Croft Guidelines for Diagnosis and Treatment of Whiplash Injuries

The Croft Guidelines (CG) are specifically for whiplash or better defined as Cervical Acceleration Deceleration (CAD) injuries in Personal Injury (PI) and Workers Compensation cases. CG are to be used by chiropractic physicians in diagnosing and treating motor vehicle collision occupant injuries (MVCOI) with CAD’s.

The CG grading system is specifically for the diagnosis and Chiropractic treatment of whiplash or CAD injuries.  Treatment protocols for cases involving whiplash injuries are included with these guidelines following grading. Dr. Art Croft, an internationally known chiropractic physician, whiplash researcher, lecturer and author, developed this CAD guideline. Croft published his first work in 1993 in American Chiropractic Association Journal and later in 1995 in the text Whiplash Injuries. Foreman & Croft published more current information in Whiplash Injuries 2001 third edition on page 61 Table 1-14. In the early 90’s I summarized the CGin an efficient singular page.  It is available free on our web site and attached to this article.

Utah Chiropractic Physicians Association was the first chiropractic association in the nation to approve the CGs. This move followed the Oklahoma Board of Chiropractic Examiners approval.  I have personally assisted several states in understand and considering or passing the CG’s. Now many states and at least one Canadian providence have adopted these CG’s. Currently the CG’s are the most used United States national standards for CAD care by doctors of chiropractic. Since 1993 many Utah chiropractic physicians have used the CGs in CAD cases. Further, since the early 90’s doctors have been submitting these standards with their reports to automobile insurance companies for motor vehicle collision occupant injuries (MVCOI) cases involving whiplash injuries.

The bottom line is with these standards; individuals with CAD injuries due to motor vehicle collisions (MVC) can receive better care attempting to return to pre-crash physical state. Automobile insurance companies (including workers compensation carriers) using unacceptable standards can be challenged since they are not adhering to accepted national researched protocols.

Some auto carriers hire unscrupulous doctors to perform unethical paper reviews and questionable defense medical examinations.  Some of the problems noted with these doctors have been making up their own substandard chiropractic care guidelines and erroneously quoting Mercy Guidelines, AMA Impairment Guides, and Agency for Health Care Policy and Research. None of these publications have anything to do with chiropractic care in CAD cases, let alone have any support from the UCPA.

States adopting the Croft standards take a major step forward in diagnostic and care guidelines for CAD victims. These standards and grading systems have been taught across the nation for years. It is the responsibility of every chiropractic physicians caring for individuals with whiplash to intimately know and understand how to properly grade CAD cases in accordance with these treatment standards. If you need to know how to use these standards contact email PI questions to inquiry(Replace this parenthesis with the @ sign),  or for more information.

A few doctors will attempt to take advantage of the system. The CG are not blank checks for insurance payments regarding CAD treatments. As taught by Personal Injury Training Institute and Dr. Croft, these protocols are not prescriptions for care nor do they provide for dishonest abuses of medically unnecessary treatment. In addition, other established chiropractic care guidelines and standards should be used to complement treatment protocols for non-CAD diagnosis. On the other hand, certain cases may require more care than protocols indicate due to underlying conditions or MVCOI complications as published.

Chiropractic physicians have amazing skills and techniques to help patients with CAD injuries. Physicians providing excellent care may find their treatment visit numbers are below the numbers found in the CG. I encourage you to continue to provide excellent care with the highest standards with the utmost credibility.

Croft Guidelines Pros & Cons

Croft Guidelines (CG) are standards that take a major step forward in diagnostic and care for whiplash or Cervical Acceleration/Deceleration (CAD) victims treated by chiropractic physicians. I have written down a few of the pros and cons of these Croft Guidelines.

The Croft Guideline Pros:

• Assist individuals with CAD injuries due to MVCOI to receive appropriate care by chiropractic physicians.

• Allow those injured in Motor Vehicle Collisions an accurate CAD diagnosis that leads to reasonable treatment parameters.

• Automobile insurance companies using unacceptable standards can be challenged when not adhering to approved and researched CAD protocols.

• Allows Chiropractic Physicians to determine CAD standards versus alleged unsubstantiated individuals or rogue chiropractors treatment opinions.

