OBJECTIFICATION OF NECK SPRAIN (WHIPLASH)
Title.
The value of objective appraisal of cervical
mobility for the diagnosis of neck sprain (whiplash).
Background.
"Whiplash" or neck sprain consists
of pain in the neck and upper back area that appears after
a brusque flexo-extension movement (typically, after a car
accident in which one has been hit from behind), and in which
there is no objectifable injury revealed in the complementary
tests.
The diagnosis of the syndrome is purely clinical; there are
no objective tests that demonstrate it, and in some cases
the evolution is torpid, tending to become chronic. Few treatments
have been shown to be truly effective.
In fact, some doctors question the validity of the diagnosis
itself, arguing that its presence is tied exclusively to psycho-social
factors (and essentially, the pursuit of work or economic
compensation as a result of the trauma that it caused), since
the frequency and duration of the syndrome in different countries
appear to be associated with the current legislation in each
area. However, this is not the unanimous posture of the medical
community. Some earlier studies suggest that there are differences
in the mobility and neuromuscular activity of those who suffer
the syndrome in comparison with healthy subjects and that
the psychological disorders found in the patients are a consequence-rather
than a cause-of the syndrome. In truth, today there is a debate
about the very existence of the syndrome, and therefore, about
the most appropriate way to treat it.
It is necessary to try to objectify the syndrome's existence-and
eventually, some of the characteristics that allow one to
follow its clinical evolution in a reliable manner-in order
to be able to compare the effectiveness and the efficacy of
different treatments afterwards.
Preliminary studies made with low back pain patients and
healthy subjects suggest that the characteristics of spinal
mobility vary in accordance with the existence of pain, which
opens the possibility of extrapolating these findings to other
segments of the spine and to the study of cervical whiplash.
Objective.
To determine whether the detailed analysis
of the characteristics of cervical mobility allow one to define:
-
Deteriorations in mobility that are specific to patients
with neck sprain and to discriminate the pathological
behaviors of simulation.
-
Parameters with prognostic value.
-
Useful parameters for the follow up of the patients'
evolution.
Methodology.
The study is currently in the design phase,
so that the general proposition this section reflects is only
an approximation. In principle, it is a matter of establishing
four groups:
-
One with an objectifiable organic disorder that can be
shown to be responsible for the symptoms in a specific
patient (in principle, symptomatic cervical disc hernias).
-
One with non-specific pain.
-
One of the healthy subjects that had suffered neck pain
in the past and who would be asked to imitate in movement
the characteristics of their mobility when they had pain
(who would act as a "control group similar to the
simulators").
-
One of healthy subjects (which would be the control group).
An analysis of mobility of the subjects in the four groups
would be made and the evolution of the first two over time
would be followed, until their recovery. Finally, the characteristics
of mobility in the four groups and their evolution over time
would be analyzed.
Participants, along with the Foundation's
Science Department.
Participating groups and centers in the Spanish
Network of Researchers in Back Disorders. Within the Network,
groups form the Kovacs Foundation, the Biomechanics Institute
of Valencia, the Department of Neurosurgery of the Hospital
de Son Dureta, the Spine Unit at the Hospital Vall d'Hebrón
and Primary Care teams from Mallorca, Menorca and Ibiza are
responsible for the work group designing the study.
Status.
In the design phase; at the same time, the
possibility of making the instruments to analyze the characteristics
of mobility available in each one of the clinical centers
that may participate in the study is being studied, since
this is an essential aspect to assure its viability.
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