Transport and Road Research Laboratory (TRRL) Research Report 136 (1988).

59 Mechanism of injury and type of injury

Whiplash terminology; whiplash injury of the back; soft tissue injuries of the back; whiplash injury of the neck and low back pain; direct impact; indirect impact; seat belt injury; chance fracture; pure ligamentous injury; facet fracture; thoraco-lumbar spine fractures; disc prolapse; late disc prolapse after acute injury; nature of impact and resulting injury pattern.

60 Pre-existing conditions

Spondylolysis & spondylolisthesis; age related disc degeneration predisposing traumatic disc prolapse.

61 Categories of injury

Bruising; ligament tears (sprains) and muscle ruptures (strains); coccygodynia; facet joint strain; fractures of spinous processes; fractures of transverse processes; disc injuries; thoracic disc injuries; lumbar disc injuries; acceleration; nerve root compression; traumatic spondylolisthesis.

62 Investigation

X-rays; MRI; computer tomography or CT scan; discography.

63 Treatment

Priority; an unstable injury of the spine; conservative treatment; bed rest; exercise; physical modalities; manual therapy; medications; injections; epidural injection; nerve root block; operations; fusion; laminectomy; spinal instrumentation.

64 The medico-legal consultation- in general

Conduct of doctor; observation; symptoms and signs; pain; where is the pain? when does it hurt? what makes the pain worse? illness behaviour; the Waddell symptoms.

65 The patient's history

The accident; immediately after the accident; medical records; previous history; post accident supervening illness; doctor's manner; patient's manner.

66 Physical examination

Aims; the Waddell signs; movement; reversed lumbar-pelvic rhythm; instability catch; examination on couch; a neurological examination; SLR; the sciatic stretch test; the knee jerk; the ankle jerk; the femoral stretch test; palpation; muscle bulk; range of movement.