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Objective: to review the available scientific knowledge on whether a strategy combining therapeutic exercise and/or education or self-management techniques is a more effective than any other therapeutic intervention in whiplash injuries. Material and method: a literature search was conducted in Pubmed Central, Web of Science and PEDro with the following inclusion criteria: randomized controlled trials published between 2012 and 2017, classifying the pathology according to the Quebec Task Force and comparing at least one intervention based on thera-peutic exercise and /or education or self-management techniques. Results: we obtained 3.587 results, 13 of which were included to the narrative synthesis. The quality of the studies included varied between medium and high. These studies analyzed a variety of outcome measures that included: cervical function, disability, pain, cervical and global physical function, psychological variables, adherence and satisfaction. Conclusions: specific cervical exercise together with educational and self-management strategies improved the analyzed outcome measures and seem to be an effective therapeutic strategy. They could be used together, displacing unimodal strategies and passive modalities, which should be used as coadjuvants and not as therapeutic axes. Neck-specific exercise is superior to global exercise and to waiting list, but we cannot establish any specific program to be superior to another. [ABSTRACT FROM AUTHOR]

Introduction: traffic accidents cause 50 million injuries per year in the world, being 'cervical whiplash' one of the most common. This disorder affect structures such as upper limb nerve trunks, leading to changes in neural mechanosensitivity. Objective: to assess impairment mechanosensitivity of median, ulnar and radial nerves in subjects with whiplash associated disorder, compared to healthy asymptomatic subjects. Material and method: cross-sectional comparative study of cross association, with a total of 20 participants (10 symptomatic). A single experimental session was scheduled for each subject, where a researcher performed the upper limb neurodynamic tests, and another measured the ROM of the last parameter of each test with goniometry and the PPT of each nerve trunk with algometry. Results: the results of the mean ROM were: 106.82 ± 11.46 for the median, 57.94 ± 8.99 for the ulnar and 45.16 ± 11.08 for the radial, for the cases; while for the control group it was: 115.55 ± 10, 59.83 ± 7.36 and 70.64 ± 21.99, respectively. Regarding the UDP, the mean of the results was: 2.05 ± 0.52 of the median, 1.98 ± 0.68 of the ulnar and 2.08 ± 0.74 of the radial for the group of cases; while for the control group it was: 2.38 ± 0.67, 3.43 ± 0.83 and 3.55 ± 1.15 respectively. The study showed statistically significant differences for the shoulder ROM (p = 0.004), as well as for the UDP of the ulnar (p <0.001) and radial (p = 0.003). Conclusion: subjects with whiplash show less range of shoulder mobility, as well as greater sensitivity of the ulnar and radial nerves. [ABSTRACT FROM AUTHOR]

Background: The aim of this study is to evaluate the physiological and psychological effect after an electromyographic biofeedback treatment in combination with progressive muscular relaxation training in patients with acute whiplash. Methods: Twelve patients with acute whiplash volunteered to participate in a quasi-experimental design and a control group. Inclusion criteria: Two months maximum after car accident, severity levels II and I. Exclusion criteria: previous history of persistent pain or serious previous injury. The groups were randomly divided in two (treatment and waiting list groups). We used electromyographic measures of the trapezius muscles with psychometric tests: Beck Anxiety and Depression Inventory; Oswestry Pain Disability Questionnaire; Visual Analog Scale of Pain; TAMPA Scale for Kinesiophobia. The treatment consisted in electromyographic biofeedback after progressive muscular relaxation training. Results: There were significant intra-group differences before and after treatment in muscular symmetry and subjective pain perception in the treatment group. Conclusions: We achieved a significant change (clinical and statistical) in subjective pain perception and muscular symmetry. This study highlights the importance of multidisciplinary work in acute pain patients and the effectiveness of clinical psychophysiological strategies with acute whiplash patients. [ABSTRACT FROM AUTHOR]

Whiplash injury usually occurs in people who suffered an automobile accident, but also occurs as a result of physical assault and other mechanisms. Diagnosis and initial management of the patient by the emergency physician or orthopedist, and prescribing indications, are taken into account by two forensic intervention specialists. One of these is the medical officer, who, through analysis of the injury mechanism, establishes a cause-effect relationship and concludes whether the accident suffered by a worker it is related to work or not, determines how long the worker will remain disabled and if the injury caused permanent disability under Federal Labor Law. The medical examiner by injury classification assists the Public Ministry so that it can frame the crime of injury to the Criminal Code of Federal District. For these reasons a review of medical information about the mechanism of injury, diagnosis, treatment and healing time was performed to help both specialists to standardize their approach in their daily activities. [ABSTRACT FROM AUTHOR]

