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Can Neck-Specific Exercise Reduce Chronic Whiplash Symptoms?

21 Jan

Did you know that an alarming 90% of neurologically injured whiplash patients DO NOT recover and have neck muscle dysfunction even up to a year after the date of their motor vehicle collision?

There is suspicion among researchers that such ongoing issues are the result of the body’s initial response to injury to the brachial plexus, the network of intersecting nerves that give rise to three main nerves that travel down the arm to the hand. To protect and ease tension on the brachial plexus, the superficial muscles to the side of the injury can become more active and take on the classic “shrugged” position, a posture commonly observed in patients with nerve damage associated with a whiplash associated disorder (WAD) injury.

Over time, this protective mechanism can weaken the deep neck muscles, which are important for maintaining proper vertebral alignment and posture. This may, in turn, result in secondary injury and the long-term problems observed in many WAD patients, even after the initial injury to the brachial plexus has resolved.

In a recent multi-center, randomized controlled trial involving 171 chronic WAD patients with radiating arm pain and associated signs of neurological deficit, researchers found that participants who performed neck-specific exercises for twelve weeks to strengthen the deep neck muscles reported improvements in overall pain, arm pain specifically, and pain frequency, with some neurological recovery. Participants who were instructed to engage in general/non-specific physical activity during the study did not report such improvements.

Two of the authors from the above study collaborated on a similar experiment and found that patients who engaged in neck-specific exercises not only experienced improvements in muscle strength and pain reduction, but they were more satisfied with the approach than participants in a general exercise group.

These studies show that when the deep muscles become the specific focus of neck exercises, the results are superior, AND this includes neurological recovery. Your doctor of chiropractic can help train you in these specific exercise approaches!

 

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 Can Even Happen in Low-Speed Collisions

17 Dec

Though whiplash injuries can arise from any sudden jar, like a slip and fall or sports injury, they are most commonly associated with motor vehicle collisions (MVCs), even those that occur at low speeds. To best understand how someone can become injured in cases where little to no vehicular damage has occurred, we need to discuss elastic and plastic deformity, as well as the various characteristics involved in MVCs.

When you hear the term “plastic,” think breaking apart or crumbling.  In a car crash, crushing metal absorbs energy. That’s an example of plastic deformity. The greater the damage, the more energy is absorbed by the crushing metal and LESS energy is transferred to the occupants (until a certain speed is reached).

In elastic deformity, little to no damage occurs, and most, if not all, of the energy passes onward. In the context of an automobile collision, a low-speed impact may not crumple the bumper or damage the rear structure of the car, and the force of the impact will continue on to the contents of the vehicle—which includes the driver and their passengers!

There are several variables that exist in car crashes that can also affect the degree of injury, such as the size of the vehicles involved, the angle of impact, the design of the vehicle, the position of the headrest, the angle of the seat, and the vehicle’s safety equipment (seat belt; air bag quantity, location, and design; breakaway seats; automated head rests; and more).

If you have a child, be sure to properly install their infant or booster seat. This includes positioning the seat on the right side of the car. The following guide from the National Highway Traffic Safety Administration can help: https://www.nhtsa.gov/equipment/car-seats-and-booster-seats

Though in most cases, the whiplash process can occur much faster than we can voluntarily brace for it, if you do see an impending collision, you may be able to reduce your risk of injury by looking forward as opposed to having your head turned at the moment of impact.

Should you experience a whiplash injury, the current research supports chiropractic care as an appropriate treatment option for reducing both 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.

A Brief Overview of Whiplash

22 Nov

Whiplash is a non-medical term that represents a large range of injuries to the neck caused by or related to a rapid, sudden movement of the neck often to and beyond the end-ranges of motion that results in injury to soft tissues and sometimes bony tissues in the neck. Cervical acceleration-deceleration (CAD) describes the mechanism of injury while whiplash associated disorders (WAD) describes the signs and symptoms of an anatomical injury.

Aside from injuries in the neck, shoulders, and back, WAD can include trauma to the brain caused the organ impacting the front and back of the inside of the skull (referred to as a coup-contra-coup injury) during the hyperextension followed by hyperflexion phases of the CAD injury. The result is a traumatic brain injury (TBI), which is commonly referred to as a concussion. Symptoms associated with TBI include forgetfulness, short-term memory loss, and “mental fog”.

One explanation for the resulting signs and symptoms associated with WAD injuries is the fact that it takes longer to voluntarily contract a muscle (about 1,000 milliseconds) vs. the time from start to finish of the whiplash process (about 300-500 ms). At about 100 ms after impact, the vehicle is accelerated forward and the seatback pushes into the spine or torso, propelling it away from the direction of the collision while the head stays stationary (due to inertia).

