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What Leads to Chronic Whiplash?

20 Aug

Whiplash associated disorder (WAD) is a very common injury that can occur in a variety of ways, but it’s most commonly associated with motor vehicle collisions. The symptoms associated with WAD have been classified as follows:

  • WAD I: Pain, stiffness, or tenderness of the neck as the only complaint with no physical exam findings (full range of motion and no muscle guarding or tenderness on examination).
  • WAD II: Pain, stiffness, or tenderness of the neck with soft tissue injury signs loss of range of motion (ROM) and/or point tenderness of the neck (e.g., a sprain/strain neck injury).
  • WAD III: Pain, stiffness, or tenderness of the neck along with neurological signs sensory deficits, motor weakness, and/or decreased or absent deep tendon reflexes.
  • WAD IV: Pain, stiffness, or tenderness of the neck along with dislocation or fracture with or without spinal cord injury.
  • Other symptoms including deafness, dizziness, tinnitus (ringing in the ears), headache, memory loss, dysphagia (difficulty swallowing), and jaw pain can be present in all grades (WAD I-IV).

About 50% of WAD patients continue to report neck pain one year after the injury occurred. These long-term symptoms and signs can vary from mild to completely disabling.

There are prognostic factors that may help predict who is at risk of developing long-term, chronic (lasting longer than three months) WAD, which include the following (partial list): women more than men, age over 50 years, lower educational attainment, those who had pre-injury neck pain and/or headaches, the higher the WAD grade (comparing WAD I-III), those reporting more frequent or severe post-injury symptoms with greater pain intensity, poor coping at six weeks post-injury, depression, feeling helpless regarding pain control, fear of movement or activity, catastrophizing, anxiety, and high frequency pre-injury healthcare utilization.

There is evidence that WAD-injured individuals can develop widespread body pain or fibromyalgia in the year following their injury. This occurs more frequently in women and in those with poor prior health, greater initial symptoms (including pain intensity), and more symptoms of depression.

Among available treatment options, manual therapies such as mobilization and manipulation—the primary form of treatment delivered by doctors of chiropractic—often receive the highest ratings from patients in regards to overall satisfaction with care.

 

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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How Does Chiropractic Help Whiplash Patients?

23 Jul

Whiplash associated disorder (WAD) injuries usually result from rear-end, low-impact crashes with about 90% occurring at speeds less than 14 mph. Approximately 40% of all WAD patients develop long-term, chronic problems. Let’s look at how chiropractic care can help crash-injured patients recover and return to their normal lives…

REDUCE INFLAMMATION: Inflammation occurs when ligaments and muscles are injured. However, the pain associated with inflammation may be delayed and not show up right away. Rather, you may wake up the next morning with acute neck and/or back pain, as WAD injuries are NOT limited to only the neck. Several studies have shown that chiropractic spinal manipulation results in the release of anti-inflammatory Interleukin 6 (IL-6), which helps reduce inflammation.

RESTORE MOVEMENT: Injured joints quickly become stiff from pain and swelling. Muscles often “splint” in response to pain as a way to protect a deeper ligament or joint-related injury. Both factors can lead a patient to unnecessarily restrict their movement, weakening that area of the body, and increasing the risk of further injury down the road.         

REDUCE SCAR TISSUE: As injured tissue heals, the body’s “Band-Aid” is actually scar tissue that is made up of similar cells as the surrounding tissue but is laid down quickly and in an unorganized way. Scar tissue reduces the ability for the injured tissue to stretch and can lead to tissue shortening. If it is performed early enough, Chiropractic adjustments help to stretch out and—in a sense—break up the scar tissue.

RELIEVE LOCALIZED PAIN: Many studies report spinal manipulation (SM) to be a safe, fast, and effective way to reduce pain. As a result, SM is now strongly recommended in treatment guidelines published throughout the world.          

REDUCE WIDESPREAD PAIN: Some WAD-injured patients develop pain not just in the neck or back but more widespread throughout their body. This is thought to be caused by “sensitization” of parts of our nervous system. Spinal adjustments have been shown to stimulate the nervous system in such a way as to reduce this hypersensitized effect.       

REDUCE STRESS & CHRONIC PAIN: Due to initial high pain intensity, stress and anxiety levels often soar following a WAD injury. Chiropractic care includes patient education, exercise, nutrition, and more to help patients cope with ongoing problems. The importance of EARLY INTERVENTION cannot be overemphasized in quest of preventing chronic, long-term pain and disability.

 

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 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.

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.