Pain Relief Chiropractic

Whiplash Associated Disorders (WAD) is the appropriate terminology to use when addressing the myriad of symptoms that can occur as a result of a motor vehicle collision (MVC). In a recent publication in The Physician and Sportsmedicine (Volume 43, Issue 3, 2015; 7/3/15 online:1-11), the article “The role of the cervical spine in post-concussive syndrome” takes a look at the neck when it’s injured in a car accident and how this relates to concussion.

It’s estimated about 3.8 million concussion injuries, also referred to as “mild traumatic brain injury” (mTBI), occur each year in the United States. Ironically, it’s one of the least understood injuries in the sports medicine and neuroscience communities. The GOOD NEWS is that concussion symptoms resolve within 7-10 days in the majority of cases; unfortunately, this isn’t the case with 10-15% of patients. Symptoms can last weeks, months, or even years in this group for which the term “post-concussive syndrome” (PCS) is used (defined as three or more symptoms lasting for four weeks as defined by the ICD-10) or three months following a minor head injury (as defined by the Diagnostic and Statistical Manual of Mental Disorders).

There have been significant advances in understanding what takes place in the acute phase of mTBI, but unfortunately, there is no clear physiological explanation for the chronic phase. Studies show the range of force to the head needed to cause concussion is between 60-160g (“g” = gravity) with 96.1g representing the highest predictive value in a football injury, whereas as little as 4.5g of neck acceleration can cause mild strain injury to the neck. In spite of this difference, the signs and symptoms reported by those injured in low-speed MVCs vs. football collisions are strikingly similar!

Research shows if an individual sustains an injury where the head is accelerated between 60-160g, it is HIGHLY likely that the tissues of the cervical spine (neck) have also reached their injury threshold of 4.5g. In a study that looked at hockey players, those who sustained a concussion also had WAD / neck injuries indicating that these injuries occur concurrently. Injuries to the neck in WAD include the same symptoms that occur in concussion including headache, dizziness/balance loss, nausea, visual and auditory problems, and cognitive dysfunction, just to name a few.

The paper concludes with five cases of PCS that responded well to a combination of active exercise/rehabilitation AND passive manual therapy (cervical spine manipulation). The favorable outcome supports the concept that the neck injury portion of WAD is a very important aspect to consider when treating patients with PCS!

This “link” between neck injury and concussion explains why chiropractic care is essential in the treatment of the concussion patient! This is especially true when the symptoms of concussion persist longer than one month!

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 perhaps most accurately, “whiplash associated disorders” (WAD) – is a term that is applied to the MANY different types of injuries that can occur at the time of an automobile collision.

The cervical spine includes bony structures, ligaments (that hold bones tightly together), tendons (that attach muscles to bones), nerves (that allow us to feel and provides muscle strength), disks (that serve as shock absorbers between our vertebra), and other connective tissues that can be injured depending on MANY factors! The brain can also be injured (i.e., concussion) in a crash WITHOUT the head hitting anything! Individuals in car accidents can also experience seat belt-related injuries to the shoulder, chest, abdomen, mid-back, and/or low-back, as well as the extremities.

There are many factors that can increase your risk of injury including the size of the two vehicles (worse when a large vehicles strikes a smaller vehicle), the direction of the collision, the position of the head upon impact (worse if rotated), the size of the neck (females are at greater risk), the angle and springiness of the seat back, the position of the head rest (too low is common), and the amount of vehicular damage (or lack thereof).

The latter is the surprising part! You may have noticed when a racecar crashes, it’s made to literally break apart until the only remaining piece is the cage that holds the driver. The reason for this is when a crash occurs, the energy of the impact (or “G-force”) is absorbed by crushing metal or breaking away parts. If the vehicle is ‘built like a tank’ and no metal crushes or parts break off, the energy is transferred to the contents inside the vehicle – namely the driver and occupants!

Hence, the concept of “no vehicular damage means no injury” is actually quite the opposite! When low-speed collisions occur, there is no energy absorption by the crushing of metal or breaking away of parts. Hence, there’s a greater chance of injury at low speeds when little-to-no damage occurs to the target vehicle!

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) is a commonly used term for an acceleration-deceleration force applied to the neck often occurring in car crashes but may arise from a slip and fall, a diving accident, or other traumatic injury. The net result is an injury to muscles, ligaments, joints, and/or nerves in the cervical spine or neck region and possibly a concussion.

This month’s article is intended to spotlight self-help strategies that YOU can do to help manage this afflicting condition. We HIGHLY recommend downloading “Whiplash Injury Recovery: A self-management guide” as it covers very important information in the 24 page PDF: (go to: http://bit.ly/WHIPLASHGUIDE ). It is authored by Professor Gwendolen Jull, the director of The Cervical Spine and Whiplash Research Unit, Division of Physiotherapy, at The University of Queensland. In her “message from the author,” she writes the following:

“This booklet aims to assist persons who have had a whiplash injury on the road to recovery. It provides information about whiplash-associated disorders, an explanation of whiplash, and exercise program which has been proven to assist in reducing neck pain and advice on how to manage your neck to prevent unnecessary strain and to assist recovery. The booklet is a self-help resource to aid recovery and to supplement any care being provided by a health care practitioner.”

