Search

Purpose: Injury to the cervical spinal cord has been suggested as a mechanism that may underpin chronic whiplash-associated disorder (WAD). This study aimed to assess metabolite concentrations indicative of neuronal injury or pathology in the cervical cord in people with chronic WAD., Methods: Forty-one people with chronic WAD (mean [SD] age 39.6 [11.0] years, 25 females) and 14 healthy controls (39.2 [12.6] years, 9 females) underwent cervical spinal cord magnetic resonance spectroscopy to measure the metabolites N-acetylaspartate (NAA), creatine (Cr) and choline (Cho). Participants with WAD completed clinical questionnaires on pain intensity (Visual Analogue Scale), disability (Neck Disability Index) and psychological factors (Pain Catastrophising Scale, Post-traumatic Diagnostic Scale), and underwent cervical range of motion assessment and pain threshold testing to cold and pressure stimuli. Data were analysed using hypothesis testing and Spearman correlations (p < 0.05)., Results: There were no differences between the WAD and control groups for NAA/Cr (median [IQR] WAD 1.73 [1.38, 1.97], controls 2.09 [1.28, 2.89], p = 0.37), NAA/Cho (WAD 1.50 [1.18, 2.01], controls 1.57 [1.26, 1.93], p = 0.91) or Cr/Cho (WAD 0.84 [0.64, 1.17], controls 0.76 [0.60, 0.91], p = 0.33). There were no significant correlations between NAA/Cr, NAA/Cho or Cr/Cho and any clinical variable (p ≥ 0.06)., Conclusions: Findings are consistent with major metabolic changes not being present in chronic WAD.

The presence of intramuscular fat (IMF) in the cervical spine muscles of patients with whiplash associated disorders (WAD) has been consistently found. The mechanisms underlying IMF are not clear but preliminary evidence implicates a relationship with stress system responses. We hypothesised that if systemic stress system responses do play a role then IMF would be present in muscles remote to the cervical spine. We aimed to investigate if IMF are present in muscle tissue remote (soleus) to the cervical spine in people with chronic WAD. A secondary aim was to investigate associations between IMF and posttraumatic stress symptom levels. Forty-three people with chronic WAD (25 female) and 16 asymptomatic control participants (11 female) participated. Measures of pain, disability and posttraumatic stress symptoms were collected from the WAD participants. Both groups underwent MRI measures of IMF in cervical multifidus and the right soleus muscle. There was significantly greater IMF in cervical multifidus in patients with WAD and moderate/severe disability compared to controls (p = 0.009). There was no difference in multifidus IMF between the mild and moderate/severe disability WAD groups (p = 0.64), or the control and mild WAD groups (p = 0.21). IMF in the right soleus was not different between the groups (p = 0.47). In the WAD group, we found no correlation between PDS symptoms and cervical multifidus IMF or between PDS symptoms and soleus IMF. Global differences in IMF are not a feature of chronic WAD, with differences in IMF limited to the cervical spine musculature. While the mechanisms for the development of IMF in the cervical spine following whiplash injury remain unclear, our data indicate that local factors more likely contribute to these differences., Competing Interests: The authors have declared that no competing interests exist.

Objectives: The aims of this study were to examine the relationship between fear of movement and activity levels in people with whiplash-associated disorders (WAD) over the first 3 months postinjury, to determine the mediating effect of: fear of movement on the relationship between catastrophizing and activity levels, and activity levels on the relationship between fear of movement and disability in patients with WAD., Materials and Methods: Ambulatory monitoring of physical activity was conducted for a minimum of 8 waking hours on 2 consecutive days within 4 weeks postinjury and at 12 weeks postinjury for 103 (74 female) people with WAD. Time spent in upright postures (uptime) and time in motion (TIM) were collected along with measures of pain, disability, pain catastrophizing, and fear of movement. The association of self-report outcome measures with uptime and TIM were examined. Mediation analyses were performed to determine the mediating effect of: fear of movement on the relationship between catastrophizing and activity, and activity levels on the relationship between fear of movement and disability., Results: Fear of movement was significantly related to uptime but not TIM. Mediation analyses showed that the relationship between fear of movement and disability was not mediated by activity levels, and that the relationship between catastrophizing and activity levels was not mediated by fear of movement., Discussion: Our data suggests measures of Fear Avoidance Model are not related to general physical activity in people with WAD. Investigation of movements specific to the cervical spine and alternative explanatory models may be required.

