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Predicting Outcomes in Whiplash

Original Editor - Tarina van der Stockt

Top Contributors - Tarina van der Stockt, Tony Lowe, Stacy Schiurring, Jess Bell, Habibu Salisu Badamasi and Robin Tacchetti

Introduction

Whiplash is an acceleration-deceleration mechanism of energy transfer to the neck.[1] It may result from rear-end or side-impact motor vehicle collisions, but can also occur during sport (diving, snowboarding) and other types of falls. The impact may result in bony or soft-tissue injuries affecting the ligaments, muscles, and nerves and may lead to other clinical manifestations call whiplash associated disorders (WAD). [2] [3] WAD is a term used to describe a collection of symptoms following a whiplash injury.[4] It is considered the most common outcome after "noncatastrophic" motor vehicle accidents.[5] WAD symptoms range from neck pain, headache, radicular symptoms, stiffness and tenderness, to loss of motor function and mental as well as stress reactions. [4][6] [7] Physiological alterations and tissue damage are often times not detectable. [8][9] [10] Usually patients recovery within 3 months after a whiplash injury but ½ of the patients with acute WAD go on to develop chronic pain and or disability. [3] To learn more about WAD you can click on the following link: Whiplash Associated Disorders

Early identification of the individuals that might have long term pain and disability will help clinicians to spend the correct resources in prevention and treatment.[11] This subject is continually being researched and therapists should stay up to date with the current research on predicting factors. [11]

[12]

Factors that predict poor outcomes

High levels of initial pain and a high score on the neck disability index are considered the strongest predictors of pain and disability after 6 months. [11] Other strong predictors include cold hyperalgesia, older age, and acute post-traumatic stress. [13]

1. High level of initial pain

Level of pain on Visual Analogue Scale 5.5/10 is considered high [11]. High levels of initial pain are considered a very strong predictor of poor outcome in the long term[3] [11]

It is an easy scale for therapists and doctors to use and can be used to measure initial pain and pain levels with activities of daily living or work activities. [14]

A 2017 meta-review also suggested that there may be an link between initial pain levels and anxiety and the outcome following acute whiplash injuries.[15]

2. Characteristics of pain

Presence of Neuropathic pain - listen to descriptors used by the patient in history taking - burning, electrical, mind of its own, area extra tender to touch (allodynia).

Neck Disability Index (NDI) is a 10-item questionnaire, filled out by the patient asking the patient to rate activities of daily living - for example, personal care, reading, driving, lifting, sleeping, recreation, as well as concentration, pain intensity and headache on a 0-5 scale indicating disability in these activities[4]. Along with pain intensity, it is considered a very strong predictor of poor outcome in terms of chronic pain and disability. The cut-off value for this assessment is NDI greater than 14.5/50 points (equivalent to 29% of 100%)[11]

3. Psychological factors

Catastrophising

Catastrophising represents "an exaggerated negative orientation toward noxious stimuli"[16] and is recognised as a multidimensional construct comprising three distinct components.[17]

  1. Rumination occurs when an individual becomes trapped in persistent thoughts about their pain, particularly focusing on the intensity of their discomfort.
  2. Magnification involves the development of fearful cognitions regarding potential serious consequences of their condition.
  3. Helplessness encompasses the belief that no effective interventions exist to reduce their pain experience.

Individuals who catastrophise typically demonstrate a fundamentally negative cognitive framework regarding their pain experience. They characteristically adopt passive coping strategies, including prolonged rest periods, increased reliance on analgesic medications, and an expectation that healthcare professionals will provide complete resolution of their symptoms without active patient participation. This psychological orientation can manifest in observable changes to the individual's physical presentation and behaviour. Research has consistently identified poor recovery expectations and passive coping mechanisms as among the most reliable predictors of outcomes in chronic whiplash-associated disorders.[18] [19][20]

Catastrophising has been described as the "most robust and reliable psychological predictor of pain experience", highlighting its central role in pain perception and management. The Pain Catastrophizing Scale provides a standardised assessment tool consisting of 13 items that allow patients to rate the frequency of specific thoughts and emotional responses during pain episodes.[2] This construct is widely recognised as a significant risk factor in pain conditions,[4] with evidence demonstrating that therapeutic interventions aimed at reducing catastrophising behaviours result in measurable improvements in both pain severity and functional disability across acute and chronic pain populations.

