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Multi-Modal Care for Whiplash Patients

20 Jun

The term whiplash associated disorders (WAD) describes a constellation of symptoms that includes (partial list) pain, stiffness/limited motion, dizziness, headache, depression/anxiety, and brain-fog. The condition is associated with accelerations/deceleration events like car accidents, sports collisions, or slip and falls. Such injuries are classified into four categories: WAD I (no/minimal complaints/injury), WAD II (soft-tissue injury – muscle/tendon and/or ligament injury), WAD III (nerve injury), WAD IV (fracture). More than 85% of those involved in a motor vehicle collision (MVC) experience neck pain, with 29-40% recovering within a little more than three months and about 23% still not having recovered after one year.

A 2016 systematic review generated treatment guidelines for patients with WAD and/or neck associated disorders (NAD) in the context of both a recent injury and for cases in which pain has persisted for longer than three months. Importantly, these guidelines were formed with input from several types of healthcare providers, including doctors of chiropractic, medical doctors, and physical therapists.

For recent-onset neck pain (0-3 months), the authors recommend multimodal care (multiple types); manipulation or mobilization; range-of-motion home exercise or multimodal manual therapy (for grades I-II NAD); adding supervised graded strengthening exercise (grade III NAD); and multimodal care (grade III WAD).

For persistent neck pain (more than 3 months), the review recommends multimodal care or stress self-management; manipulation with soft tissue therapy; high-dose massage; supervised group exercise; supervised yoga; supervised strengthening exercises or home exercises (grades I-II NAD); multimodal care or practitioner’s advice (grades I-III NAD); and supervised exercise with advice or advice alone (grades I-II WAD). For patients with persistent neck and shoulder pain, evidence supports mixed supervised and unsupervised high-intensity strength training or advice alone (grades I-III NAD).

The term, “multi-modal care” is defined as a grouping of manipulation, mobilization, and soft tissue techniques (myofascial release, contract-hold, trigger point therapy, muscle energy, and more). Multi-modal care may also incorporate the use of hot or cold packs, assisted stretching, advice to stay active or modify activity, and neck/shoulder exercise training. Doctors of chiropractic often take a multi-modal approach when treating patients with musculoskeletal pain, including those with whiplash associated disorders.

 

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Whiplash and Mid-Back Pain – How Can This Happen?

20 May

Research regarding whiplash or whiplash associated disorders (WAD) classically focuses on neck pain; however, the data show acute thoracic spine / mid-back pain (MBP) occurs in 66% of WAD injures with 23% still complaining of MBP at one-year post-injury.

It’s easy to visualize how the cervical spine or neck can be injured in an automobile collision (or sport-related collision or a fall) as the head, which weighs an average or twelve pounds, whips back and forth in a “crack-the-whip” like manner, often well beyond the normal, physiological range of motion. This same stretching (eccentric loading) followed by compression (concentric loading) also occurs in the mid-back, which can injure ligaments, joint capsules, neural structures, and more. Also, the thoracic spine contributes to 33% of flexion and 21% of rotation IN THE NECK, making the mid-back a vital spinal region that facilitates neck movement and function!

In WAD cases, mid-back pain often hides in the shadows of a more obvious and often more serious neck injury, as the brain typically perceives pain from the greatest source. Additionally, the neuronal input to the sensory cortex of the brain (the area of the brain that perceives pain) is most highly represented from the head, hands, and feet and less from the mid-back or torso.

The seat belt may also contribute to injury—both to the anterior chest region including rib cage, sternum, breast tissue, abdominal organs, as well as to the mid-back. The oblique angle of the chest-restraint is an important factor when discussing the mechanism of injury, as it causes trunk/torso rotation during the rebound or flexion phase of WAD. Another mechanism of injury includes blunt trauma, of which the driver is especially at risk due to the close proximity of the steering wheel and the chest. This can lead to contusion or bruising, fracture, and/or injury to the abdominal and/or chest organs (heart and lungs).

Obviously, the speed of impact, angle of the collision, bracing of the person (or lack thereof), and overall physical condition of the patient can greatly affect the outcome of WAD-related injuries. The importance of assessing the whole person is essential in obtaining an accurate diagnosis and establishing a comprehensive treatment plan for the WAD patient.

