Pain Relief Chiropractic

Whiplash is an injury commonly associated with motor vehicle collisions (MVC) caused by a rapid forward and backward “whipping” of the neck. What varies between each case is the degree of injury and what anatomical parts of the neck are actually injured. Let’s take a look at the spine so we can better understand where the pain actually comes from…

The cervical spine is made up of seven moving vertebrae. The top vertebra (C1) is called the atlas and is shaped like a ring. This ring shape allows the head to rotate left and right so we can check traffic, carrying on conversation with someone sitting off to the side, and so on. It pivots around a peg called the “dens” of C2, or the axis, and the function of these first two vertebrae is very important. This is because the upper most three nerves that exit through this part of the cervical spine innervate the head and dysfunction here may be the cause of some headaches. Chiropractic adjustments concentrate a great deal on restoring function to this area. The C4-6 vertebrae make up the most mobile region of the spine in the forward and backwards directions. Generally, the greater the mobility, the lesser the stability, and because of this, injury to this area is quite common. We often see arthritis in this region first and we focus on keeping the areas that are less mobile (areas above and below C4-6) as mobile as possible. The upper back/lower neck area includes the rib / vertebrae joints, which are also commonly involved in whiplash injuries. Chiropractic adjustments applied to this region also help to restore function and mobility. The thoracic spine is made up of 12 vertebrae and includes the rib cage as well as the shoulder blades (scapulae). This area is sometimes neglected during treatment as the main focus is often placed on the more painful areas of injury like the neck. The lumbar spine consists of five vertebrae and is also frequently overlooked as an injured area due to the distance away from the neck. However, seat belts frequently injure the breast, chest, mid-back, and/or low back regions.

There are several tissues that could be injured. The ligaments — the tough, non-elastic tissue that holds bone to bone — function to maintain stability between the vertebrae. The articular capsule is also made of ligaments and is a frequently injured area, which generates pain with movement of the head and neck. Muscles and the tendon attachments are elastic and function to move the structures. Stability is facilitated by good muscle tone and strength and is a strong focus of treatment. Injury to these structures are called, “…soft tissue injuries,” and make up the majority of whiplash associated disorders (WAD II category).

The intervertebral disks are made up of a fibroelastic cartilage on the outside and a more liquid-like center that functions as shock absorbers between the vertebrae. Injury to the disk includes tears, cracks, and/or fissures where the liquid center part can migrate through and can rupture. Injury to the nervous tissues includes the free nerve endings when the articular capsule is “sprained.” Nerve root injuries are most commonly “pinched” or compressed by a “ruptured disk” and send pain, numbness, and/or muscle weakness to specific areas of the arm and/or hand. These injuries are classified as WAD III injuries and usually carry a worse prognosis than WAD II injuries.

Determining which tissues are injured, managing the acute, subacute, and chronic stages of healing and facilitating self-management strategies are the primary goals of chiropractic treatment of the whiplash injured patient.

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 usually occurs as a result of a car crash when the head moves in a fast, uncontrolled way in many possible directions. The forwards-backwards movement is described in a classic “whiplash” injury but side-to-side, rotational, or a combination of movements often occur, especially if we add in the factor of the head being turned or rotated when the impact occurs, regardless of how the car is hit. This month, let’s talk treatment!

Think of “Whiplash Management” in steps:

STEP 1: IMMEDIATELY seek chiropractic attention following a whiplash injury: This is important as studies show delayed treatment is associated with worse outcomes after the dust settles. To avoid long-term disability, DON’T WAIT! Pain usually scares people into a guarded, protective way of thinking. The longer you wait, the greater the muscle tightness, spasm, weakening, and your increased fear of activity because of the pain!

STEP 2: Reduce Inflammation: The words “pain” and “inflammation” are quite synonymous. If you feel “hurt,” you are “inflamed.” We must begin anti-swelling/inflammation measures ASAP after an injury like whiplash. The BEST/safest approach is an ICE PACK – rotate it on/off/on/off/on every 15 minutes (1.25 hours/session) three times a day OR, CONTRAST ice with heat (10 min. ice/5 min. heat x3, ending with ice = 40 min.). BOTH methods produce a PUMP-like effect to quickly get rid of the inflammation. You also have the option of OTC medications (Aspirin, ibuprofen, and naproxen) but these NSAIDs (non-steroidal anti-inflammatory drugs) carry significant side-effects for some people, the most evident early on being stomach upset/irritation (later, liver and kidney damage) so be careful! You don’t want to have to treat an ulcer on top of your whiplash! Consider anti-inflammatory nutrients, herbs, vitamins, and food – they’re safe and effective (we’ve discussed these previously – SEARCH the web for more information).

