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Whiplash Injury Prevention

20 Nov

Some studies have suggested that 85% of all whiplash injuries occur from rear-end collisions. So, what are some different ways that we might be able to avoid injury if such an event occurs?

HEADREST: It’s important that your headrest is high enough so that your head and neck doesn’t roll over it in a collision, which can increase the risk of injury to the neck and head. Additionally, be careful to keep your head within eight cm (3.14 in) of the headrest while driving. By reducing the spacing between your head and the headrest, you can lower your risk for sustaining a brain injury in a rear-end collision. Today’s cars may also feature an active head restraint system that adjusts the head rest in an effort to shorten the distance between the head and the headrest when an accident occurs. ADVICE: Check the position and condition of your head restraint!

SEAT BACK POSITION: At least one study has concluded that vehicle occupants may have a higher injury risk if the seat back is fully upright. On the other hand, a seat back that leans too far back may serve as a ramp for the body during an accident, which could slide the head over the headrest. This too can increase the risk of injury. ADVICE: Recline the seat back somewhat while driving, but not too far.

BODY SIZE EFFECTS: A literature search study reviewed the potential injury effects as it relates to differences in anatomical size, head-neck orientation, the facet joints (small gliding joints in the back of the cervical spine), and neck muscles mass. The authors of the study reported that smaller sized necks, head positions outside of neutral (vs. looking straight forwards), and smaller muscle mass increased the potential for neck injury in a rear-end collision. ADVICE: Strengthen/exercise your neck muscles.

AIR BAGS & SEAT BELTS: Though these are not an “option” and have become “standard equipment” in cars, it’s clear that airbags and seat belts have saved far more lives compared with the injuries (including some deaths) that can be attributed to them. According to one source, more than 30,000 lives have been saved by front and side airbags. ADVICE: Make sure you act on any recall involving your airbag (and any recalls involving your car in general) and WEAR your seatbelt!

FACTORS DIFFICULT TO STUDY: Given all the variables involved in “real-world” car crashes, it is very difficult to predict which criteria are most important for injury prevention. For example, vehicular weight/size difference, multiple collisions—from different directions, readiness for impact, etc. The BEST ADVICE  – Stay alert, keep your eyes on the road, and don’t speed.

 

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 Injuries and Missed Diagnoses of Traumatic Brain Injury

22 Oct

Traumatic brain injury (TBI) is also becoming a “hot topic” as it relates to motor vehicle collisions (MVC). The question is: how often is TBI missed?

The simple answer is: FREQUENTLY! This is due to the fact that attention is often drawn toward other injuries such as a neck injury or a limb injury. One study found that doctors were more likely to miss an mTBI diagnosis in patients who had sustained an arm or leg fracture. Among a total of 251 trauma patients, only 8.8% were diagnosed with mTBI at the time of injury vs. 23.5% who were eventually diagnosed at a later date. The authors of the study note the importance for healthcare providers to not be overly focused on the most obvious injury, as it may result in missing an mTBI diagnosis and the opportunity for early management of the condition—potentially leading to greater pain, suffering, and long-term disability.

But how “good” is our ability to assess mTBI? In a recent study on the ability of sideline assessments to predict subsequent problems after a sport-related concussion, researchers concluded that although sideline measures are useful for diagnosing concussion, they are not suitable for determining the extent of injury one to two weeks post-injury.

Part of the problem associated with concussion, regardless of cause, is an overall lack of knowledge about the condition on the part of athletes, parents, coaches, and medical professionals. In a Canadian survey of members of these groups, “predictors” of better concussion knowledge included prior personal experience or history of concussion. Factors affecting knowledge included language, age, educational level, annual household income, and TBI history.

Yet another issue is the “under reporting” of concussion. Looking at gender differences in a total of 288 athletes across 7 sports (198 males, 90 females), in spite of having similar knowledge about concussion, female athletes were more likely to report their concussive symptoms than males.

Sobering facts: 1) About 1.7 million cases of TBI occur in the US annually, and approximately 5.3 million live with a disability caused by TBI; 2) Annual direct and indirect TBI costs are estimated at $48-56 billion; 3) Among children under fourteen years of age, TBI results in 2,685 deaths and 37,000 hospitalizations; 4) Between 50-70% of TBI accidents are the result of a motor vehicle crash.

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 Injuries and Neck Strain

21 Sep

The terms “whiplash” and “neck strain” are often used interchangeably, though there’s debate about whether this is appropriate. Let’s take a closer look at the differences between these two common descriptions of neck pain…

The term “strain” technically means a stretch injury to a muscle and/or the tendon that attaches muscle to bone. The terms mild, moderate, and severe offer a classification approach commonly used by healthcare providers to describe the degree of injury. As implied, a mild strain is just that—little to no muscle fiber or tendon tearing has occurred and thus, the injury will have a faster recovery time than a moderate strain. Moderate strains include partial tissue tearing and take longer to mend. Severe strains described complete tearing and in certain muscles in our body, surgery may be needed to repair the tear.

There are many muscles and tendons in the neck that overlap each other to allow for various functions or movements to occur. The deep “intrinsic” muscles are described as “fine movers” and allow for the individual cervical vertebra to move in a very specific manner and direction. The superficial muscles are larger, stronger, and utilized in global/large movements and help to protect the neck and the deeper, more delicate structures.

It can take a total of about 600 msec for the head to “whip” forward and backward in a classic rear-end collision, which is faster than we can voluntarily contract a muscle. This explains why an injury is difficult (if not impossible) to avoid in a motor vehicle collision, even if you “see” that an accident is about to happen.

