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Chronic Whiplash and Whiplash-Associated Disorders: An Evidence-Based Approach

Schofferman, Jerome MD; Slosar, Paul MD

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Journal of the American Academy of Orthopaedic Surgeons: March 2008 - Volume 16 - Issue 3 - p 121-122
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The Authors Reply: We appreciate the comments from Dr. Raisbeck but respectfully disagree. The term whiplash is certainly used by orthopaedic surgeons and other specialists who treat neck pain after a motor vehicle collision (MVC). In fact, there was an entire chapter about whiplash in a recent monograph published by the AAOS.4 A PubMed search for whiplash articles published in the past year yielded 106 hits. A search limited to the journals Spine and the Journal of Spinal Disorders & Techniques, both of which are edited by orthopaedists, and of Spine Journal, edited by a neurosurgeon, yielded 136 hits. In addition, there is a journal devoted to whiplash.5 The professional texts that include the term in their titles are too numerous to list. Finally, an associate editor of JAAOS invited us to write this paper, and he and the editor-in-chief both approved the title and content. We do agree, however, that whiplash is not an accurate description of the injury, and we discussed this in our paper.

We did our best to avoid bias in our selection of evidence. Where controversy exists, we tried to show both sides. Then we drew our opinion on the relative strengths of the evidence. We cited systematic reviews when possible (ie, high level of evidence). In contrast, the references offered by Dr. Raisbeck in contradiction are texts, not evidence-based references. The first, the singleauthor text,2 was written by a psychiatrist and at best falls to the level of opinion. The book does not discuss many of the significant clinical and biomechanics articles of the last 10 years. We, however, have shown in our paper that there are many structural causes of chronic neck pain after MVC, and it is our task to use the published evidence to find the cause of pain and to provide specific treatment when possible. The Nachemson and Jonsson book3 has very minimal discussion on the subject, and it is neither comprehensive nor evidence-based.

Finally, we do not understand Dr. Raisbeck's question about placebocontrolled studies. The highest level of evidence for studies of therapy is a high-quality, randomized, placebo-controlled study or a systematic review of a level I randomized controlled trial, according to JAAOS criteria.6 Obviously, prognostic studies require different criteria.

Jerome Schofferman MD

Paul Slosar MD

Daly City, CA


1. Schofferman J, Bogduk N, Slosar P: Chronic whiplash and whiplashassociated disorders: An evidencebased approach. J Am Acad Orthop Surg 2007;15:596-606.
2. Maleson A: Whiplash and poor science in medical journals, in Whiplash and Other Useful Illnesses. Montreal, Quebec: McGill-Queens University Press, 2002, pp 17-18,22.
3. Nachemson AL, Jonsson E (eds): Neck and Back Pain: The Scientific Evidence of Causes, Diagnosis, and Treatment. Philadelphia, PA: Lippincott Williams & Wilkins, 2000.
4. Johnson MC, Zigler J: Whiplash: Diagnosis and treatment, in Fischgrund J (ed): Neck Pain. Rosemont, IL: American Academy of Orthopaedic Surgeons, 2004, pp 27-34.
5. Journal of Whiplash and Related Disorders. Salem, OR: Haworth Press. Available at: Accessed January 30, 2008.
6. Levels of Evidence For Primary Research Question. Available at: Accessed January 30, 2008.
© 2008 by American Academy of Orthopaedic Surgeons