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Alberta Rodeo Riders Do Not Develop Late Whiplash To the Editor: We were surprised to see that Shannon, et al's paper regarding the comparative rates of chronic whiplash in Alberta rodeo athletes versus members of the rodeo audience merited publication1. Despite these authors' claim that "we have no reason to believe that the distribution of such injuries should be strikingly different in these 2 groups", we would have surmised that the peer reviewers of this article would have easily discovered the reason that escaped Shannon, et al and yet would have been readily apparent to most lay readers of the study. We find the authors' conclusions just as publication-worthy as those of a study of the average height of NBA basketball players versus game attendees, with the conclusion that the difference of more than a foot in height is best explained by the theory that the attendees must be lacking in nutrition. In a similar vein, Shannon, et al explained the difference in symptom duration between rodeo athletes and audience members as the result of a specious biopsychosocial theory that sidesteps the enormous amount of literature indicating an organic etiology of most chronic whiplash symptoms, instead blaming the chronic symptoms on an irrational fear of whiplash injury in the patient2-10. In arriving at their biopsychosocial explanation for their findings, Shannon, et al managed to overlook the fact that rodeo athletes are self-selected ultra-hardy members of the population, located at the furthest right extreme of the injury susceptibility bell curve. While few laypeople are aware of the definitions of the epidemiologic terms "bias" and "confounding," most are aware of the intuitive concept that professional athletes should not be compared to nonprofessional athletes for the characteristics that make them most likely to become professional athletes: physical prowess and injury resistance. It is rather surprising that the reviewers who green-lighted this paper for publication were not more attentive. In our opinion, this paper should not have been published in its current form. CHRISTOPHER CENTENO, MD, Centeno-Schultz Clinic, Westminster, Colorado; MICHAEL D. FREEMAN, MD, Oregon Health and Science University School of Medicine, Department of Public Health and Preventive Medicine, Salem, Oregon, USA. Address reprint requests to Dr. C. Centeno, Centeno-Schultz Clinic, 11080 Circle Point Road, Bldg. 2, Ste. 140, Westminster, Colorado 80020. E-mail: centenooffice@centenoclinic.com REFERENCES 1. Shannon AL, Ferrari R, Russell AS. Alberta rodeo athletes do not develop the chronic whiplash syndrome. J Rheumatol 2006; 33:975-7. [MEDLINE] 2. Barnsley L, Lord SM, Wallis BJ, Bogduk N. The prevalence of chronic cervical zygapophysial joint pain after whiplash. Spine 1995;20:20-5; discussion 26. [MEDLINE] 3. Krakenes J, Kaale BR, Moen G, Nordli H, Gilhus NE, Rorvik J. MRI assessment of the alar ligaments in the late stage of whiplash injury — a study of structural abnormalities and observer agreement. Neuroradiology 2002;44:617-24. [MEDLINE] 4. Kristjansson E, Leivseth G, Brinckmann P, Frobin W. Increased sagittal plane segmental motion in the lower cervical spine in women with chronic whiplash-associated disorders, grades I-II: a case-control study using a new measurement protocol. Spine 2003;28:2215-21. [MEDLINE] 5. Lord SM, Barnsley L, Wallis BJ, Bogduk N. Chronic cervical zygapophysial joint pain after whiplash. A placebo-controlled prevalence study. Spine 1996;21:1737-44; discussion 1744-5. [MEDLINE] 6. Panjabi MM, Ito S, Pearson AM, Ivancic PC. Injury mechanisms of the cervical intervertebral disc during simulated whiplash. Spine 2004;29:1217-25. [MEDLINE] 7. Siegmund GP, Myers BS, Davis MB, Bohnet HF, Winkelstein BA. Mechanical evidence of cervical facet capsule injury during whiplash: a cadaveric study using combined shear, compression, and extension loading. Spine 2001;26:2095-101. [MEDLINE] 8. Sterling M, Jull G, Vicenzino B, Kenardy J. Sensory hypersensitivity occurs soon after whiplash injury and is associated with poor recovery. Pain 2003;104:509-17. [MEDLINE] 9. Treleaven J, Jull G, Sterling M. Dizziness and unsteadiness following whiplash injury: characteristic features and relationship with cervical joint position error. J Rehabil Med 2003;35:36-43. [MEDLINE] 10. Wallis BJ, Lord SM, Bogduk N. Resolution of psychological distress of whiplash patients following treatment by radiofrequency neurotomy: a randomised, double-blind, placebo-controlled trial. Pain 1997;73:15-22. [MEDLINE]
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