Background and Aims: Reduced pain sensitivity following exercise is termed exercise induced hypoalgesia (EIH). Preliminary evidence suggests that impairment of EIH is evident in individuals with whiplash associated disorders (WAD) following submaximal aerobic exercise. This study aimed to compare EIH responses to isometric and aerobic exercise in patients with chronic WAD and healthy controls and investigate relationships between EIH, conditioned pain modulation (CPM) and psychological factors in patients with chronic WAD., Methods: A cross sectional pre-post study investigated the effect of a single session of submaximal aerobic cycling exercise and a single session of isometric timed wall squat exercise on EIH in a group of participants with chronic WAD (n=21) and a group of asymptomatic control participants (n=19). Bivariate analyses between EIH and baseline measures of CPM and psychological features (fear of movement, pain catastrophization and posttraumatic stress symptoms) were also investigated., Results: The isometric wall squat exercise but not the aerobic cycling exercise resulted in EIH in both groups (P<.023) with no between-group differences (P>.55) demonstrated for either exercise. There were no significant associations measured between EIH (for either exercise performed), and CPM, or any of the psychological variables., Conclusions: This study showed that individuals with chronic WAD and mild to moderate pain and disability, and no evidence of dysfunctional CPM, demonstrated reduced pain sensitivity, both in the cervical spine and over the tibialis anterior following an isometric, timed wall squat exercise. Cycling exercise did not increase pain sensitivity., Implications: Individuals with chronic WAD and mild to moderate levels of neck pain and disability may experience less pain sensitivity both locally and remotely following an exercise program directed at non-painful muscles performing isometric exercises. Individuals cycling for 30min at 75% of age-predicted heart rate maximum do not experience increased pain sensitivity., (Copyright © 2016 Scandinavian Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.)

The fear avoidance model (FAM) has been proposed to explain the development of chronic disability in a variety of conditions including whiplash-associated disorders (WADs). The FAM does not account for symptoms of posttraumatic stress and sensory hypersensitivity, which are associated with poor recovery from whiplash injury. The aim of this study was to explore a model for the maintenance of pain and related disability in people with WAD including symptoms of PTSD, sensory hypersensitivity, and FAM components. The relationship between individual components in the model and disability and how these relationships changed over the first 12 weeks after injury were investigated. We performed a longitudinal study of 103 (74 female) patients with WAD. Measures of pain intensity, cold and mechanical pain thresholds, symptoms of posttraumatic stress, pain catastrophising, kinesiophobia, and fear of cervical spine movement were collected within 6 weeks of injury and at 12 weeks after injury. Mixed-model analysis using Neck Disability Index (NDI) scores and average 24-hour pain intensity as the dependent variables revealed that overall model fit was greatest when measures of fear of movement, posttraumatic stress, and sensory hypersensitivity were included. The interactive effects of time with catastrophising and time with fear of activity of the cervical spine were also included in the best model for disability. These results provide preliminary support for the addition of neurobiological and stress system components to the FAM to explain poor outcome in patients with WAD.

