Pain Relief Chiropractic

Last time, we began discussing common myths about whiplash injuries, and this month, we will continue on that course. Remember, the amount of injury that occurs in an acceleration/deceleration injury is dependant on many factors, some of which include gender (females>males), body type (tall slender = worse), the amount of vehicular damage (less is sometimes worse as the energy of the strike was not absorbed by crushing metal), head position at the time of impact (rotation is worse than looking straight ahead), and more. Therefore, each case MUST be looked at on its own merits, not just analyzed based on a formula or accident reconstruction.

MYTH #5: THERE MUST BE DIRECT CONTACT WITH THE NECK FOR INJURY TO OCCUR. Injury to the neck most commonly occurs due to the rapid, uncontrolled whipping action of the head, forcing the neck to move well beyond its normal range of motion in a forwards/backwards direction (if it’s a front or rear-end collision) or, at an angle if the head is rotated or when the strike occurs at an angle. When this occurs, the strong ligaments that hold the bones together stretch and tear in a mild, moderate, or severe degree, depending on the amount of force. Once stretched, increased motion between the affected vertebra results as ligaments, when stretched, don’t repair back to their original length and, just like a severe ankle sprain, future problems can result. This excess motion between vertebra can result in an accelerated type of arthritis and is often seen within five years following a cervical sprain or whiplash injury.

MYTH #6:  SEAT BELTS PREVENT WHIPLASH INJURIES. It’s safe to say that wearing seat belts saves lives and, it’s the law! So, WEAR YOUR SEAT BELTS! They protect us from hitting the windshield or worse, being ejected from the vehicle. But, as far as preventing whiplash, in some cases (low speed impacts where most of the force is transferred to the car’s occupants), the opposite may actually be true. (This is not an excuse to not wear a seatbelt!) The reason seat belts can add to the injury mechanism is because when the chest or trunk is held tightly against the car seat, the head moves through a greater arc of motion than it would if the trunk were not pinned against the seat, forcing the chin further to the chest and/or the back of the head further back. The best way to minimize the whiplash injury is to have a well-designed seat belt system where the height of the chest harness can be adjusted to the height of the driver so that the chest restraint doesn’t come across the upper chest or neck. Move the side adjustment so the chest belt crosses between the breasts (this also reduces injury risk to the breasts) and attaches at or near the height of the shoulder (not too high). Another preventer of whiplash is positioning the head restraint high enough (above the ears typically) and close to the head (no more than ½ to 1 inch) so the head rest stops the backwards whipping action. Also, keep the seat back more vertical than reclined so the body doesn’t “ramp” up the seat back forcing the head over the top of the head restraint.

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 associated with the rapid, uncontrolled movement of the head as it whips back and forth during a motor vehicle collision. Though different types of injuries are associated with rear vs. front vs. side collisions, the net result is similar: the neck hurts! This month, we will look at several “myths” or untruths associated with the cause of whiplash or WAD, whiplash associated disorders.

MYTH #1: MEN ARE MORE VULNERABLE TO INJURY BECAUSE OF THEIR GREATER NECK MUSCLE MASS: FACT: This is exactly the opposite! Women are more vulnerable because they have LESS muscle mass, and hence, less tissue stopping the neck from going through a greater range of motion during the “crack the whip” process. Woman with long, slender necks are especially more vulnerable. They also take longer to recover and are more likely to suffer permanent residual problems long after their case settles.

MYTH #2: YOU CAN’T HAVE A CONCUSSION UNLESS YOU HIT YOUR HEAD: This seems logical as most concussions occur from direct head trauma. However, during the whiplash process the brain, which is suspended by ligament-like structures inside the skull, bathed in a liquid, can literally smash into the inside wall of the skull resulting in concussion just from the whipping action, without hitting anything. Permanent residuals such as memory problems, articulating thoughts, staying on task, and more can result. This is often called “post-concussive syndrome” or “mild traumatic brain injury.”

MYTH #3: NEGATIVE X-RAYS MEANS NO INJURY: Often, in the ER after a motor vehicle collision, x-rays are taken and read by the radiologist as “…essentially normal.” This can be confused as meaning, “…then there was no injury.” X-rays only show the bones in the neck and head region, not the muscles, tendons, ligaments or nerves. MRI (magnetic resonant imaging) shows more of these “soft tissues,” not just bone. But, due to the high costs of MRI, x-rays are performed first, and only later, if symptoms warrant it, is an MRI ordered. Soft tissue injury to the ligaments (the tissues that strongly hold bone to bone) can be assessed when we take flexion / extension (or bending forwards & backwards) x-rays, but many times these are not ordered in the ER.

