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Shaw Chiropractic
A Medical-Legal Newsletter for Personal Injury Attorneys
by Dr. Steven W. Shaw

International Whiplash Conference

Last month I attended the International Whiplash Conference in Toronto Canada to hear the worlds leading medical researchers present and review the most current whiplash literature. Speakers included Robert Teasell MD from the University of Western Ontario and Nikolai Bogduk MD of Austraila. Both of these physician/researchers are well respected in the area of Whiplash Associated Disorders (WAD). The conference lasted 4 days and covered a lot of territory. In this newsletter I will summarize the points which I believe to be valuable to the practicing personal injury attorney.

Dr. Teasell spent several hours reviewing the Quebec Task Force on Whiplash Associated Disorders (QTFWAD). This literature review and cohort study has been used throughout the world by defense oriented organizations to argue against the dramatic effects of WAD. Dr. Teasell offered his opinions regarding the paper and summarized that the conclusions made by the task force were in direct contradiction and inconsistent with the papers reviewed. He pointed out many flaws but most import were the criteria for disability. Disability was defined as inability to work in any capacity. He also noted that the number of studies accepted for the research were minuscule compared to the 10,000 papers which were reviewed. The problems in the QTFWAD study are summarized in his presentation notes which are available from my office if you have an interest in adding them to your library.

Dr. Bogduk was a totally different animal. He is by far the leading researcher in whiplash and spinal anatomy. In fact, his early research published in the late 1980s revolutionized the management of spine related disorders. He was the first anatomist and physician to demonstrate the neurologic innervation of the disc which prior to that time was considered to be both avascular and without neurologic influence. His research resulted in a paradigm shift in the physician community regarding the source of back and neck pain and the resulting management. To put things into a nutshell, Dr. Bogduk proved that back and neck pain from the disc does not require that the disc be herniated and result in nerve compression. He found that the disc itself has pain receptors and that internal disc damage is pain productive and may refer pain through other neurologic pathways.

Dr. Bogduk reviewed literature from Japan which demonstrated the current theory of WAD injury mechanism. The Japanese researchers, using high speed video fluoroscopic imaging, recorded the coupling movements of the cervical spine in rear impact motor vehicle collisions. They found that hyperextension of the neck was not necessary to cause damage to the disc. In fact, they found that segmental extension was present at relatively low speed collisions which was significant enough to cause tearing of the anterior disc fibers without tearing of other ligaments of longer length. They demonstrated a S shaped spine deformity with associated shearing and extension displacements which had potential disc and zygapophyseal joint damage consequences. An interesting concept to say the least.

I had heard about Dr. Bogduk from others who had seen him speak before at other conferences. He has the reputation of being curt, rude and intolerant of others of differing opinion. Although I enjoyed his lectures I must admit that he is everything his reputation suggested. The audience was composed of pain specialists of varying communities. The majority of physicians were spine surgeons, anaesthesiologists, and physiatrists. Chiropractors and physical therapists composed perhaps 5% of the audience of approximately 400 specialists.

Dr. Bogduk systematically took each professions approach to WAD management and demonstrated that we were all failures based upon the available literature. He did not suggest that we were not effective. Rather that there was no literature to support what we do. He did point out that surgical procedures and injection procedures were completely useless for WAD neck pain. He also pointed out that physiological therapeutics such as those used by chiropractors did demonstrate short term benefit but were no better in the long run than any other approach. He humorously continued to point out that a surgeon was no better at treating WAD than the practitioner of crystal therapy or prayer.

Despite his cynicism there were some lessons in the lectures by Dr. Bogduk which you as a personal injury attorney can use to defend your client’s right to choose physicians other than orthopedists. The argument that non-orthopedists are less capable or less competent has been shot down by the worlds leading researcher. We are all equally incompetent to treat WAD. With this in mind patient satisfaction and cost of care become increasingly more important. In the hands of a well trained chiropractic physician both of these issues are addressed.

My staff and I are committed to keep you abreast of the current literature so that you can use it effectively to assist your clients. For more information about the International Whiplash Conference do not hesitate to call me at 1-800-232-6824.