At 150-300 ms, the torso can “ramp up” due to the reclined angle of the seatback. Depending on the headrest position and type, the head can hyperextend over the headrest. The amount of rebound is partially affected by the “springiness” of the seatback and the amount of vehicular damage (or lack thereof), since crushing metal absorbs energy. Thus, injury can occur even when the vehicle receives little to no car due to the energy of the impact being transferred to the contents of the vehicle—including its occupants.

The whole whiplash process is over well before one can contract muscles in preparation to a crash, so it’s virtually impossible to avoid injury.

Research shows that WAD patients can experience better outcomes if they seek prompt treatment focused on restoring motion to the affected areas. Time and time again, chiropractic care has been demonstrated to not only help WAD patients get out of pain and return to their normal activities but it also achieves high scores regarding patient satisfaction.

 

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 Management Options – Where Does Chiropractic Fit In?

25 Oct

Recent studies suggest that in a rear-end collision, the injuries collectively described as whiplash associated disorders (WAD) result from the simultaneous hyperextension of the lower cervical spine and hyperflexion of the upper cervical spine. This can lead to a variety of injuries to the bony and/or soft tissues of the neck, some of which may not manifest for hours, days, or even weeks following a car accident.

Traditionally, doctors have advised patients with an acute whiplash injury to limit movement, which may have included the use of a cervical collar. However, more recent studies have found that restricting motion in the neck can actually hinder recovery from WAD. Rather, new data suggests that early mobilization actually improves outcomes for WAD patients, reducing their risk for long-term disability.

The primary form of treatment utilized by doctors of chiropractic is spinal manipulation (SM), which is described as a high velocity, low amplitude (HVLA) thrust applied to specific joints in the neck, mid-back, low-back, pelvic regions as well as to extremity joints. Manipulation improves the mobility of the spinal facet joints, which allows for an increase in the global range of motion of the neck.

SM also breaks the vicious pain cycle where the inflow of sensory information to the brain is attenuated, thus reducing the reflex muscle spasm and accompanying pain. Additionally, there is substantial evidence that SM increases pain tolerance or thresholds by modulating central (brain) sensory processing (called central sensitization). There are also measurable neuro-endocrine benefits following SM as well as many other measurable “somato-visceral” reflex responses.

Chiropractic management of WAD injuries includes not only SM (both HVLA and non-thrust types), but also soft-tissue therapies, exercise training, the use of physiotherapy modalities (electric stim, ultrasound, laser or light therapy, and more), nutritional counseling, ergonomic/work modifications, and more. Doctors of chiropractic frequently co-manage WAD patients with other healthcare providers when it is appropriate.

 

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.

Concussion and Whiplash – Is There a Connection?

24 Sep

Whiplash or whiplash associated disorders (WAD) represent a constellation of symptoms that are very similar to those reported by patients who have sustained a concussion or minor-traumatic brain injury (mTBI). These shared symptoms include (but are not limited to): headache; neck pain; nausea/vomiting; dizziness; balance issues; vision problems; and difficulty concentrating. Chiropractic care focused on the cervical spine has been demonstrated to benefit patients with WAD. Is it possible that the same form of treatment can help the mTBI patient as well?

In the March 2015 issue of the journal The Physician and Sportsmedicine, researchers looked at case studies involving five patients with concussion symptoms that did not resolve within 30 days and had become chronic. The mechanism of injury in three of the cases was sport-related, while the other two stemmed from a slip and fall and a motor vehicle collision. Treatment focused on the cervical spine and included the use of either spinal manipulative therapy (SMT) or mobilization; active release technique (ART) to stretch tight neck muscles; and exercises aimed at strengthening the deep neck flexor muscles and/or other surrounding neck musculature.

  • Case 1: A 25-year-old professional mixed martial arts male injured from sparring presented four months after the injury. After three treatments, he reported a significant reduction in symptoms, with full resolution after eight treatments.
  • Case 2: A 59-year-old female who hit the back of her head on the ground after a fall presented with 31-month duration of symptoms that reportedly improved significantly within three months of twice-per-week treatments.
  • Case 3: A 19-year-old male junior hockey player presented two years after the initial injury and reportedly experienced an 80% improvement in his symptom after four treatments spread out over a three-week timeframe.
  • Case 4: A 19-year-old male injured in a car accident presented 14 weeks after the injury and reported a nearly 50% reduction in symptoms after one treatment and full resolution after eight treatments.
  • Case 5: A 51-year-old female hockey player who was struck on the left side of the head presented five weeks post-injury and reported a full resolution of symptoms after three treatments per week for six weeks.

The important point here is that treatment was aimed ONLY at the cervical spine, not the concussion, with excellent results in each case. These findings indicate the need for larger studies concerning the use of conservative chiropractic care for cases of mTBI that do not resolve within a month’s time.

 

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.

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.