MYTH #4: REST AND TIME ALONE WILL HEAL WHIPLASH: Though time for healing plays a role in recovery following all injuries, many patients find this approach fails and their pain persists. In fact, studies suggest that mobilization and manipulation performed as soon as possible after a whiplash injury yields significantly better outcomes than wearing a cervical collar and not moving the neck. Whiplash injuries, when not properly treated, often results in permanent loss of motion, pain, headache, and more. The days of rest and time only should be replaced by the sports medicine model of hot/cold packs, modalities such as interferential, pulsed magnetic stimulation, light or laser therapy, manipulation, massage, traction and guided exercise. Not, “…wait and watch.”

Tune in next month for addition myths about whiplash as there are MANY! Rest assured that prompt chiropractic care is the best approach for treatment of the whiplash injured patient.

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 injuries occur as the result of a sudden acceleration followed by deceleration, and the degree of injury is dependent on many factors. Some of these include: the size of the vehicle, the conditions of the road, the angle of the seat back, the “springiness” of the seat back, the position of the head rest, the size of the patient’s neck, the position of the patient’s head and neck at the time of impact, the awareness of the impending collision, etc. Hence, each case must be evaluated and managed using a unique, individualized approach.

The chiropractic encounter begins with the history and examination. Here we will ask many questions and perform tests that will give us clues to understand the mechanism of injury, identify the primary tissues injured, and determine the best treatment approaches to utilize.

There are many different chiropractic treatment approaches available for patients with whiplash injuries. For example, manual therapies include spinal manipulation, mobilization, manual traction, muscle relaxation and/or stimulation methods, the assessment of the patient’s physical capacities with issuing specific exercises and, considerations of modifying work station issues and/or lifestyle changes. Chiropractic manipulation is a very common approach utilized in the treatment of joint dysfunction. That is, restoring normal movement to the joints affected negatively by the whiplash injury. Terms such as, “stuck,” “fixed,” “subluxation,” and the like are often used to describe altered joint position or function. Typically, the manipulation (also called “adjustment”) is applied well within the normal range of motion of the joint using a “high velocity” (or fast) movement through a short distance in the direction that attempts to correct the joint dysfunction. Because the procedure is quick and of short distance, patients frequently state, “…that felt great!” In fact, if the pre-adjustment position of the patient hurts or is uncomfortable, we will instead use a slow, mobilizing movement.

Exercise strategies are important and typically employed as soon as possible. The type of exercise is (again) case specific, but in general, exercises are initially prescribed in a manner that restores movement with as little discomfort as possible. Following the goal of increasing range of motion, strengthening the injured region with stabilization exercises, and restoring sensory-motor activity to the muscles becomes the primary focus in the management of the whiplash patient. When the intervertebral disks are “deranged” or altered, directions that minimize radiating pain are emphasized in the exercises. After careful in-office training, the patient is instructed to perform exercises at home, often multiple times a day, for stability of the spine and to re-establish motor control and movement. Ergonomic and daily lifestyle modifications are frequently addressed to avoid the possibility of the condition being irritated on a regular basis, thus interfering with the healing process. If a patient is stressing the injured area at work, job modifications can make or break the success of the management program.

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.

Health Update: Whiplash

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.

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Whiplash, or more properly stated, Whiplash Associated Disorders (WAD), is usually associated with car accidents, slip and falls and sports injuries. It is a very common injury affecting millions of people around the world, and costing health care systems billions of dollars. The question of the month is, what can we do to AVOID or prevent whiplash?

STEP 1. SHOP FOR A SAFER CAR. There are many resources that you can review such as the “Insurance Institute for Highway Safety” that have published ratings for the safest seats, head restraints, and include many makes and models of cars, SUV’s and trucks. For example, Volvo and Saab have recently designed car seats where the seat back collapses backwards upon impact so as to minimize the rebound response in a rear-end collision, thus minimizing the head and neck from whipping back and forth. Therefore, before YOU purchase your next car, compare the vehicle’s structural design, its size and weight, the restraint systems, the airbags, the head rests, as well as crash avoidance features. Remember, in general, small cars put you at greater risk simply due to the small mass equaling less protection.

