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Whiplash Injury – A “Must Read” About Important FACTS!

21 Jun

Whiplash-associated disorders (WAD) is defined as “an acceleration-deceleration mechanism of energy transfer to the neck.” WAD may result from rear-end or side-impact motor vehicle collisions (MVCs), diving and other sports-related injuries, as well as from falls, assaults, and more. Because many bones and soft tissues may be involved in WAD, there are a variety of clinical signs and symptoms associated with the disorder.

In 1995, the Quebec task force coined the term WAD and broke it down into five divisions: WAD 0 includes no pain or exam findings; WAD I includes neck pain, stiffness, or tenderness as the only complaint with no exam signs; WAD II includes pain, stiffness, or tenderness with exam findings such as decreased range of neck motion and/or point tenderness of the neck; WAD III includes all of WAD II plus altered nerve function (sensory deficits and/or muscle weakness or altered deep tendon reflexes); and WAD IV includes fracture or dislocation with or without spinal cord injury.

WAD is usually seen in rear-end, low-impact collisions with about 90% of cases occurring at speeds of <14 mph. In a rear-end collision, the trunk of the body is initially forced back into the seatback followed by hyperextension of the neck and head, which then recoil forwards—all within about 600 msec, which is much faster than the 1,000 msec needed to voluntarily brace our muscles.

Studies support that the source of neck pain arises more often from injured joints than injured muscles. In about 60% of cases, neck pain is due to injury of the small facet joints, which are located on the sides of the neck, especially at levels C2-3 and C5-6. This can give rise to upper neck pain and/or headache (from C2-3), and/or lower neck pain radiating to the shoulder blades (C5-6) or worse, into the arms.

Fortunately, most acute WAD injured patients recover within three months. Unfortunately, about 40% do not improve and are then classified as having “chronic whiplash” (cWAD). Risk factors for WAD developing into cWAD include the following: 1) rapid and severe onset of neck pain and stiffness symptoms; 2) neurological deficit with arm pain (WAD III); 3) headaches; and 4) when urgent hospital admission is necessary. Older patients, those with pre-existing neck or low back pain, and individuals with slender necks have an elevated risk for a poor recovery. Depression, anxiety, and mood disorders are common in those with cWAD as well.

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 Concussion – Important Nutritional Considerations

21 May

Mild traumatic brain injury (mTBI) is one of the many conditions that can accompany a whiplash injury. The term is often used interchangeably with concussion, while “post-concussion syndrome” and TBI (without the word “mild”) refer to long-term residual symptoms. Symptoms associated with mTBI initially include dizziness, nausea, and headaches followed by slow cognition—difficulty processing thought, losing one’s place during discussions, difficulty with verbal expression, and more. Many mTBI sufferers describe this as “mental fog.”

Following mTBI, the brain releases various chemicals that help repair damaged neurons and reduce the risk of neurodegeneration. One such chemical is brain-derived neurotrophic factor (BDNF), and one of the best methods for increasing BDNF levels is intense exercise. However, because patients are advised to rest and slowly return to their normal activities following an mTBI, proper nutrition and supplements are necessary to boost BDNF levels. This can include consuming protein-rich foods such as a daily shake made of whey protein or pea and rice protein with added branched chain amino acids. Research has shown that combining this with 10 grams of creatine monohydrate is important for energy production in the brain. A recommended daily dose of 5000 IU of vitamin D can also assist in raising BDNF levels.

The research shows that a high-quality fish oil of up to 4000 mg/day in the first three weeks followed by 2000 to 4000 mg/day for three months can aid recovery. Omega-3 fatty acids (EPA and DHA) can help reduce inflammation from mTBI. The DHA in fish oil helps improve the strength and flexibility of the cell membranes of neurons, while EPA suppresses the production of pro-inflammatory chemicals such as prostaglandins and others.

