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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
856 Century Drive, Suite C
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
856 Century Drive, Suite C
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
856 Century Drive, Suite C
Mechanicsburg Pa, 17055
Member of Chiro-Trust.org

Posture and Whiplash

20 Mar

Posture assessment is a key component of the chiropractic examination, and the posture of the head and neck is especially important for a patient recovering from a whiplash injury. Forward head carriage describes a state in which the head sits more forward on the shoulders than it should. In order for the muscles in the neck and shoulders to keep the head upright, they must work harder. This added strain can increase one’s risk for neck pain and headaches, which is why retraining posture is a key component to the management of neck pain and headaches in patients with or without a history of whiplash.

Forward head carriage also increases the distance between the back of the head and the headrest in the seated position, especially when the seat is reclined. In a rear-end collision, a gap greater than a half an inch between the head rest and the back of the head increases the probability of injury due to the greater distance the head can hyperextend as it rebounds backwards into the headrest.  This makes posture correction of forward head carriage an important aspect of treatment from both a preventative and curative perspective.

So this begs the question, can forward head carriage be corrected?  The simple answer is “yes!” One study evaluated the effects of a 16-week resistance and stretching program designed to address forward head posture and protracted shoulder positioning.

Researchers conducted the study in two separate secondary schools with 130 adolescents aged 15–17 years with forward head and protracted shoulder posture. The control group participated in a regular physical education (PE) program while the experimental group attended the same PE classes with the addition of specific exercises for posture correction. The research ream measured the teens’ shoulder head posture from the side using two different validated methods and tracked symptoms using a questionnaire. The results revealed a significant improvement in the shoulder and cervical angle in the experimental group that did not occur in the control group.

The conclusion of the study strongly supports that a 16-week resistance and stretching program is effective in decreasing forward head and protracted shoulder posture in adolescents.  This would suggest that a program such as this should be strongly considered in the regular curriculum of PE courses since this is such a common problem.

Doctors of chiropractic are trained to evaluate and manage forward head posture with shoulder protraction. This can prove beneficial in both the prevention as well as management of signs and symptoms associated with a whiplash injury.

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

Dr. Brent Binder 856 Century Drive, Suite C Mechanicsburg Pa, 17055

Member of Chiro-Trust.org

A Brief Look at Whiplash Injuries

20 Feb

Whiplash is an injury to the soft-tissues of the neck often referred to as a sprain or strain. Because there are a unique set of symptoms associated with whiplash, doctors and researchers commonly use the term “whiplash associated disorders” or WAD to describe the condition.

WAD commonly occurs as a result of a car crash, but it can also result from a slip and fall, sports injury, a personal injury (such as an assault), and other traumatic causes. The tissues commonly involved include muscle tendons (“strain”), ligaments and joint capsules (“sprains”), disk injuries (tears, herniation), as well as brain injury or concussion—even without hitting the head!

Symptoms vary widely but often include neck pain, stiffness, tender muscles and connective tissue (myofascial pain), headache, dizziness, sensations such as burning, prickly, tingling, numbness, muscle weakness, and referred pain to the shoulder blade, mid-back, arm, head, or face. If concussion occurs, additional symptoms include cognitive problems, concentration loss, poor memory, anxiety/depression, nervousness/irritability, sleep disturbance, fatigue, and more!

Whiplash associated disorders can be broken down into three categories: WAD I includes symptoms without any significant examination findings; WAD II includes loss of cervical range of motion and evidence of soft-tissue damage; and WAD III includes WAD II elements with neurological loss—altered motor and/or sensory functions. There is a WAD IV which includes fracture, but this is less common and often excluded.

Treatment for WAD includes everything from doing nothing to intensive management from multiple disciplines—chiropractic, primary care, physical therapy, clinical psychology, pain management, and specialty services such as neurology, orthopedics, and more. The goal of treatment is to restore normal function and activity participation, as well as symptom management.

The prognosis of WAD is generally good as many will recover without residual problems within days to weeks, with most people recovering around three months after the injury. Unfortunately, some are not so lucky and have continued neck pain, stiffness, headache, and some develop post-concussive syndrome. The latter can affect cognition, memory, vision, and other brain functions. Generally speaking, the higher the WAD category, the worse the prognosis, although each case MUST be managed by its own unique characteristics. If the injury includes neurological loss (muscle strength and/or sensory dysfunction like numbness, tingling, burning, pressure), the prognosis is often worse.

Chiropractic care for the WAD patient can include manipulation, mobilization, and home-based exercises, as well as the use of anti-inflammatory herbs (ginger, turmeric, proteolysis enzymes (bromelain, papain), devil’s claw, boswellia extract, rutin, bioflavonoid, vitamin D, coenzyme Q10, etc.) and dietary modifications aimed at reducing inflammation and promoting healing.

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

Dr. Brent Binder
856 Century Drive, Suite C
Mechanicsburg Pa, 17055

Member of Chiro-Trust.org

What Are Whiplash-Associated Headaches?

23 Jan

Whiplash and headaches are a very common duo that frequently occur after motor vehicle collisions. The good news is that most headaches that arise immediately following a head injury (or shortly thereafter) usually improve after minutes or days. But unfortunately for some, these headaches may persist over the longer term and even become a permanent part of life.

Researchers use the terms “post-traumatic” and “post-concussive” headache to describe long-term, intractable headaches associated with trauma. Given the back-and-forth, to-and-fro (and every combination in between) mechanism of injury in car crashes, it’s easy to understand why headaches develop. What isn’t so easy to appreciate is why most clear out while others don’t and become chronic.

Mild brain injuries are essentially a concussion (also referred to as mild traumatic brain injury or mTBI). This is usually a brief disturbance of brain function causing loss of consciousness or transient difficulty in thought processes. Mental fog, difficulty completing simple tasks, and losing one’s place in the middle of a thought or sentence are common mTBI symptoms.

Because standard neurological exam and imaging techniques (CT, MRI, X-Ray, and EEG) usually come back negative, many physicians have resorted to calling these symptoms “psychological.” However, newer technologies such as diffuse tensor imaging or functional MRI can detect  the microscopic injuries to the nerve fibers in the brain that may cause the previously described symptoms.

A unique difference between the classic chronic tension-type headache vs. those associated with post-concussive syndrome are the additional neurological symptoms: dizziness, ringing in the ears, blurred vision, psychological symptoms including depression, anxiety, personality change, sleep disturbance, and impaired libido.

Additionally, patients may also experience difficulty concentrating, poor work efficiency, and difficulty maintaining attention or retaining information—it’s no wonder why disability rates are so high in this patient population. It’s a LOT to deal with!

Treatment of this type of headache and constellation of symptoms has traditionally centered on treating each symptom individually, as there is no “magic pill” that gets to the underlying brain disturbance. However, there is hope that patients can benefit from a multi-disciplinary method of combining several techniques such as transcranial pulsed electromagnetic field, biofeedback, brain stimulating games or exercises, chiropractic management of the cervical spine, cognitive behavioral therapy (CBT), the use of fish oil, vitamin D3 with a gluten-free diet, etc.

Doctors of chiropractic are trained to identify these types of headaches and frequently team up with allied healthcare providers to form a “team” to BEST serve the patient’s needs. Though it is fortunate most headaches associated with car accidents gradually taper off by the three- to six-month point, it’s important to NOT lose hope for the less fortunate who continue to struggle with post-concussion syndrome headaches

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

Dr. Brent Binder
856 Century Drive, Suite C
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.