Fear of movement

The Tampa Scale of Kinesiophobia (TSK) serves as a standardised 17-item assessment tool designed to quantify an individual's fear of movement and potential re-injury. The instrument yields scores ranging from 17 to 68, with a threshold score of 37 indicating clinically significant kinesiophobia.[4] This validated questionnaire provides rehabilitation professionals with objective data regarding the extent to which fear-based beliefs may be influencing a patient's movement patterns and treatment engagement.

Beyond formal assessment tools, clinical examination should incorporate direct exploration of the patient's specific concerns and fear-related cognitions through targeted questioning. Practitioners should systematically enquire about the nature of the patient's apprehensions, including whether they harbour beliefs that their spine is inherently fragile or vulnerable to damage. Understanding which particular movements, activities, or therapeutic exercises the patient is actively avoiding provides crucial insight into the scope and specificity of their kinesiophobic responses.[21] This qualitative information complements quantitative TSK scores and enables clinicians to develop more personalised, fear-informed treatment approaches.

Post traumatic stress reaction

Post-traumatic stress reactions following whiplash injury represent a critical psychological factor in recovery outcomes, with the combination of elevated pain levels and post-traumatic stress symptoms serving as a particularly strong predictor of poor prognosis.[22] These reactions affect approximately 25% of individuals who sustain whiplash injuries in motor vehicle accidents, making them a substantial clinical consideration in this population.[4]

Post-traumatic stress presentations are characterised by three distinct symptom clusters.[23]

  1. Re-experiencing symptoms manifest as intrusive thoughts about the accident that spontaneously occur throughout daily activities, often accompanied by distressing nightmares related to the traumatic event.
  2. Avoidance behaviours involve deliberate social withdrawal and active evasion of any stimuli, thoughts, or situations that serve as reminders of the accident.
  3. Hyperarousal states are evident through heightened vigilance, exaggerated startle responses, increased irritability, and elevated physiological arousal including rapid respiration patterns.

Clinical assessment should incorporate direct enquiry regarding the frequency of accident-related thoughts and observation of whether patients repeatedly recount details of their traumatic experience during consultations. The Impact of Events Scale (IES) provides a standardised 15-item screening tool that measures current subjective distress specifically related to the traumatic life event.[24] This instrument has been subsequently revised to include hyperarousal symptom assessment, resulting in the 22-item Impact of Events Scale-Revised (IES-R). Importantly, administration of these scales should be delayed until at least six weeks post-injury, as intrusive thoughts and stress responses are considered normal adaptive responses within this initial timeframe.

Link to the revised scale: (IES)-R

Perception of injustice has emerged as an additional significant predictor of long-term disability and persistent pain following whiplash injury,[23] suggesting that cognitive appraisals of fairness and blame attribution may substantially influence recovery trajectories.

4. Physical factors

Widespread tenderness in areas not affected by the injury; this can include the front of the shins and widespread hypersensitivity when tested with blunt pressure [25]

Cold pain threshold alteration (hyperalgesia) is associated with higher pain and disability 6 months after the whiplash. Cold pain threshold alterations, characterised by hyperalgesia to thermal stimuli, represent a significant prognostic indicator associated with elevated pain intensity and disability levels six months following whiplash injury. This phenomenon manifests clinically when contact with metallic objects at temperatures of 15-20 degrees Celsius produces abnormal burning sensations rather than the expected cool sensation. Research demonstrates that even a minimal decrease of one degree in cold pain threshold compared to normative values substantially increases the probability of developing moderate to severe long-term symptoms.[13]

Cold hyperalgesia is recognised as a robust sensory predictor of poor outcomes, particularly when considered alongside impaired sympathetic vasoconstriction responses.[13] Thermal hyperalgesia, encompassing both heat and cold sensitivity, typically emerges in the early post-injury period specifically amongst individuals who subsequently develop persistent moderate to severe pain and functional disability.[25] This early presentation suggests that thermal hyperalgesia may serve as an important clinical marker for identifying patients at high risk of chronicity.

