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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.

Understanding Whiplash Associated Disorders

24 Sep

Whiplash associated disorders (WADs) can be a very confusing condition characterized by a myriad of symptoms stemming from a forceful, rapid back-and-forth motion of the head and neck. While this process commonly occurs during a rear-end crash, it can also arise from a slip-and-fall injury, sports injury, physical abuse, or any type of trauma involving a quick, forceful impact. To understand how this happens, let’s discuss the mechanism of injury and how fast the head and neck movements are that occur in a classic rear-end collision.

One paper that utilized kinematic studies on cadavers and healthy volunteers reported that a WAD injury can occur in any one of three stages during the impact. STAGE 1: Flexion or forward movement of the head/neck starts with a flattening of the normal C-shaped curve. STAGE 2: The curve then reverses into an S-shaped curve with the lower half of the cervical spine (or neck) extending (C-shaped) and upper half flexing (reverse C-shape) forming the S-shaped spinal curve prior to the head/neck fully flexing. STAGE 3: The entire cervical spine extends into an extreme of the normal C-shaped curve as the head rebounds backward, hopefully stopped by a properly fitting headrest!

These three stages occur FAST—in about 600 milliseconds, which is MUCH quicker than someone can voluntarily contract a muscle. Hence, it’s next to impossible to “brace” for the impact because it’s over before we can react!

Anatomically, the front of the cervical spine is made up of large square-shaped bones called vertebral bodies (VBs) of which there are seven in the neck, each separated by a shock-absorbing disk. There is a strong ligament that runs the entire length of the spine in the front and back of the VBs that help stabilize the spine, or vertebral column. There’s another ligament in the back part of the vertebral canal where the spinal cord travels from the brain to the low back and two “facet joints” at each of the seven vertebrae that holds them together. Hence, each level is like a tripod with a big supporting leg in the front (the VBs) and two spatulated legs in the back (the facets) that allow for motion and protect the cord and exiting nerve roots, which allows us to feel textures and temperatures, as well as move our limbs.

When the head whips forward (Stages 1 & 2), the front of the cervical spine jams together while the facets in the back spread open. This is where the VBs in front can compression fracture and/or the capsules surrounding the facet joints in the back can over-stretch and tear. The latter has been reported to be a common and major source of post-crash pain in WAD injuries.

While many individuals will heal without significant issues after a whiplash injury, up to 50% will continue to experience symptoms such as neck and upper back pain, stiffness, loss of mobility, dizziness, blurred vision, headache, memory loss, and other cognitive dysfunctions associated with concussion. This underscores the importance of seeking prompt treatment (chiropractic care offers a great choice) to reduce the risk of WAD transitioning into a chronic, long-term, and life affecting condition.

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 Associated Headaches

17 Aug

One of the symptoms commonly associated with whiplash associated disorder (WAD) is headaches. The current research suggests that up to 50% of patients who experience whiplash-associated headaches may continue to suffer from them for up to a year or more, and many of those will continue to have headaches as late as five years following their whiplash injury event. There are many potential causes for WAD-related headaches, which can include cervical injury, jaw dysfunction (TMJ), psychological distress (depression and anxiety), brain structure abnormalities (concussion), and/or overuse of headache medications.

To address these potential causes of whiplash associated headaches, treatment may include the following:

MANUAL THERAPIES: Mobilization and manipulation, which are commonly used by doctors of chiropractic, have been demonstrated to be effective for reducing pain and improving function for many conditions, including WAD and headaches of cervical origin. Treatment may also involve massage and physical therapy modalities, depending on the patient’s needs.

EXERCISE: A review of research published between 1990 and 2015 found that craniocervical, cervicoscapular, and posture correction exercises can be helpful in the treatment of whiplash-related headaches.

STAY ACTIVE: Try to carry on with normal activities within pain tolerances, as movement is needed to keep soft tissues healthy and to ensure a continuous supply of nutrients to the cervical disks. Don’t use a cervical collar to immobilize the neck unless directed to do so by your doctor.

NUTRITIONAL SUPPORT: There are several vitamins and supplements that have been shown to reduce inflammation and/or reduce pain. These include flavonoids, curcuminoids, omega-3 fatty acids, taurine, and vitamin D. Adopting an anti-inflammatory diet can also aid in the healing process.

Doctors of chiropractic frequently use a combination of these approaches when managing WAD patients to help reduce pain and disability and assist the patient in returning to their normal activities as soon as possible.

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 for Chronic Whiplash-Related Pain

27 Jul

A study published in 2019 found that nearly half of whiplash associated disorders (WAD) sufferers are still symptomatic one year after their injury. Why is that, and what can one do to reduce their risk for chronic WAD symptoms?

The most common source of pain from WAD injuries arises from joint capsules and ligaments, which are tough, tight bands of tissue that hold joints together and help stabilize the cervical spine. When these soft tissues are damaged, the body will take measures to restrict movement so that the injury doesn’t become more severe. This is one reason why cervical range of motion is reduced when the neck is injured.

You may recall that a patient with whiplash used to be fitted with a cervical collar to protect the neck and limit movement. However, researchers have since discovered that, in many cases, restricting all cervical movement for a prolonged period of time can lead to a weakening of the deep neck muscles—which are important for maintaining cervical posture—and the buildup of potentially troublesome scar tissue. These days, patients are encouraged to remain active provided their movements do not generate acute pain. Not only does staying active reduce the risk of deep neck muscle atrophy, but movement is necessary to produce the compressive forces that help maintain the flow of nutrients to the cartilaginous tissues in the neck.

