Whiplash and Work Disability

Whiplash results from a sudden trauma, usually involving an accident, where the injured person’s car is 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 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 questionnaires were resent 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 one-month mark were most predictive of those that would still be disabled at one year. What was interesting was that most of the previously accepted risk factors of long-term disability such as the intensity of manual labor  or educational level were not found to be helpful in predicting long-term disability prior to the one-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 soley managing the patient’s 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. Therefore, it is 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 healthcare 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 healthcare 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.