Introduction: In this preliminary study we determined whether MRI markers of cervical muscle degeneration [elevated muscle fatty infiltration (MFI), cross-sectional area (CSA), and reduced relative muscle CSA (rmCSA)] could be modified with exercise in patients with chronic whiplash., Methods: Five women with chronic whiplash undertook 10 weeks of neck exercise. MRI measures of the cervical multifidus (posterior) and longus capitus/colli (anterior) muscles, neck muscle strength, and self-reported neck disability were recorded at baseline and at completion of the exercise program., Results: Overall significant increases in CSA and rmCSA were observed for both muscles, but significant reductions in MFI were only evident in the cervical multifidus muscle. These changes coincided with increased muscle strength and reduced neck disability., Conclusions: MRI markers of muscle morphology in individuals with chronic whiplash appear to be modifiable with exercise., (© 2015 Wiley Periodicals, Inc.)

Background and Purpose: Healthcare providers' beliefs may play a role in the outcome of whiplash-associated disorders (WAD), a condition which is proposed to be culturally dependent. Clinical practice guidelines recommend an active approach for the management of WAD, which is often delivered by physiotherapists. However, there is no data on physiotherapists' whiplash beliefs. Our primary objective was to determine physiotherapists' beliefs from Queensland (Australia) and Singapore, two cultures with differing prevalence of chronic musculoskeletal pain and chronic WAD., Methods: A pen and paper survey of musculoskeletal physiotherapists practicing in Queensland and Singapore was conducted. Participants completed questionnaires consisting of patient vignettes and statements inquiring knowledge and attitudes towards WAD. Chi-square tests of significance were used to compare the responses of physiotherapists from both samples., Results: Ninety-one (response rate 45%) Queensland-based and 94 (response rate 98%) Singapore-based physiotherapists participated in the study. The beliefs in the management strategies for the patient vignettes were generally consistent with practice guidelines. A higher proportion of Queensland-based physiotherapists expected permanent disabilities for the patient vignette depicting chronic WAD (Queensland: 55% Singapore: 28% Pearson chi-sq 18.76, p < 0.005).Up to 99% of the physiotherapists from both samples believed in encouragement of physical activity, the effectiveness of exercise and multimodal physiotherapy for WAD. Significantly higher proportions of Singapore-based physiotherapists believed in ordering radiographs for acute WAD (Pearson chi-sq 41.98, p < 0.001) and also believed in a psychogenic origin of chronic WAD (Pearson chi-sq 22.57, p  0.001)., Conclusion: The majority of beliefs between physiotherapists in Queensland and Singapore were similar but there were specific differences. Physiotherapists' whiplash beliefs in Queensland and Singapore did not clearly reflect the difference in prevalence of chronic musculoskeletal pain or chronic WAD in Queensland and Singapore., (Copyright © 2014 John Wiley & Sons, Ltd.)

Study Design: Cross-sectional., Objectives: To quantify the magnitude and distribution of muscle fat infiltration (MFI) within the cervical multifidus and semispinalis cervicis muscles in participants with chronic whiplash-associated disorders (WADs) compared to those who have fully recovered from a whiplash injury and healthy controls., Background: Previous research has established the presence of increased MFI throughout the cervical extensor muscles of individuals with WAD when compared to healthy controls. These changes appear to be greater in the deepest muscles (eg, multifidus and semispinalis cervicis) than in the more superficial muscles. A detailed analysis of the distribution of MFI within these deep extensor muscles in chronic WAD, recovered, and control groups would provide a foundation for further investigation of specific mechanisms, etiologies, and targets for treatments., Methods: Fifteen participants (WAD, n = 5; recovered, n = 5; and control, n = 5) were studied using a 3-D fat-water separation magnetic resonance imaging sequence. Bilateral measures of cervical multifidus and semispinalis cervicis MFI in 4 quartiles (1 [medial] to 4 [lateral]) at cervical levels C3 through C7 were included in the analysis. Intrarater and interrater reliability were established. A mixed-model analysis was performed to control for covariates, identify interaction effects, and compare MFI distribution between groups., Results: The limits of agreement confirmed strong intrarater and interrater agreement at all levels (C3-C7). Sex, age, and body mass index were identified as significant covariates for MFI. Significant interactions were found between group and muscle quartile (P<.001) and between muscle quartile and cervical level (P<.001). Pairwise comparisons for intraquartile MFI between groups revealed significantly greater MFI in the WAD group when compared to the recovered group in the first quartile (P<.001), second quartile (P<.001), and third quartile (P = .03). When compared to the control group, the WAD group had significantly greater MFI in the first quartile (P = .002) and the second quartile (P = .045). The control group had significantly higher MFI in comparison to the recovered group in the first quartile (P = .048)., Conclusion: This study provides preliminary data mapping the spatial distribution of MFI in the cervical multifidus and semispinalis cervicis muscles in individuals with chronic WAD, those who have recovered from a whiplash injury, and healthy controls. Muscle fat infiltration is more concentrated in the medial portion of the muscles in all participants. However, the magnitude of MFI in the medial quartiles (1 and 2) is greatest in the chronic WAD group.

