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The Link Between Whiplash and Jaw Pain

23 Sep

While neck pain is most commonly associated with whiplash associated disorder (WAD), patients often report jaw or temporomandibular joint (TMJ) pain following a car accident, sport injury, or slip and fall.

Common symptoms associated with temporomandibular disorders (TMD) include pain in the jaw joint area (in front of the ear), neck and shoulder pain, ear area pain with chewing or yawning, a “stuck” or locked feeling, and clicking, popping, or grating sounds with jaw movements. Patients with TMD may also feel like their teeth don’t fit well together, or report toothaches, headaches, dizziness, and tinnitus (ringing in the ear).

An MRI (magnetic resonant imaging) study of TMD following a WAD injury revealed joint effusion or swelling and/or disk displacement in more than half of the participants, along with alterations in the thickness of the lateral pterygoid muscle (LPM) that helps open the mouth. Studies have shown that rear-end collisions can result in trauma to the muscles in the area of the TMJ, along with its joint capsule and fibroelastic disk. Post-traumatic muscle imbalance can then perpetuate the problem, leading to chronic TMD.

A 2018 study found that patients with TMD following a whiplash injury (wTMD) had higher pain intensity scores, worse exam findings, worse function, and greater muscle atrophy in the LPM than patients whose TMD resulted from another cause. The patients with wTMD were also more likely to be affected by stress and headaches than the other TMD patients.

The authors concluded that TMD is a common WAD-related injury, and MRI findings of disk displacement and LPM alterations are often found together. They also point out that TMD from whiplash appears to involve a different mechanism than TMD from other types of trauma or no trauma.

Doctors of chiropractic are trained in the assessment and treatment of WAD, including TMD, which often involves a multi-faceted approach that includes manipulation, mobilization, and soft tissue techniques (myofascial release, contract-hold, trigger point therapy, muscle energy, and more).

 

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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Whiplash and Tinnitus

22 Aug

While tinnitus is commonly associated with a ringing sound in the ears, it can also involve a buzzing, hissing, or whistling noise. The sound can be intermittent or constant and can change in volume. The noise often intensifies in a quiet room when background noise is absent, such as at night, which can interfere with sleep. Approximately 50 million adults in the United States are affected by tinnitus, and up to 90% of people with tinnitus have some degree of noise-induced hearing loss. Though tinnitus can be due to many different causes, trauma-induced tinnitus from motor vehicle collisions is common.

Studies have demonstrated that an 8 mph (12.87 kmph) rear-end collision can result in 4.5g of neck acceleration, which can cause a sprain/strain injury to the neck that can lead to the cluster of symptoms that characterize whiplash associated disorders (WAD) such as neck pain, back pain, mental fog, headache, balance disturbance, depression, anxiety, tinnitus, and more.

Additionally, this process can also accelerate the head, essentially slamming the brain against the inside of the skull, followed by a rebound into the opposite side of the skull. This can lead to bruising on the brain, which is commonly called a concussion but is more formally known as a mild-traumatic brain injury (mTBI). This type of injury shares many symptoms with WAD, including tinnitus. If symptoms persist, the condition is known as post-concussive syndrome (PCS).

This has led researchers to speculate that WAD and mTBI often co-occur, and treatment to address cervical spine dysfunction commonly observed in WAD patients may also help patients with PCS. In a 2015 study involving five patients with diagnosed PCS, researchers observed that when the patients received manual therapy treatment to address cervical spine dysfunction, they reported improvements in several symptoms associated with PCS.

Doctors of chiropractic are highly trained to manage cervical spine dysfunction, a common sequela following a motor vehicle collision. Frequently, the many symptoms associated with WAD, including tinnitus, improve once the dysfunction is managed through manual therapies applied to the muscles and joints in the neck. If you are suffering from the aftermath of an MVC, please see your chiropractor!

 

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.

Reducing the Risk of Car Accident Injury

22 Jul

While doctors of chiropractic enjoy helping their patients get better, the preference is to avoid injury in the first place, and if that’s not possible, to reduce the risk for serious injury. This is especially important when it comes to car accidents, as whiplash associated disorders (WAD) injuries can persist for months to years and greatly reduce one’s ability to carry out their normal activities.

