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Whiplash Injuries and Neck Strain

21 Sep

The terms “whiplash” and “neck strain” are often used interchangeably, though there’s debate about whether this is appropriate. Let’s take a closer look at the differences between these two common descriptions of neck pain…

The term “strain” technically means a stretch injury to a muscle and/or the tendon that attaches muscle to bone. The terms mild, moderate, and severe offer a classification approach commonly used by healthcare providers to describe the degree of injury. As implied, a mild strain is just that—little to no muscle fiber or tendon tearing has occurred and thus, the injury will have a faster recovery time than a moderate strain. Moderate strains include partial tissue tearing and take longer to mend. Severe strains described complete tearing and in certain muscles in our body, surgery may be needed to repair the tear.

There are many muscles and tendons in the neck that overlap each other to allow for various functions or movements to occur. The deep “intrinsic” muscles are described as “fine movers” and allow for the individual cervical vertebra to move in a very specific manner and direction. The superficial muscles are larger, stronger, and utilized in global/large movements and help to protect the neck and the deeper, more delicate structures.

It can take a total of about 600 msec for the head to “whip” forward and backward in a classic rear-end collision, which is faster than we can voluntarily contract a muscle. This explains why an injury is difficult (if not impossible) to avoid in a motor vehicle collision, even if you “see” that an accident is about to happen.

To further differentiate the whiplash injury from a simple muscle strain, the brain is suspended by ligaments and cushioned further by fluid inside the calvarium (or skull) and can easily get bruised by literally slamming into the walls on the inside of the skull in a whiplash injury. This results in “traumatic brain injury” (TBI) or concussion. Interestingly, it’s been reported that one does NOT have to directly hit the head on a hard object to suffer TBI.

The symptoms associated with TBI include mental fog; fatigue/tiredness; slow mental functioning, such as having difficulty formulating thoughts, staying on task, and/or expressing one’s self; visual complaints; memory loss; and/or headache. The term “Whiplash Associated Disorder” or WAD is preferred, as it encompasses the many different symptoms associated with whiplash.

Doctors of chiropractic are trained to evaluate, diagnose, and treat patients who have sustained a whiplash injury. Generally, the sooner treatment commences after the injury, the more favorable the outcome or prognosis. Therefore, don’t delay in obtaining care following a collision!

FOR A FREE NO-OBLIGATION CONSULTATION CALL 717-697-1888

Dr. Brent Binder
4909 Louise Drive, Suite 102
Mechanicsburg Pa, 17055
Member of Chiro-Trust.org

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

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Chronic Whiplash Injuries and Pain Thresholds

21 Aug

Researchers have observed a phenomenon called “central sensitization” (CS) that is common in patients who have long-term, chronic pain following trauma such as whiplash. With CS, the patient’s ability to feel pain is abnormally high or hypersensitive, so when pain from pressure, temperature, electrical, or other sources are applied to the skin, they feel it sooner and more intensely than individuals without CS.

Why is this so important? Well, if we can find a way to raise the pain threshold in patients with CS, then this could reduce the intensity and frequency of their sometimes intense and debilitating chronic pain.

Researchers have found that pain thresholds improve after an anesthetic agent is injected into myofascial trigger points (MTrP)—those tight, sore “knots” commonly found in muscles after injuries such as whiplash trauma. It has been proposed that these MTrP may act as “thermostats” controlling the manner in which the brain perceives and relays pain.

To test this theory, a 2017 double-blind study randomly assigned chronic pain whiplash patients to either a group receiving the “real” anesthetic agent or a “sham” or fake injection of the MTrP. The researchers measured pain (on a 0-10 scale), pressure perception, grip strength, and the range of motion (ROM) of the jaw in subjects from both groups before and after each intervention.

As postulated, only the group receiving the “real” anesthetic agent had improved pressure pain tolerance in addition to increased jaw ROM. Unexpectedly, both groups experienced similar improvements when rating their pain on a 0-10 scale. This study concluded that the pain threshold associated with CS can be modulated by injecting myofascial trigger points (with or without an anesthetic agent), although only the anesthetized group had objective improvement (jaw ROM and pressure sensitivity improvement). Interestingly, the treatment of painful trigger points has LONG been a common form of care utilized by chiropractic, known as trigger point therapy or TPT. Myofascial release is another soft-tissue technique commonly utilized over MTrP by chiropractors.

This study may help explain why so many patients benefit from chiropractic care following whiplash trauma as well as other injuries. The added benefits from spinal manipulation and modality use over trigger points are two additional ways chiropractic care can benefit those suffering from both acute and chronic pain associated with whiplash trauma.