To further differentiate the whiplash injury from a simple muscle strain, the brain is suspended by ligaments and cushioned further by fluid inside the calvarium (or skull) and can easily get bruised by literally slamming into the walls on the inside of the skull in a whiplash injury. This results in “traumatic brain injury” (TBI) or concussion. Interestingly, it’s been reported that one does NOT have to directly hit the head on a hard object to suffer TBI.

The symptoms associated with TBI include mental fog; fatigue/tiredness; slow mental functioning, such as having difficulty formulating thoughts, staying on task, and/or expressing one’s self; visual complaints; memory loss; and/or headache. The term “Whiplash Associated Disorder” or WAD is preferred, as it encompasses the many different symptoms associated with whiplash.

Doctors of chiropractic are trained to evaluate, diagnose, and treat patients who have sustained a whiplash injury. Generally, the sooner treatment commences after the injury, the more favorable the outcome or prognosis. Therefore, don’t delay in obtaining care following a collision!

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

Dr. Brent Binder
4909 Louise Drive, Suite 102
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.

Chronic Whiplash Injuries and Pain Thresholds

21 Aug

Researchers have observed a phenomenon called “central sensitization” (CS) that is common in patients who have long-term, chronic pain following trauma such as whiplash. With CS, the patient’s ability to feel pain is abnormally high or hypersensitive, so when pain from pressure, temperature, electrical, or other sources are applied to the skin, they feel it sooner and more intensely than individuals without CS.

Why is this so important? Well, if we can find a way to raise the pain threshold in patients with CS, then this could reduce the intensity and frequency of their sometimes intense and debilitating chronic pain.

Researchers have found that pain thresholds improve after an anesthetic agent is injected into myofascial trigger points (MTrP)—those tight, sore “knots” commonly found in muscles after injuries such as whiplash trauma. It has been proposed that these MTrP may act as “thermostats” controlling the manner in which the brain perceives and relays pain.

To test this theory, a 2017 double-blind study randomly assigned chronic pain whiplash patients to either a group receiving the “real” anesthetic agent or a “sham” or fake injection of the MTrP. The researchers measured pain (on a 0-10 scale), pressure perception, grip strength, and the range of motion (ROM) of the jaw in subjects from both groups before and after each intervention.

As postulated, only the group receiving the “real” anesthetic agent had improved pressure pain tolerance in addition to increased jaw ROM. Unexpectedly, both groups experienced similar improvements when rating their pain on a 0-10 scale. This study concluded that the pain threshold associated with CS can be modulated by injecting myofascial trigger points (with or without an anesthetic agent), although only the anesthetized group had objective improvement (jaw ROM and pressure sensitivity improvement). Interestingly, the treatment of painful trigger points has LONG been a common form of care utilized by chiropractic, known as trigger point therapy or TPT. Myofascial release is another soft-tissue technique commonly utilized over MTrP by chiropractors.

This study may help explain why so many patients benefit from chiropractic care following whiplash trauma as well as other injuries. The added benefits from spinal manipulation and modality use over trigger points are two additional ways chiropractic care can benefit those suffering from both acute and chronic pain associated with whiplash trauma.

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

Dr. Brent Binder
4909 Louise Drive, Suite 102
Mechanicsburg Pa, 17055

Member of Chiro-Trust.org

Chronic Pain and Whiplash

24 Jul

Most sprains and strains typically take six weeks to recover, provided the patient receives proper care, which may include self-management strategies. However, something is different about a whiplash associated disorders (WAD) injury in that many patients do not recover.

At the Whiplash 2017 Symposium held in Australia, Dr. Michele Sterling stated, “Whiplash associated disorders are a costly burden to Australian society. Up to 50% of people who experience a whiplash injury will never fully recover. Whiplash is resistant to treatment and no early management approach has yet been shown to prevent chronic pain. We are hoping this study will provide a promising treatment for chronic pain.”

Experts in the field presented important information about the development and prevention of disorders associated with a WAD injury such as chronic pain, post-traumatic stress disorder (PTSD), and depression after trauma. The University of North Carolina’s Dr. Samuel McLean reported that approximately 30% of people present to the emergency room (ER) in developed countries after trauma exposure (such as car accidents) and approximately nine out of ten are discharged without proper evaluation of these common neuropsychiatric problems. One problem in making a neuropsychological diagnosis is that these conditions often develop sometime after the initial presentation to the ER.

Dr. McLean and his team are currently researching the biological basis of brain injury in a new unprecedented study.  Participants will be enrolled at the immediate post-trauma level and will receive a comprehensive evaluation including genomic, neuroimaging, neurocognitive, behavioral, and symptom assessments. Dr. McLean states that WHEN the biology of PTSD, depression, and chronic pain is understood, then proper tools can be developed to identify the disorders and interventions to treat them can be achieved.

The problems associated with traumatic brain injury (TBI) are not new, but TBI is rarely dealt with until long after the WAD injury. Part of this is due to a lack of understanding of TBI on the doctor’s part and the other is a reluctance to discuss the symptoms of cognitive dysfunction on the patient’s part. This is because the symptoms are often vague, hard to describe, or somewhat embarrassing.

Questions specifically related to TBI include: Do you have problems staying on task? Do you easily lose your place during a discussion or thought process? Do you have to review your work more times than usual? Does it take longer to process information that you hear or read? Do you have mental fog?

Often, only when these questions are asked will the patient and doctor realize that there may be the need for a thorough neuropsychological evaluation. This study hopes to be able to develop new tools for evaluating TBI and to develop new interventions to help these patients.

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

Dr. Brent Binder
4909 Louise Drive, Suite 102
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 “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
4909 Louise Drive, Suite 102
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.