Studies also support administering glutathione (an antioxidant normally found in our cells), as it reportedly reduces brain tissue damage by an average of 70%. Other helpful options include vitamin C, selenium, niacinamide or B3, N-acetyl-L-cysteine (750-1000mg), broccoli extract, magnesium, curcumin (found in turmeric), and green tea extract.

Your doctor of chiropractic can help guide you in managing your nutritional program following a concussion.

 

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 – Can We Predict Long-Term Problems?

23 Apr

Whiplash associated disorders (WAD) are most often associated with motor vehicle collisions (MVC) but can occur from any form of trauma arising from slips and falls, sports injuries, and more. A question patients suffering from WAD commonly ask is, “How long will this take to get better?”

There are many factors in play with regards to how quickly one recovers from any injury: the type and degree of injury, the type of care, the “will” to get better, the patient’s education level, gender, emotional factors, and so much more. But what does the research say regarding risk factors for a prolonged recovery from WAD?

A Danish study found that WAD patients with immediate, high-intensity neck pain and stiffness were more likely to be disabled one year following their injury than those with a delayed onset of symptoms or those with low-grade pain. By combining scores for neck pain and stiffness along with other non-painful symptoms (such as blurred vision, nausea, and dizziness), the authors found that they could identify those at risk for long-term disability within a week of their accident.

Their study included 141 adults who contacted the ER within two days of the MVC complaining of neck pain or headaches arising from rear-end collisions without loss of consciousness or amnesia. None had prior neck or back pain or a history of severe headaches. The researchers found that 75% of patients with reduced neck motion still reported disability after one year.

Interestingly, the research team observed that patients involved in ongoing litigation (lawsuits) were at no greater or lesser risk of suffering long-term disability. In a recent large-scale study using an online survey completed by 127,959 respondents, researchers found that collision severity, poor expectations of recovery, victim mentality, dizziness, numbness or pain in the arms, and lower back pain each increased the risk of a poor recovery.

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 – What Will X-Ray Tell Me?

26 Mar

Although whiplash injuries arising from motor vehicle collisions (MVC) are very common, there doesn’t seem to be consistency in the evaluation one receives at an emergency room (ER) or later in an outpatient setting when it comes to the utilization of x-ray and other imaging. So, what are the pros and cons of imaging a whiplash patient?

A review of published guidelines suggests that if a person involved in a MVC presents to the ER awake, alert, with no neurological deficit or other distracting injury, with no neck pain or midline tenderness, and has a full range of neck motion, then x-ray is not considered necessary. If a fracture is suspected, an x-ray and/or CT (Computerized Tomography) scan is appropriate. Magnetic resonance imaging (MRI) has a role when a soft tissue injury such as a ligament tear, spinal cord injury, and/or arterial injury is suspected by clinical impression and/or prior imaging.

The major concern involving trauma to the neck is fracture, but this is actually quite uncommon as a result of an MVC. Some ERs routinely x-ray all trauma cases to rule on the presence or absence of fracture, though CT scan is much more sensitive than x-ray, especially in subtle or the not-so-obvious types of fracture.

Doctors and hospitals utilize treatment guidelines in an effort to provide the best possible care while limiting potentially unnecessary testing. For example, the Canadian C-Spine Rule (CCR) is an assessment to help determine who does vs. does not need x-rays in trauma cases.

According to the CCR, those over 65 years of age or those who have significant trauma and/or numbness in the extremities should receive x-rays. Situations in which x-rays are not needed include a simple rear-end MVC; if the patient can walk around; delayed (not immediate) onset of neck pain; or the absence of midline neck tenderness.

Another study reported that more than 800,000 patients in the United States (US) receive a cervical x-ray each year. Minimizing x-ray use is important, not just because of patient exposure to radiation, but because more than 97% of x-rays are interpreted as negative, and costs associated with x-ray exceeds $175,000,000 per year! Hence, there is a definite need for better guidelines in the US like the CCR!