Background: the cervical sprain or whiplash incidence has high costs in medical care, disabilities and work absences. The aim was to demonstrate that disability days caused by cervical sprain I and II are reduced without the use of neck immobilizer collar (NIC). Methods: a transversal study in 100 patients with cervical sprain I and II at the emergency room was evaluated. The use of the collar and disability days was measured. Descriptive statistical was used. Results: patients treated with NIC and anti-inflammatory (AI) were 68 % and 32 % patients treated without NIC and only with AI. The mean work absence was 11.75 days in 86 % of patients, 74.4 % used NIC. Within the patients (14 %) that had not work absence, only 28.6 % used NIC with a χ² = 11.63 and a p < 0.001. Conclusions: the days of disability and recovery were lower in patients who did not use the collar. [ABSTRACT FROM AUTHOR]

Introduction. An important health problem is denominated "whiplash" (post-traumatic cervical syndrome caused by car accidents). It is common to demand and the use of "soft collars" for its treatment without a scientific basis. Material and methods. Sixty patients with whiplash syndrome in 2 randomized groups were handled with and without soft collars, physiotherapy, early mobilization, and oral medication. Radiographic and pain control, this latter with Visual Analogue Scale (VAS). Statistical analysis with Student t test was applied. Results. There was no significant difference between the 2 groups. The recovery "without collar" was faster and in major percentage than those who used the device. The lordosis recovery in both groups was statistically significant (p = 0.0001). Discussion. In spite of the "popularity" and the common use of immobilization in "whiplash" injuries, this is not scientifically supported, and some studies shows that it can be detrimental for some patients, delaying its recovery. Since the problem affects in multiple areas life's patients, it is important to find the best therapeutic treatment. Conclusions. "Whiplash" can be treated with early physiotherapy, analgesics and muscle relaxants medications, and it is not indicated the use of "soft collars" for this pathology. [ABSTRACT FROM AUTHOR]

Introduction: Interpretation of cervical curvature in acute acceleration injury of the cervical spine is highly uncertain. Some authors suggest that loss of lordosis is a sign that adversely affects the prognosis of these patients. Other authors suggest that these findings are normal variables. Objective: To determine the normal value of cervical curvature and realize a comparative analysis between healthy subjects and patients with acute acceleration injury of the cervical spine, and to identify the level of correlation between cervical curvature, intensity of symptomatology, evolution time and age in patients. Material and methods: Cross-sectional, comparative, observational, prospective and correlative study of cervical curvature between 110 patients and 110 healthy subjects. Results: The mean value of cervical curvature was 11.7° SD 11.9° and 9.7° SD 10.7° in patients and in healthy subjects respectively. There was no significative difference between both mean values (α = 0.05). The adopted value for cervical curvature in both groups have little tendency to be minor while age of subjects decrease too, existing a minimal correlation in patients (r = 0.26) and in healthy subjects (r = 0.32). There is no correlation between cervical curvature, symptomatology and evolution time. Conclusions: Cervical curvature has great variety of statistical patterns of alignment. The predominant pattern is lordotic. No lordotic cervical curvature observed in patients with acute acceleration injury of the cervical spine, is a no pathologic anatomic variant although statistically infrequent observed in healthy subjects too. [ABSTRACT FROM AUTHOR]

Objective. To correlate the cervical degree of whiplash injury according to the clinical classification of the Quebec task force, with the changes observed in the alignment of the cervical lordosis in the lateral X-rays. Methods. Our study is retrospective and cross-sectional, realized all patients, taken care in the service of urgencies of the Hospital, between January of 2004 to December of 2004 with the diagnose of whiplash secondary to automobile collision. They were included (n = 254) patients, older than 14 years, injury smaller to 3 days of evolution, and with clinical and radiological file. Those with fracture or associate dislocations were excluded and secondary injury to traumatism or falls. All the injuries were classified according to the clinical criteria to the Quebec task force; and the alterations in the lateral X-ray projection according to the criteria of Tamaka. The two variables were correlated using the test of Chi square, with a value of 0.05 probability. Results. According to the degree 109 patients (43%) with whiplash degree I, 125 patients (49%) with whiplash degree II, and 20 patients (8%) with whiplash degree III; and with respect to the changes in the cervical lordosis appeared, 130 (51%) with lordosis, 106 (41%) with straight of the cervical lordosis and 18 (8%) with khyposis. Both variables were correlated obtaining the following results: whiplash degree I: 53 with lordosis, 46 straight, and 10 with kyphosis; whiplash degree II: 68 with lordosis, 50 with straight and 7 with kyphosis; and whiplash degree III: 9 with lordosis, 10 with straight, and 1 with kyphosis. Conclusions. According to the results, we reached the conclusion that the lateral X-ray is not a trustworthy indicator for the diagnose or whiplash injury, and that it does not exist correlation with the classification proposed by the Quebec task force, considered at the moment a "gold standard, for the accomplishment of the diagnose in this type of injuries. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Freud introduced two concepts of illness gain-one was a more external conscious adaptive form of gain, called secondary gain, and the other was a more internal unconscious destructive form of gain, called the need to be ill. Both forms of illness gain are interdependent and secondary gain can generate a need to be ill. METHOD: Empirical research was used to examine the question of how and why some disorders, such as post-traumatic stress disorder, repetitive strain injury, and whiplash injury, are liable to generate illness gain in affected individuals. RESULTS: This article describes how and why these disorders are becoming more common. CONCLUSIONS: It is important for the therapist to know the background of these disorders in order to be able to combat the associated secondary gain. [ABSTRACT FROM AUTHOR]