Chiropractic management focuses on the entire person, frequently uncovering complaints in other spinal regions as well as in the extremities in WAD-related injured patients. Moreover, treating postural issues such as a short leg, ankle pronation, oblique pelvis, forward head posture, protracted shoulders, and more is vitally important in obtaining satisfying patient outcomes!

 

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Is There a Difference Between Whiplash and Non-Whiplash Neck Pain?

22 Apr

When we hear the term “whiplash injury,” we likely think of car crashes, though whiplash can result from other causes, like a fall or sports collision. Though whiplash is associated with a variety of symptoms, neck pain with lower pain thresholds (called central sensitization) is one of the most common. Neck pain can also occur in the absence of trauma or a known pathology. This is called mechanical neck pain (MNP).

Past research has shown that the combination of manual therapies (including mobilization and manipulation) and neck-specific exercises can benefit patients with neck pain, but is there a different treatment response between whiplash patients and MNP patients?

A 2017 study evaluated this very question. The authors recruited 28 patients with either grade I or II whiplash (pain with or without exam findings but no neurological losses) and 22 MNP patients. The patients in the MNP group were only included if their symptoms could be provoked by changes in cervical posture, neck movement, and palpation of certain neck muscles. The research team measured neck pain intensity, neck-related disability, pain area, cervical range of motion, and pressure pain thresholds (the amount of pressure measured to induce pain using a spring-loaded pressure gauge) both initially at baseline and again after six treatment sessions.

The results showed that whiplash sufferers initially had significantly higher pain-related disability, larger pain area, and central sensitization. In spite of this, the investigators observed that after six treatments, the patients in both groups achieved similar improvements with respect to cervical range of motion (flexion/extension, left/right side bending, and rotation), neck pain intensity, neck pain-related disability, pain area, and pressure point thresholds. However, the whiplash patients continued to experience a lower pain threshold than participants in the MNP group.

The good news for whiplash patients is that another 2017 study demonstrated that treating painful myofascial trigger points can help restore pain thresholds. Doctors of chiropractic frequently utilize the two treatment approaches from this study—manual therapy and specific neck exercises—in addition to other management approaches to achieve successful outcomes for patients with neck pain, either whiplash or MNP.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Neck Posture BEFORE a Car Wreck – Is It Important?

22 Mar

Abnormal postures of the neck—straight and reversed (kyphotic) curves, for example—are commonly encountered after an individual has experienced a motor vehicle collision (MVC). Many studies discuss the mechanism of injury during a rear-impact MVC that result in a straight or kyphotic curve, but few have considered the importance of this abnormal posture being present BEFORE the MVC and the role that plays regarding the degree of the resulting injury.

A group of researchers looked at this very issue and compared what happens to the cervical spine that is “normal” (lordotic) vs. straight vs. reversed (kyphotic) in a classic rear-end MVC. When the neck flexes or bends forward, the facet joints in the cervical vertebrae open up and the facet capsules and associated ligaments stretch or elongate. To determine what degree of injury would arise among the three postures, researchers measured the amount of stretch/elongation in these ligaments using a validated mathematical model of the human head-neck complex. With a normal lordotic posture, the greatest load during the simulated rear-end collision occurred high in the neck at C2-3, in the back part of the cervical spine, and from C3-4 to C6-7, on the sides of the cervical spine.

Most importantly, as the normal lordotic curve reduced to a straight and then further into a kyphotic or reversed curve, the researchers observed increases in the elongation magnitudes in the facet joints by up to 70%! Excessive elongation of the ligaments and join capsules can result in tearing and subsequent laxity to the facet joints as well as the surrounding ligamentous supporting tissues.

Laxity in these supporting tissues can lead to excessive movement between each vertebra and predispose them to accelerated degenerative changes leading to spinal instability over time. This study provides quantitative kinematic data that is level- and region-specific and supports the clinical findings that abnormal spinal curvatures increase the likelihood of whiplash injury severity.

