Pain Relief Chiropractic

Whiplash, or better termed “Whiplash Associated Disorders” (WAD), is a condition that carries multiple signs and symptoms ranging from neck pain and stiffness to headache, confusion, ringing in the ears, and more. But can WAD cause dizziness? Let’s take a look!

Dizziness is a general term that is used rather loosely by the general population. We’ve all experienced dizziness from time-to-time that is considered “normal,” such as standing up too quickly or while experiencing a rough flight.

Often, dizziness and problems with balance go hand in hand. There are three main organs that control our balance: 1) the vestibular system (the inner ear); 2) the cerebellum (lies in the back of the head); and, 3) the dorsal columns (located in the back part of the spinal cord). In this article, we will primarily focus on the inner ear because, of the three, it’s unique for causing dizziness. Our vision also plays an important role in maintaining balance, as we tend to lose our balance much faster when we close our eyes.

It’s appropriate to first discuss the transient, usually short episode of “normal” lightheadedness associated with rising quickly. This is typically caused by a momentary drop in blood pressure, and hence, oxygen simply doesn’t reach the brain quick enough when moving from sitting to standing. Again, this is normal and termed “orthostatic hypotension” (OH).

However, OH can be exaggerated by colds, the flu, allergy flairups, when hyperventilating, or at times of increased stress or anxiety. OH is also associated with the use of tobacco, alcohol, and/or some medications. Bleeding can represent a more serious cause of OH such as with bleeding ulcers or some types of colitis, and less seriously, with menstruation.

The term BPPV or benign paroxysmal positional vertigo, has to do with the inner ear where our semicircular canals are located. The canals lie in three planes and give us a 3D, 360º perspective about where we are in space. The fluid flowing through these canals bends little hairlike projections, which are connected to sensory nerves that tell the brain about our spatial position. If the function of these canals is disturbed, it can mixup the messages the brain receives, thus resulting in dizziness. Exercises are available on the Internet that can help with BPPV (look for
Epley’s and BrandtDaroff exercises).

DANGEROUS causes of dizziness include: HEART – fainting (passing out) accompanied by chest pain, shortness of breath, nausea, pain or pressure in the back, neck, jaw, upper belly, or in one or both arms, sudden weakness, and/or a fast or irregular heartbeat. STROKE – sudden numbness, paralysis, or weakness in the face, arm, or leg, especially if only on one side of the body; drooling, slurred speech, short “black outs,” sudden visual changes, confusion/difficulty speaking, and/or a sudden and severe, “out of the ordinary” headache. CALL 911 (or the number for emergency services if you’re outside the United States) if you suspect you may be having a heart attack or stroke!

First, what is whiplash? It’s a lot of things, which is why the term WAD or Whiplash Associated Disorders has become the most common term for the main signs and symptoms associated with a whiplash injury. WAD is usually associated with a motor vehicle collision, but sports injuries, diving accidents, and falls are other common ways to sustain a WAD injury.

To answer the question of the month, in most cases, the recovery rate is high and favors those who resume their normal daily activities. The worse thing you can do when you sustain a WAD injury is to not do anything! Too much rest and inactivity leads to long-term disability. Of course, this must be balanced with the degree of injury, but even when the injury requires some “down time,” stay as active as possible during the healing phase.

Many people recover within a few days or weeks while a smaller percentage require months and about 10% may only partially recover. So what can be done to give you the best possible chance to fully recover as soon as possible?

During recovery, you can expect your condition to fluctuate in intensity so “listen” to your body, let it “guide” you during activity and exercise, and stay within “a reasonable boundary of pain” during your activity. Remember, your best chance for full recovery FAVORS continuing a normal lifestyle. Make reasonable modifications so you can work, socialize, and do your “normal” activities!