STEP 2. POSITION THE HEAD RESTRAINTS PROPERLY. This means put them in their “up” position. The most common problem with head restraints is that they are placed too low and offer little to no protection if and when you are struck from behind. In fact, 80% of cars have the head restraint in the low or “down” position, which (surprisingly) is WORSE than having no head restraint at all! This is because when the head restraint is too low, it acts like a fulcrum, hitting the middle of the neck promoting MORE hyperextension when compared to having no head restraint whatsoever. Remember, head restraints are designed to fit an “average man,” making it challenging for a tall or short person to obtain a good “fit.” A good position for a head restraint is within 1 inch of the back of the head and 1-2 inches above the mid-portion of the head as “ramping” often occurs especially if the seat back is reclined backwards, and the whole body slides up and over the head restraint.

STEP 3. PREPARE FOR THE CRASH. This actually may NOT be possible since the “whipping” action happens within 500 milliseconds and voluntary muscle contraction is about twice as slow, not to mention that the crash can occur at lightning fast speeds leaving you with little time to prepare. However, if you do have time to prepare, do the following: 1. Put your head and neck all the way back into the seat back and a properly adjusted head restraint so that there is firm contact. 2. Extend the elbows and straighten the arms gripping firmly onto the steering wheel in preparation to brace yourself. 3. Place your foot on the brake as firmly as possible (assuming that you are stopped in traffic). 4. Look straight ahead avoiding neck or head rotation. 5. Tilt your head back slightly so that your eyes are pointed toward the top of the windshield. 6. Prior to impact, shrug your shoulders upwards toward the ears and brace yourself firmly.

STEP 4. SEEK IMMEDIATE TREATMENT. It is critical to obtain treatment as quickly as possible as there is a tremendous advantage to start treatment especially with the first 2 weeks post-collision to avoid the likelihood of a chronic potentially disabling condition.

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.

PAY ATTENTION WHILE YOU DRIVE. Too often, we get distracted while driving. Any time our eyes leave the road, the potential for an accident increases significantly. This can occur when changing the radio to a different station, eating while driving, reading while driving, talking on the phone, texting (equals the effects of 2-3 alcoholic beverages), driving under the influence of certain prescription medications (pain killers for example), driving under the influence of alcohol or other chemical agents, and turning your head during conversation. We have a responsibility when we are driving to keep our eyes on the road, as many accidents occur within split seconds of time. If we are not paying attention, we will not be able to avoid a potential collision.

THE CONCEPT OF “NO CRUSH, NO CRASH INJURY” IS SIMPLY NOT TRUE. In fact, just the opposite is true. That is, the greater the amount of crushing metal at the time of collision, the greater the amount of energy absorption that occurs, resulting in less force transferred to the contents inside the vehicle (namely you or me). This is why, many times, people are injured in low speed collisions because there is no energy absorbed by crushing metal as noted by the absence of or, minimal damage to the car.

FOLLOWING YOUR DOCTOR’S ORDERS. It is very important that we do not inadvertently hurt or harm ourselves further by NOT following the advice of our health care practitioner. This means initially using ice to reduce inflammation and swelling, possibly wearing a soft cervical collar during the first few days after the injury to “rest” the injured structures, following proper nutritional advice for optimal healing benefits, and following exercise recommendations. This last treatment approach is vital in the prevention of long term, chronic neck complaints. Other ways you can REALLY help are to follow cervical traction orders. Cervical traction is a very effective method of reducing muscle spasm, separating the joint spaces, improving disk nutrient transfer and water content, reduce the pinching effect of the nerves, and as a result, speeding up the recovery process. Follow your treatment schedule; that is, DON’T SKIP APPOINTMENTS! During office visits, it is necessary to discuss not only what is working well, but also what may not be working so modifications to your care plan can occur on a timely basis. The primary goal of whiplash management is to prevent the condition from becoming chronic and long-term, and the first few weeks of treatment are critical!

ERGONOMIC MODIFICATIONS. An important part of managing whiplash injuries is preventing daily irritations from tasks that we have to do. Hence, we will discuss adjusting your work station for optimum positioning and avoidance of poor posture, such as using office chairs with arm rests, sitting posture modifications, and computer monitor positioning. Proper sleep positions and pillow design are also reviewed.

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.