Whiplash can be defined as an “acceleration-deceleration mechanism of energy transfer to the neck. It may result from …motor vehicle accidents… The impact may result in bony or soft tissue injuries – whiplash injury, which in turn may lead to a variety of clinical manifestations – whiplash associated disorders” (MAA, 2014).

This definition arises from the Quebec Task Force (QTF), a group who were sponsored from a public insurer in Canada who developed a guide for managing whiplash in 1995 (Physiopedia, n.d.) – several updated versions have since been published. The QTF focused on clinical issues, specifically risk, diagnosis, prognosis and treatment of whiplash and these guidelines were largely developed by consensus and the expert knowledge of members of the QTF (MAA, 2014).

To assist in the diagnosis of WAD, the QTFC (Quebec Task Force Classification) was introduced by the QTF. It indicated 5 grades of WAD (grade 0 through to grade 5), with each grade corresponding to a treatment recommendation. However, some have questioned the usefulness of the QTFC, as evidence demonstrated differences in physical and psychological impairments between individuals who recovered fully from a WAD, compared to those who were left with chronic pain and disability (Sterling, 2004).

As a result, Sterling (2004) introduced a modified QTFC as per the below –

Proposed classification grade

Physical and psychological impairments present

WAD 0 No complaints about neck painNo physical signs
WAD I No complaints of pain, stiffness or tenderness onlyNo physical signs
WAD IIA Motor impairment

  • decreased ROM
  • altered muscle recruitment patterns (CCFT)

Sensory Impairment

  • local cervical mechanical hyperalgesia
WAD IIB Motor impairment

  • decreased ROM
  • altered muscle recruitment patterns (CCFT)

Sensory Impairment

  • local cervical mechanical hyperalgesia

Psychological impairment

  • elevated psychological distress (GHQ, TAMPA)
WAD IIC Motor impairment

  • decreased ROM
  • altered muscle recruitment patterns (CCFT)
  • increased JPE

Sensory Impairment

  • local cervical mechanical hyperalgesia
  • generalized sensory hypersensitivity (mechanical, thermal, ULNT)
  • Some may show SNS disturbances

Psychological impairment

  • elevated psychological distress (GHQ, TAMPA)
  • elevated levels of acute posttraumatic stress (IES)
WAD III Motor impairment

  • decreased ROM
  • altered muscle recruitment patterns (CCFT)
  • increased JPE

Sensory Impairment

  • local cervical mechanical hyperalgesia
  • generalized sensory hypersensitivity (mechanical, thermal, ULNT)
  • Some may show SNS disturbances

Neurological signs of conduction loss including:

  • decrease or absent deep tendon reflexes
  • muscle weakness
  • sensory deficits

Psychological impairment

  • elevated psychological distress (GHQ, TAMPA)
  • elevated levels of acute posttraumatic stress (IES)
WAD IV Neck complaintFracture or dislocation

 

Furthermore a useful algorithm, known as the Canadian C-Spine Rule (CCR) was adapted by Stiell et al. (2003), to indicate whether radiography is indicated in those who may present with cervical spine injury and trauma (perhaps not only from motor vehicle collision)…

 

Canadian C-Spine Rule

Both the MQTFC and the CCR are standardised and well evidenced ways of ensuring good and accurate assessment and diagnosis of varying degrees of whiplash, given the amount of variables that can contribute to a variety of WAD. It also ensures good practice in the communication of such diagnoses between healthcare providers during a referral pathway.

Follow the links in the references below for further reading…

References

Motor Accidents Authority (2014) Guidelines for the management of acute whiplash associated disorders for health professionals 2014, 3rd edition, accessed online 06/02/2015  https://www.maa.nsw.gov.au/__data/assets/pdf_file/0011/18956/Final-Guidelines-for-the-management-of-a~d-WAD-disorders-for-health-professionals-3rd-edition-2014-MAA32-0914-28-11-14a.pdf

Physiopedia (n.d.) Whiplash Associated Disorder, accessed online 6/2/1015 – http://www.physio-pedia.com/Whiplash_Associated_Disorders

Sterlin M (2004) A proposed new classification system for whiplash associated disorders—implications for assessment and management, Manual Therapy, vol 9 (2): 60-70.

Stiell IG, Clement CM, McKnight RD, Brison R, Schull MJ et al., (2003) The Canadian c-spine rule versus the NEXUS low-risk criteria in patients with trauma, New England Journal of Medicine, vol 349 (26): 2510-2518.