2009James Elliott, 2005
Time to jump off the
‘patho-anatomical wagon’?
James Elliott PT, PhD
Patho-anatomical and
patho-physiological
features of Whiplash
40% will continue to
have symptoms at six-
months
(Hartling et al. 2001)
10-25% will continue to
have symptoms at
two-years
(Radanov et al. 1995; Sterling et al. 2003;2006)
Prognostic factors to
characterize the acute
& chronic condition
(Sterling et al. 2003;2006)
Cost$
$230+ billion USD
$530 + million AUS
(Blincoe et al, 2002); MAIC figures
Where is the problem (s)?
Where is the problem (s)?
Ligamentous
Facetogenic
Discogenic
Where is the problem (s)?
Ligamentous
Facetogenic
Discogenic
2009James Elliott, 2005
Up to 90% of asymptomatic
subjects would show signs of
lumbar DDD
~40% of healthy subjects
over 40 years of age would
demonstrate similar/same
findings on c-spine scans
Muscle changes have been
observed clinically
Kader et al, 2000; Hyun et al., 2007
Lumbar spine
Upper Cervical spine
Presence of paraspinal muscular
alterations has been observed clinically
with MRI
What do we know?
Recent musculoskeletal MRI research in
asymptomatic and symptomatic subjects
Elliott et al., 2005, 2006, 2007, 2008
What do we know?
What needs to be
answered?
Are these muscular changes on MRI
associated with the clinical signs and
symptoms of persistent WAD?
Are these muscular changes UNIQUE to
WAD?
2009James Elliott, 2005
Cervical Paraspinal Musculature
Multifidus
Semispinalis Cervicis
Semispinalis Capitis
Splenius Capitis
Upper Trapezius
2009James Elliott, 2005
www.mricro.com
Rorden, 2000
MRI Measure
Pixel Intensity Profile
RCPMIN
Healthy control
WAD
Left
Healthy control
WAD
Left
C3 Multifidus
Elliott et al., 2006
Healthy Control
WAD
Mean differences for the fat indices in the cervical extensor muscles
across segmental levels (C3-C7) (p <0.0001)
(Elliott et al., 2006)
113 Females
79 WAD & 34 Normal
C3
C4
C5
C6
C7
Fat:Muscle Index
0.20
0.25
0.30
0.35
0.40
0.45
Multifidus
Semispinalis Cervicis
Semispinalis Capitis
Splenius Capitis
Upper Trapezius