Study Design: A population based cross-sectional study., Objective: To clarify relative constituents of viable muscle in 2-dimensional cross-sectional area (CSA) measures of ventral and dorsal cervical muscles in patients with chronic whiplash-associated disorders (WAD), idiopathic neck pain, and healthy controls., Summary of Background Data: Previous data using T1-weighted magnetic resonance image demonstrated large amounts of neck muscle fat infiltration and increased neck muscle CSA in patients with chronic WAD but not in idiopathic neck pain or healthy controls., Methods: Magnetic resonance images were obtained for 14 cervical muscle regions in 136 females, including 79 with chronic whiplash, 23 with chronic idiopathic neck pain, and 34 healthy controls., Results: Without fat removed, relative CSA of 7 of 14 muscle regions in the participants with chronic WAD was larger, 3 of 14 smaller and 4 of 14 similar to healthy individuals. When T1-weighted signal representing the lipid content of these muscles was removed, 8 of 14 relative muscle CSA in patients with whiplash were similar, 5 of 14 were smaller and only 1 of 14 was larger than those observed in healthy controls. Removal of fat from the relative CSA measurement did not alter findings between participants with idiopathic neck pain and healthy controls., Conclusion: These findings clarify that previous reports of increased relative CSA in patients with chronic whiplash represent cervical muscle pseudohypertrophy. Relative muscle CSA measures reveal atrophy in several muscles in both patients with WAD and idiopathic neck pain, which supports inclusion of muscle conditioning in the total management of these patients., Level of Evidence: 3.

The lack of efficacy of rehabilitative approaches to the management of chronic whiplash-associated disorders (WAD) may be in part due to heterogeneity of the clinical presentation of this patient population. The aim of this study was to identify homogeneous subgroups of patients with chronic WAD on the basis of symptoms of PTSD and sensory hypersensitivity and to compare the clinical presentation of these subgroups. Successive k-means cluster analyses using 2, 3 and 4 cluster solutions were performed by using data for 331 (221 female) patients with chronic (>3 months) WAD. The 4 cluster solution was identified as the most clinically relevant, yielding 4 distinct clusters: no to mild posttraumatic stress symptoms and no sensory hypersensitivity (nPnH), no to mild posttraumatic stress symptoms and sensory hypersensitivity (nPH), moderate to severe posttraumatic stress and no sensory hypersensitivity (PnH) and moderate to severe posttraumatic stress and sensory hypersensitivity (PH). The nPnH cluster was the largest cluster, comprising 43.5% of the sample. The PH cluster had significantly worse disability, pain intensity, self-reported mental health status and cervical range of motion in comparison to the nPnH and nPH clusters. These data provide further evidence of the heterogeneity of the chronic WAD population and the association of a more complex clinical presentation with higher disability and pain in this patient group., (Copyright © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.)

