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The Whiplash Encyclopedia, Second Edition

Author(s): Robert Ferrari, MD, FRCPC, FACP
  • ISBN-13: 9780763729349
  • ISBN-10:0763729345
  • Hardcover    736 pages      © 2006
Price: $311.95 US List
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With the second edition of The Whiplash Encyclopedia, Robert Ferrari revisits the notion that whiplash is an example of illness induced by society, in general, and by physicians in particular. The second edition takes the work out of understanding all the different dimensions of whiplash, be it why some people get chronic neck pain and others do not, what causes jaw pain, what therapies work and which do not, how we can understand the effect that psychosocial factors have on recovery, what effect litigation and insurance systems have on recovery, and many other topics. The Whiplash Encyclopedia leaves no topic on whiplash uncovered, and can be used in any medicolegal practice. The next time you have a question about whiplash, the answer is likely to be found in The Whiplash Encyclopedia.

The Whiplash Encyclopedia, Second Edition explores new theories being heralded to explain chronic whiplash; discusses Central Sensitization; and includes a new chapter in whiplash mythology. In addition, it expands on the knowledge of what causes (and what does not cause) the many neurological and cognitive symptoms reported by whiplash patients. The second edition also investigates the Whiplash Cultures and countries where chronic whiplash is epidemic and examines those cultures by laying them next to countries that, despite having motor vehicle collisions as frequently as elsewhere in the world, and frequently having physicians diagnose acute whiplash, rarely or uncommonly has anyone taking the stage as chronic whiplash characters.

Features & Benefits

What's new:

  • A chapter listing the myths of whiplash and which scientific literature can be used to expose those myths in medicolegal practice
  • A chapter explaining all the car crash literature and how it is meaningful in the legal setting
  • A chapter on the controversial topic of fibromyalgia
  • Two bibliographies, the first providing relevant comments on individual scientific papers, and the second dividing the literature according to topic for easy research
  • A chapter on secondary gain, an important legal concept
  • Expansive chapters devoted to understanding psychosocial research and whiplash
  • Chapters on neck anatomy, and diagnostic tools used by physicians.

Chapter 1: The Making of a Whiplash Culture
Key Points
Cultural Observations
Singapore versus Australia
New Zealand versus Australia
Australia, Then and Now
United Kingdom—Social Copying
Chronic Whiplash – Epidemicus and Incognitus

Chapter 2: Railway Spine

Key Points
“Discovery” of Railway Spine
Theories about Railway Spine
From Railway Spine to Whiplash – the Recycling of Nervous Irritation

Chapter 3: Traumatic Neurosis
Key Points
Solving Railway Spine

Chapter 4: The Medical History of Whiplash
Key Points

Chapter 5: Chronic Neck Pain
Key Points
The Acute Whiplash Injury
Radiology of Whiplash
• Whiplash and the Straight Spine
Whiplash and Disc Degeneration
Myelograms, Bone Scans, and Discograms
MRI Studies of Whiplash Patients
• Summary
Chronic Whiplash—Chronic Damage to the Joints?
Posture, Muscle Dysfunction and Chronic Neck/Back Pain
Whiplash Experiments
Measurements in Whiplash Experiments
Delta V
Delta V and Impact Direction
Delta V, Vehicle Size, and Striking Velocity
Head Acceleration
The Hare, the Monkey, and Their Dummy Friends
Human Whiplash Experiments

Chapter 6: Temporomandibular Disorders and Whiplash
Key Points
Theories Abound
TMJ Experiments
TMJ Radiology
• Neck Pain as a Cause of Jaw Pain
Psychological Factors and Symptoms
• Mechanisms

Chapter 7: Whiplash on My Mind
Key Points
Disturbances of Balance and Hearing
• Balance Tests
• Hearing Tests
• Probable Sources of These Symptoms
• Summary
Disturbance of Vision 
• Probable Sources of These Symptoms
Disturbance of Cognition
• Electroencephalograms (EEGs)
• Magnetic Resonance Imaging (MRI) and Other Brain Scans
• Whiplash Experiments
• Probable Causes of Cognitive Symptoms
• Diagnosing Brain Injury
Limb Pain and Numbness
Thoracic Outlet Syndrome
The Sensitivity of Whiplash