Doctors of chiropractic see many whiplash patients either soon after an injury or later, though sometimes it may be years before a patient with whiplash presents for care. For patients under age 65 who have a full range of cervical motion, no neurological deficits or complaints, no other distracting injuries, and no midline tenderness, in most cases, x-rays can wait.

 

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 – Who Will Get Better?

19 Feb

Though most patients with a whiplash injury improve within a few months, about 25% have long-term pain and disability that may persist for many months or years.

 

Now, a team of scientists from Northwestern Medicine Feinberg school of Medicine reports that it may be possible to determine which whiplash patients will develop chronic pain, disability, and/or post-traumatic stress disorder (PTSD) within one to two weeks of their injury—leading to specialized treatment that may reduce their risk for developing a chronic condition.

 

Using a specialized form of MRI that measures the fat and water ratio in the neck muscles, the researchers found that greater fat infiltration into these muscles indicated rapid muscle atrophy. The presence of fat in the muscle is not related to the person’s weight, size, or shape and is believed to represent an injury that is more severe or serious than what might be expected from a typical low-speed car crash.

 

However, though the lead investigator notes that the fat infiltration into the muscle appears to be a response to an injury, what has actually been injured—muscle, nerves/spinal cord, and/or more—remains a mystery.

Another study by the same research team found that chronic pain whiplash victims also exhibited a high level of muscle fat in their legs—indicating atrophy. The researchers hypothesize that these patients may have partially damaged their spinal cord, as this group of patients also reported feeling weak and clumsy when walking.

Current research indicates that when managing whiplash cases, early return to activity, movement restoration, and exercises that specifically target the deep neck flexors lead to better outcomes than a “wait and watch” approach.

Doctors of chiropractic also utilize manipulation, mobilization, exercise training, diet, and nutrition, and encourage a return to a normal lifestyle as quickly as possible when treating patients with a whiplash injury.

What You NEED to Know About Whiplash

22 Jan

Whiplash injuries are very common and are primarily associated with car and rear-end collisions in particular. This is what happens when you’re rear ended…

  1. At 0-50 milliseconds (ms): As the car is initially propelled forward, the seatback pushes the torso forward while the head remains in its original position, which straightens or flattens out the cervical curve.
  2. At 50–75 ms: As the torso accelerates forward, the head/neck moves backwards forming an S-shaped curve with flexion of the upper cervical region and extension of the lower cervical region, stressing the ligaments in back (upper) and front (lower) cervical spine regions.
  3. At 150-175 ms: The torso is at its maximum forward position in reference to the neck and the head/neck is forced into peak extension (backward bending). The head may contact the head restraint or ride over it if of the torso slides up the back a reclined seat. This can further damage the ligaments in the front of the cervical spine.
  4. At 200-600 ms: The head and torso are then thrown forward by the rebound off the seatback, hyperflexing the neck (and mid- and/or low-back) and potentially causing further injury to the ligaments in the back of the spine. Depending on whether or not a seatbelt is in use, the head may strike the steering wheel and/or windshield causing further injury.

It may seem logical to think that if we can anticipate an impending MVC, then less injury will occur. Unfortunately, this doesn’t hold true because the total length of time it takes for the sequence described above to occur is about 600 ms and we cannot voluntarily contract our muscles in less than 800-1000 ms. Therefore, you simply won’t have time to brace yourself for impact.

If cervical rotation occurs at the time of impact, such as looking into the rearview mirror, then the risk for injury may increase. There is recent evidence suggesting that it is difficult to avoid rotation of the cervical region during a collision because the diagonal path of the chest restraint promotes trunk rotation in the later stage of whiplash as the torso rebounds forward.  Nonetheless, looking straight ahead at the time of impact may reduce the degree of injury in some collisions.

To achieve the best long-term outcome, treatment should emphasize movement and exercise as soon as possible. In addition to treatments performed in the clinic, doctors of chiropractic commonly recommend whiplash patients to perform home exercises, home cervical traction, and other self-help methods with the objective of returning to a normal lifestyle as quickly as possible.