Impaired integration of the body schema with motor processes may contribute to painful and/or restricted movement in chronic pain. Laterality judgment tasks assess this integration of the body schema with motor processes. The purpose of this study was to assess if patients with chronic whiplash associated disorders (WAD) are impaired on laterality judgment tasks. Accuracy (ACC) and reaction time (RT) for foot and neck laterality tasks were assessed in 64 (35 female) patients with chronic (>6 months) WAD and 24 (14 female) asymptomatic subjects. Pain characteristics, post-traumatic stress symptoms, cold pain thresholds (CPT) and pressure pain thresholds (PPT) were collected for patients with WAD. The effect of WAD and body part on laterality task performance was assessed. For patients with WAD, the correlations between neck task performance and pain characteristics, post-traumatic stress symptoms and pain thresholds were assessed. There was no effect of group on laterality performance. Subjects showed better RT (p < 0.001) and ACC (p = 0.001) on the neck task in comparison to the foot task. There was a significant correlation between CPT and ACC (r = 0.33) and RT (r = -0.33) on the neck laterality task in patients with WAD. Cervical spine PPT were significantly correlated with accuracy (r = 0.36) and RT (r = 0.29) in patients with WAD. These findings suggest that patients with chronic WAD are not impaired on neck or foot laterality judgment tasks. Laterality training is not indicated in the management of chronic WAD., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Study Design: Prospective longitudinal., Objective: To quantify the temporal development of magnetic resonance imaging changes in oropharyngeal morphometry in subjects with varying levels of disability following a whiplash injury., Background: A recent cross-sectional investigation has identified reductions in the size and shape of the oropharynx in subjects with chronic whiplash-related disability when compared to healthy controls. The temporal development of such changes and their relationship to persistent disability have yet to be investigated., Methods: Forty-one subjects (30 women) with acute whiplash injury were included. Repeated measures T1-weighted magnetic resonance imaging was used to measure and compare cross-sectional area (CSA) in square millimeters and shape ratio (SR) of the oropharynx at 4 weeks, 3 months, and 6 months postinjury. Subjects were classified at 6 months by their Neck Disability Index scores into the following categories: recovered (less than 8%), mild disability (10%-28%), and moderate/severe disability (greater than 30%). The effects of time and group and the interaction effect of group by time on oropharynx morphometry (CSA, SR) were investigated using repeated-measures, linear, mixed-model analysis. Based on previous research findings, age, gender, and body mass index were entered into the analyses as covariates. Where significant main or interaction effects were detected, pairwise comparisons were performed to investigate specific differences in the dependent variable between groups and within groups over time., Results: There was a significant interaction effect for group by time for both the CSA and SR values. Age significantly influenced SR (P = .024) and body mass index significantly influenced CSA (P = .001). There was no difference in CSA or SR across all groups at 4 weeks postinjury. However, at 6 months, CSA was significantly different between the recovered group and the moderate/severe group (P = .001). The recovered group demonstrated a significant increase in CSA (P = .04) over time, whereas the moderate/severe group significantly decreased (P = .01). At 6 months, the moderate/severe group had a reduced SR compared to the mild group (P = .03). No differences in CSA or SR of the oropharynx were found between the mild and recovered groups throughout the study., Conclusion: Temporal reductions in CSA of the oropharynx occur following whiplash and persist to a greater extent in those with moderate/severe symptoms at 6 months postinjury. Studies are planned (1) to better investigate the underlying mechanisms of CSA reductions, (2) to determine their relevance to functional recovery and production of voice following whiplash, and (3) to evaluate multidisciplinary assessment and management of these patients.

