Pain Relief Chiropractic

Whiplash is a common problem following motor vehicle collisions and because prevention is considered the best medicine, here are some tips to AVOID car crashes altogether …

Don’t eat, take your eyes off the road while talking, fiddle with the radio or iPod, talk on your cell phone, or text while driving! The National Safety Council estimates 1.6 million crashes are caused by cell phone use, and you’re four times more likely to have a crash while talking on a cell phone. In 2011, 23% of auto collisions involved cell phone use, and of those, 21% involving people between ages 16 and 19 were fatal. A good website to check out WITH YOUR CHILDREN is http://www.textinganddrivingsafety.com. Texting while driving results in a minimum of five seconds of eyes off the road, which is equal to the length of a football field if you’re traveling at 55 mph (~88 km per hour). While talking on the phone increases your crash risk by 30%, texting increases your risk 2,300%! About one in seven drivers between ages 16-20 involved in car wrecks admit to texting or talking on their mobile devices at the time of the crash, and 82% of Americans age 16-17 own cell phones. A third say they text while driving, 52% say they talk on a cell phone while driving, and 77% of young adults are very or somewhat confident that they can safely text while driving. About half of young drivers have seen their parents drive and talk on a cell phone, and 15% have seen them texting while driving. One in four adults have sent or received text messages while driving and half of kids age 12-17 have been in a car while the driver was texting. One in five drivers of ALL ages confess to surfing the web or texting while driving AND they “justify it” with excuses like “reading a text is safer than composing and sending one,” “the phone is held near the windshield for better visibility,” “I increase the following distance,” and “I text only at a stop sign or red light.”

So WHAT CAN BE DONE to change this behavior? Ten states in the United States prohibit ALL drivers from using handheld cell phones while driving and 32 states prohibit novice drivers from cell phone use. Thirty-nine states prohibit ALL drivers from text messaging. Parents can “DRIVECAM” their kids’ cars – a device that monitors a driver’s activity and provides real-time feedback with video. Use the AT&T “Drive Mode” app. It’s a FREE APP for Android & Blackberry that prohibits texting while driving. Teens and parents can also take the text-free-driving pledge at textinganddrivingsafety.com. Social media sites for anti-texting & driving awareness include Facebook & Twitter: @RayLaHood, @DistrationGov, @NHTSgov, @DriveSafely. Check out blogs such as FromReidsDad.Org, RookieDriver.wordpress.com, ctdrive.blogspot.com, and EndDD.org.

One Belgium-based project tricked teen drivers into thinking that in order to pass their driving test, they had to be able to successfully text and drive on a tight course. The results on You Tube are both funny AND frightening. Student reactions included: “If this becomes law, I’ll stop driving,” “It’s impossible,” “What you’re asking is dangerous,” “People will die,” and “Honestly, I feel like an idiot who can’t drive.”

Drive safely and enjoy a long, happy life!

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.

When discussing the topic of whiplash injury recovery, prompt assessment, treatment, education, reassurance, and advice can be VERY EFFECTIVE in helping the injured crash victim improve during the acute stage of the injury (first three months). But after three months, when the condition becomes more chronic, which interventions are the most beneficial? More specifically, what is the role of having a “positive outlook” on the outcome of care?

We can “classify” injuries associated with whiplash into three primary categories: Type I WAD (Whiplash Associated Disorders) – Soft tissue injury without range of motion loss; Type II WAD – Soft tissue injury with cervical or neck motion loss; and Type III WAD – The above PLUS neurological findings (numbness, tingling, and/or muscle weakness). Statistically, patients with Type I and II WAD generally have good treatment results with plans that include exercise and group therapy. At six months, 65% are able to return to work, 92% are able to return to work on at least a part-time basis, and 81% report that no further care is needed. Coordination exercises are also reported to be helpful and are recommended to be included in treatment plans.

In those with chronic WAD (more than three months of symptoms), patients with negative thoughts did worse than those who were not afraid to perform tasks and who were less emotional in stressful situations. Most importantly, negative thoughts and increased pain behavior can be IMPROVED using a structured treatment approach that includes education about the neurophysiology of pain and how to overcome the fear factor associated with chronic pain behavior. In fact, the MOST important predictor of persistent disability in patients with chronic WAD is how well the injured patient believes he/she CAN perform a task and their emotional reaction to stressful situations. So, how is this done?

