Whiplash injuries from MedLink Neurology available at www.medlink.com

Historical note and nomenclature Whiplash is an acceleration-deceleration mechanism of energy transfer to the neck that may result from rear-end or side-impact motor vehicle collisions. Common whiplash is a trauma causing cervical musculoligamental sprain or strain due to hyperextension-flexion and excludes fractures or dislocations of the cervical spine, head injury, or alteration of consciousness. Chronic or late whiplash syndrome refers to persistent symptoms present more than 6 months after the accident. Other terms that some clinicians prefer include "cervical sprain," "cervical myofascial pain syndrome," "acceleration-deceleration injury," and "hyperextension injury." Terms for this type of injury in other languages include le coup du lapin in French and schleudertrauma in German (Evans 1995). In 1995, the Quebec Task Force proposed a classification system for whiplash injuries (Spitzer et al 1995). Grade 1 signifies neck complaints of pain, stiffness, or tenderness without physical signs. Grade 2 represents neck complaints and musculoskeletal signs including decreased range of motion and point tenderness. Grade 3 indicates neck complaints and neurologic signs including decreased or absent deep tendon reflexes, muscle weakness, and sensory deficits. Grade 4 includes neck complaints and fracture or dislocation. Controversy about late whiplash syndrome is paralleled by similar controversy about the sequelae of usually mild head and neck injuries that often occurred in railway accidents in the second half of the 19th century: "railway spine" (Evans 1994). In publications from 1866 to 1882, Erichsen proposed that these injuries were due to "molecular disarrangement" or anemia of the spinal cord. In 1879, Rigler proposed compensation neurosis as the cause of an epidemic of compensation claims for railway accidents in Prussia. In 1888, Oppenheim disagreed with this explanation and popularized the term "traumatic neurosis." Charcot felt that posttraumatic symptoms were actually due to hysteria and neurasthenia. Throughout the 19th century in the United States, as today, there were misgivings about physicians becoming involved in medico-legal cases. A common concern was that physicians were available as hired guns with any opinion for a price. The whiplash mechanism of injury may have first been recognized in United States Navy pilots who developed neck injuries from acceleration-deceleration forces when their planes were launched by catapults following World War I. Although the pilots were shortly thereafter provided with headrests and shoulder harnesses, automakers in the civilian sector took some 50 years to provide the same safety equipment. Crowe, an orthopedist, is often cited as coining the term "whiplash" during …