Chiropractic focuses on the “3-P’s” – Pain management, Posture correction, and Prevention through the use of manual therapies, posture correction techniques, exercise training specific to each individual, and lifestyle management through diet and stress management strategies. The importance of restoring abnormal posture of the cervical spine is well illustrated by this study. Discuss this with your doctor of chiropractic to minimize your risk of injury in the event of a future trauma!

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Can Whiplash Treatment Outcomes Be Predicted Early On?

21 Feb

Whiplash associated disorders (WAD) refers to a collection of neck-related symptoms that are most commonly associated with car crashes. Experts estimate that up to 50% of acute WAD-injured patients will develop some form of long-term disability. Being able to predict who is more likely to develop long-term disability is VERY important, as it can place a substantial burden on not only the patient and their family, but society as a whole.

In order to determine which risk factors may predict whether or not WAD patient is at increased risk for long-term disability, a recent study analyzed findings from twelve systemic reviews. The researchers found that higher levels of post-injury pain and disability, higher WAD grades (WAD II & III), cold hypersensitivity, post-injury anxiety, catastrophizing, compensation and legal factors, and early-use healthcare each raise the risk for ongoing disability. The research team also determined the following are NOT associated with prolonged recovery: post-injury MRI or x-ray findings, motor dysfunction, or factors related to the collision.

In essence, this study looked at prognostic factors for a “typical” acute or newly injured WAD patient and found that those with severe neck pain and anxiety, who are seeking or have sought legal advice, and who had early healthcare use are at greater risk of a prolonged recovery. The type of accident (rear-end, T-bone, front-end, crash speed), examination findings, and x-ray findings do not appear to increase the risk of becoming chronic.

These findings parallel other studies regarding the association of chronic pain and psychosocial factors prolonging recovery including non-specific chronic low back pain as well as other conditions – even carpal tunnel syndrome! The authors emphasize the need for future studies to focus on how this type of information can be used in the treatment planning of WAD patients in the acute stage in order to PREVENT the progression to chronicity.

Doctors of chiropractic often see WAD-injured patients weeks or months after their accident, after they’ve been managed by primary care as well as by various specialty services. However, some patients will elect to seek chiropractic care soon after an accident. Future studies need to focus on the outcome of care rendered by different provider types to determine if one form of care minimizes the chronicity spiral that unfortunately exists. Until then, rest assured that exercise, self-management strategies, and independence from prolonged care is the foundation and mission of the chiropractors associated with ChiroTrust!

 

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Can Neck-Specific Exercise Reduce Chronic Whiplash Symptoms?

21 Jan

Did you know that an alarming 90% of neurologically injured whiplash patients DO NOT recover and have neck muscle dysfunction even up to a year after the date of their motor vehicle collision?

There is suspicion among researchers that such ongoing issues are the result of the body’s initial response to injury to the brachial plexus, the network of intersecting nerves that give rise to three main nerves that travel down the arm to the hand. To protect and ease tension on the brachial plexus, the superficial muscles to the side of the injury can become more active and take on the classic “shrugged” position, a posture commonly observed in patients with nerve damage associated with a whiplash associated disorder (WAD) injury.

Over time, this protective mechanism can weaken the deep neck muscles, which are important for maintaining proper vertebral alignment and posture. This may, in turn, result in secondary injury and the long-term problems observed in many WAD patients, even after the initial injury to the brachial plexus has resolved.

In a recent multi-center, randomized controlled trial involving 171 chronic WAD patients with radiating arm pain and associated signs of neurological deficit, researchers found that participants who performed neck-specific exercises for twelve weeks to strengthen the deep neck muscles reported improvements in overall pain, arm pain specifically, and pain frequency, with some neurological recovery. Participants who were instructed to engage in general/non-specific physical activity during the study did not report such improvements.

Two of the authors from the above study collaborated on a similar experiment and found that patients who engaged in neck-specific exercises not only experienced improvements in muscle strength and pain reduction, but they were more satisfied with the approach than participants in a general exercise group.

These studies show that when the deep muscles become the specific focus of neck exercises, the results are superior, AND this includes neurological recovery. Your doctor of chiropractic can help train you in these specific exercise approaches!

 

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.