Pain Relief Chiropractic

Whiplash associated disorders (WAD) are most often associated with motor vehicle collisions (MVC) but can occur from any form of trauma arising from slips and falls, sports injuries, and more. A question patients suffering from WAD commonly ask is, “How long will this take to get better?”

There are many factors in play with regards to how quickly one recovers from any injury: the type and degree of injury, the type of care, the “will” to get better, the patient’s education level, gender, emotional factors, and so much more. But what does the research say regarding risk factors for a prolonged recovery from WAD?

A Danish study found that WAD patients with immediate, high-intensity neck pain and stiffness were more likely to be disabled one year following their injury than those with a delayed onset of symptoms or those with low-grade pain. By combining scores for neck pain and stiffness along with other non-painful symptoms (such as blurred vision, nausea, and dizziness), the authors found that they could identify those at risk for long-term disability within a week of their accident.

Their study included 141 adults who contacted the ER within two days of the MVC complaining of neck pain or headaches arising from rear-end collisions without loss of consciousness or amnesia. None had prior neck or back pain or a history of severe headaches. The researchers found that 75% of patients with reduced neck motion still reported disability after one year.

Interestingly, the research team observed that patients involved in ongoing litigation (lawsuits) were at no greater or lesser risk of suffering long-term disability. In a recent large-scale study using an online survey completed by 127,959 respondents, researchers found that collision severity, poor expectations of recovery, victim mentality, dizziness, numbness or pain in the arms, and lower back pain each increased the risk of a poor recovery.

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.

Although whiplash injuries arising from motor vehicle collisions (MVC) are very common, there doesn’t seem to be consistency in the evaluation one receives at an emergency room (ER) or later in an outpatient setting when it comes to the utilization of x-ray and other imaging. So, what are the pros and cons of imaging a whiplash patient?

A review of published guidelines suggests that if a person involved in a MVC presents to the ER awake, alert, with no neurological deficit or other distracting injury, with no neck pain or midline tenderness, and has a full range of neck motion, then x-ray is not considered necessary. If a fracture is suspected, an x-ray and/or CT (Computerized Tomography) scan is appropriate. Magnetic resonance imaging (MRI) has a role when a soft tissue injury such as a ligament tear, spinal cord injury, and/or arterial injury is suspected by clinical impression and/or prior imaging.

The major concern involving trauma to the neck is fracture, but this is actually quite uncommon as a result of an MVC. Some ERs routinely x-ray all trauma cases to rule on the presence or absence of fracture, though CT scan is much more sensitive than x-ray, especially in subtle or the not-so-obvious types of fracture.

Doctors and hospitals utilize treatment guidelines in an effort to provide the best possible care while limiting potentially unnecessary testing. For example, the Canadian C-Spine Rule (CCR) is an assessment to help determine who does vs. does not need x-rays in trauma cases.

According to the CCR, those over 65 years of age or those who have significant trauma and/or numbness in the extremities should receive x-rays. Situations in which x-rays are not needed include a simple rear-end MVC; if the patient can walk around; delayed (not immediate) onset of neck pain; or the absence of midline neck tenderness.

Another study reported that more than 800,000 patients in the United States (US) receive a cervical x-ray each year. Minimizing x-ray use is important, not just because of patient exposure to radiation, but because more than 97% of x-rays are interpreted as negative, and costs associated with x-ray exceeds $175,000,000 per year! Hence, there is a definite need for better guidelines in the US like the CCR!

Doctors of chiropractic see many whiplash patients either soon after an injury or later, though sometimes it may be years before a patient with whiplash presents for care. For patients under age 65 who have a full range of cervical motion, no neurological deficits or complaints, no other distracting injuries, and no midline tenderness, in most cases, x-rays can wait.

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.

Though most patients with a whiplash injury improve within a few months, about 25% have long-term pain and disability that may persist for many months or years.

Now, a team of scientists from Northwestern Medicine Feinberg school of Medicine reports that it may be possible to determine which whiplash patients will develop chronic pain, disability, and/or post-traumatic stress disorder (PTSD) within one to two weeks of their injury—leading to specialized treatment that may reduce their risk for developing a chronic condition.

Using a specialized form of MRI that measures the fat and water ratio in the neck muscles, the researchers found that greater fat infiltration into these muscles indicated rapid muscle atrophy. The presence of fat in the muscle is not related to the person’s weight, size, or shape and is believed to represent an injury that is more severe or serious than what might be expected from a typical low-speed car crash.

However, though the lead investigator notes that the fat infiltration into the muscle appears to be a response to an injury, what has actually been injured—muscle, nerves/spinal cord, and/or more—remains a mystery.

Another study by the same research team found that chronic pain whiplash victims also exhibited a high level of muscle fat in their legs—indicating atrophy. The researchers hypothesize that these patients may have partially damaged their spinal cord, as this group of patients also reported feeling weak and clumsy when walking.

Current research indicates that when managing whiplash cases, early return to activity, movement restoration, and exercises that specifically target the deep neck flexors lead to better outcomes than a “wait and watch” approach.

Doctors of chiropractic also utilize manipulation, mobilization, exercise training, diet, and nutrition, and encourage a return to a normal lifestyle as quickly as possible when treating patients with a whiplash injury.

