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(1) “Few topics provoke so much controversy or heated opinion, based on so little fact as whiplash injuries. In emergency departments, orthopaedic, neurological and rheumatological clinics, and not least in the Courts, this common syndrome is shrouded in mystery and creates clinical insecurity in those who attempt to explain its mechanism, its prognosis and treatment. These problems are compounded in medico-legal practice where the potential rewards of successful litigation may colour the clinical picture. Most victims of whiplash injury have, however, sustained no more than a minor sprain to the soft tissues and unusually severe or protracted complaints may demand explanations which lie outside the fields of organic and psychiatric illness”.¹

Although this was originally stated in 1989 as we approach the millennium the quotation is equally apposite today.

The development of mechanised forms of transport has inevitably led to an increased number of accidents and personal injury. As the rail network expanded and carried more passengers increased numbers of complaints of spinal injury to the back and neck were reported leading to a condition commonly known as the Railway Spine. In common with the whiplash injury seen today no demonstrable abnormality was found and whether the symptoms were genuine or not was the subject of prolonged and acrimonious debate.

The subsequent introduction of the automobile was associated with reports of similar neck and back injuries but only after the statutory speed restriction of 4 miles per hour was lifted, when it was no longer necessary for the vehicle to be escorted by a man carrying a red flag. The increasing numbers of vehicles with greater engine power and higher velocity on our roads resulted in neck injuries occurring so frequently that the term whiplash now has become part of everyday language.

Cervical spine injury occurs in all forms of transport and in the past 20 years it has most frequently arisen after road traffic accidents. It may now have reached