The KEY: Stay in control of your condition – DO NOT let it control you! Here are some tips:

• POSTURE CONTROL: Keep the weight of the head back by gliding your chin back until you “hit” a firm end-point. Then release it slightly so it’s comfortable—this is your NEW head position!
• FLEXIBILITY: Try this range of motion (ROM) exercise… Slowly flex your neck forwards and then backwards, then bend your neck to the left and then the right, and then rotate it to the left and to then to the right. THINK about each motion and avoid sharp, knife-like pain; a “good-hurt” is okay! Next, do the same thing with light (one-finger) resistance in BOTH directions. Try three slow reps four to six times a day!
• MUSCLE STRENGTH: Try pushing your head gently into your hand in the six directions listed above to provide a little resistance. Next, reach back with both hands or wrap a towel around your neck and pull forwards on the towel while you push the middle of your neck backwards into the towel doing the chin-tuck/glide maneuver (same as #1). Repeat three to five times slowly pushing, and more importantly, release the push slower! This is the MOST IMPORTANT of the strengthening exercises in most cases! Next, “squeeze” your shoulder blades together followed by spreading them as far apart as possible (repeat three to five times).
• PERIODIC BREAKS: Set a timer to remind yourself to do a stretch, get up and move, to tuck your chin inwards (#1) and do some of #2 and #3 every 30-60 minutes.
• LIFTING/CARRYING/WORK: Be SMART! Do not re-injure yourself. Change the way you handle yourself in your job, in the house, and while performing recreational activities.
• HOUSEHOLD ACTIVITIES: Use a dolly to move boxes and keep commonly used items within easy reach (not too high or low).

Be smart, stay educated, work within the range your body tells you is “safe” and most importantly, STAY IN CONTROL!!!

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs. If you, a friend, or family member requires care for Whiplash, we would be honored to render our services.

YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR WHIPLASH!

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

There is certainly a lot of interest in concussion these days between big screen movies, football, and other sports-related injuries. Concussion, traumatic brain injury (TBI), and mild traumatic brain injury (mTBI) are often used interchangeably. Though mTBI is NOT the first thing we think about in a low-speed motor vehicle collision (MVC), it does happen. So how often do MVC-related TBIs occur, how does one know they have it, and is it usually permanent or long lasting?

Here are some interesting statistics: 1) The incidence rate of fatal and hospitalized TBI in 1994 was estimated to be 91/100,000 (~1%); 2) Each year in the United States, for every person who dies from a brain injury, five are admitted to hospitals and an additional 26 seek treatment for TBI; 3) About 80% of TBIs are considered mild (mTBI); 4) Many mTBIs result from MVCs, but little is known or reported about the crash characteristics. 5) The majority (about 80%) of mTBI improve within three months, while 20% have symptoms for more than six months that can include memory issues, depression, and cognitive difficulty (formulating thought and staying on task). Long-term, unresolved TBI is often referred to as “post-concussive syndrome.”

In one study, researchers followed car crash victims who were admitted into the hospital and found 37.7% were diagnosed with TBI, of which the majority (79%) were defined as minor by a tool called Maximum Abbreviated Injury Scale (MAIS) with a score of one or two (out of a possible six) for head injuries. In contrast to more severe TBIs, mild TBIs occur more often in women, younger drivers, and those who were wearing seatbelts at the time of the crash. Mild TBI is also more prevalent in frontal vs. lateral (“T-bone”) crashes.

As stated previously, we don’t think about our brains being injured in a car crash as much as we do other areas of our body that may be injured—like the neck. In fact, MOST patients only talk about their pain, and their doctor of chiropractic has to specifically ask them about their brain-related symptoms.

How do you know if you have mTBI? An instrument called the Traumatic Brain Injury Questionnaire can be helpful as a screen and can be repeated to monitor improvement. Why does mTBI persist in the “unlucky” 20%? Advanced imaging has come a long way in helping show nerve damage associated with TBI such as DTI (diffuse tensor imaging), but it’s not quite yet readily available. Functional MRI (fMRI) and a type of PET scanning (FDG-PET) help as well, but brain profusion SPECT, which measures the blood flow within the brain and activity patterns at this time, seems the most sensitive.

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs. If you, a friend, or family member requires care for Whiplash, we would be honored to render our services.

YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR WHIPLASH! FOR A FREE NO-OBLIGATION CONSULTATION CALL 717-697-1888

Last month, we looked at the VERY important deep neck flexor muscles. As promised, this month, we will cover exercises to work the deep neck extensors.

Since the 1990s, the deep neck flexors have been getting most of the attention as being the “missing link” in rehab of the neck after whiplash. As important as the deep neck flexors are, the deep neck extensors cannot be ignored. In fact, BOTH the deep neck flexors and extensors have to work in concert to control segmental movement! A 2013 study reported the deep neck extensors can become quite de-conditioned and weak in patients with neck pain. Recent studies confirm that neck pain patients typically display reduced activation AND a less defined activation pattern in the deep neck extensors, and the amount of weakness and poor activation is proportional to the amount of pain present (i.e., the higher the pain level, the worse the activity response).

PROCEDURE 3 (Prone Neck Extensors): Lying on your stomach, arms at your sides, palms facing outwards, tuck in the chin without looking down. Lift you head and chest off the floor and hold the position for ten seconds or as long as can be tolerated. Remember, stay within “reasonable boundaries of pain” (that only YOU can define) and gradually add repetitions over time.

PROCEDURE 4 (Neck Extensor Isometrics): Sitting or standing, tuck in your chin without looking down. Extend the head back slightly and place one hand behind the head. Slowly push the head back into your fingers at about 10% of maximum force and gradually use a greater amount of force over time. Once you feel you have good motor control and are tolerating the exercise well, vary the amount of resistance from 10% to 90%, gradually increasing then decreasing the resistance SLOWLY (crescendo and decrescendo the resistance)!

PROCEDURE 5 (Neck Extensor Isotonics): Same as above but this time the head moves while applying a steady light (10-25% of max.) resistance from full extension into full flexion. Repeat this for three to five slow repetitions through the full range. Keep your chin tucked while moving the head into your hand. The object is to SMOOTHLY move your head into and out of flexion/extension SLOWLY through as much of the range as possible (remember you define the pain boundaries)!

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs. If you, a friend, or family member requires care for Whiplash, we would be honored to render our services.

YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR WHIPLASH!

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

Whiplash, or “Whiplash Associated Disorders” (WAD), results from a sudden jarring motion, often from a car crash that occurs too fast for someone to voluntarily “brace” themselves. This is because the whole “whiplash cycle” is over within 300msec, and we cannot contract a muscle faster than 700-800 msec. Other injury factors include: the type and angle of the crash, the size of the involved vehicles, the speed, the absorption of the crash by crushing metal (or lack thereof), the size of the person (and gender), angle of the seat back and it’s “stiffness,” the position of the head rest, and the slipperiness of the road. ALL these factors (and more) help determine whether an injury occurs as well as the degree of injury!

There is so much published about neck pain resulting from whiplash that it’s confusing (to say the least) about which exercises are best for the whiplash patient. Rather, each patient needs to be assessed and managed based on their unique situation.

In regards to neck pain, an exercise program must have three goals: Stretching, Strengthening, and Stabilizing. All three goals work towards a common purpose: To restore function. Initially, when pain factors are high, patients perform active movement within reasonable pain boundaries to improve their cervical range of motion. Once movement is fairly well tolerated, it’s time to focus on strengthening exercises.

There are certain muscles that can “hide” behind larger, stronger muscles and are more difficult to isolate, and therefore, very often remain weak — even sometimes in spite of strengthening exercises. One VERY important muscle group is called the deep neck flexors, which “hide behind” the stronger, more superficial neck flexing muscle called the sternocleidomastoid (SCM). To “trick” the SCM into NOT contracting (so we can engage and exercise the deep neck flexors), we drop the chin to the chest without flexing the head forwards (like the downward motion when nodding “yes”). Try it! You should feel “the pull” or a stretch in the muscles in the back of your neck. This is referred to as “craniocervical flexion” but we’ll call it a “chin tuck.”