The underlying mechanisms responsible for cold pain threshold alterations are multifactorial and may reflect several pathophysiological processes. Potential explanations include direct peripheral nerve damage,[13] alterations in central pain processing mechanisms [2], or dysfunction within the sympathetic nervous system.[25] These mechanisms highlight the complex interplay between peripheral and central nervous system changes that can occur following whiplash trauma, emphasising the importance of comprehensive sensory assessment in the early post-injury period.

Positive Upper limb tension test 1 (ULTT1) or brachial plexus provocation test

The Upper Limb Tension Test 1 (ULTT1), also referred to as the brachial plexus provocation test, serves as an important clinical examination procedure in the assessment of whiplash-associated disorders. A positive or heightened response to this neurodynamic test typically emerges in the immediate post-injury period and demonstrates significant prognostic value, as it is characteristically observed in individuals who subsequently develop persistent moderate to severe pain and functional disability.[25]

In patients presenting with chronic whiplash-associated disorders, the ULTT1 reveals specific biomechanical changes that reflect underlying neurophysiological alterations. The presence of bilaterally decreased elbow extension range of motion during test performance indicates the development of both motor and sensory system changes attributable to central sensitisation processes. This bilateral presentation is particularly significant as it suggests that the sensitisation extends beyond the initial injury site to affect central nervous system pain processing mechanisms.[25]

The ULTT1 findings provide rehabilitation professionals with valuable clinical information regarding the extent of nervous system involvement and the potential for central sensitisation in whiplash patients. These neurodynamic changes help explain the complex symptom presentations often observed in chronic whiplash-associated disorders and can inform treatment planning and prognostic discussions.

For more information on this test follow the link to Neurodynamic Assessment


Additional factors to consider

Weaker predictors of risk , which can help with the prognosis and intervention decision making but cause and effect cannot be shown, include being of the female gender (the most robust risk predictor), and report of low back pain with evaluation after the incident [11]

Poor predictors include: range of motion of the cervical spine and changes in neck muscle activation after whiplash is not considered a significant predictor of long term pain and disability, [3] accident parameters as recalled by the patient are not considered a predictor for recovery, and past medical history [11]

Risk stratification for whiplash

A whiplash risk stratification tool ( WhipPredict) is a research-generated tool used to predict outcomes such as the likelihood of developing moderate/severe disability or experiencing full recovery from whiplash injury.[26]

WhipPredict was designed to predict ongoing pain-related disability. WhipPredict, with higher sensitivity, will correctly identify a higher proportion of patients who will not recover when recovery is defined in terms of pain, disability, or perceived recover.[26]Whiplash risk stratification online tool

Management

Some research exists of the beneficial interventions for the different phases of whiplash but further study is definitely indicated. Management of whiplash can be divided into the three phases of recovery: Acute (< 2 weeks), subacute (2-12 weeks), chronic (> 12 weeks).[27] Exercise and therapy that includes mobilisation has been studied the most an appears to be superior treatment in terms of acute and chronic WAD. [27] Moderate to aggressive mobilisation and exercise should be avoided in the acute and subacute phases. [27]Interdisciplinary treatments are also extensively studied and psychological counseling combined with physiotherapy has better results than physiotherapy alone. [27]

General treatment strategies will be discussed below.

Acute Phase

Studies have shown that patients can have a rapid improvement in symptoms within the first 90 days following the injury but then the recovery plateaus. A great number of patients experience ongoing pain and disability. This means that the first 3 months after the injury is crucial in the management of these patients. [28]

An interdisciplinary team approach is advised for patients that fall within in the moderate to high risk for long term pain and disability following a whiplash injury. This will include physiotherapy to restore ROM, pain treatment and medication for adequate pain relief, and psychology to specifically target the patient’s post traumatic stress reaction. [13]

Manage initial pain to reduce pain experience and address neuropathic pain (e.g. manual therapy, aerobic exercise, local exercise to reduce pain experience, and neuropathic medication).