The back-and-forth whiplash process can also result in trauma to the brain, also known as a concussion. The brain is suspended in the skull by ligaments and is cushioned by fluid. In a rear-end collision, the oblique angle of the chest restraint results in a twisting of the torso upon impact as the body accelerates forward. The brain slams into the front inside of the skull and then rebounds and hits the back inside of the skull as the trunk is forced backward during the deceleration phase of the injury. Depending on the degree of force, concussion can involve the front, back, or both parts of the brain resulting in memory problems, confusion, fatigue/drowsiness, dizziness, vision problems, headache, nausea/vomiting, light/noise sensitivity, and more. The good news is that chiropractic care applied to the cervical spine has been demonstrated to benefit patients with these post-concussive symptoms that often accompany WAD, which may reduce the chances that such symptoms become chronic in nature. The current research suggests that patients who seek treatment soon after a whiplash event— like a car accident, slip and fall, or sports collision—are not only more likely to experience a faster recovery but they are also less likely to develop a chronic condition. Chiropractic care offers a safe and conservative form of treatment for WAD that is often recommend by treatment guidelines.

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.

Chiropractic Care for Whiplash Injuries

24 Feb

Whiplash associated disorders (WAD) describes a constellation of symptoms that can arise following a motor vehicle collision (MVC), sports collision, or slip and fall. The typical initial treatment approach for WAD is non-surgical care, but what does the research say is the best non-surgical approach?

To start, most (if not all) studies on WAD center around the concept of preventing chronicity of WAD. In other words, the GOAL of care is to restore function and get the patient back to their normal lifestyle (work and play), which has been emphasized as being most important, even more so than pain resolution, though the two often go hand-in-hand. What are the best treatments in the initial stages—acute (less than two weeks) and sub-acute (two to twelve weeks)—of healing that can best reduce the risk of a patient developing chronic WAD (over twelve weeks)?

To answer the question, researchers reviewed studies from a 30-year time frame (1980-2009) and published their findings in a five-part series.

The first article in the series offered an overview and summary of the entire work. The second focused on the acute stage which included 23 studies that met the inclusion criteria. The researchers concluded that EXERCISE and MOBILIZATION treatment approaches had the strongest research support—two services STRONGLY EMBRACED by chiropractic.

The third article in the series focused on the subacute stage (2-12 weeks), which included 13 studies. The authors described research support for “the use of interdisciplinary interventions and chiropractic manipulation” but stated that the level of evidence was not strong for ANY treatment approach in the sub-acute stage. Investigators concluded that more research was needed with respect to this stage of care.

The fourth article in the series centered on the chronic stage (more than three months), of which 22 studies were included. Here, EXERCISE programs were reported to offer relief, at least over the short-term, while nine studies supported effectiveness for an interdisciplinary approach. Manual joint manipulation and myofeedback training were also reported as useful for pain relief.

The authors also stated that there was strong evidence to suggest that immobilization with a soft collar was not only ineffective but may impede recovery.

Do you see the “theme” of this research series? Services offered by chiropractic (exercise training, manipulation, and mobilization) are recommended at each stage of WAD 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.

Management Strategies for Whiplash and Dizziness

20 Jan

Of all the symptoms associated with whiplash associated disorders (WAD), dizziness may be one of the most concerning to patients because of how it can limit their ability to get up and move around. What can be done to treat dizziness following a WAD injury?

Two studies published in 2019 suggest that manual therapies and therapeutic exercises may be an effective option for such patients.

The first study included 40 WAD patients randomly assigned to either a treatment group or control group. The treatment group engaged in twelve 50-minute exercises sessions spread out over a six-week time frame. The exercises included standing on a foam surface and turning the head side-to-side; walking on an inclined plane and turning the head side-to-side; standing on a trampoline and moving the eyes side-to-side; heel-to-toe walking on a line for up to 5 meters (16.4 feet), and standing on one leg. If able, the treatment group repeated the same exercises with their eyes closed. Assessments completed at the end of the experiment revealed substantial improvements in both dizziness and quality of life among participants in the exercise group that were not experienced by those in the control group.

In the other study, researchers assigned 86 patients with chronic cervicogenic dizziness to one of three groups: SNAG (Sustained Natural Apophyseal Glide) exercise for six weeks; passive joint mobilization with range of motion (ROM) exercises for six weeks; or a control group that received no treatment. The SNAG exercises involved two movements (repeated ten times each): 1) Sit/Stand. Place a towel across the upper neck; as you pull forward with the towel, chin-tuck while pushing back into the towel. 2) Hold one end of the towel against the chest; rotate the head/neck toward the same side as far as possible; with the towel wrapped across the top of the neck, gently push the head further into rotation.

The research team reported that participants in both treatment groups experienced improvements with respect to dizziness, balance, cervical range of motion, and head repositioning accuracy. The authors of the study concluded that both treatment approaches are effective for cervicogenic dizziness (dizziness caused by cervical dysfunction).

The good news is that both spinal mobilization and active exercise are utilized by doctors of chiropractic!

 

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.