PROCEDURE 1: Perform the above “chin tuck” by lying on your back, chin tuck, and press your neck down into the bench or floor, hold for three-to-five seconds and then release the chin tuck SLOWLY (two times slower than the initial downward movement). If you can’t get your neck to flatten out, repeat this with a small rolled up towel placed behind the neck. Start with three-to-five repetitions and gradually increase the reps and sets. To make this more “portable” so you can do this during the day, see Procedure 2.

PROCEDURE 2: In a seated or standing position, place your finger tips behind your neck and push your neck into your fingers gradually increasing the pressure as you apply the “chin tuck.” Do this slowly, applying gradual pressure INTO your finger tips and then (MOST IMPORTANTLY), release the pressure SLOWLY (again, two times slower than the initial “push”). Repeat three-to-five times for one session and do multiple sessions during the day. SET THE TIMER on your cell phone for two or three hrs to REMIND you to do these multiple times a day!

Next month, we will address the deep neck extensors, as well as other deep muscles!

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs. If you, a friend, or family member requires care for Whiplash, we would be honored to render our services.

YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR WHIPLASH! FOR A FREE NO-OBLIGATION CONSULTATION CALL 717-697-1888

Whiplash, or “Whiplash Associated Disorders” or WAD, is the result of a sudden “crack the whip” of the head on the neck due to a slip and fall, sports injury, a violent act, or most commonly, a motor vehicle collision (MVC), particularly a rear-end collision. In describing “what can I expect” after a whiplash injury, one thing is for certain, there are many faces of whiplash, meaning the degree of injury can range from none to catastrophic depending on many factors, some of which are difficult or impossible to identify or calculate. Let’s take a closer look!

Even though the good news is that most people injured in a car crash get better, 10% do not and go on to have chronic pain, of which about half have significant difficulty working and/or doing desired everyday activities. There is a “great debate” as to the way experts describe “chronic whiplash syndrome” (CWS) as well as how these cases should be managed. Some feel there is something PHYSICALLY wrong in the CWS patient, especially if severe neck or head pain persists for more than one year. There is some proof of this as Dr. Nikolai Bogduk from the University of Newcastle in Australia and colleagues have used selective nerve blocks to anesthetize specific joints in the neck to determine exactly where the pain is generated. The patient then has the option to have that nerve cauterized or burned and pain relief can be significant in many cases. Dr. Bogduk and his group admit that these CWS patients have more psychological symptoms, but they feel this is the result of pain, not the CAUSE.

On the other hand, experts such as Dr. Henry Berry from the University of Toronto report the EXACT OPPOSITE. He argues that it’s not JUST the physical injury that has to be dealt with but also the person’s “state of mind.” Dr. Berry states that when stepping back and looking at all the complaints or symptoms from a distance, “…you see these symptoms can be caused by life stress, the illness ‘role’ as a way of adjusting to life, psychiatric disorders, or even [made up by the patient].” Berry contends that it’s important to tell the patient their pain will go away soon, advises NO MORE THAN two weeks of physical therapy, and sends people back to work ASAP.

Oregon Health Sciences University School of Medicine’s Dr. Michael D. Freeman, whose expertise lay in epidemiology and forensic science, disagrees with Dr. Berry stating that the scientific literature clearly supports the physical injury concept and states, “…the idea that it is a psychological disturbance is a myth that has been perpetuated with absolutely no scientific basis at all.” Dr. Freeman states that 45% of people with chronic neck pain were injured in a motor vehicle crash (which includes three million of the six million of those injured in car crashes every year in the United States).

Here’s the “take home” to consider: 1) CWS occurs in about 10% of rear-end collisions; 2) Some doctors feel the pain is physically generated from specific nerves inside the neck joints; 3) Others argue it’s a combination of psychological factors and care should focus on preventing sufferers from becoming chronic patients.

Many studies report that chiropractic offers fast, cost-effective benefits for whiplash-injured patients with faster return to work times and higher levels of patient satisfaction.

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs. If you, a friend, or family member requires care for Whiplash, we would be honored to render our services.

YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR WHIPLASH! FOR A FREE NO-OBLIGATION CONSULTATION CALL 717-697-1888