Whiplash injuries are very common and are primarily associated with car and rear-end collisions in particular. This is what happens when you’re rear ended…

1. At 0-50 milliseconds (ms): As the car is initially propelled forward, the seatback pushes the torso forward while the head remains in its original position, which straightens or flattens out the cervical curve.
2. At 50–75 ms: As the torso accelerates forward, the head/neck moves backwards forming an S-shaped curve with flexion of the upper cervical region and extension of the lower cervical region, stressing the ligaments in back (upper) and front (lower) cervical spine regions.
3. At 150-175 ms: The torso is at its maximum forward position in reference to the neck and the head/neck is forced into peak extension (backward bending). The head may contact the head restraint or ride over it if of the torso slides up the back a reclined seat. This can further damage the ligaments in the front of the cervical spine.
4. At 200-600 ms: The head and torso are then thrown forward by the rebound off the seatback, hyperflexing the neck (and mid- and/or low-back) and potentially causing further injury to the ligaments in the back of the spine. Depending on whether or not a seatbelt is in use, the head may strike the steering wheel and/or windshield causing further injury.

It may seem logical to think that if we can anticipate an impending MVC, then less injury will occur. Unfortunately, this doesn’t hold true because the total length of time it takes for the sequence described above to occur is about 600 ms and we cannot voluntarily contract our muscles in less than 800-1000 ms. Therefore, you simply won’t have time to brace yourself for impact.

If cervical rotation occurs at the time of impact, such as looking into the rearview mirror, then the risk for injury may increase. There is recent evidence suggesting that it is difficult to avoid rotation of the cervical region during a collision because the diagonal path of the chest restraint promotes trunk rotation in the later stage of whiplash as the torso rebounds forward.  Nonetheless, looking straight ahead at the time of impact may reduce the degree of injury in some collisions.

To achieve the best long-term outcome, treatment should emphasize movement and exercise as soon as possible. In addition to treatments performed in the clinic, doctors of chiropractic commonly recommend whiplash patients to perform home exercises, home cervical traction, and other self-help methods with the objective of returning to a normal lifestyle as quickly as possible.

Last month, we discussed whiplash injury prevention by focusing on the physical characteristics of crashes. This included information about head restraints, collision speed, seat back position, body size differences, air bags, and more. This month, we’ll focus on the MOST important aspect of whiplash prevention: driver distraction!

According to a survey of 6,000 drivers conducted by the National Highway Traffic Safety Administration (NHTSA), 20% of those surveyed in the 18-20 years old age group and 30% of those 21-34 years of age claimed texting does not affect their driving.

Of the 6,000 drivers surveyed, 6% reported having been in a crash in the prior year and 7% had been in a near-crash, with men being at a slightly higher risk than women. Young drivers, those 18-20 years old, had the highest incidence of crash or near-crash experiences (23%) compared with all other age groups while interestingly, drivers aged 65 years and older had the lowest (8%). The younger drivers reported almost double the number of crashes (17%) as drivers in their early 20s (9%) and up to four-times more than the other age groups (4-6%).

Of the 718 drivers who were involved in a crash or near-crash in the previous year, 6% reported phone usage at the time (4% talking, 1% sending a text or email, and 1% reading a text or email). The young driver (18-20 years old) group, reported the highest cell phone use (13%) at the time of the crash or near-crash (2% talking, 8% sending a text or email, 3% were reading a text or email). The highest incidence of talking on the phone at the time of crash/near-crash was in the age 25-34 years old group (10%). Not too long ago, we reported statistics comparing texting to drunk driving, and the data was sobering. Researchers from the Monash University Accident Research Centre in Australia found that texting severely impaired driving skills, as participants spent 400% more time with their eyes off the road!

Hands-free devices are NOT without risks either. Put simply, the brain is distracted when talking, as attention is displaced from the road to the conversation—especially if the conversation is heated! Interestingly, the Texas A&M Transportation Institute reported that voice-to-text offers no safety advantage over manual texting while the AAA Foundation for Traffic Safety reported voice-activated in-car technologies “dangerously undermine driver attention.”

To summarize, avoid all distractions while driving and keep your eyes on the road!

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.

Some studies have suggested that 85% of all whiplash injuries occur from rear-end collisions. So, what are some different ways that we might be able to avoid injury if such an event occurs?

HEADREST: It’s important that your headrest is high enough so that your head and neck doesn’t roll over it in a collision, which can increase the risk of injury to the neck and head. Additionally, be careful to keep your head within eight cm (3.14 in) of the headrest while driving. By reducing the spacing between your head and the headrest, you can lower your risk for sustaining a brain injury in a rear-end collision. Today’s cars may also feature an active head restraint system that adjusts the head rest in an effort to shorten the distance between the head and the headrest when an accident occurs. ADVICE: Check the position and condition of your head restraint!

SEAT BACK POSITION: At least one study has concluded that vehicle occupants may have a higher injury risk if the seat back is fully upright. On the other hand, a seat back that leans too far back may serve as a ramp for the body during an accident, which could slide the head over the headrest. This too can increase the risk of injury. ADVICE: Recline the seat back somewhat while driving, but not too far.

BODY SIZE EFFECTS: A literature search study reviewed the potential injury effects as it relates to differences in anatomical size, head-neck orientation, the facet joints (small gliding joints in the back of the cervical spine), and neck muscles mass. The authors of the study reported that smaller sized necks, head positions outside of neutral (vs. looking straight forwards), and smaller muscle mass increased the potential for neck injury in a rear-end collision. ADVICE: Strengthen/exercise your neck muscles.

AIR BAGS & SEAT BELTS: Though these are not an “option” and have become “standard equipment” in cars, it’s clear that airbags and seat belts have saved far more lives compared with the injuries (including some deaths) that can be attributed to them. According to one source, more than 30,000 lives have been saved by front and side airbags. ADVICE: Make sure you act on any recall involving your airbag (and any recalls involving your car in general) and WEAR your seatbelt!

FACTORS DIFFICULT TO STUDY: Given all the variables involved in “real-world” car crashes, it is very difficult to predict which criteria are most important for injury prevention. For example, vehicular weight/size difference, multiple collisions—from different directions, readiness for impact, etc. The BEST ADVICE  – Stay alert, keep your eyes on the road, and don’t speed.

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.