Objectives: Increased sensitivity to pressure is commonly associated with painful musculoskeletal conditions, including whiplash-associated disorders (WADs). Pressure pain thresholds (PPTs) close to the site of presumed tissue damage are thought to represent the degree of peripheral nociceptive sensitization. PPTs over healthy tissue, away from the site of injury, are a marker of central nervous system hyperexcitability. There is uncertainty, however, as to what extent does the sensitization of the nociceptive system, whether peripheral or central, contribute to the ongoing, habitual pain experienced by people with WAD., Methods: One hundred patients with WAD were assessed within 4 weeks of their accident and followed after 3 months; 24-hour average neck pain score, PPTs at the cervical spine and tibialis anterior, demographic factors, and psychological measures were collected., Results: Cervical PPT and neck pain score were significantly, but weakly correlated (r = -0.20 to -0.33). There was no significant correlation between tibialis anterior PPT and pain score at any time point (r = -0.01 to -0.21). Regression analyses indicated a strong influence of generalized psychological distress and fear avoidance on the relationship between PPT and pain report., Discussion: The competing explanations for these findings are that either PPTs provide a poor marker of peripheral and central sensitivity or that these processes are only weakly related to the day-to-day pain experienced by patients with WAD. The latter explanation is supported by the confounding effect of psychological factors on pain score.

Objectives: To examine the development of fear avoidance behaviours following whiplash injury using two different measures of fear avoidance, the Pictorial Fear of Activities Scale-Cervical (PFActS-C), and the Tampa Scale of Kinesiophobia (TSK-17). Secondarily we assessed the capacity of these measures to predict recovery status at long term follow up and initial cervical range of movement (ROM)., Methods: Ninety-eight patients with acute WAD were recruited and completed measures of pain and disability (NDI), fear avoidance beliefs and cervical ROM at baseline (<4 weeks), 3 and 6 months post injury. Participants were grouped based on NDI scores at 6 months follow up as either recovered (NDI <10), mild (NDI 10-28) or moderate/severe (NDI ≤ 30)., Results: Repeated measures, linear mixed model analysis showed a significant main effect for time and group for both TSK-17 and PFActS-C scores (P ≤ 0.001). On both measures the moderate/severe group scored significantly higher than the mild and recovered groups. TSK-17 scores, age and initial pain intensity at baseline significantly predicted NDI scores at 6 months (P = 0.002). PFActS-C scores, age and initial pain intensity at baseline significantly predicted initial cervical extension and rotation ROM (P = 0.001)., Discussion: Fear avoidance beliefs and behaviours develop quickly following whiplash injury and influence both the initial physical presentation and long term outcome of patients with WAD. The PFActS-C may provide a measure of fear of movement which is more specific to the cervical spine in patients with WAD in comparison to the TSK-17.

Background: Radiological findings associated with poor recovery following whiplash injury remain elusive. Muscle fatty infiltrates (MFI) in the cervical extensors on magnetic resonance imaging (MRI) in patients with chronic pain have been observed. Their association with specific aspects of pain and psychological factors have yet to be explored longitudinally., Materials and Findings: 44 subjects with whiplash injury were enrolled at 4 weeks post-injury and classified at 6 months using scores on the Neck Disability Index as recovered, mild and moderate/severe. A measure for MFI and patient self-report of pain, loss of cervical range of movement and posttraumatic stress disorder (PTSD) were collected at 4 weeks, 3 months and 6 months post-injury. The effects of time and group and the interaction of time by group on MFI were determined. We assessed the mediating effect of posttraumatic stress and cervical range of movement on the longitudinal relationship between initial pain intensity and MFI. There was no difference in MFI across all groups at enrollment. MFI values increased in the moderate/severe group and were significantly higher in comparison to the recovered and mild groups at 3 and 6 months. No differences in MFI values were found between the mild and recovered groups. Initial severity of PTSD symptoms mediated the relationship between pain intensity and MFI at 6 months. Initial ROM loss did not., Conclusions: MFI in the cervical extensors occur soon following whiplash injury and suggest the possibility for the occurrence of a more severe injury with subsequent PTSD in patients with persistent symptoms.

