Whiplash associated disorders (WAD) is a term used to describe the constellation of signs and symptoms that can arise following the sudden acceleration-deceleration of the head and neck that can occur in automobile collisions, physical trauma (such as sports or assault), or a serious fall. It’s estimated that half of WAD patients will continue to experience ongoing mental and physical symptoms that can dramatically affect their quality of life in many ways. This begs the question, is chronic WAD rooted in the injury itself or in the mental, social, and psychological response (psychosocial) to the condition?

When confronted with stress, the human body engages the neurobiological stress systems. This includes the hypothalamic-pituitary-adrenal axis, which produces cortisol; the sympathetic nervous system, which releases adrenaline and prepares the body for rapid action; and various neurotransmitters and areas of the brain to help make rapid decisions. In a life-or-death situation, this can help save a life. If these neurobiological stress systems remain engaged, then over time they can have a detrimental effect on the body, which can impede recovery. The aftermath of a car accident can bring additional stressors that can disrupt normal routine from caring for loved ones who may have also been injured to dealing with insurance companies, body shops, and litigation, exacerbating these unconscious biological reactions. The stress response may also trigger behaviors like kinesiophobia and catastrophizing, which can stimulate a negative disposition toward recovery or even cause one to restrict activity out of fear of worse pain or reinjury, both of which can elevate the risk for progression to chronic WAD.

On the other hand, a study that monitored more than 600 car accident victims who have visited the emergency room found that those with more severe pain were more likely to report moderate-to-severe pain in the following months. In a 2021 study, researchers observed that chronic WAD patients exhibited small but significant impairments in neck muscle control, suggesting that nervous system injury may play a role in progression to chronic WAD symptoms. A systematic review published in 2022 found that peripheral nerve injury and neuropathic pain may be more common among WAD patients than previously thought, and such issues may not be detected with current WAD diagnosis practices.

In the end, we may come to understand chronic WAD as an interplay between both more severe initial injury and the psychosocial response that arises in its aftermath. While it’s not yet possible to identify perfectly screen for which WAD patients may develop chronic pain and disability, the current data suggest that early intervention may be the best preventative course of action. Instead of a wait-and-see approach, patients may benefit from prompt treatment to address musculoskeletal injuries as well as encouragement to remain active within pain tolerance with assurance that recovery is highly likely. As for treatment options, there are many available to the whiplash patient, but a 2022 study found that the use of manual therapies—such as spinal manipulation, the primary treatment provided by doctors of chiropractic—can significantly reduce recovery time and lead to better outcomes for pain reduction, physical function, and quality of life.