[Whiplash injuries--a psychosomatic perspective].

Background: Psychosocial impairment after whiplash injury could be extensive; presumably about 15% of whiplash patients suffer from long lasting disabling health problems and about 5% do not return to work.

Material And Methods: A PubMed search of all available literature on whiplash and whiplash-associated disorders was performed.

Results: Psychosocial impairment following whiplash injury is influenced by vulnerability factors, the biomechanical trauma and factors affecting symptom formation. Vulnerability factors indicating a poorer prognosis include low mental abilities, previous mental illness, old age and female sex, pre-existing cervical degenerative changes, narrow spinal canal and high neurobiological reactivity to sustained activation. The actual physical trauma consists of a nonphysiologic kinematic response in the cervical column, which may induce stress in neural structures, facet joints and musculature. Activation of reflex connections may lead to disturbances in the posture control and autonomic system. Trauma-related prognostic factors include head position at impact and degree of acute psychological stress reactions. Manual work, expectation of disability and an ongoing compensation claim case seem to be important moderator variables affecting symptom formation.

Interpretation: An integrated psychosomatic model is needed to explain psychosocial impairment after whiplash injury as presented.