As stated above, an improved knowledge about pain and how the nervous system is “wired” — from the tip of the finger hitting a hot stove to the central processing center in the brain — REALLY HELPS. When this process is understood, it reduces much of the “fear of the unknown” that chronic WAD patients experience. When you think about it, pain is actually a good thing, as it warns us when to slow down or stop AND tells us when it’s OK to continue with tasks or desired activities. It helps define boundaries within which we can SAFELY FUNCTION by forewarning us to SLOW DOWN or modify. Exercise and staying active are some of the most important factors for success in managing almost ALL musculoskeletal conditions, and knowing the difference between “safe” vs. “harm” when it comes to interpreting pain can result in a lower risk for chronic pain problems.

Once this “knowledge” is understood and appreciated, the injured whiplash patient literally “proves” to him/herself that they are in CONTROL of their condition and can begin to return towards more normal function. The success of this approach centers on introducing the WAD patient to a step-by-step activity re-integration process through structured exercises and careful guidance. For example, muscles can become weak and shrink within 24-48 hours of being inactive. After days, weeks, months, and/or years of modified or stopped activity, this kind of weakness becomes obvious and the whiplash patient may gradually become more and more afraid of performing an activity / exercise in fear that doing so could make the problem worse. This negative thought is a HUGE HURDLE to overcome but must be dwelt with systematically to gain success in returning to life’s required and desired ADLs. As chiropractors, we will guide you in this learning process. When needed, we often work with other healthcare professionals as a team to reach this goal. Remember, THE POWER OF POSITIVE THINKING can make or break a successful outcome – let us help you in this process!

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.

Many people seek chiropractic care for low back, mid-back, neck pain, and pain in the extremities, but what about balance and / or dizziness, as they often go together? Can chiropractic management help people suffereing from frequent falls due to balance and/or dizziness problems? Let’s take a look!

When considering treatment for balance, we must talk about the “proprioceptive system.” The way the body “communicates” between all the various body parts is by proprioceptors, which are located in skeletal muscles and joint capsules, and these relay information to the brain. This information from the various body parts is then integrated with incoming information from the vestibular system (inner ear). The brain also relies heavily on the cerebellum located in the back of the head, which is largely responsible for coordinating the unconscious (automatic) aspects of proprioception. The ability to maintain balance, such as when standing on one leg (eyes open and closed), is dependent on the ability for the ALL THREE of these systems to work properly, and like any other skill, “…practice makes perfect!” Please try standing on one leg and then shut your eyes. Can you feel your ankle, foot, leg, and the rest of your body struggle to keep you balanced? For those of us under age 60, it’s “normal” to be able to balance on one foot with eyes closed for 25 seconds (or 10 and 4 seconds if you are between 60-69 or, 70-79 years old, respectively)! Scary, isn’t it? But don’t feel bad, as most of us can’t do this at first. With practice and the right exercises, you will be able to do it. Your “kinesthetic sense” CAN BE improved, and we as chiropractors can guide you in the process. So, how does dizziness fit into this picture? Let’s talk about the ear!

Our ears have two jobs: hearing and balance. The outer ear catches sound and funnels it to the eardrum which vibrates and moves three little bones that transmit the information to the cochlea and finally to the brain allowing us to hear sound. Deep inside the ear is the “vestibular apparatus,” which is the organ of equilibrium that assists in balance. Here, three semi-circular canals are filled with fluid and two sac-like structures located at the base called the utricule and saccule. The fluid in the canals flows past little hair-like structures that are connected to nerves that relay information to the brain, telling it where we are in space (horizontal – laying down, vertical – standing) and if we’re moving forwards / accelerating or moving up/down (like in an elevator).

There are little tiny “stones” in these two sacs that move the little hair-like structures but they can dislodge into the canal and alter the flow of fluid (like a rock sticking out of a flowing river creating eddy currents), which alters the direction the little hairs bend, resulting in vertigo or dizziness as the brain is receiving conflicting information from the hairs bending in multiple/different directions. This is called “BPPV” (benign paroxysmal positional vertigo), which is brief episodes of vertigo immediately following a change in head position such as rolling over in bed, getting up from sitting or laying, etc. This is the most common cause of vertigo. If you Google “BPPV,” you will find different exercises that can move these little stones back into position (Brandt-Daroff and Epley’s maneuver), both of which work well often within a day or two. This is a good place to start, and if the balance/dizziness (vertigo) doesn’t improve, then we will consider other possibilities such as inner ear inflammation or acute vestibular neuritis, Meniere’s disease, vestibular migraine, acoustic neuroma, blood pressure issues, medication side effects, and more. We can teach you the BPPV exercises and perform cervical adjustments, which can also help significantly.