Chapter 8: The Psychology of Whiplash
Key Points

Chapter 9: Psychocultural Illness (Model 1)
Key points
Psychosocial Profile
• Contribution of Personality Traits
Symptom Expectation, Amplification, and Attribution
• Symptom Expectation
• Symptom Amplification
• Symptom Attribution
• Summary
The Treatment Industry
Litigation, Compensation, and Insurance Companies
• Lawyers
• Insurance Companies

Chapter 10: Somatization and Adoption of the Sick Role
Key Points
Illness and Disease
Sick Role and Illness Behavior
• Secondary Gain
• Economy of Secondary Gain
• Somatization
• Mechanism of Adoption of the Sick Role
• Diagnosis of Somatization and Adoption of the Sick Role
• Illness Behavior as a Choice
• Other Labels for Adoption of the Sick Role
• Summary
• Adoption of the Sick Role - Historic Observations
• Observations
Fibromyalgia and Motor Vehicle Collisions
• First Consideration
• Second Consideration
Differential Diagnosis
• Posttraumatic Stress Disorder
• Conversion Disorder

Chapter 11: Causation by Way of the Collision
Key Points
Thin Skull (or Eggshell Skull) Rule
• Psychocultural Illness
• Adoption of the Sick Role
Thin Skull Rule
Convenient Focus

Chapter 12: Treatment, Assessment, and Prognosis
Key Points
• Did a Physical Injury Occur?
• Timing of Symptoms
• Gathering Prognostic Factors
• Life Stressors
• Coping Styles
• Non-Organic Features
Physical Examination
• Lack of Objectivity in Most Cases
• Looking for Specific Signs
• Non-Organic Findings
Radiological Assessment
Any Other Investigations?
• Detection of Malingering
• Malingering of Pain
• Malingering Cognitive Dysfunction
• Malingering Psychological (Mental) Disorder
• Summary
• Evidence-Based Medicine
• Passive Versus Active Therapy
• Prolotherapy
• Facet Joint Injections and Radiofrequency Neurotomy
• Drugs
• Active Therapy Works
• Physician Resistance to Chronic Whiplash
• The Optimal Whiplash Prescription
• Treating Chronic Pain
• Summary

Chapter 13: Annotated Bibliography—Alphabetically by First Author
Methodologic Critique: Part I - Research Articles.
• Summary
• Introduction
• Methods
• Results
Methodologic Critique: Part II. Reviews, Editorials, and Letters
• Summary
• Introduction
• Methods
• Results
Annotated Bibliography

Chapter 14: Literature Review by Topic
Whiplash Cultures
Railway Spine and Nervous Irritation
Traumatic Neurosis
Theories of Injury Mechanism in Whiplash
Whiplash and Postural Problems
Whiplash and X-rays, Disc Degeneration
Whiplash and Discography
Whiplash and Bone Scans
Whiplash and Magnetic Resonance Imaging
Whiplash and Computed Tomography
Whiplash and Thermography
Whiplash Experiments—Animal
Whiplash Experiments—Dummy/Computer Models
Whiplash Experiments—Human Cadaver
Whiplash Experiments—Volunteer
Whiplash Experiments—Low Velocity Collisions
Whiplash and the Temporomandibular Joint
Whiplash and Balance/Dizziness/Vertigo
Whiplash and the Ear
Whiplash and the Eye
Whiplash and Brain Injury
Whiplash and Headache
Whiplash and Thoracic Outlet Syndrome/Limb Numbness
Whiplash and Electronystagmography or Electromyography
Whiplash and SPECT or PET Scans (Brain Imaging)
Whiplash and Brainstem Auditory Evoked Potentials
Whiplash and Electroencephalography (EEG)
Whiplash and Head Restraints
Whiplash and Seat Belts/Seats
Psychology of Whiplash—General
Symptom Expectation
Symptom Amplification
Symptom Attribution
Psychology of Whiplash—Effects of Psychosocial Profile
Psychology of Whiplash—Effects of Insurance Battles, Litigation, and Compensation
Psychology of Whiplash—Effects of the Patient–Physician/Therapist Relationship
Illness Behavior and Adoption of the Sick Role
Whiplash and Fibromyalgia

