Which finding would be a CONTRAINDICATION to using manual traction for whiplash in a patient with a recent motor vehicle collision?

• A. Rheumatoid arthritis
• B. Cervical hypomobility
• C. Headaches
• D. Neck pain

Answer: (A)

Rheumatoid arthritis can involve the cervical spine and cause instability, especially at the atlantoaxial joint. In RA, inflammation and ligament laxity (and sometimes bony erosion) can lead to atlantoaxial instability. Applying manual traction in this setting risks causing sudden vertebral displacement and potentially spinal cord or brainstem injury or vertebral artery compromise. Because of that, rheumatoid arthritis with cervical involvement is a clear contraindication to cervical manual traction in a patient with whiplash after a motor vehicle collision.

Cervical hypomobility, headaches, and neck pain by themselves do not contraindicate manual traction; these findings may either guide cautious treatment or be managed with alternative approaches depending on the overall exam and clinical stability.