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, we would be honored to render our services.

Whiplash injuries are most commonly associated with motor vehicle collisions (MVC), although they can happen from anything that results in a sudden movement of the head — from slip and fall injuries, carnival rides, sports-related injuries, and more. When associated with MVCs, the terms “acceleration/deceleration injury” or “whiplash associated disorders (WAD)” are often applied, depending on the direction of the collision. When the striking vehicle rear-ends the target vehicle, the term “acceleration/deceleration injury” is used. WAD encompasses all scenarios and also includes the type and extent of injury. The degree of injury has been broken down into four main categories with the least amount of injury = WAD I, and the worst soft tissue injury category as WAD III. Fractures are covered separately in the WAD IV category. It has been found that the more severe the soft tissue injury (WAD III > WAD II > WAD I), the worse the prognosis, or the greater the likelihood of long-term injury-related residual problems.

We are often asked why the neck is so vulnerable to injury in a MVC. The simple answer is the head, which weighs about 12-15 pounds (~5-7 kg), is supported by the neck and not all necks have the same length, strength, and mass. This is the reason women (especially those with longer, thin necks) are most vulnerable to the forces that occur in a WAD injury. Another reason whiplash injury can occur is the relatively “slow” speed at which we can voluntarily contract our muscles (>600 msec.) vs. relatively fast speed at which a typical rear-end collision takes to move the head on the neck during whiplash (~300 msec.)! Though the whiplash time duration will vary somewhat, depending on the speed of the collision, angle of the seat back, the distance between the head and the headrest, the “springiness” of the seat back, the weight of the two vehicles, the slipperiness of the road, if the brakes are locked, (…AND MORE!), here’s a typical breakdown of what takes place in a rear-end collision (within a 300 millisecond “typical” time frame):

0 ms
The rear-end is impacted and the car is propelled forwards and/or crushes while the occupant(s) remain stationary. No force is yet applied to the occupant.
100 ms
The seat back accelerates the torso forwards while the head stays stationary (due to inertia).
150 ms
The torso/trunk may “ramp up” the seat back (esp. if reclined); the lower neck is pushed forwards by the accelerating torso/seat; the upper neck/head rotates and hyper-extends backwards.
175 ms
The head is still moving backwards while the torso starts to spring and accelerate forward, as the head reaches a peak of full extension.
300 ms
As the head, neck and torso continue to accelerate, the neck/head is “whipped” forwards hyper-flexing the neck.

The degree of injury is affected by all the items previously listed above and more. For example, if the headrest is more than two inches (~5 cm) away from the back of the head, and/or if “ramping” occurs and the head “misses” the headrest, hyper-extension can result and the soft tissues in the front of the neck can become over-stretched and/or the back of the neck can become over-compressed. Or if the rebound phase into flexion exceeds the tissue capacities, the back part of the neck can become over-stretched and the front part over-compressed.

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 started the discussion of self-care options in the management of whiplash or CAD (cervical acceleration-deceleration) or WAD (whiplash associated disorders). In this series, we are describing various treatment methods that you can be taught to help facilitate in the management process during the four stages of healing (acute, subacute – discussed last month; remodeling and chronic – addressed this month).

Like in the acute and subacute stages, many of the same self-care techniques can be applied here as well. You will NEVER “hurt” yourself with ice or ice/heat combinations (done properly), so they can be continued indefinitely. Many patients find this helpful. Using the analogy of a cut on the skin, in the acute stage, the cut is fresh and new. It is quite pain sensitive and unstable and it will continue to bleed if you don’t take it easy. After 72 hours (entering the subacute stage), the wound has an immature scab on it and it can still easily be re-injured, and if this occurs, especially by NOT self-managing properly, the recovery time can be significantly prolonged. So, “DON’T PICK AT YOUR CUT!!!” As we enter the later subacute phase (fourteenth week), the wound’s scab is quite mature, and self-care can be appropriately more aggressive. Think strengthening and activity restoration!

