The insurance industry pays out 2bn a year for neck injuries but an orthopaedic surgeon claims 'there's no such thing as whiplash'
Edina, played by Jennifter Saunders, in Absolutely Fabulous
They are easy to spot, walking delicately, their necks and shoulders seemingly immovable. Wincing when they catch my eye, I know before they speak that they’ve been ‘in a car crash’ and think they ‘might have whiplash’. Of course, we don’t jump to any conclusions. Indeed, they may have a serious neck injury that needs treating. But whiplash is a diagnosis we are very careful about making.
You are bound to have read that the rise in claims for this injury is pushing up our motor insurance premiums. About 600,000 whiplash claims are made each year, costing 1.9 billion – the equivalent of 66 on every car policy. Yet GPs say a quarter of these could be fake, according to a survey by Axa Insurance.
As a trainee orthopaedic surgeon, I spend lots of time seeing these patients in Accident & Emergency, and all of this comes as little surprise. But what may come as a shock to motorists is that whiplash isn’t a real medical diagnosis.
In medical literature, whiplash is used to describe a movement of the head and neck – NOT any of the resulting conditions. Calling something a whiplash injury is like saying one is suffering a falling injury. It means little without saying what the result is.
But whiplash has become a diagnosis in itself. One reason is that it is being used by some doctors to describe a soft-tissue injury to the neck.
Muscles are made up of fibres that can overstretch and tear, although they will heal within a couple of weeks. Yet people who say they have whiplash – which in nine out of ten cases occur in collisions under 30mph – often still feel pain months after the injury was sustained.
It can be self-perpetuating to some extent. If a doctor agrees that you have whiplash, tells you to wear a collar and take painkillers, you are going to take it quite seriously.
Most patients are seen in A&E following minor road accidents, and perhaps checked over by junior medics who may not appreciate the potential fallout of their diagnosis. I have never said ‘You have whiplash’ to a patient, although I have suggested they have a sprained neck or pulled a muscle.
The difficulty is separating those looking for money from those in genuine pain and those suffering from the psychological impact of an accident.
Most patients who come in claim to have pain in and around the neck, the shoulders or lower back. Some feel pain or tingling in the arm, while others complain of headaches, hearing or visual problems.
What many patients have in common is
that they are the anxious type. Studies have also shown that those who
go frequently to their GP about unrelated conditions are more likely to
suffer from prolonged neck pain following a low-speed crash. It is also
the case for those with a history of depression.
a young professional with an active life and no mental health problems
is less likely to suffer from the condition.
are some of the reasons why many doctors argue the condition is
psychological rather than physical. According to the Judicial Studies
Board, which publishes legal guidelines for general damages claims,
whiplash that takes more than a year to recover from can earn a patient
over 5,000 in compensation. Even if patients get better in weeks, they
could be in line for 1,000.
not dismissing neck injuries – they can be serious and we are careful
to assess all patients, regardless of their symptoms after a crash.
The difficulty is separating those looking for money from those in genuine pain and those suffering from the psychological impact of an accident
High-speed accidents are the ones that usually result in serious injury. Sudden forward flexion of the neck can cause serious damage to the upper spine, or the neck can be extended backwards, causing fractures in the vertebrae. Some cars spin in a crash, and the violent rotation can cause ligament tears in the neck, or brain injuries. These are serious, even life-threatening conditions that show up on scans.
If it was agreed that whiplash was a mental health problem as a result of a car accident, should patients still be compensated As a doctor, I don’t feel I am qualified to make that call.
But if this is a case of mind over matter, then it can be tackled. If the patient has reached the stage of diagnosable depression – which up to 40 per cent of whiplash sufferers do – then anti-depressants could be beneficial.
See your GP if you’ve been in an accident and are still in pain two weeks later, because the doctor needs to ascertain that no new symptoms have developed. If not, they may suggest pain relief, but would look at how you’re feeling post-accident.
There is a general feeling among orthopaedic surgeons that patients who are more positive in their outlook recover faster after surgery.
As for the future, perhaps the medical profession needs to be on alert. Better awareness of what is really wrong with these patients could lead to swifter diagnosis of psychological problems after an accident. And those looking to take advantage may think twice before pulling a fast one.