Anatomy of a Neck Injury

AuthorSamuel D. Hodge, Jr./Jack E. Hubbard
ProfessionSkilled litigator, is chair of the department of legal studies at Temple University/Professor of Neurology at the University of Minnesota
Anatomy of
a Neck Injury
Nobody really knows
when the term
“whiplash injury”
originated, and U.S.
insurance companies,
which each year
pay out substantial
damages to supposed
whiplash victims,
undoubtedly wish
it never had. The
sudden backward
snap of the head to
which whiplash is
ascribed generally
happens in rear-end
automobile collisions;
these annually result in
thousands of cases of
alleged neck injury.
Time Magazine,
October 31, 1960
These words written more than one half-century ago are as valid today as when they were
first printed. Simply put, whiplash remains extremely controversial in both medical and
legal circles. In fact, the term still evokes strong reactions in a great number of people.
This chapter discusses the anatomy of the cervical spine and explores the lingering con-
troversy surrounding these flexion/extension type injuries. It also offers insight into the
mechanism of injury, the treatment of neck problems, and an overview of this dispute in
a litigation setting including trial strategies.
The Problem
Claimants’ attorneys vigorously advocate that whiplash is a legitimate injury and point
to their many clients whose lives have been altered as the result of this injury.1 Defense
counsel and insurance companies remain skeptical because there is little objective evi-
dence to verify this neck injury and they believe that many of the claims are the mere
creation of greedy trial lawyers and fraudulent claimants.2 One published article even
goes so far as to label whiplash a social disease because it brings together accident victims
“from of all walks of life—the guilty, the innocent, the upwardly mobile, the downtrod-
den, and the woebegone all take the stage.”3
Cottage industries have sprouted up advocating one position or the other, and these
businesses are not limited to doctors and lawyers. For instance, biomechanical engineers
offer expert testimony on whether it is possible for the neck to have been injured in a
low-impact accident,4 and a specialized journal was created on the topic.5
Certain undisputed facts, however, have emerged over the years in relation to this
problem. Whiplash or whiplash-associated disorders refers to a constellation of symp-
toms that occur following an injury to the neck, usually as the result of sudden extension
and flexion forces, and the malady can inculpate the intervertebral joints, disks, muscles,
ligaments, and tendons.6 Motor vehicle accidents resulting in a flexion/extension move-
ment of the cervical spine are some of the most common causes of neck injuries, with an
estimated one million claims per year in the United States alone.7 Part of this number
is attributable to the increased stiffness of newer automobile chassis to improve crash-
worthiness and stiffer seat back designs.8 These injuries, frequently termed sprains or neck
sprains, are the most commonly reported injuries involving insurance claims, accounting
for 66 percent of all bodily liability cases as well as 57 percent of those advancing claims
for personal injury protection benefits. The cost of these cases is about $8.8 billion and
accounts for roughly 25 percent of the total dollars paid for all crash victims combined.9
Neck pain is not limited to automobile accidents as its source and can be caused by
a host of other problems such as cervical radiculopathy, cervical spondylosis, cervical
myleopathy, a herniated disk, neoplasms, and systemic inflammatory disorders. The pain
may develop with no precipitating trauma, the person may have the immediate onset of
discomfort, or the pain may happen days after the event.10 Surprisingly, a person’s gender
plays a role in the development of the injury, with women having a 10 percent higher
incidence than men.11
The National Institute of Neurological Disorders and Strokes reports that neck and
head problems associated with whiplash usually clear up within a few days or weeks and
most patients recover within three months after injury.12 Nevertheless, some people com-
plain of symptoms for years with no clear demonstrable cause.13 In fact, the incidence and
outcome of whiplash injuries are greatly influenced by pain and suffering damages, injury
severity, legal factors, and sociodemographic characteristics.14 Studies also show that a
claimant’s early expectation for recovery is a significant prognostic dynamic in recovery
and potentially modifiable.15 These findings are supported by an unrelated report that
determined that a person’s causal beliefs in whiplash may play a major role in the perceived
disability and duration of neck complaints following an accident, in that pain catastroph-
izing is predominantly related to concurrent disability. This finding is consistent with the
opinion that an early belief that neck pain is caused by the medico-cultural entity whiplash
has a detrimental effect on the duration and outcome of the symptoms.16
On the flip side of this issue, contrary to the experience in the United States, Lithu-
anians and Greeks, who have very little financial expectations from chronic whiplash
claims, do not appear to suffer from prolonged whiplash injuries and are able to recover
from an acute whiplash injury within a few weeks or months.17 In Germany, a prospec-
tive outcome of accident victims who sustained whiplash injuries found the same positive
prognosis, with recovery most of the time within three weeks, and virtually all within six
Medical Considerations
The concept of a whiplash-type injury was first introduced in 1928 when Dr. Crowe
presented several cases of a “lash-like effect” injury to the neck following rear-end col-
lisions.19 The term whiplash, however, was first coined in the medical literature by Davis
in a discussion of neck injuries.20 Over the years, the nature of this injury has remained
controversial. In his 1964 book on neck and arm pain, Dr. Rene Cailliet21 summarizes the
then-contemporary understanding of whiplash:
Symptoms attributed to this syndrome are vaguely described, the etiology is dramati-
cally explained, the mechanisms of injury are poorly understood, and the treatment is
empirical at best. In this state of total confusion and ignorance the injured have been
neglected, mistreated and even accused of deception, while many uninjured complain-
ers have been exorbitantly and unjustifiably rewarded.22
In an attempt to apply science to this controversy, the Quebec Task Force on Whiplash-
Associated Disorders was assembled at the request of the automobile insurance industry
of Quebec, Canada.23 The mandate of the Quebec Task Force (QTF) was fivefold: (1) to
make recommendations for prevention of whiplash, (2) to understand the natural history
of these flexion/extension injuries, (3) to establish a medically sound approach for the
diagnosis and treatment of whiplash including an understanding of its mechanism, (4) to
develop a teaching strategy regarding this type of trauma for medical and paramedical
professionals, and (5) to assist in the rehabilitation of whiplash-injured patients. The find-
ings of the QTF were published in 1995.24 The QTF sifted through 10,000 articles but
concluded that only 346 reports were of adequate scientific merit to be considered.25 Fol-
lowing the QTF report, a subsequent publication by Rodriquez (and several coauthors)
updated the QTF approach to the year 2004.26
This chapter references these two important works as well as additional publications
on the subject in order to consider (1) the anatomy of the neck, (2) the definition of a
whiplash injury with a description of symptoms, (3) the mechanism of the injury, (4) iden-
tifying the source of whiplash injury, and (5) the prognosis and treatment of this disorder.

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