FOR A FREE NO-OBLIGATION CONSULTATION CALL 717-697-1888

Dr. Brent Binder
4909 Louise Drive, Suite 102
Mechanicsburg Pa, 17055

Member of Chiro-Trust.org

Chronic Pain and Whiplash

24 Jul

Most sprains and strains typically take six weeks to recover, provided the patient receives proper care, which may include self-management strategies. However, something is different about a whiplash associated disorders (WAD) injury in that many patients do not recover.

At the Whiplash 2017 Symposium held in Australia, Dr. Michele Sterling stated, “Whiplash associated disorders are a costly burden to Australian society. Up to 50% of people who experience a whiplash injury will never fully recover. Whiplash is resistant to treatment and no early management approach has yet been shown to prevent chronic pain. We are hoping this study will provide a promising treatment for chronic pain.”

Experts in the field presented important information about the development and prevention of disorders associated with a WAD injury such as chronic pain, post-traumatic stress disorder (PTSD), and depression after trauma. The University of North Carolina’s Dr. Samuel McLean reported that approximately 30% of people present to the emergency room (ER) in developed countries after trauma exposure (such as car accidents) and approximately nine out of ten are discharged without proper evaluation of these common neuropsychiatric problems. One problem in making a neuropsychological diagnosis is that these conditions often develop sometime after the initial presentation to the ER.

Dr. McLean and his team are currently researching the biological basis of brain injury in a new unprecedented study.  Participants will be enrolled at the immediate post-trauma level and will receive a comprehensive evaluation including genomic, neuroimaging, neurocognitive, behavioral, and symptom assessments. Dr. McLean states that WHEN the biology of PTSD, depression, and chronic pain is understood, then proper tools can be developed to identify the disorders and interventions to treat them can be achieved.

The problems associated with traumatic brain injury (TBI) are not new, but TBI is rarely dealt with until long after the WAD injury. Part of this is due to a lack of understanding of TBI on the doctor’s part and the other is a reluctance to discuss the symptoms of cognitive dysfunction on the patient’s part. This is because the symptoms are often vague, hard to describe, or somewhat embarrassing.

Questions specifically related to TBI include: Do you have problems staying on task? Do you easily lose your place during a discussion or thought process? Do you have to review your work more times than usual? Does it take longer to process information that you hear or read? Do you have mental fog?

Often, only when these questions are asked will the patient and doctor realize that there may be the need for a thorough neuropsychological evaluation. This study hopes to be able to develop new tools for evaluating TBI and to develop new interventions to help these patients.

FOR A FREE NO-OBLIGATION CONSULTATION CALL 717-697-1888

Dr. Brent Binder
4909 Louise Drive, Suite 102
Mechanicsburg Pa, 17055

Member of Chiro-Trust.org

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

The “Many Faces” of Whiplash

19 Jun

Whiplash typically involves an injury to the neck, but it can often include symptoms outside of the cervical region, which is why the term “whiplash associated disorder” (WAD) may be a more appropriate description for the condition. WAD is most commonly associated with car accidents, but other forms of trauma, such as a slip and fall, can also result in WAD. So what makes WAD so unique?

Researchers have divided WAD into three primary classes: WAD I is basically pain with negative examination findings; WAD II includes pain with examination findings such as loss of motion; and WAD III includes the WAD II findings plus neurological losses (altered sensation and/or strength in the arm). There is also a WAD IV that includes fractures and dislocations.

Whiplash associated disorder may include a constellation of symptoms that are often wide ranging —from nothing to minor, short-term discomfort to chronic, permanent, disabling problems that greatly affect the rest of the patient’s life. Studies have shown that recovery is more likely in patients with a WAD I injury than those with a WAD II injury. Likewise, the chance of recovery is higher among those with WAD II than those with WAD III.

But the controversy in any classification system include the “outliers”, or those that don’t get better when the physical factors involved and the WAD class suggests they should. This is what has perplexed researchers and healthcare professionals since this injury was first described in 1928 among those injured in train accidents (under the term “railroad neck”).

A 2017 review of past studies suggests that physical factors may play a smaller role in recovery prediction than psychosocial factors, or how the injured person deals with the injury emotionally or mentally. The review found the risk of pain becoming a chronic issue (lasting longer than three months) is elevated in patients with greater post-injury pain intensity and disability, whiplash grades (WAD III > WAD II > WAD 1), cold hyperalgesia (more sensitive to cold sensation), post-injury anxiety, catastrophizing (thinking things are worse than they are), and how long a patient waited to seek treatment.

Doctors of chiropractic are trained to assess and treat patients with WAD as well as provide them with exercises and other self-help management strategies to better enable them to recover from their injury.

