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Screening for Both Concussion and Whiplash

25 Mar

Whiplash injuries are often associated with car accidents and concussions are typically connected with sports collisions, but there’s a growing body of research suggesting that patients should be screened for both conditions following either type of incident.

In one study, researchers measured the forces applied on the brain both as it impacted the headrest during a rear-end collision and when struck from the rear while wearing a football helmet. They found similar head angular velocities between both crash simulations, suggesting both types of collision can result in brain injury.

On the other hand, a 2015 study reported that athletes with stronger deep neck flexor muscles experienced a faster recovery after a concussion. Past research has also indicated that stronger neck muscles may reduce the severity of whiplash injury to the neck during a motor vehicle collision. This data suggests that reduced injury to the cervical spine and associated tissues during a collision may lessen the severity of an accompanying concussion.

In a 2019 study published in the Journal of Orthopedic Sports & Physical Therapy, researchers reported that the overlap in symptoms between whiplash and concussion are strikingly similar, but the guidelines for diagnosis and treatment for the two are implemented separately, which could potentially lead to misdiagnosis and a delay in appropriate management, along with an increased risk for a poor outcome. The authors concluded that proper assessment and management should incorporate the principles set forth in BOTH whiplash and post-concussive guidelines. Moreover, coordinating other diagnostic principles such as imaging guidelines should also be incorporated to offer these patients optimum quality assessment and management strategies.

These suggestions are backed by a series of case studies of whiplash-injured patients with symptoms that suggested co-existing post-concussion syndrome. The patients reported improvements in function following a course of treatment derived from guidelines for managing both whiplash and post-concussion syndrome.

Likewise, a study published in 2015 by authors affiliated with Canadian Memorial Chiropractic College revealed that the post-concussive syndrome patients experienced favorable outcomes when they received treatment similar to that provided to whiplash associated disorder patients to restore function in the cervical spine.

These findings suggest that whiplash and concussion commonly co-occur, and patients should be screened for both, regardless of how the injury occurred, whether from an automobile crash or a sporting collision. Treatment guidelines show that the non-surgical, conservative treatment provided by doctors of chiropractic is an excellent option for these types of injury.

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.

At-Home Exercise for Whiplash Associated Disorders

15 Feb

There is plenty of research supporting chiropractic care as an excellent approach for managing whiplash associated disorders (WAD). While the in-office treatment aspect of care—spinal manipulation, mobilization, soft tissue therapy, massage, modalities, etc.—is important for restoring motion and reducing pain in the neck and surrounding areas, it’s the at-home exercises that not only maintain those improvements but reduce the risk for developing chronic pain or experiencing re-injury in the future.

When the neck is injured in a whiplash event—like a car accident—the superficial muscles in the neck will spasm to protect the nearby tissues from further injury. In the short term, this is a good thing, but if movement remains restricted, the deep neck muscles that are important for maintaining posture can become deconditioned.

As the deep neck muscles weaken, the superficial muscles that normally control voluntary movements will take on the added work, resulting in further weakening of the deep neck muscles—setting up a vicious cycle that can prolong or even prevent WAD recovery. In fact, a 2018 study followed 141 WAD patients for one year and found that those who were unable to return to their pre-injury work activities had an average of 50% reduction in neck muscle strength.

That’s why it’s important to engage in at-home exercises to strengthen the deep neck flexor muscles and put them back to work (so you can get back to your life).

One exercise can be performed by retracting your chin inward followed by nodding your head (as if you’re agreeing with what someone said). You can apply resistance by placing your fist under your chin and slowly working against both the upward and downward movements. Start at 10% maximum resistance. As you improve and as tolerance allows, add additional resistance (up to 50-75% max) and reps to your sets, enough to feel fatigue. If you apply 100% resistance, no motion will occur, which is called an isometric contraction, which works too but not as well as isotonic strengthening (resistance with movement).

There are several ways to strengthen and recondition the deep neck muscles, and your doctor of chiropractic will show you the ideal exercises for your unique case and provide additional self-care recommendations to optimize the healing process, which can include exercise advice, dietary recommendations, and nutrition supplement guidance.

