Department of Physical Therapy Student Theses, Dissertations and Capstones

Document Type


Degree Name

Doctor of Philosophy (PhD) in Physical Therapy

Copyright Statement

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College of Health Care Sciences - Physical Therapy Department

First Advisor

Joshua Cleland

Second Advisor

James Elliott

Third Advisor

Dave Walton

Publication Date / Copyright Date



Nova Southeastern University


Purpose/hypothesis: Neck pain and related symptoms following a motor vehicle collision (MVC) can significantly influence the quality of life for some people. While the MVC related mechanics of the head and neck gives rise to the term whiplash, the signs and symptoms of neck related disability are often complex and are clinically referred to as whiplash associated disorder(WAD). Muscle fatty infiltrate (MFI) has been associated with persistent WAD, but its influence on the generation and maintenance of WAD is largely unknown. The purpose of this study was to evaluate the relationship between MFI and baseline demographic variables related to persistent WAD.

Methods: 97 Participants presenting to an academic emergency medicine department in Chicago, IL enrolled in a parent longitudinal study investigating recovery from whiplash injury ( Identifier: NCT02157038). Within 1-week of the MVC, an MRI of the cervical spine was performed to quantify the percentage of MFI. Baseline demographics included: NeckDisability Index (NDI) scores, numeric pain rating scale (NPRS), age, sex, sleep disturbance scores, and BMI. At 2-weeks, 3 and 12-months post-MVC, NDI and NPRS scores were collected along with a co-registered MRI of the cervical spine. Final group membership was based on 12-month NDI scores: Recovered (< 10%) or persistent WAD (> 10%). Using logistic regression, at each time point, the variables were evaluated to determine significance associated with persistent WAD along with effect sizes.

Results: At baseline, variables found to be predictive for the persistent WAD group were: Female sex, increased MFI, and sleep disturbance. For persistent group classification, an R-squared of 0.27 for the model was reported as was odds ratios (OR) for individual variables ranging from 1.1 to 4.38. Across the 12 months, except for sleep at 2 weeks, the effects of MFI, sex, and sleep disturbance were significant, and R-squared increased to 0.56.

Conclusion: Results demonstrate an association with females, increased MFI, and sleep disturbance on persistent WAD. The variables maintained their significance across time along with increasing R-squared values related to the prediction of persistent WAD.


Physical Therapy


Chronic pain, Muscle fatty infiltrate, Sex, Sleep, Whiplash