We have performed a retrospective study whose objective was to compare neurological change results, days spent in hospital, and complications associated to early surgery (less than three days) or late one (over than 3 days) in patients suffering from acute-traumatic cervical spine lesion. From 1998 to 2001, it was carried out an analysis of the records from patients having been diagnosed cervical fracture or luxation with neurological lesion and fulfilling inclusion requisites. Two groups arose: early surgery n = 13, and late surgery n = 11. In both groups the neurological condition was analyzed at admission and discharge, days in hospital, and associated complications. Both groups were similar in age, sex, and lesion mechanism. There was no significant difference in neurological recovery, days in hospital, and associated complications p > 0.05). Actually, there was a significant difference in regard to intensive therapy period (p < 0.05). We recommend treating these patients in a surgical way seventy-two hours after the lesion, once the patient's general condition is stable. [ABSTRACT FROM AUTHOR]

At the present time the lesions to level of neck for mechanism of Whiplash is more frequent, and we don't have a method I practice in order to can diagnostic and value the adequate treatment. For the one which the Whiplash-Associated Disorders believes the classification of Quebec the who orb it like a clinical syndrome, recommending the utilization of the rigid collar, the early mobilization, wing physiotherapy. It was carried out a study of a cohort in the period of July of the 2000 to March of the 200l in patient with lesions for Whiplash, utilizing the scale of Quebec and the handling referred by the WAD, finding improvement of the symptom at 10 days, could incorporate their activities the 48%, at 21 days the 73% and at 30 days the 85%. The treatment is valued with taste χ² finding statistically significant with (p > 0.05). [ABSTRACT FROM AUTHOR]

In order to identifying the correlation among degree of severity of the lesion for whiplash (classification of Quebec) in sharp phase and the muscular spasm of the neck, between September and December of the 2002, he/she was carried out an observational, prospective, transverse study and correlational in 24 patients with lesion for whiplash that selection approaches, 12 women and 12 men completed, with 26.2 year-old average. The variables were: degree of clinical lesion of Quebec, muscular group of the affected neck, arches of mobility, activity spontaneous electromiographic, age and sex. The lesion of Quebec G II happened in 14 patients (58.3%), G I in 6 (25%), G III in 4 (16.7%); there was clinical affection in later muscles in 100% of the cases, 66.7% (16) in lateral and 70.8% (17) in previous, with regular mobility in 13 patients, bad in 9 and good in 2. The activity electromyographic in esternocleiodomastoideo was of 4 Um (9) and 5 Um (3); in scalene 4 Um (9), 5 Um (6); in trapeciuo superior 4 Um (9) and 5 Um (13), paravertebral 4 Um (12) 5 Um (11). The relationship between lesion degree and activity electromyographic in test of Kruskal-Wallis was significant (p smaller than 0.05) for superior trapezius (alpha 0.043) and paravertebral (alpha 0.006), relationship confirmed with r of Pearson in superior trapezius (alpha 0.014) and paravertebral (alpha 0.000). The lesion of Quebec degree II is more frequent, it limits the movement range in neck from 25% to 50%, its correlation with clinical spasm and activity electromyographic is significant in later muscles in degrees of severity. [ABSTRACT FROM AUTHOR]

Se presenta la respuesta de los autores a una carta al editor sobre el artículo "Chronic Whiplash and Whiplash Associated Disorders: An Evidence-Based Approach," publicado en 2007 en la revista "Journal of the American Academy of Orthopaedic Surgeons."

Se presenta una carta al editor sobre el artículo "Chronic Whiplash and Whiplash Associated Disorders: An Evidence-Based Approach," publicado en 2007 en la revista "Journal of the American Academy of Orthopaedic Surgeons."