Advice/education [27] oral and video education might be more effective than handing out a pamphlet for the patient to read. [29]

Catastrophisation. The intervention will change according to the goal set for this patient; if the goal is to return to work then the focus should be on graded activity and exposure, if reducing pain levels is the goal then monitoring thoughts and restructuring cognitive behavior will be the objective. Treatments should be combined with other management techniques.[16]

cognitive restructuring is a useful intervention, It involves a three step process: list/document/discuss pain related thoughts. Draw out negative thoughts to make them aware of them. Do you think this is helpful? What use is that? Replace with positive thoughts.

Fear of movement and re-injury - controlled/supported exposure to feared activities. Support and coach them.

Post traumatic stress. Early specific treatments for post traumatic stress is more effective than general cognitive behavioural therapy. [13] PTS reaction - outside PT domain/expertise (clinical psychologist, CBT, EMDR - eye movement desensitization reprocessing)

Physical interventions include:

  1. Gentle desensitisation techniques to treat widespread tenderness, exposure to aerobic exercise, slow and graded.
  2. Mobilisation programs includes activities that are aimed at improving or maintaining mobility [29]
  3. Strong evidence exists that active mobilisation is linked to less pain and some evidence that it might improve range of motion in acute WAD. [29]
  4. Neck Specific Exercise - Physiotherapist guided neck specific exercises has been shown to decrease disability after 3 months when compared to physical activity prescription [30]
    • Cervical range of motion was shown to improve with physiotherapy guided and a self administered program with low load exercises but only the physiotherapy approach produced improvement in motor control. [24]
    • Active mobilisation [27]

Electromagnetic field therapy - some limited research has shown this to be effective [27]

Treatments deemed not effective include: soft collar immobilization (may impede recovery), laser acupuncture, education alone, [27] and exercise programmes purely focused on strength and endurance and not on mobility [29]

Medication. Some evidence show that methylprednisolone infusion is effective in acute WAD. [29] NSAIDs might be helpful in the acute phase to reduce inflammation and pain but due to it's side effects should not be used for the long term. [31] No studies exist to show the effect of muscle relaxants, antidrepessants, or anticonvulsants and according to general consensus opioids should be avoided. [31]

Sub-acute Phase

Limited studies focus on this phase.

Interdisciplinary treatment is most effective with manipulation / mobilisation showing some benefit.

Chronic Phase

Rehabilitation done by a physiotherapist can produce meaningful changes in the symptoms of a patient with chronic pain after a whiplash.[24] Exercises seems to be the most effective non-invasive treatment in this phase. [27] When treating chronic whiplash patients the focus on improving the impaired physical movements and activities, and working on the patient’s psychosocial abilities and activities. [14]

Manual therapy - joint manipulation has shown to be helpful as well as myofeedback training. [27] A multi-model physiotherapy approach was compared to a patient self-management program. Both groups improved with their NDI scores but more so in the physiotherapy group. The physiotherapy group also had a greater improvement in NPI scores. [24] The following treatments were included in the physiotherapy group:[24]

  1. specific low load exercises for the neck flexor and extensor muscles as well as the scapular and postural muscles.
  2. kinesthetic exercises
  3. low velocity manual therapy techniques
  4. education on ergonomics, ADL, and work settings
  5. assurance

Physiotherapy can aggravate some patients with chronic WAD and therefore the authors of this study chose only low load interventions. [24] However, when a patient has widespread mechanical and thermal hypersensitivity then physiotherapy should not be the only treatment these patients receive. [24]

It has been shown that psychological factors in chronic WAD could be due to ongoing pain and disability. Patients with increased psychological problems one week following the accident is related to the decrease in neck movement. Thus the longer the symptoms are present the greater the psychological impact becomes, as the pain and disability improves the psychological factors also improve. [4]

Resources

[32]