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.

Useful Tests for Diagnosing Whiplash

21 Jan

When it comes to whiplash associated disorders (WAD), the process of making an accurate diagnosis and treatment recommendation can vary from healthcare provider to healthcare provider depending on their educational background, ongoing training, and clinical experience. There is also a growing pile of research with respect to WAD that helps refine existing processes and introduce new perspectives to take on the condition and its treatment. Here are developments that can help doctors better evaluate the presence and severity of WAD.

In a 2017 study, researchers evaluated a diagnostic test that utilizes six isometric muscle fatigue tests of the neck and arm muscles in search of an inexpensive and relatively low-tech method for identifying the presence and degree of WAD injury—WAD I (no/minimal complaints/injury), WAD II (soft-tissue injury—muscle/tendon and/or ligament injury), WAD III (nerve injury), WAD IV (fracture). The study included 75 patients who had experienced a whiplash injury in the previous six hours and 75 non-injured subjects with a similar make-up (age, gender, body type, etc.).

            The investigators observed that the participants with WAD injuries fatigued at a much faster rate in each of the six tests, and those with a higher grade of WAD injury experienced fatigue even quicker. Based on the fatigue data alone, evaluators were able to identify the WAD patients with a more than 90% accuracy. While additional studies are underway to confirm these findings with more participants, this may offer healthcare providers an easy, accurate, and safe method to determine the severity of WAD injury and offer more tailored treatment recommendations in the time period immediately following an automobile collision.

A study published in 2020 used video fluoroscopy (VF) to observe both WAD patients with chronic neck pain and non-injured subjects while they performed five movements to a firm end range involving the motion of the cervical spine. Using the VF data, radiologists were able to differentiate members of the two groups with significant accuracy. The use of x-ray taken at a firm end range of each motion can also be used to make these measurements. This is important as most patients and healthcare providers don’t have ready access to VF but many times, X-rays can be done in the office or a short drive away.

The most current treatment guidelines for WAD recommend seeking care as soon as possible versus taking a wait-and-see approach. Chiropractic care is an excellent option that can reduce one’s risk for developing chronic WAD symptoms that may be more difficult to resolve.

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.

Car Crash Characteristics and Whiplash Recovery

17 Dec

While many cases of whiplash that result from a motor vehicle collision (MVC) have a successful outcome, some experts estimate that up to 25% of whiplash patients will experience chronic pain and disability. Several studies have sought to identify characteristics that differentiate these individuals from those who recover so that additional treatment can be offered to reduce the risk for chronicity. Let’s see if the characteristics of a MVC can shed any light on this…

In a 2019 study, researchers assessed 37 acutely injured patients within a week of their MVC, two weeks later, and three months later in order to determine any association between pain and disability with both specific crash measurements (head turned at time of impact, seatbelt use, whether or not airbags deployed, if the vehicle was struck while stopped or while turning, the principle direction of force, damage cost estimates, speed of impact, etc.) and patient characteristics (sex, body mass index, signs of post-traumatic distress, negative affect, etc.).

The research team identified a positive association between the percentage of self-reported neck disability at three months post-MVC and post-traumatic distress, negative affect (such as anger or sadness), and uncontrolled pain. There was no direct effect with crash characteristics such as vehicle damage, principle direction of force, or speed change. Though they recommended a larger study to confirm their findings, researchers were unable to establish a link between chronic whiplash pain and disability and specific crash characteristics. That is, there was no apparent connection between a person’s risk for ongoing whiplash issues and the severity of the collision. This study points out that recovering from a whiplash associated disorder requires a biopsychosocial care approach, not just focusing on the biology or tissue damage/diagnosis, but also the patient’s attitude about the injury and getting better.

This echoes a similar study that linked post-traumatic stress disorder (PTSD) with prolonged whiplash associated disorders recovery. In the study, researchers found that hyperarousal/numbing PTSD symptoms were predictive of long-term neck pain-related disability.

