Andy Griffith, Whiplash, and Your Neck!
Dear Patients & Friends:
There is an episode in the iconic Andy Griffith TV Show series where Goober has a fender bender, listens to others complain about neck pain, and begins to complain of neck pain and whiplash. Andy attempts to trick him into catching a football to demonstrate that his pain is imaginary, or “psychosomatic.” At the end of the show Goober himself accidentally raises his hands over his head, demonstrating that he really wasn’t disabled with pain after all.
While the series remains at the top of my favorite list, sadly this particular episode is a metaphor for the typical response of many to complaints of whiplash and neck pain generally. “You’ll be alright,” the doctor says after x-rays in the emergency room (ER) demonstrate no broken bones. Actually the majority of patients we see after motor vehicle accidents are told in the ER that their x-rays are “negative,” meaning that no problems were found by the radiologist.
This leaves the patient wondering, “If the x-rays are negative, why do I still hurt?” Worse, friends and co-workers may have the same response Andy had, and suggest, “Maybe it’s in your head.”
While research does indicate psychosocial factors play a role in whiplash symptoms, there is no evidence such factors are any more important after whiplash than they are after a heart attack, for example.
In contrast, a review of trials of whiplash-associated disorder (WAD) prognosis indicated that a number of variables predict whether neck pain and other symptoms will persist after a motor vehicle accident: a) high baseline pain (>5.5/10), b) headache with neck pain, c) no college, d) no seatbelt use, e) low back pain at time of MVA, f) high Neck Disability Index score (> 14.5/50), g) pre-injury neck pain or report of neck pain at time of MVA, h) catastrophizing, believing the problem is far worse than it is, i) female sex, and j) WAD grade 2 or 3, and WAD grade 3 alone. In addition, there is growing evidence that pre-accident history of headache, rear-end collision, older age and collision severity may be predictors of poor outcome as well.
Even the variables on the above list that may be thought to be evidence of “psychosomatic” have alternative explanations.
For example, patients who have not been to college generally also have less insurance benefits, and may have greater difficulty arranging for child care and for scheduling and paying for visits for exercise therapy or chiropractic.
That females are more susceptible to whiplash than males may be due to the fact that women in general have smaller diameter and less muscular necks to support their skull.
It is no surprise that patients who catastrophize are more likely to continue hurting, since, regardless of whether your problem is whiplash or a herniated disc, worrying and stressing about your pain is nowhere near as effective a treatment approach as is using ice, stretching and walking. The message there is, don’t just talk and worry about your pain, DO something about it.
Unfortunately just as sadly as was Goober’s catastrophizing response to his neck being sore, the typical patient’s response may be just as bad. Patients typically ignore their pain and go back to their workplace where they spend years of long days bent over a computer while taking pills to mask their pain, getting little exercise or chiropractic that might actually improve muscle strength and joint stiffness and help their body resolve their problem.
That is precisely why we often see patients for the first time perhaps 10 or 20 years after whiplash, suffering from headaches and migraines that started months or years after their trauma, which improve or even resolve after a single month of chiropractic.
At the end of the day Andy is still my hero, and I love the messages of 99.9% of his shows. But as a chiropractor with over 30 years of experience I can tell you that while there are a few Goobers out there catastrophizing their pain, guilty of psychosomatic illness, for the vast majority of sufferers even years after whiplash the pain is not in your head, it’s in your neck!
Wishing you a wonderful Easter Holiday,
Robert A. Leach, DC, MS, FICC(h), CHES
Originally aired on October 31st, 1966, during season 7 of the award winning Andy Griffith TV Show series, episode 196 was titled, “Mind Over Matter,” and featured Andy demonstrating that Goober’s neck pain was not due to whiplash but was merely psychosomatic: http://www.tvland.com/shows/andy-griffith-show/episode-guide/season-7
Risk factors and prognosis for whiplash was refined recently and published in 2013 in the Journal of Orthopedics and Sports Physical Therapy: http://www.ncbi.nlm.nih.gov/pubmed/23322093
The Quebec Task Force grading system for Whiplash Associated Disorders (WAD) is explained in Wikipedia: http://en.wikipedia.org/wiki/Whiplash_%28medicine%29