should be simple and consists primarily of reassurance and home exercise. Disability, both occupational and avocational, should be avoided or minimized. As with other impairment evaluations, the clinical assessment (history, physical examination, and review of diagnostic studies) must be thorough. If there are ratable findings, examiners must determine their reliability and whether the examinee has achieved maximal medical improvement. Most cases of WAD do not result in permanent impairment, but when there is ratable impairment it usually falls in DRE Cervical Category II, with a rating of 5% to 8% whole person permanent impairment. Managing patients’ beliefs and expectations following motor vehicle injury can help guide them to continue or promptly return to normal activities. {223}