References

  1. ↑ Alalawi A, Luque-Suarez A, Fernandez-Sanchez M, Gallina A, Evans D, Falla D. Do measures of physical function enhance the prediction of persistent pain and disability following a whiplash injury? Protocol for a prospective observational study in Spain [published correction appears in BMJ Open. 2020;10(11):1]. BMJ Open. 2020;10(10):e035736.
  2. ↑ 2.0 2.1 Spitzer WO. et al. (1995). Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: redefining "whiplash" and its management. Spine (Phila Pa 1976)., 20(8 Suppl), pp. 1-73.
  3. ↑ 3.0 3.1 3.2 3.3 Daenen L, Nijs J, Raadsen B, Roussel N, Cras P, Dankaerts W. Cervical motor dysfunction and its predictive value for long-term recovery in patients with acute whiplash-associated disorders: a systematic review. Journal of rehabilitation medicine. 2013 Feb 5;45(2):113-22. [Accessed 14 June 2018] Available from: http://www.ingentaconnect.com/contentone/mjl/sreh/2013/00000045/00000002/art00001?crawler=true&mimetype=application/pdf
  4. ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 Golbakhsh MR, Mirbolook G, Mirbolook AR, Noughani F, Siavashi B, Gholizadeh A. Effect of Mental and Behavioral Factors on Severity of Disability following Whiplash Injury. Trauma Monthly. 2017;22(6). [Accessed 14 June 2018] Available from: http://traumamon.portal.tools/71693.pdf
  5. ↑ Walton DM, Elliott JM. An Integrated Model of Chronic Whiplash-Associated Disorder. J Orthop Sports Phys Ther. 2017;47(7):462-71.
  6. ↑ Hayashi K, Miki K, Ikemoto T, Ushida T, Shibata M. Factors influencing outcomes among patients with whiplash-associated disorder: A population-based study in Japan. Plos one. 2019 May 14;14(5):e0216857.
  7. ↑ Kasch H, Jensen LL. Minor head injury symptoms and recovery from whiplash injury: a 1-year prospective study. Rehabilitation Process and Outcome. 2019 Apr;8:1179572719845634.
  8. ↑ Peolsson A, Karlsson A, Ghafouri B, Ebbers T, Engström M, Jönsson M, Wåhlén K, Romu T, Borga M, Kristjansson E, Bahat HS. Pathophysiology behind prolonged whiplash associated disorders: study protocol for an experimental study. BMC musculoskeletal disorders. 2019 Dec;20(1):1-9.
  9. ↑ Aarnio M, Fredrikson M, Lampa E, Sörensen J, Gordh T, Linnman C. Whiplash injuries associated with experienced pain and disability can be visualized with [11C]-D-deprenyl positron emission tomography and computed tomography. Pain. 2022 Mar;163(3):489.
  10. ↑ Dalal K, Peterson G, Peolsson A. Health related quality of life (HRQOL) from the perspective of patients with chronic whiplash-associated disorders (WAD) in Sweden. BMC Musculoskeletal Disorders. 2025 Feb 14;26(1):154.
  11. ↑ 11.0 11.1 11.2 11.3 11.4 11.5 11.6 11.7 Walton DM, MacDermid JC, Giorgianni AA, Mascarenhas JC, West SC, Zammit CA. Risk factors for persistent problems following acute whiplash injury: update of a systematic review and meta-analysis. journal of orthopaedic & sports physical therapy. 2013 Feb;43(2):31-43. [Accessed 14 June 2018] Available from: https://scholar.google.com/scholar_url?url=http://www.jospt.org/doi/pdfplus/10.2519/jospt.2013.4507&hl=en&sa=T&oi=gsb-gga&ct=res&cd=0&ei=z48iW5iCN8OOygTTnLfgDA&scisig=AAGBfm2vfvPVzZoOSqUFSR19jsevoaEIkQ
  12. ↑ SpineLive. Whiplash Reasons. Published Aug 2015. Available from: https://www.youtube.com/watch?v=svR1pClh4DE[last accessed 18 June 2018]