Stage 3 – REMODELING phase (14 weeks to 12 months or more): In this stage, we are now three months to a year out from the injury date and hence, we SHOULD now be more “aggressive” with care. During the late acute and subacute stages, you would have been performing exercises focused on movement restoration (range of motion / ROM exercises with LIGHT resistance) in addition to self-applied myofascial release techniques using foam rolls, tennis balls, TheraCane, and/or the Intracell (and possibly others). It is NECESSARY to continue the use of these methods, as they help reduce the chances for any scar tissue to become permanent. In this stage, we will guide you into more advanced exercises that include aerobics (walking, walk/run combinations, etc.) as studies show that whole body aerobic exercise helps MANY specific area injuries, including WAD/CAD injuries. Stretching short/tight muscles, working on balance-challenging exercises (rocker or wobble boards, balance beams, gym balls, eyes closed specific action movements) are VERY IMPORTANT, as they retrain your neuromotor system and reintegrate neural pathways that have been disrupted by the injured tissues and retrain faulty movement patterns you’ve developed from compensating due to pain. Strengthening exercises will include the core since the head sits on the neck, the neck on the trunk, the trunk on the legs, and ALL of this sits on the feet (so we’ll even consider stabilizing the sub-talar joint at the ankle and if pronation is excessive, foot orthotics can help whiplash patients)!

Stage 4: CHRONIC (Permanent): ALL OF THE ABOVE can be employed after the one to two year point to “maintain” your best level of function. If you still have pain, try to “ignore it” and KEEP MOVING, stay active, stay engaged in work, family activities, and DON’T let the condition “win.” AVOID CHRONIC DISABILITY by staying active and fit!

Whiplash is a condition that can occur from MANY causes – in fact, anything that results in a sudden change in the head/neck position. Usually, there is a rapid acceleration that injuries the soft tissues around the neck area by stretching them beyond their limits. Hence, the more accurate terms for whiplash are, “cervical acceleration-deceleration” or CAD as it describes the mechanism of the injury and “whiplash associated disorders” (WAD) describing the degree of injury.

Most commonly, when we think about whiplash, we immediately envision a motor vehicle collision (MVC), but prior to the invention of the automobile, the term “railroad spine” was coined to describe injuries to the neck from crashes that occurred between trains. Since then, due to pilots landing planes on aircraft carriers, sports injuries, and the rise of the automobile, this once rare condition has affected MOST of us at some point in time!

Today’s topic will focus on self-care. What can you and I do for ourselves WHEN we suffer a CAD injury? Since there are different levels of injury severity, keep in mind that EACH CASE IS UNIQUE and we will ONLY be discussing general options. So ALWAYS let your symptoms guide you in the process of care – that is, if you feel a sharp, piercing/stabbing, activity or movement stopping type of pain, STOP!!! Don’t further injure your tissues!!! We will discuss a common WAD II injury (soft-tissue injury limiting motion but not injuring nerves) and we’ll look the acute and sub-acute stages of the injury.

Stage 1 – ACUTE: The inflammatory phase (up to 72 hours). ICE is necessary to decrease swelling (inflammation). Limit motion but try NOT to use a collar unless you have no choice as even small movements that avoid the sharp/knife-like pain are better than no movement at all. A collar may be needed when driving (especially if the roads are bumpy)! Anti-inflammatory herbs like ginger, turmeric, boswellia, bioflavonoid, and others reduce inflammation WITHOUT irritating the stomach, liver, kidneys, and will NOT inhibit the chemicals needed for healing (like NSAIDs do!). Chiropractic care SHOULD begin ASAP after an injury. We may only use gentle manual traction and/or mobilization, also staying within reasonable pain boundaries. It’s been well proven that early movement is best!

Stage 2 – SUB-ACUTE: The repair phase (72 hours to 14 weeks). Ice can continue if it helps control pain. You can also alternate ice and heat at 10/5/10/5/10 minutes, starting and ending with ice (it “pumps” the tissues). Cervical range of motion (ROM) exercises with LIGHT resistance (use 1 or 2 fingers against the head and push in a forward, backward, sideways, and rotating directions first with “isometrics” – not moving the head, and when tolerated, “isotonic” – moving the head against the LIGHT pressure applied in BOTH directions within the range that avoids sharp/knife-like pain. Movement, strength, pain, and coordination are ALL better managed when light resistance + motion is used vs. not moving (isometrics). Self-applied methods of performing “myofascial release” (which we will teach you) include: Self-massage, the use of a tennis ball and/or foam roll, the use of a TheraCane or Intracell (Exercise Stick), and others. During this repair phase, chiropractic adjustments REALLY help!!! We will continue this discussion next 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.