Study Design: Retrospective investigation of muscle changes in patients suffering from chronic whiplash-associated disorders (WAD)., Objectives: To quantitatively compare the presence of muscle alterations (fatty infiltrate [MFI] and cross-sectional area [CSA]) in the anterior musculature of the cervical spine in a cohort of chronic whiplash patients (WAD II) and healthy control subjects across muscle and cervical segmental level., Summary of Background Data: Magnetic resonance imaging can be regarded as the gold standard for muscle imaging. There is little knowledge about in vivo features of anterior neck muscles in patients suffering from chronic WAD and how muscle structure differs across the factors of muscle, vertebral level, age, self-reported pain and disability, body mass index, and duration of symptoms., Methods: Reliable magnetic resonance imaging measures for MFI and CSA were performed for the anterior cervical muscles bilaterally in 109 female subjects (78 WAD, 31 healthy control; 18-45 years, 3 months to 3 years postinjury). The measures were performed on all subjects for the longus capitis and colli and the sternocleidomastoid muscles., Results: The WAD subjects had significantly larger MFI and CSA for the anterior muscles compared to healthy control subjects (all P < 0.0001). In addition, the amount of MFI varied by both cervical level and muscle, with the longus capitis/colli having the largest amount of fatty infiltrates at the C2-C3 level (P < 0.0001). MFI was inversely related to age, self-reported pain/disability, and body mass index but directly proportional to duration of symptoms., Conclusion: There is significantly greater MFI and CSA in the anterior neck muscles, especially in the deeper longus capitis/colli muscles, in subjects with chronic WAD when compared to healthy controls. Future studies are required to investigate the relationships between muscular morphometry and symptoms in patients suffering from acute and chronic WAD.

Sensory hypersensitivity indicative of augmented central pain processing is a feature of chronic whiplash associated disorders (WAD). This study investigated the immediate effects of a cervical spine manual therapy (SMT) technique on measures of central hyperexcitability. In a randomised, single blind, clinical trial, 39 participants with chronic WAD were randomly assigned to a cervical SMT (lateral glide) or manual contact intervention. The Neck Disability Index (NDI) and GHQ-28 were administered at baseline. Pressure pain thresholds (PPTs), thermal pain thresholds (TPTs) and Nociceptive Flexion Reflex (NFR) responses (threshold and VAS of pain) were measured pre and post intervention. There was a significantly greater increase in NFR threshold following SMT compared to the manual contact intervention (p = 0.04). PPTs at the cervical spine increased following both SMT (mean +/- SE: 24.1 +/- 7.3%) and manual contact (21 +/- 8.4%) with no difference between interventions. There was no difference between interventions for pain ratings with the NFR test, PPTs at the Median Nerve or Tibialis Anterior, heat or cold TPT. SMT may be effective in reducing spinal hyperexcitability in chronic WAD., (Crown Copyright 2009. Published by Elsevier Ltd. All rights reserved.)

Whiplash is a heterogeneous condition with some individuals showing features suggestive of neuropathic pain. This study investigated the presence of a neuropathic pain component in acute whiplash using the Self-reported Leeds Assessment of Neuropathic Signs and Symptoms' scale (S-LANSS) and evaluated relationships among S-LANSS responses, pain/disability, sensory characteristics (mechanical, thermal pain thresholds, and Brachial plexus provocation test (BPPT) responses) and psychological distress (General Health Questionnaire-28 (GHQ-28)). Participants were 85 people with acute whiplash (<4 weeks) (54 females, age 36.27+/-12.69 years). Thirty-four percent demonstrated a predominantly neuropathic pain component (S-LANSS>or=12). This group showed higher pain/disability, cold hyperalgesia, cervical mechanical hyperalgesia, and less elbow extension with the BPPT (p<0.03) when compared to the group with non-neuropathic pain (S-LANSS0.09). None of the S-LANSS items could discriminate those with cold hyperalgesia (p=0.06). A predominantly neuropathic pain component is related to a complex presentation of higher pain/disability and sensory hypersensitivity. The S-LANSS may be a useful tool and the BPPT a useful clinical test in the early assessment of whiplash.