Tag Archives: neck pain

Whiplash “Basics.”

12 Dec

Whiplash is a non-medical term typically describing what happens to the head and neck when a person is struck from behind in a motor vehicle collision. Let’s look at some basic facts about whiplash:

Before cars, trains were the main source of whiplash and was called “railroad spine.”

Better terms for whiplash injuries include “cervical acceleration-deceleration” (CAD) which describes the mechanism of the injury, and/or the term “whiplash associated disorders” (WAD), which describes the residual injury symptoms.

Whiplash is one of the most common non-fatal injuries involved in car crashes.

There are over one million whiplash injuries per year due to car crashes alone.

An estimated 3.8 per 1,000 people per year have a whiplash injury.

In the United States alone, 6.2% of the population has “late whiplash syndrome” (symptoms that do not resolve at one year).

1 in 5 cases (20%) remain symptomatic at one year post-injury of which only 11.5% returned to work and only 35.4% of that number returned to the same level of work after 20 years.

The majority of whiplash cases occur in the fourth decade of life, females>males.

Whiplash can occur from slips, falls, and brawls, as well as from horse-riding, cycling injuries, and contact sports.

Injury from whiplash can occur at speeds of 15 mph or less.

In the “classic” rear end collision, there are four phases of injury (time: 300msec)

Initial (0msec) – before the collision (the neck is stable)

Retraction (1-150msec) – “whiplash” starts where the head/neck stay in the original position but the trunk is moving forwards by the car seat. This is where the “S” shaped curve occurs (viewing the spine from the side).

Extension (150-200msec) – the whole neck bends backwards (hopefully stopped by a properly placed head rest).

Rebound (200-300msec) – the tight, stretched muscles in the front of the neck propels the head forward immediately after the extension phase.

We simply cannot voluntarily contract our neck muscles fast enough to avoid injury, as injury to the neck occurs within 500msec. and voluntary contraction or bracing takes 800msec or longer.

Injury is worse when the seat is reclined as our body can “ramp” up and over the seat and headrest. Also, a springy seat back increases the rebound affect.

Prompt treatment is better than waiting for a long time. Manipulation is a highly effective (i.e., COME SEE US!) treatment option.

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 both presently and in the future.

 

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Neck Pain – Where Is It Coming From?

10 Dec

Neck pain can arise from a number of different tissues in the neck. Quite often, pain is generated from the small joints in the back of the vertebra (called facets). Pain can also arise from disk related conditions where the liquid-like center part of the disk works its way out through cracks and tears in the thicker outer part of the disk and can press on nerves producing numbness and/or weakness in the arm. It is possible to “sprain” the neck in car accidents, sports injuries, or from slips and falls. This is where ligaments tear and lose their stability resulting in excessive sliding back and forth of the vertebrae during neck movements. When muscles or their tendon attachments to bone are injured, these injuries are called “strains” and pain can occur wherever the muscle is torn. There is also referred pain. Here, the injury is at a distance away from where the pain is felt. A classic referred pain pattern is shoulder blade pain when a disk in the neck herniates. Let’s take a closer look at two conditions we often diagnose and treat as chiropractors:

Spinal Stenosis: This occurs when the canals in the spine narrow to the point of pinching the spinal cord in the trefoil shaped central canal (called “central stenosis”) or when the nerve roots get pinched in the lateral recesses (called lateral recess stenosis). This can occur from arthritis in the facet joints, disk bulging or herniations, thickening of ligaments, shifting of one vertebra over another, aging, heredity (being born with a narrowed canal), and/or from tumors. Usually, combinations of several of the above occur simultaneously. When this is present in the neck, it can be more serious compared to stenosis in the low back as the spinal cord ends at the upper part of the low back (T12 level) so only the nerves get pinched. Stenosis in the neck however pinches the spinal cord itself. Symptoms can include pain in one or both arms, but it’s more dangerous when leg pain, numbness, or weakness occur (called myelopathy). Rarely, loss of bowel or bladder control can occur which is then considered a “medical emergency” and requires prompt surgery.

Cervical Disk Herniation: As previously stated, the liquid-like center of the disk can work its way through cracks and tears in the outer layer of the disk and press on a nerve resulting in numbness, pain, and/or weakness in the arm. The classic presentation is the patient finding relief by holding the arm over the head, as this puts slack in the nerve and it hurts less in this position. The position of the head also makes a difference as looking up usually hurts more and can increase the arm pain/numbness while looking down reduces the symptoms. We will carefully test your upper extremity neurological functions (reflexes, muscle strength, and sensation as each nerve performs a different function in the arm), and we can tell you which nerve is pinched after a careful examination. This condition can lead to surgery so please take this seriously.

The good news is that chiropractic care can manage both spinal stenosis and cervical disk herniations BEFORE they reach the point of requiring surgery. So make chiropractic your FIRST choice when neck pain occurs!

 

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Whiplash Diagnosis.

10 Dec

Whiplash is, by definition, the rapid acceleration followed by deceleration of the head causing the neck to “crack like a whip” forwards and backwards at a rate so fast that the muscles cannot react quickly enough to control the motion. As reported last month, if a collision occurs in an automobile and the head rests are too low and/or seat backs too reclined and the head moves beyond the allowable tissue boundaries, “whiplash” injury occurs.