  13. ↑ 13.0 13.1 13.2 13.3 13.4 13.5 Sterling M, Jull G, Vicenzino B, Kenardy J, Darnell R. Physical and psychological factors predict outcome following whiplash injury. Pain. 2005 Mar 1;114(1-2):141-8. [Accessed 14 June 2018] Available from: https://scholar.google.com/scholar_url?url=http://www.academia.edu/download/46453352/Sterling_M_Jull_G_Vicenzino_B_et_al._Phy20160613-23878-ftxn8w.pdf&hl=en&sa=T&oi=gsb-gga&ct=res&cd=0&ei=FI0iW9mYJo_-yQTEtJ-gCQ&scisig=AAGBfm3nqbcO77XbvxRcJiBocwgLwu5aGg
  14. ↑ 14.0 14.1 Hendriks EJ, Scholten-Peeters GG, van der Windt DA, Neeleman-van der Steen CW, Oostendorp RA, Verhagen AP. Prognostic factors for poor recovery in acute whiplash patients. Pain. 2005 Apr 1;114(3):408-16. [Accessed 14 June 2018] Available from: http://www.academia.edu/download/41859453/Prognostic_factors_for_poor_recovery_in_20160201-7069-15o997z.pdf
  15. ↑ Sarrami P, Armstrong E, Naylor JM, Harris IA. Factors predicting outcome in whiplash injury: a systematic meta-review of prognostic factors. J Orthop Traumatol. 2017;18(1):9-16.
  16. ↑ 16.0 16.1 Scott W, Wideman TH, Sullivan MJ. Clinically meaningful scores on pain catastrophizing before and after multidisciplinary rehabilitation: a prospective study of individuals with subacute pain after whiplash injury. The Clinical journal of pain. 2014 Mar 1;30(3):183-90. [Accessed 14 June 2018] Available from: https://scholar.google.com/scholar_url?url=http://sullivan-painresearch.mcgill.ca/pdf/abstracts/2014/Scottetal2014.pdf&hl=en&sa=T&oi=gsb-gga&ct=res&cd=0&ei=BZIiW6rcGpLWygT11bHQCQ&scisig=AAGBfm0IwFurhAKGQz_pvBETeDEzxtLb6A
  17. ↑ Sullivan MJ, Rodgers WM, Kirsch I. Catastrophizing, depression and expectancy for pain and emotional distress. Pain. 2001 Mar 1;91(1-2):147-54. [Accessed 15 June 2018] Available from: http://sullivan-painresearch.mcgill.ca/pdf/abstracts/sullivanmar2001.pdf
  18. ↑ Campbell L, Smith A, McGregor L, Sterling M. Psychological Factors and the Development of Chronic Whiplash-associated Disorder(s): A Systematic Review. Clin J Pain. 2018;34(8):755-68.
  19. ↑ Peterson G, Ljunggren S, Peolsson A. Factors Related to Pain and Disability Outcomes After an Internet-Delivered or Physiotherapist-Led Exercise Program for Individuals With Chronic Whiplash Symptoms: Secondary Analysis of a Randomized Controlled Study. JMIR Human Factors. 2025 May 30;12(1):e67991.
  20. ↑ Paré C, Yamada K, Sullivan MJ. Temporal Relations Between Pain Catastrophizing and Adverse Health and Mental Health Outcomes After Whiplash Injury. The Clinical Journal of Pain. 2024 Jan 1;40(1):10-7.
  21. ↑ Anarte‐Lazo E, Liew BX, Devecchi V, Bernal‐Utrera C, Rodriguez‐Blanco C, Falla D. Network analyses reveal the interaction between physical features, fear of movement and neck pain and disability in people with acute and chronic whiplash‐associated disorders. European Journal of Pain. 2024 Feb;28(2):322-34.
  22. ↑ Smith A, Becker S. Increased behavioural inhibition and decreased behavioural activation in whiplash‐associated disorders: Associations with health outcomes. European Journal of Pain. 2025 Feb;29(2):e4721.
  23. ↑ 23.0 23.1 Sullivan MJ, Thibault P, Simmonds MJ, Milioto M, Cantin AP, Velly AM. Pain, perceived injustice and the persistence of post-traumatic stress symptoms during the course of rehabilitation for whiplash injuries. Pain. 2009 Oct 1;145(3):325-31. [Accessed 15 June 2018] Available from: http://www.academia.edu/download/43075568/Pain_perceived_injustice_and_the_persist20160225-28621-1vu0w2l.pdf