In addition to managing musculoskeletal disorders with manual therapies, nutritional recommendations, modalities, and specific exercise recommendations, doctors of chiropractic may utilize more whole body, health-oriented approaches to help patients learn how to relax and reduce stress and anxiety with techniques such as deep-breathing, visualization, contract-relax or tensing exercises, and more. When needed, your chiropractor can coordinate with primary care and specialty care providers, such as mental health counselors and clinical psychologists.

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 Weakened Neck Muscles

19 Nov

The whiplash process can lead to a number of concurrent symptoms (neck pain, headaches, limited cervical range of motion, etc.) referred to as whiplash associated disorders, or WAD. It’s estimated that about one in five WAD patients will also develop potentially chronic, concussion-like symptoms like brain fog, difficulty concentrating, and other cognitive impairments. A 2020 study shed light on a way to help identify such patients early on so targeted treatment could help keep their WAD from becoming chronic and persistent.

In the study, researchers used resting-state-fMRI (rs-fMRI) to image 23 patients with chronic WAD and compared their findings with assessments used to objectively measure neck disability, traumatic distress, depression, and pain. The research team identified an association between fat infiltration into the cervical muscles and abnormalities in the brain network structure associated with WAD-related neuropsychological issues. That is, the patients with more fatty tissue in their neck muscles were also those with more signs of brain injury or altered brain function.

When deep muscles and associated soft tissue in the neck are injured in a whiplash event, the body may recruit superficial muscles to help stabilize the body and maintain posture. While this can protect the deep muscles from further injury in the short term, it can decondition these muscles over time and allow fatty deposits to infiltrate its tissue.

In another study that followed 141 WAD patients and 40 non-injured subjects for one year, researchers observed that the WAD patients demonstrated a loss in neck muscle strength throughout the year, even if their neck pain resolved and their cervical range of motion returned to normal. Additionally, the patients who had not recovered enough to return to work after a year had an average of 50% loss of strength in their neck muscles.

The findings of these studies suggest that when the whiplash process is forceful enough to  injure the soft tissues of the neck in a manner that leads to abnormal muscle activity that allows important muscles to weaken and for fatty deposits to develop, then the same event can also lead to a potential brain injury, with resulting cognitive symptoms. If so, then identifying WAD patients with cervical muscle weakness early may help doctors uncover which patients may need more substantive care to reduce their risk for ongoing WAD issues. 

Several treatment guidelines indicate that chiropractic care is a great first-choice treatment option for the WAD patient, which may involve a multimodal approach to restore motion in the affected joints and strength in the deep and superficial cervical muscles.

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.

Predicting Whiplash Outcomes

19 Oct

With up to 50% of whiplash associated disorder (WAD) patients experiencing long-term symptoms, is there a way to predict which patients are likely to recover following a whiplash injury? To answer this question, a team of researchers analyzed findings from twelve systemic reviews to identify prognostic factors that could help predict patient outcomes following a whiplash associated disorders (WAD) injury.

The authors concluded that the outcome of acute whiplash was dependent more on the association between initial pain and anxiety and less with physical factors such as MRI or x-ray findings, motor examination findings, and collision factors (impact direction, car speed at impact, seatbelt or headrest use, or the extent of vehicular damage).

What can be done for the patients who are at greatest risk for ongoing issues? A 2020 study investigated the potential benefits that a multimodal rehabilitation (MMR) program had for sub-acute (six to twelve weeks) and chronic (more than twelve weeks) WAD patients with soft tissue injuries and no nerve injury or bone fractures. The participants were first examined by a multi-professional team that included a pain and rehabilitation specialist (PM&R), a psychologist, an occupational therapist (OT), a physiotherapist (PT), a social worker, and a nurse. This same team then treated the patients over a five-week timeframe.

The investigators then compared standardized questionnaires completed by participants both before and after the treatment period and then one year later. The researchers reported that participants achieved significant long-term improvements with respect to overall physical and mental health, pain intensity, ability to carry out everyday activities, anxiety, and depression.

Many chiropractors utilize a multi-modal approach when treating WAD patients to address three goals: pain management, functional restoration, and self-management strategies to minimize the need for long-term professional care.  When needed, a coordinated care approach is set up between allied healthcare professions that may include PT, OT, clinical psychology, and/or others.

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.