One of the most important steps you can take is to focus on the road while driving and eliminate distractions, which includes not texting while driving. In one study, researchers observed that even using hands-free functions increased the risk a driver would drift into another lane, drive too closely to the car in front of them, and be less responsive to changing road conditions. Other common distractions include fiddling with the radio, eating, reading (yes, people do this!), talking with other passengers (especially if you turn your head to look at them), and driving while intoxicated, while under the influence of legal/illicit drugs or medications, or while tired.

Strategies to stay safe on the road include taking regular breaks (if driving a long distance), keeping your eyes moving (check mirrors frequently), not speeding or driving faster than road conditions allow, following traffic rules, using your signals, avoiding night and bad weather driving, heeding caution signs, and keeping your car properly serviced (including making sure there is enough air in your tires and that your tires are in good condition). Additionally, it’s important to respond quickly to vehicle recalls. As they say, “An ounce of prevention is worth a pound of cure!”

Sometimes it’s not always possible to avoid an accident. Wearing a seatbelt can reduce the risk you’ll be ejected from the vehicle in the event of an accident (which almost certainly results in fatality) or suffer more serious injuries. Making sure your head rest is properly adjusted can also reduce your risk for a serious head/neck injury.

Automobile manufacturers continue to implement safety improvements in their vehicles. For example, a review of data between 1995 to 2016 supports that vehicle safety design improvements reduced the frequency of rollover crashes from 7% to 3.5% when comparing 1995-1999 vs. 2010-2016 model year vehicles, respectively. Starting in 1997, General Motors (GM) introduced high retention seats in their new model cars, SUVs, vans, and light trucks. A recent study compared the 1991 to 2000 Fatality Analysis Reporting System (FARS) data to the 2001-2008 FARS data to evaluate the impact of high retention seats. The data show that in rear impacts, high retention seats reduced the fatality risk from 27.1% to 16.6% and the risk of serious injury by 70.2%.

If you’re involved in a car accident, even a low-speed collision, it’s important to be evaluated by a doctor of chiropractic to ensure any soft-tissue injuries that result are properly treated as soon as possible in order to reduce your risk for ongoing pain and disability.

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.

Multi-Modal Care for Whiplash Patients

20 Jun

The term whiplash associated disorders (WAD) describes a constellation of symptoms that includes (partial list) pain, stiffness/limited motion, dizziness, headache, depression/anxiety, and brain-fog. The condition is associated with accelerations/deceleration events like car accidents, sports collisions, or slip and falls. Such injuries are classified into four categories: WAD I (no/minimal complaints/injury), WAD II (soft-tissue injury – muscle/tendon and/or ligament injury), WAD III (nerve injury), WAD IV (fracture). More than 85% of those involved in a motor vehicle collision (MVC) experience neck pain, with 29-40% recovering within a little more than three months and about 23% still not having recovered after one year.

A 2016 systematic review generated treatment guidelines for patients with WAD and/or neck associated disorders (NAD) in the context of both a recent injury and for cases in which pain has persisted for longer than three months. Importantly, these guidelines were formed with input from several types of healthcare providers, including doctors of chiropractic, medical doctors, and physical therapists.

For recent-onset neck pain (0-3 months), the authors recommend multimodal care (multiple types); manipulation or mobilization; range-of-motion home exercise or multimodal manual therapy (for grades I-II NAD); adding supervised graded strengthening exercise (grade III NAD); and multimodal care (grade III WAD).

For persistent neck pain (more than 3 months), the review recommends multimodal care or stress self-management; manipulation with soft tissue therapy; high-dose massage; supervised group exercise; supervised yoga; supervised strengthening exercises or home exercises (grades I-II NAD); multimodal care or practitioner’s advice (grades I-III NAD); and supervised exercise with advice or advice alone (grades I-II WAD). For patients with persistent neck and shoulder pain, evidence supports mixed supervised and unsupervised high-intensity strength training or advice alone (grades I-III NAD).

The term, “multi-modal care” is defined as a grouping of manipulation, mobilization, and soft tissue techniques (myofascial release, contract-hold, trigger point therapy, muscle energy, and more). Multi-modal care may also incorporate the use of hot or cold packs, assisted stretching, advice to stay active or modify activity, and neck/shoulder exercise training. Doctors of chiropractic often take a multi-modal approach when treating patients with musculoskeletal pain, including those with whiplash associated disorders.