STEP 3: AVOID INACTIVITY: This is important since the “natural” thing to do is nothing, “…because it hurts!” WE will guide you in this process as you need to know how much and what type of activity is safe and appropriate. You have to “interpret” the pain as being either safe or harmful and then you react accordingly. You MUST tell us the type of pain (sharp, knife-like is harmful vs. a “good” stretch type of hurt is safe), how much pain there is (7-10 on a 0-10 scale is potentially harmful), how constant it is, and what helps/hurt (what have you tried and learned so far). THEN, we will guide you appropriately (with your help)!

STEP 4: DO NORMAL ACTIVITY: This dovetails our last point. Get on with your normal activities as avoiding work and other ADLs (activities of daily living) leads to “disability thinking” or thinking you’re worse than you are. DON’T LET THAT HAPPEN. Talk to us!!!

STEP 5: AVOID prolonged faulty postures: Whether it’s a conversation with a person who is NOT directly in front of you, a faulty computer screen position, talking in a car without turning your body (look straight ahead), or talking on the phone, CHANGE IT!

STEP 6: COMPLY with a home-based exercise program: This is HUGE! We will guide you in this process. We will start with ice and then possibly a home traction device, isometrics followed by Theratube or band (isotonic) exercises, posture training, and much more. You NEED guidance in this area – let us HELP YOU!

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.

Exercise is an important part of whiplash treatment and is often overlooked by both patients and doctors. We will focus on several practical and effective exercises over the next several Health Updates. The first of this series can be called “brain exercises.”

The following URL offers you a 37 page PDF of a booklet that contains GREAT information and includes the exercises reviewed below:

http://tinyurl.com/WhiplashExercises

Brain Exercise #1: Eyes Still, Move Head. Hold a pen a comfortable distance in front of your eyes and keep looking at it as you rotate your head from side to side ten times. Stop if you feel dizzy but keep trying after resting. Repeat three times a day.

Brain Exercise #2: Head Still, Move Eyes. Keep your head still (move only your eyes) while you move the pen left to right as far as you can ten times without losing sight of the pen. Stop if you feel dizzy but keep trying later in the day. Repeat three times a day.

Brain Exercise #3: Standing Balance Test. Stand with your feet close together (or, feet shoulder width apart if you feel unsteady). You should feel steady for 30 seconds with your eyes open AND closed. Try it (count to 30)! If you feel unsteady, this exercise should be repeated often until you feel improvement with the eyes closed! A variation is to place one foot in front of the other, switching feet after each test. Notice this one is more difficult. A third position is standing on ONE foot (switch sides after each test) with the eyes open AND again closed. This one is REALLY hard! Stand near a counter or corner of a room to “catch” yourself – don’t fall.

Notice that these exercises are NOT neck specific; there are others exercises for that. Rather, these incorporate eye / head movements, coordination/balance challenges and address symptoms such as dizziness, headache, post-concussion symptoms (memory loss, difficulty concentrating, etc.), and others. These exercises can be very helpful as they “exercise” our neuropathways, or the “wiring” within our nervous system so that information flows freely to and from our brain, spinal cord, and our various body parts. These help us function safer and better in ALL of our desired daily activities! We can train you in these exercises if you feel uncomfortable doing these on your own.

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, as previously discussed, occurs quicker than the speed at which we can voluntarily contract our muscles in attempt to guard ourselves against injury. Hence, it is nearly impossible to properly brace in anticipation of an impending collision. When muscles, ligament, and joint capsules become injured, there is pain, and as a result, reflex muscle spasm occurs as the body attempts to “splint” the area to protect it. This sometimes sets up a vicious cycle which can make the pain last longer, hurt more intensely and / or hurt more frequently. Because of pain, as well as direct muscle injury that sometimes occurs in whiplash associated disorders (WAD), the natural tendency is to stop doing many activities and guard against motion both because of pain and the fear of it hurting worse. In both cases, the result is the same: muscle atrophy or shrinkage and muscle weakness due to not using the muscle.