Chapter 15: Anatomy and Function of the Neck
Intervertebral Discs
Facet joints
Spinal Cord and Nerves
Blood Supply
Brachial Plexus and Thoracic Outlet
Neck Movements
Temporomandibular Joint

Chapter 16: Diagnostic Tests
Normal and Abnormal Test Results
• Statistics of Being Normal
• Causal Relationship
• Summary
Radiologic Tests
• X-rays
• Discography
• Bone Scans
• Myelography
• Computed Tomography
• Magnetic Resonance Imaging
• Temporomandibular Joint Imaging
• Summary
Neurologic Tests
• Electroencephalography
• Brainstem Auditory Evoked Responses
• Electronystagmography
• Electromyography
• Nerve Conduction Studies
• Summary

Chapter 17: Dispelling the Myths—Issues for Cross-Examination

Chapter 18: Whiplash Timelines
Historic timelines
Radiologic timelines
Neurologic timeline
Timeline of experiments

Chapter 19: In Search of the Whiplash Injury

Chapter 20: Whiplash Experiments
Accelerations and Forces
Summary of Whiplash Experiments

Chapter 21: A Closer Look at a Very Low-Velocity Impacts
Mistaking Subsequence For Consequence
The Role of Very Low-Velocity Studies
Whiplash Loading in Low-Velocity Impacts
Low-Velocity Studies and the Whip's Lash

Chapter 22: Head Restraints, Seat Belts, and Whiplash
Head Restraints
Seat Belts

Chapter 23: Control of Illness Behavior
States of Consciousness
• Conscious State
• Unconscious State
• Preconscious State
• Subconscious State
• Summary
Secondary Gain
Economy of Secondary Gain
Enacting of Motivations and Automaticity
Control of Goal-Oriented Behavior
Goal-Dependent Automaticity

Chapter 24: Tertiary Gain
Tertiary Gain
Economy of Tertiary Gain
Pursuit of Tertiary Gain
Interaction of Secondary and Tertiary Gain Pursuit



Robert Ferrari, MD, FRCPC, FACP

It was not until the author entered specialty training and witnessed first hand the shambles that the health care profession had made of whiplash that he felt compelled to seek the truth by peering deeper into this medicolegal and social conundrum. As an internal medicine and rheumatology training fellow, he began a literature search that took him back to the 19th century and Railway Spine, and forward through thousands of articles on the topic, until models of chronic whiplash evolved, and the seedy underbelly of this problem revealed itself. Whiplash, he learned, is not so much a matter of science, but more so of society.

While in private practice in Canada as an internist with an interest in musculoskeletal disorders, rheumatic diseases, and chronic pain, the author went on to become a leading researcher on whiplash, collaborating with researchers in Lithuania, Norway, Germany, and Greece. He is the most published person on the topic of whiplash, with an excess of 100 peer-reviewed articles in a wide array of scientific journals and many more to come.

He is the author of Rheumatology Guidebook, Thin Skulls and Physical Injury, and Life After Whiplash.

  • "This is an important topic which involves several professional areas. The author tries throughout the work to differentiate between facts and myths by drawing from his vast personal experience and those of other researchers.  The persistence of chronic neck symptom in the absence of objective findings is a dominating theme which seems to drive the socioeconomic and legal issues of this valuable work. I strongly recommend it to all parties involved in dealing with patients with whiplash injuries."

    Edward Abraham, MD
    University of Illinois at Chicago
    College of Medicine
    Doody Enterprises, Inc.
    October 2005