Whiplash and Work Disability

Whiplash results from a sudden trauma, usually involving an accident, where the injured person’s car was struck from behind, from the front, or from one of the sides. The injury is caused from the head quickly accelerating, like a “crack the whip” action, which often results in headache, neck pain and sometimes loss of memory or the ability to concentrate. There are many reports about whiplash and factors about the collision that may predict who will become disabled from such an injury. Previous reports have suggested that female gender (due to a slender neck), older age (due to less flexible joints), marital status (due to stress if divorced or single), heavy manual labor, self-employment, previous psychological problems, the inability to concentrate, catastrophizing about pain, and fear of relapse by doing regular activity have all been common issues discussed in research articles. In order to sort through these possible risk factors of a prolonged recovery and disability, a recent February 2009 study looked at this question and reviewed 879 claims. Those involved in the car accidents were sent questionnaires that requested information about the accident, the injuries that had occurred, their current complaints, and questions regarding work and disability. These questions were rechecked at 6 and 12 months after the accident date. Of the 879 claims, 59% were found to be work disabled. The most important factors were age and concentration complaints identified at the 1-month were most predictive of those that would still be disabled at 1 year. What was interesting was that most of the previously accepted risk factors of long-term disability such as the intensity of manual labor, educational level, and the like, were not found to be helpful in predicting long-term disability prior to the 1 year point with only age and concentration impairment being identified. The authors suggested that we should focus treatment on the complaints involving concentration – that is, brain related functions, rather than managing solely the physical complaints.

A condition called mild traumatic brain injury or, post-concussive syndrome, can apply to people injured in car accidents who have lost some of the higher cortical or brain related functions. Though the majority of patients will usually recover from this, a minority will not. It is therefore, important for patients and healthcare providers to become keenly aware of symptoms like memory loss (primarily short-term), loss of your train of thought (forgetting what you were about to say), or having difficulty formulating what you want to say (getting the right words out). Many patients are reluctant to say anything to their health care provider as they are often embarrassed and don’t feel comfortable talking about it. They often think they are “…just going through a stage,” and that they may “sound strange” if they discuss these symptoms and therefore avoid even bringing it up during the history. In the end, most patients are relieved after they find out that it’s “not all in their head,” and are more comfortable discussing it when they know their health care provider is aware of their cognitive dysfunction and that it’s a real problem. As one patient put it, “…I thought I was going crazy,” when in fact these, sometimes quite subtle, symptoms are very important clues in identifying this condition so that prompt attention can be directed at these problems. We are keenly aware of this information and are happy to share it with you so that you can feel more comfortable discussing it with us as well as any other symptoms that exists because of a whiplash injury.

If you or a loved one is suffering with whiplash, sharing this information may be one of most significant acts of kindness that you can give to those that you care about.