  24. ↑ 24.0 24.1 24.2 24.3 24.4 24.5 24.6 Jull G, Sterling M, Kenardy J, Beller E. Does the presence of sensory hypersensitivity influence outcomes of physical rehabilitation for chronic whiplash?–A preliminary RCT. Pain. 2007 May 1;129(1-2):28-34. [Accessed 14 June 2018] Available from: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.611.9615&rep=rep1&type=pdf
  25. ↑ 25.0 25.1 25.2 25.3 25.4 Sterling M, Jull G, Vicenzino B, Kenardy J. Sensory hypersensitivity occurs soon after whiplash injury and is associated with poor recovery. Pain. 2003 Aug 1;104(3):509-17. [Accessed 15 June 2018] Available from: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=11&ved=0ahUKEwjmhuWX0dbbAhUCVK0KHVlgDRQQFghdMAo&url=https%3A%2F%2Fpdfs.semanticscholar.org%2F07ff%2F7e81af852a6dcba56b5dba0f3fc9dba724e5.pdf&usg=AOvVaw0fCGn5gYPGxrzb1aFIs9SX
  26. ↑ 26.0 26.1 Ritchie C, Hendrikz J, Jull G, Elliott J, Sterling M. External validation of a clinical prediction rule to predict full recovery and ongoing moderate/severe disability following acute whiplash injury. journal of orthopaedic & sports physical therapy. 2015 Apr;45(4):242-50.
  27. ↑ 27.00 27.01 27.02 27.03 27.04 27.05 27.06 27.07 27.08 27.09 Teasell RW, McClure JA, Walton D, Pretty J, Salter K, Meyer M, Sequeira K, Death B. A research synthesis of therapeutic interventions for whiplash-associated disorder: part 1–overview and summary. Pain Research and Management. 2010;15(5):287-94. [Accessed 19 June 2018] Available from: http://downloads.hindawi.com/journals/prm/2010/106593.pdf
  28. ↑ Kamper SJ, Rebbeck TJ, Maher CG, McAuley JH, Sterling M. Course and prognostic factors of whiplash: a systematic review and meta-analysis. Pain. 2008 Sep 15;138(3):617-29. [Accessed 14 June 2018] Available from: http://www.academia.edu/download/41675199/Course_and_prognostic_factors_of_whiplas20160128-23571-1o7c4mo.pdf
  29. ↑ 29.0 29.1 29.2 29.3 29.4 Teasell RW, McClure JA, Walton D, Pretty J, Salter K, Meyer M, Sequeira K, Death B. A research synthesis of therapeutic interventions for whiplash-associated disorder (WAD): part 2–interventions for acute WAD. Pain Research and Management. 2010;15(5):295-304. [Accessed 19 June 2018] Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2975532/pdf/prm15295.pdf
  30. ↑ Ludvigsson ML, Peterson G, O’Leary S, Dedering A, Peolsson A. The Effect of Neck-specific Exercise With, or Without a Behavioral Approach, on Pain, Disability, and Self-Efficacy in Chronic Whiplash-associated Disorders. Clin J Pain. 2015 Apr;31(4):294-303. [Accessed 14 June 2018] Available from: http://www.academia.edu/download/43630977/The_Effect_of_Neck-specific_Exercise_Wit20160311-20625-1cp7azf.pdf
  31. ↑ 31.0 31.1 Curatolo M. Pharmacological and interventional management of pain after whiplash injury. journal of orthopaedic & sports physical therapy. 2016 Oct;46(10):845-50. [Accessed 19 June 2018] Available from: https://www.jospt.org/doi/pdf/10.2519/jospt.2016.6906
  32. ↑ Physiopedia. Dr James Elliott - advice for clinicians from the latest whiplash research. Available from: https://www.youtube.com/watch?v=0bwhMfnUg6U [last accessed 18 June 2018]
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