BACKGROUND: Whiplash Associated Disorders is a cause of considerable individual suffering and societal cost. In the absence of radiological or electrodiagnosic evidence of injury in spite of significant neck stiffness and pain, treatment options are generally limited to conservative modalities with limited scientific support. However, injections of local anesthetic solution to myofascial trigger points in the neck region may provide prompts temporary relief of symptoms. Based on this observation we assumed that similar results can be achieved with surgical excision of trigger points.

METHOD: In a prospective series of 108 patients with chronic neck pain after whiplash, cervical range-of-motion studies were performed before and 1-2 weeks after excision of trigger points in painful muscles of the neck. Preoperatively, all patients reported failure of conservative treatment for more than one year.

RESULTS: Significant increase in neck mobility for each of six variables: flexion-extension, rotation right-left, abduction right-left, was documented at follow-up 1-2 weeks after surgery (p<0.0001), with 69% increase in total cervical range of motion. The statistical analysis of data also confirmed a significant positive correlation between improved neck mobility and reduction of pain at rest (p<0.0002) and after exercise (p DISCUSSION: The early-outcome data from soft tissue surgery provide an explanatory model for the common failure of radiological and electrodiagnostic studies to identify pain generators in chronic whiplash syndrome with neck pain and stiffness.