FOR A FREE NO-OBLIGATION CONSULTATION CALL 717-697-1888

Dr. Brent Binder
4909 Louise Drive, Suite 102
Mechanicsburg Pa, 17055

Member of Chiro-Trust.org

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

The Vitamin D and Whiplash Connection

22 May

As previously discussed, many patients with a whiplash injury also experience some degree of traumatic brain injury (TBI), which can prolong the recovery process. A 2012 study involving patients with severe TBI found the rate of favorable recovery increased 25% in participants who took a vitamin D supplement as part of their treatment plan. Why is that?

Vitamin D is a fat-soluble micronutrient that regulates inflammation and skeletal muscle size and function. Due to a systemic inflammatory response (specifically pro-inflammatory cytokines), studies have found that vitamin D levels can drop in the body by as much as 74% within three weeks of a major trauma or following a surgical procedure. This was observed in another study published in 2012 that found 77% of a group of 1,830 trauma patients had deficient or insufficient levels of vitamin D, REGARDLESS of age!

Unfortunately, experts estimate that between 30-50% of the United States population is chronically vitamin D deficient. Since vitamin D levels will drop as part of the healing process, you can imagine that people who already have poor vitamin D levels may be in for a longer course of recovery.

Not only that, but because vitamin D plays a role in keeping the musculoskeletal system strong and healthy, people with vitamin D deficiency may be at a greater risk for getting injured in the event of a car accident, collision, or slip and fall. Further, those who do get injured may have a greater risk for sustaining a more severe injury than they may might have had their vitamin D levels been adequate.

Most experts recommend spending time in the sun each day in order for the body to naturally produce vitamin D, but the combination of available sunlight due to latitude or time of year may make this less than practical. Thus, a vitamin D supplement is commonly recommended as part of a healthy lifestyle (minimum 1000 IU/day).

Doctors of Chiropractic commonly provide nutritional counseling which is a large part of the educational/treatment process. Other anti-inflammatory vitamins include magnesium, fish oil, ginger, turmeric, probiotics, and more. An anti-inflammatory diet can be extremely helpful as well!

FOR A FREE NO-OBLIGATION CONSULTATION CALL 717-697-1888

Dr. Brent Binder
4909 Louise Drive, Suite 102
Mechanicsburg Pa, 17055

Member of Chiro-Trust.org

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Study Reveals Link Between Whiplash and Injury to the Brain

20 Apr

In a 2010 study, researchers examined MRIs taken from 1,200 patients (600 whiplash and 600 non-whiplash neck pain patients) and noted that those who had sustained whiplash were more likely to have a brain injury than non-whiplash neck pain patients.

The specific type of brain injury found is a form of herniation called Chiari malformation, where the bottom part of the brain (the cerebellum) drops through the opening in the base of the skull called the foramen magnum. Their findings showed an alarming 23% of the whiplash cases studied had this anatomical abnormality.

Dr. Michael Freeman, Dr. Ezriel Kormel, and colleagues collaborated in this effort and evaluated the patients using MRI in both recumbent (laying down) AND upright positions. Interestingly, they found 5.7% and 5.3% of those in the non-whiplash neck pain group and 9.8% and 23.3% in the whiplash group had the Chiari malformation using the recumbent vs. upright MRI positions, respectfully.

Dr. Kormel stated, “This condition can be quite painful and endanger the patient’s health, with symptoms that may include headaches, neck pain, upper extremity numbness and tingling, and weakness. In a few cases, there can also be lower extremity weakness and brain dysfunction.” In a radio interview, he added the advice that ANYONE suffering from whiplash should see a healthcare provider immediately.

This study is important for a number of reasons. First, it revealed that there is often a more serious injury when whiplash occurs than what is initially found. Second, psychological findings like depression, anxiety, and difficulty coping with the decreased ability or inability to be productive at home or work may suggest the presence of an anatomical injury which simply has not yet been found. Third, MRI is frequently ONLY performed in a laying down position. This study didn’t find much difference between laying vs. weight-bearing MRI positions in the non-whiplash neck pain patients but not so in the whiplash neck pain group! In this group, the ability for MRI to detect Chiari malformation/brain injury more than doubled using weight-bearing MRI.

Expanding the last point, since one out of five whiplash patients had a brain injury that is more likely to be detected using a non-traditional upright MRI position, a “new” standard” for the use of MRI in the evaluation of the whiplash patient should be considered. This is especially important in those cases that are non-responsive to quality care or if their doctor had only ordered a recumbent MRI previously.

Doctors of all disciplines should be aware of this study and the need for a more thorough evaluation, especially when a whiplash patient is not responding as one might expect.

 

FOR A FREE NO-OBLIGATION CONSULTATION CALL 717-697-1888

Dr. Brent Binder
4909 Louise Drive, Suite 102
Mechanicsburg Pa, 17055
Member of Chiro-Trust.org