Chronic Whiplash injuries – a $1 billion a year issue

Whiplash injuries, usually the result of being rear-ended in a motor vehicle accident, are the most common reason for compensation claims – from 20% to 40%, depending on whether you’re talking about cost of claims or numbers. The national cost is estimated at around $1 billion a year.

We have reviewed and summarised the latest industry research below for you.

A study by researchers at the University of Sydney on Chronic Whiplash injuries and Physiotherapy Effectiveness was recently published in the Lancet and discussed on the ABC’s Health Report.

The trial was funded by the National Health and Medical Research Council with supplementary funding from the Motor Accidents Authority of New South Wales and the Motor Accidents Insurance Commission Queensland.

The study looked at the effectiveness of a comprehensive physiotherapy programme vs advice in people with a chronic (>3 months and <5 years grade 1 or 2 WAD whiplash-associated disorder.

Participants were mainly middle-aged, there were more women than men, and participants had their whiplash-associated disorder symptoms for nearly 2 years. More people were eligible for compensation than were not, with about a third having settled a claim. Participants typically reported moderate pain and disability and lower quality of life than the Australian population norms.

Participants in the first group received 20 hours of tailored and supervised exercise sessions over a 12 week period. This programme included specific cervical spine exercises, manual therapy techniques, home exercise programme, whole body exercise, graded activity programme and specific cognitive-behavioural therapy.

The second group got a booklet, one session with the physiotherapist and they had two phone follow-ups. They were taught how to exercise and self-manage their symptoms.

Across a range of outcome measures; pain, disability, range of movement, quality of life – there were no differences between the two groups. The group that got the much more comprehensive program didn’t have better outcomes than the group that had the fairly simple approach of one session with a physiotherapist with two phone follow-ups. The study established that short intervention with a couple of quick follow-ups is as good as quite intensive treatment. However and not surprisingly a large number of participants remained relatively disabled by their pain.

ABC interviewer Dr Norman Swan suggested people going through a compensation claim may be more vulnerable to chronic pain. One of the lead researchers Dr Chris Maher advised there was no evidence of this found in the study but commented that people going through a compensation claim tend to have fragmented treatment with worse health outcomes.

  1. Comprehensive physiotherapy exercise programme or advice for chronic whiplash (PROMISE): a pragmatic randomised controlled trial. Lancet, Early Online Publication, 4 April 2014. Prof Chris G Maher PhD et al.
  2. Dr Norman Swan ABC Health Report, Monday 28th April.

Our CDC physiotherapists have reviewed this research – they remain of the opinion that Physiotherapy remains an important management strategy for acute and chronic whiplash injuries because whilst it may not resolve the condition it provides education, relief of symptoms and improved range of motion.