 

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.

Whiplash and Mid-Back Pain – How Can This Happen?

20 May

Research regarding whiplash or whiplash associated disorders (WAD) classically focuses on neck pain; however, the data show acute thoracic spine / mid-back pain (MBP) occurs in 66% of WAD injures with 23% still complaining of MBP at one-year post-injury.

It’s easy to visualize how the cervical spine or neck can be injured in an automobile collision (or sport-related collision or a fall) as the head, which weighs an average or twelve pounds, whips back and forth in a “crack-the-whip” like manner, often well beyond the normal, physiological range of motion. This same stretching (eccentric loading) followed by compression (concentric loading) also occurs in the mid-back, which can injure ligaments, joint capsules, neural structures, and more. Also, the thoracic spine contributes to 33% of flexion and 21% of rotation IN THE NECK, making the mid-back a vital spinal region that facilitates neck movement and function!

In WAD cases, mid-back pain often hides in the shadows of a more obvious and often more serious neck injury, as the brain typically perceives pain from the greatest source. Additionally, the neuronal input to the sensory cortex of the brain (the area of the brain that perceives pain) is most highly represented from the head, hands, and feet and less from the mid-back or torso.

The seat belt may also contribute to injury—both to the anterior chest region including rib cage, sternum, breast tissue, abdominal organs, as well as to the mid-back. The oblique angle of the chest-restraint is an important factor when discussing the mechanism of injury, as it causes trunk/torso rotation during the rebound or flexion phase of WAD. Another mechanism of injury includes blunt trauma, of which the driver is especially at risk due to the close proximity of the steering wheel and the chest. This can lead to contusion or bruising, fracture, and/or injury to the abdominal and/or chest organs (heart and lungs).

Obviously, the speed of impact, angle of the collision, bracing of the person (or lack thereof), and overall physical condition of the patient can greatly affect the outcome of WAD-related injuries. The importance of assessing the whole person is essential in obtaining an accurate diagnosis and establishing a comprehensive treatment plan for the WAD patient.

Chiropractic management focuses on the entire person, frequently uncovering complaints in other spinal regions as well as in the extremities in WAD-related injured patients. Moreover, treating postural issues such as a short leg, ankle pronation, oblique pelvis, forward head posture, protracted shoulders, and more is vitally important in obtaining satisfying patient outcomes!

 

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.

Is There a Difference Between Whiplash and Non-Whiplash Neck Pain?

22 Apr

When we hear the term “whiplash injury,” we likely think of car crashes, though whiplash can result from other causes, like a fall or sports collision. Though whiplash is associated with a variety of symptoms, neck pain with lower pain thresholds (called central sensitization) is one of the most common. Neck pain can also occur in the absence of trauma or a known pathology. This is called mechanical neck pain (MNP).

Past research has shown that the combination of manual therapies (including mobilization and manipulation) and neck-specific exercises can benefit patients with neck pain, but is there a different treatment response between whiplash patients and MNP patients?

A 2017 study evaluated this very question. The authors recruited 28 patients with either grade I or II whiplash (pain with or without exam findings but no neurological losses) and 22 MNP patients. The patients in the MNP group were only included if their symptoms could be provoked by changes in cervical posture, neck movement, and palpation of certain neck muscles. The research team measured neck pain intensity, neck-related disability, pain area, cervical range of motion, and pressure pain thresholds (the amount of pressure measured to induce pain using a spring-loaded pressure gauge) both initially at baseline and again after six treatment sessions.

The results showed that whiplash sufferers initially had significantly higher pain-related disability, larger pain area, and central sensitization. In spite of this, the investigators observed that after six treatments, the patients in both groups achieved similar improvements with respect to cervical range of motion (flexion/extension, left/right side bending, and rotation), neck pain intensity, neck pain-related disability, pain area, and pressure point thresholds. However, the whiplash patients continued to experience a lower pain threshold than participants in the MNP group.

The good news for whiplash patients is that another 2017 study demonstrated that treating painful myofascial trigger points can help restore pain thresholds. Doctors of chiropractic frequently utilize the two treatment approaches from this study—manual therapy and specific neck exercises—in addition to other management approaches to achieve successful outcomes for patients with neck pain, either whiplash or MNP.

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.