When gathering information from the patient, this portion of the history is called “mechanism of injury” and it is VERY IMPORTANT, as it helps us piece together what happened at the time of impact. For example, was the head turned upon impact? Was the impact anticipated? What were the weather conditions (visual, road conditions)? What was the direction of the strike (front, rear, side, angular, or combinations of several)? Did a roll over occur? Was a seat belt used (lap and chest) and were there any seat belt related injuries (to the low back/pelvis, breasts/chest, shoulder, neck)? Any head impact injuries with or without loss of consciousness (if so, how long)? Any short-term memory loss and residual communication challenges (post-concussive syndrome)? All of the answers to these questions are very important when determining the examination path, establishing the diagnoses, and determining the treatment plan.

We also discussed last month the WAD classification or, Whiplash Associated Disorders, which was coined in 1995 by the Quebec Task Force. Types I, II, and III are defined by the type of tissues injured and the history and examination findings. In 2001, the Quebec Task Force found that WAD II (loss of range of motion or ROM/negative neurological findings) and WAD III (both ROM loss and neurological loss) carried progressively greater risk of prolonged recovery compared to WAD I injuries (those with pain but no loss of motion or neurological findings).

Establishing a strong diagnosis allows for accuracy in prognosis and treatment plan recommendations. For example, in WAD II & III injuries, flexion/extension x-rays are needed to determine the extent of ligament damage as normally, the individual vertebrae should not translate or shift forwards or backwards by more than 3.5mm. Similarly, the angle created between each vertebra in flexion & extension should be within 11 degrees of the adjacent angles, and if that’s exceeded, ligament damage is likely to have occurred. So often, ER records describe little to no information about the historical elements reviewed in the 1st paragraph and if x-rays were taken, they rarely include flexion/extension stress x-rays.

Headaches are another component of WAD. Here, the first three sets of nerves that exit the uppermost levels of the spine (C1, C2, and C3) innervate the head. When a patient describes headaches that start in the upper part of the neck and radiate up into the head, the distribution of the pain by history can tell us which nerve(s) are most affected. In the examination, applying manual pressure to the base of the skull can reproduce pain when a nerve is injured. Tracking these findings on a regular basis can tell us how the condition is healing. Chiropractic is at the forefront of diagnosis for WAD!

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Whiplash – Can We Predict Long-Term Problems?

9 Dec

Whiplash (or the rapid acceleration forwards followed by deceleration or sudden stopping of the moving head during the whiplash event) occurs at a speed that is so fast, we can’t prepare for it. In other words, by the time it takes us to voluntarily contract a muscle to guard ourselves against injury, that rapid forward/backwards “whipping” of the head and neck is already over! When considering the details of the injury event, sometimes we lose focus on what REALLY matters. Is there a way to reduce the chances for a long-term chronic, disabling, neck pain / headache result? Last month, we found out that the long-term use of a cervical collar is NOT a good idea. What are some other ways to prevent long-term disability?

A very interesting study investigated the first 14 days of treatment during the acute stage of whiplash neck sprain injuries following a car accident. The researchers wanted to determine what long-term consequences resulted from two different treatment approaches. In one group (201 patients, 47% of the total group), the patients were encouraged to, “…act as usual,” and continue in their normal daily, pre-injury activities. The patients in the second group were given time off from work and were immobilized in a soft cervical collar during the first 14 days after the car crash. At the end of the 14 days, there was a significant reduction of symptoms between the first visit to the fifteenth day (24 hours after the 14 day initial treatment time frame in both groups). However, when evaluated at the six-month point, the group that continued their normal daily routine, did not take time off work, and did not wear a collar had, “…a significantly better outcome,” compared to the other group. This study supports that over-treatment with a collar and time off from work “sets people up” for adopting a “sick role” where the patient is overly-focused on their problem. This study parallels what we discussed last month and embraces the chiropractic philosophy to staying active, exercise, don’t use a collar, and the use of manipulation which exercises joints and keeps them from stiffening up, thus reducing pain and the fear of doing activity!

Another study looked at different presenting physical factors that might be involved in the development of long-term handicaps after an acute whiplash injury in a group of 688 patients. They measured these physical factors at three, six, and twelve month intervals and found the relative risk for a disability a year after injury increased with the following: 1) A 3.5 times disability increase with initial high pain intensity of neck pain and headaches; 2) A 4.6 times increase with initial reduced neck movement or ranges of motion; and 3) A 4 times greater chance with initial multiple non-painful complaints (such as balance disturbance, dizziness, concentration loss, etc.). In yet another study, both physical and psychological factors were found to predict long-term disability. These included initial high levels of reported pain and poor activity tolerance, older age, cold sensitivity, altered circulation, and moderate post-traumatic stress.

The “bottom line” is that as chiropractors, we are in the BEST position to treat and manage whiplash injured patients based on the type of care we perform and offer. We promote exercise of muscles and joints, encourage activity not rest, and minimize dependence on medication, collars, and other negative treatment approaches.

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