There are other reasons that muscles become weak. When an injury occurs, a herniated or “ruptured” disk can injure the spinal nerves exiting the spine. The disk is like a jelly donut where the center is liquid-like surrounded by a thick ring of fibrocartilage and functions as a “shock-absorber” as it sits between 2 vertebral bodies

Think of the spinal nerves like electrical wires that connect a fuse box to a house. The fuse box is the spinal cord and each wire represents the spinal nerves going to different parts of the house (body). In the cervical spine or neck, each wire goes to different parts like the head, shoulder, arm, and hand and innervates specific areas. Patients who have a pinched nerve from a whiplash injury describe their symptoms as numbness, tingling, pain and/or muscle weakness in a specific distribution or area.

There are 8 pairs of nerves in the neck that travel to different parts of the head (C1-3), the shoulders (C4, 5), and the arm (C6-T2). Let’s say a patient has numbness and tingling down the arm to the 4th & 5th fingers and the pinky side of the hand. That immediately tells us as chiropractors that the C8 nerve is injured (pinched) because that’s the pain pattern of the C8 nerve.  Certain muscles are controlled by C8 that we can test in our office to determine if they are weak (abnormal) or strong (normal).

We grade the weakness between 0-5 (5=normal). The chiropractic treatment is aimed at un-pinching the nerve which results in a return of normal nerve function or no numbness/tingling and a strong C8 muscle (finger flexion strength). To accomplish this, we may use a combination of treatments such as spinal adjustments, mobilization, traction, exercises, and/or modalities (electric stim, light therapy, ultrasound or others).

We realize you have a choice in where you choose your healthcare services.  If you, a friend or family member requires care for whiplash, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

Whiplash is most commonly studied when it is a result of a rear collision where the occupant of the vehicle is injured  from a flexion (forwards) and extension (backwards) whip-like mechanism of injury, but what happens when a T-bone type of impact occurs?

The answer to this question is quite similar to many of the factors associated with any collision: the size of the bullet vs. target vehicle, the speed at which the collision occurs, the deployment or lack thereof of the airbag(s), the position of the neck at the time of impact, the “build” of the patient (skinny/tall vs. muscular), the road conditions, the “springiness” and angle of the seat back, and so forth. Unique to side impacts is the location of the strike to the target vehicle (front, middle, rear) and perhaps more importantly, the lack of space between the occupant and the point of the strike as there is a relatively shallow “crumple zone” between the occupant and the side of the vehicle.

Probably one of the best examples of how side impacts from different angles can be appreciated is to think about what happens to a person when they ride the “Bumper Cars” at the local fair. Though many fairs have now banned that “ride,” you may recall participating or watching those kids who were “having fun.” When a bumper car is struck in a classic “T-Bone” manner in the front end, the target car is spun around and the occupant hangs on for dear life. Similarly, a side strike from to the rear of the bumper car spins the back end around. When the occupant is aware of the impending crash, they grip the wheel, tuck their head by shrugging their shoulders and make their body rigid and typically, do not get “whipped around” as much as those that don’t anticipate the impact. Because the bumper cars don’t dent or crush (that is, there is no plastic deformity where damage occurs, only elastic deformity where there is no damage or, no energy absorption by crushing of the car), ALL of the crash energy is transferred to the occupant or the contents. If a person has a purse lying on the floor of the bumper car, it can go flying out and spill all over. Similarly, the person who is unaware of the impending collision will “go flying,” giving great satisfaction to the driver of the bullet bumper car.

When considering factors such as plastic vs. elastic deformity, side air bags, and the shallow crumple zone on the sides of motor vehicles, some manufactures stand out in their ability to protect the occupants in side impact collisions. Generally, those vehicles with a stiff side and roof structure have been found to be the best in protecting the occupant from injury by maintaining the survival space and dissipating the energy, or force, of the impact away from the occupant. Manufactures that stand out include Volvo, Mercedes, and Subaru. They have had the best design for decades and remain at the forefront for occupant protection in side impact collisions. The combination of energy absorbing side structure design and the side airbag has proven to be one of the most important factors in improving the crashworthiness in side impact collisions. Side air bags became popular in the 1990s. In 2012, more than 95% of all passenger cars sold in the US are equipped with side impact airbags as standard equipment.

We realize you have a choice in where you choose your healthcare services.  If you, a friend or family member requires care for whiplash, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.