In the table of contents, you will see whiplash defined, recovery information, and “helping yourself” topics followed by posture correction, proper sitting positions, lifting, carrying, and work instructions, as well as how to go about household activities. This 24-page guide concludes with exercise instructions followed by formal exercises, how often you should do them, and things to remember.

Here are some highlights: 1) Most people recover from a whiplash injury at different rates; 2) Recovery ranges from days to months and occasionally one to two years – the majority recover fully; 3) Research supports trying to continue with your normal daily activities – modify as needed and gradually return to normal work, recreation, and social activities; 4) Be adaptive – make modifications to avoid flair-ups; 5) Some activities hurt, but that doesn’t automatically mean further injury. If you recover quickly, make modifications as necessary but continue the activity; 6) You are your BEST resource in the recovery process (stay motivated to fully recover); 7) Stay active. Try to do as many of your normal activities as possible and gradually increase the intensity, frequency, and duration until normal function is returned; 8) Try to keep working – work with your employer and co-workers so you can stay on the job; 9) Don’t skip simple pleasures – enjoy time with family and friends, participate in social outings, begin or rediscover a new hobby; 10) Work with healthcare providers (like your doctor of chiropractic) to gradually introduce and increase exercises to regain motion, strengthen weak muscles, and improve function; 11) Be aware of your posture; 12) Modify activities to reduce strain during work and recreation; 13) Be more active / less sedentary to PREVENT neck pain; 14) Take breaks and change body positions throughout the workday; 15) Arrange your workstation/desk (monitor position, keyboard / mouse and chair “set-up”) to be more ergonomic; 16) Think about how you are sitting; 17) Act as usual, be active, be aware (posture, taking breaks, etc.); 18) DO YOUR EXERCISES (modify according to comfort); 19) Follow the instructions during exercise training (avoid sharp/knife-like pain); and 20) Communicate with your healthcare provider when questions arise! Please take the time to download the PDF.

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.

Whiplash (or WAD – whiplash associated disorders) can be defined by a sudden movement of the head and neck beyond its normal range of motion resulting in pain and stiffness and less often, numbness and tingling in the arms and hands. Prognosis is a term associated with a predicted outcome of a condition with the passage of time, either with or without treatment. A condition is considered “stable” when symptoms aren’t changing and are not likely to change significantly over the next several months to a year. In general, recovery may depend on the severity of the injury. Usually, minor whiplash injuries will resolve completely within approximately one to two weeks, moderate whiplash injuries within approximately four to eight weeks, and severe whiplash may or may not completely “resolve.” Rather, severe whiplash may result in a chronic condition which may lead to a permanent reduction or a complete loss of certain functions. There are “risk factors” that can result in either a prolonged recovery or just a partial recovery, regardless of the degree of injury which makes the process of prognosing whiplash cases challenging. Let’s take a closer look!

There have been many published studies that have looked at the long-term prognosis of whiplash injuries using different approaches. For example, one study reported that reduced cervical range of motion was able to predict those less likely to fully recover after one year.

Another study broke down acute whiplash patients into seven risk levels using one-year work disability (total number of days missed from work) as the main outcome measure. The age of injured subjects ranged from 18-70 years and injuries varied between WAD 1 to 3 (WAD 1 = Pain but no loss of motion, primarily soreness; WAD 2: Loss of motion and muscle tightness/pain; WAD 3: Same as WAD 2 but WITH neurological problems like numbness &/or weakness in the arms due to nerve injury). The study evaluated a total of 483 women and 250 men within ten days of their motor vehicle collision (MVC). At the end of one year, a total of 605 participants completed the study and were given a “RISK SCORE” which included: a) initial neck pain/headache intensity; b) the number of non-painful complaints; and c) active cervical range of motion. When researchers compared the patients’ RISK SCORE at the one-year mark to their work disability (number of sick days), they found a direct correlation between lower scores and lower work disability and higher scores and greater work disability. They concluded that this could be a valuable tool to assess a patient’s ability to return to work following WAD injuries.

It’s worth noting that many studies have found no association between the amount of damage to the vehicle and the patient’s risk for a poor outcome.

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.

Last month, we covered the importance of your car seat’s head restraint for preventing whiplash. This month, let’s discuss additional measures one can take…

AIRBAGS: In addition to a correctly positioned head restraint, having a vehicle that is equipped with airbags has been described as “essential in the prevention of injuries and/or death,” especially in frontal or head-on collisions. Airbags are inflatable devices that fill up in a fraction of a second during a serious motor vehicle collision (MVC). Depending on the year, make, and model of your vehicle, airbags are located in the front of the steering column, by the glove compartment on the passenger side, and possibly in the doors and/or in the column between the doors. These offer additional protection that seatbelts alone cannot provide and can prevent the head and chest from striking the steering wheel, dashboard, or the door in the case of side-impact airbags. The front airbags typically do not deploy in rear or side impact collisions whereas the side airbags will deploy in side impacts and rollovers, thus providing protection between the occupants and doors, side windows, and roof. In order to maximize your protection from injury in a front-end collision, make sure you do the following each time you get into your vehicle: 1) always wear both your lap and shoulder seat belts as airbags are designed to work WITH the lap/shoulder belt system; 2) maintain a safe distance between you and the driver’s side airbag of at least 10 inches / 25 centimeters (if you’re too close, you risk making contact with the airbag as it inflates which can cause abrasions and bruising); 3) position the steering wheel towards your chest (not your head or neck); 4) move the passenger seat back as far as possible because of the greater distance/larger airbag that exists between the passenger and dashboard; 5) make sure passengers avoid putting their feet up on the dash or placing any objects between their body and the dashboard.