The Croft Guideline Cons:

• There may be a few doctors who will attempt to take advantage of the system, dishonest abuses of medically unnecessary treatment.

• Certain atypical CAD cases may require greater care than protocols indicate due to underlying conditions or complications.

• Limited to Cervical spine/CAD injuries.

This is an attempt to summarize some of the known benefits and problems with the CG’s. This summary is not designed to fully educate the details of the CG’s. Please see my summary of the CG listed below. 

Dr. Jeffrey A. States maintains a second opinion/impairment rating practice and is the main speaker for Personal Injury Training Institute. He believes there are volumes of information available regarding MVCOI’s provided by the best educators in this field including Murphy, Croft and Nordoff. Personal Injury Training Institute is not another information disseminating company. It is a problem solving, nuts and bolts training, teaching tried and true methods for helping physicians and attorneys work together to assist individuals with MVCOI’s. For more information visit Our PI trainings series is available online. Visit our website for a practical usable summary of the Croft Guidelines.

CROFT GUIDELINES – Classifications of Cervical Acceleration/Deceleration (CAD) Trauma

Types of Collisions: (Occupant maybe driver or passenger.  Criteria does not consider loss of consciousness, the use of seat belts, shoulder harnesses or other factors).

Type I**   Primary rear impact (struck car moving or stationary)
Type II**  Primary side impact
Type III** Primary frontal impact
Other:       Multiple Impacts, Rollover, Spinout etc.

CAD Grades of Severity of Injury**:

Grade I:   Minimal; No limitations of motion or ligamenetous injury, No neurological findings
Grade II:  Slight; Limitations of motion no ligamenetous injury, no neurological findings
Grade III: Moderate; Limitations of motion; some ligamenetous injury, neurological findings may be present.
Grade IV: Mod/severe; Limitations of motion; ligamenetous instability; neurological findings present. Fracture or disc derangement
Grade V:  Severe; requires surgical management/stabilization

Stages of Injury:**                 

Stage I:         acute; inflammatory phase;    0 – 72 hours
Stage II:       sub-acute; repair phase;          72 hours – 14 weeks post MVCOI
Stage III:     remodeling phase;                     14 weeks – 12 months or more post MVCOI
Stage IV:      chronic;                                          permanent injury


   Protocol Frequency and Duration of Care in CAD Traumatology**

                     5x/w       3x/w       2x/w          1x/w       1x/mos.        TD                    TN

Grade I        1w          1-2w       2-3w          <4w              *              <11w             <21
Grade II       1w          <4w        <4w           <4w         <4mo.          <29w             <33
Grade III      1-2w       <10w      <10w         <10w       <6mos.       <56w            <76
Grade IV      2-3w       <16w      <12w         <20w       prn               prn                prn
Grade V       Surgical stabilization necessary–chiropractic care post-surgical

TD = treatment duration                 * Possible follow-up at one month
TN = treatment total number         prn May require permanent monthly or prn (as needed) treatment

Factors potentially complicating CAD trauma management & medical treatment duration:

1. Advanced age**
2. Metabolic disorders**
3. Congenital anomalies of the spine**
4. Developmental anomalies of the spine**
5. Degenerative disc disease** 
6. Disc protrusion (HNP)**
7. Spondylosis** 
8. Facet arthrosis**
9. Rheumatoid arthritis or other spinal arthritides**
10. Ankylosing spondylitis or other spondylarthropathy**
11. Scoliosis**
12. Prior spinal surgery** 
13. Osteoporosis**
14. Prior vertebral fracture**
15. Paget’s disease or other bone disease**
16. Spinal or foraminal stenosis**
17. Prior spinal injury**
18. Paraplegia or quadriplegia**
19. Fibromyalgia
20. MVC known injury risk factors

**SRISD = Spine & Research Institute of San Diego ¤ **Whiplash Injuries Foreman & Croft 1995, 2001 ¤ **Am Chiro Assoc. J © 1999-2011 Personal Injury Training All Rights Reserved Permission is granted to use.


Croft Guidelines for Diagnosis and Treatment of Whiplash Injuries.