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Whiplash - Risk Factors For Recovery

Whiplash Associated Disorder (WAD) is a common pain syndrome resulting most commonly from rear shunt car accidents.

Recovery from this injury varies greatly and we can identify risk factors which make it more likely that someone will not progress well.

Yellow Flags - Risks For Disability And Work Loss


Yellow flags are the name given to risk factors for disability and work loss after low back pain. They can be seen in more detail at the New Zealand Acute Low Back Pain Guide.


Medical professionals use flags as ways of indicating and measuring what is going on in various (usually musculoskeletal) conditions. It’s also a way of remembering to ask the right questions and to have an objective score to some extent upon which we can make our decisions about the patient’s condition.


Red Flags are risk factors for serious clinical conditions when we are assessing someone with spinal or other pain.


Yellow Flags are a way of assessing risk factors for work loss or disability after an episode of low back pain. This system was developed in New Zealand and if you are interested go to New Zealand Acute Low Back Pain Guide to see the information in detail.


Even though these flags were developed with reference to low back pain, many of the factors will likely affect recovery in WAD and are worth considering.


Attitudes & Beliefs About Pain


Our attitudes and beliefs are extremely important when it comes to pain problems. They inform all our activities and plans for the future. One man, in response to our question about what he thought was going on inside this back, said:

“My back is like a stack of digestive biscuits.”


You can imagine what would happen if you thought this about your back. You would be afraid that your back would crumble at any movement or stress, so you would do VERY little. Very little indeed. Advice and encouragement to do exercises and increase your activities will fall on deaf ears. MUCH too dangerous.


Beliefs about pain which can be barriers to recovery are:

  • The belief that pain is harmful.
  • Pain usually means damage, that we have harmed some of our tissues, such as an ankle sprain. This is the normal way we are brought up to understand, the typical medical model of pain. Pain means damage and so we should take care.

    When we have back pain things are different. There may be some tissue damage initially, but being careful and protecting the area does not work well with back pain. Thinking back pain is harmful holds us back from going back to normal activity as soon as we can.

  • The belief that pain must disappear completely before return to work/activity.
  • We don’t wait until all our ankle pain has gone before we get walking on it again. We know that getting going on the injured joint again is the best way of returning to normal. The same applies to back pain. Even if we feel like avoiding activity, the best way of returning to normal is to start doing normal things again.

  • The belief that pain is not controllable.
  • Even though pain comes upon us without invitation and forces us to adapt, we do have ways of affecting it for better or worse. We can change our postures and activities, take painkillers, rest more.

  • Catastrophic thinking - interpreting bodily sensations very negatively, always thinking the worst. This all-or-nothing type of thinking holds people back severely, stopping them making realistic interepretations of what’s going or what influence they can have over their pain.


The next category of Yellow Flags covers the behaviour of whiplash sufferers towards their pain


Cited Reference:
Moore A, Jackson A, Hammersley S, Hill J, Mercer C, Smith C, Thompson J, Woby S, Hudson A (2005). Clinical guidelines for the physiotherapy management of Whiplash Associated Disorder. Chartered Society of Physiotherapy. London.


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