SEAT BELTS: It has been estimated that in Canada alone, if all drivers and passengers wore their seat belts, 300 road fatalities could be avoided each year! Seat belts have always been considered the BEST way to protect against injury or death in a car crash. These typically cross the lap and chest and prevent the occupant from being ejected or thrown about inside the vehicle in an accident. Here are some important points to remember: 1) wear a lap/shoulder belt system whenever possible; 2) sit up straight, positioning the lap belt low over the pelvic bones/hips, NOT over the stomach; 3) place the shoulder harness over the shoulder, across the chest, and NEVER place the belt under the arm or behind the back; 4) all occupants must wear a seat belt regardless if the vehicle is moving or not; and 5) a pregnant occupant should place the lap belt over the pelvic bones below the baby, not over or above the stomach/baby.

 ANTI-LOCK BRAKE SYSTEMS (ABS): Here, electronic controls stop your wheels from locking up when the brake pedal is forcibly pressed to help the driver maintain control on rough, wet, and slippery surfaces. This helps prevent skidding and can result in a shorter stopping distance.  An ABS can also help drivers more safely steer around what they’re heading towards while allowing for maximum braking pressure. Tips include: 1) HOLD / DON’T PUMP the brake pedal firmly; 2) keep steering around objects while fully braking; 3) DO NOT expect the braking distance to be shorter; 4) have the ABS inspected at the recommended number of miles noted in your vehicle’s manual; and 5) MOST IMPORTANT, stay a safe distance behind the vehicle ahead of you – NO TAILGAITING!

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.

Whiplash injuries commonly result from motor vehicle collisions (MVC) and are caused by a sudden jolt that initiates a startle response that has been found to tighten the muscles deep inside the neck, which has been reported to increase the risk of injury to the joints and structures of the cervical spine. The amount of physical injury to the person is highly variable depending on many factors that include, but are not limited to, the size of the involved vehicles, speed at impact, amount of energy absorbed by crushing metal (especially the lack thereof), a slender female neck vs. shorter muscular male neck, the stiffness and angle of the seat back, the direction of the impact, head position (rotation is worse vs. straight), headrest position, and more. A cervical sprain/strain is commonly diagnosed in MVCs and these tend to resolve with chiropractic care, often without complications. However, this is not always the case. What factors are involved that result in one case improving and/or resolving but not another, especially when everything seems identical (or at least similar)? What does post-traumatic stress disorder (PTSD) have to do with MVCs? Is this a factor triggering a prolonged recover? Is PTSD commonly associated with whiplash injuries?

In a group of 112 PTSD whiplash patients, researchers examined the role of pain as well as pain-related psychological variables. Participants completed various questionnaires at three different time points after admission into a standardized multidisciplinary rehabilitation program. The findings revealed consistency with other studies showing injury severity indicators including high pain levels, reduced function / disability, and more severe scores on pain-related psychological variables in those suffering from PTSD following a whiplash injury. However, contrary to expectations, pain severity did NOT contribute to the persistence of PTSD. Rather, the most significant variables were self-reported disability, catastrophizing, and perceived injustice. These results suggest that early intervention that focuses on pain management and disability following whiplash might reduce the severity of PTSD but not the persistence of it. Rather, interventions that focus on resolving perceptions of injustice appear to be most important for helping patients recover from PTSD.

Similarly, another study looked at the factors that result in the best treatment outcome for patients involved in motor vehicle collisions (MVCs) with the subsequent onset of PTSD. Here, researchers carried out a review of prior studies to identify the risk factors associated with a prolonged recovery and a treatment strategy proposed to resolve the PTSD. They reported that at least 25% of study participants who sustained a physical injury developed PTSD and that the prevalence is most likely even higher in those who developed chronic whiplash.

Looking at what factors of PTSD are the most accurate predictors of duration and severity of PTSD, another study investigated the relationship between PTSD symptoms of avoidance, re-experience, and hyperarousal and their role in interfering with the resolution, the severity and duration of neck complaints following MVCs. Questionnaires were sent to 240 MVC injured patients that had initiated compensation claims with a Dutch insurance company and were evaluated three times – initially, at six months, and again at twelve months. They found that the hyperarousal symptoms of PTSD initially had predictive validity for persistence and severity of post-whiplash syndrome at six and twelve months. They concluded that the hyperarousal symptoms of PTSD had the greatest detrimental effect on the severity and recovery of PTSD and focusing treatment at that was most important.

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.