Chiropractic and Auto Accidents
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- For more information visit: www.thechiropracticimpactreport.com for any and all questions regarding auto accident injuries.
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- It is estimated that 15-40% of those who are injured in a motor vehicle collision will suffer from ongoing chronic pain.(Journal of the American Academy of Orthopedic Surgeons, 2007)
- Whiplash injuries not only increase the incidence of chronic neck and shoulder pain, it also significantly increases the incidence of other systemic ill health effects. In other words, whiplash injuries cause more than neck pain and headache, it hurts the health of the entire body.(Journal of Clinical Epidemiology, 2001)
- That essentially 100% of those who are suffering from chronic pain caused by a whiplash injury will have an abnormal psychological profile with standard assessments, and the only way to resolve the abnormal psychological profile was to successfully treat the chronic spinal pain. Psychotherapy was not able to improve the abnormal psychological profile, nor was it able to improve the patient’s chronic pain complaint.(Pain, 1997)
- In the longest study ever performed on whiplash-injured patients (a study looking at the health status 17 years after injury), 55% of the patients still suffered from pain caused by the original trauma.(Accident Analysis and Prevention, 2002)
- 90% of those who are initially given a cervical collar for their whiplash injuries will be suffering from chronic neck pain 6 months later.(Spine, 2000)
- 2% of whiplash-injured patients will have severe pain and problems that require ongoing medical investigations and drugs 7.5 years after being injured.(Injury, 2005)
- 1 in every 100 (1%) people on our planet suffer from chronic neck pain caused by whiplash injury.(Pain, 1994)
Motor vehicle collisions have been the number one cause of death of our children for decades.
Since 911 (September 11, 2001), about 3,000 Americans have died as a consequence of terrorism; about 360,000 Americans have died in motor vehicle crashes.
Since the start of the American Revolution in 1775, about a million Americans have died in our wars. Since Henry Ford introduced the mass-produced motorcar in 1913, more than 2.5 million Americans have met their deaths on the road.
And millions of Americans who did not die from motor vehicle collisions were injured.
The Bottom Line… To understand whiplash injury and treatment, it is most important to know the answers to these three questions:
- What tissues are injured in a motor vehicle collision?
- What tissues are the primary sources for chronic spinal pain?
- What tissues are primarily affected by the chiropractic adjustment?
The tissues in and around the spine, including but not limited to the facet joints and the tissues of the disc joints
Consequently, it is inevitable that some whiplash-injured patients will develop chronic pain and that chiropractic is often the best management choice for these patients.
Whiplash - Which Treatment Method Is Best?
Whiplash, or better termed, cervical acceleration-deceleration disorder (CAD) is primarily an injury to the soft tissues of the neck – that is, the muscles, their tendon insertions, and the ligaments that hold the joints firmly together. Neck pain is a very common health problem that affects between 10–15% of the population and drives people to all types of health care providers. We have previously discussed the reasons why whiplash /CAD injuries occur, the examination process and the prognosis aspects but the argument continues as to what treatment methods work the best when managing patients with CAD.
In the May 21, 2002 issue of the Annals of Internal Medicine, a group of medical doctors and PhD’s reported on neck pain treatment comparing traditional medical and physical therapy approaches verses spinal manipulation. In the study, they compared three common neck pain treatment approaches in a group of 183 patients with chronic neck pain (patients who had neck pain for more than 3 months). The 3 methods included traditional medical care which included medication utilization and rest, manual therapy (chiropractic adjustments) and physical therapy (active exercise training). After 7 weeks of treatment, the percentage of patients who felt either totally resolved (cured) or much improved were 68.3% receiving manual therapy / chiropractic care, 50.8% receiving physical therapy, and 35.9% receiving medical care. The author, Jan Lucas Hoving, PhD reports that manual therapy / chiropractic was found to be more effective than the other 2 methods “…on almost all outcome measures,” not just a few! Further, although PT scored better than traditional medical care, “…most of the differences were not statistically significant,” meaning, not that much better. The authors appropriately reported that further study was needed to better understand the differences between methods.
In 2008, the “Decade Task Force” reviewed 10 years of studies on the treatment of neck pain and found similar results and referenced many studies that indicated spinal manipulation for neck pain, headaches, whiplash, and other neck related conditions was one of the most effective methods and that patients with neck pain should be given the option of receiving manual therapy / chiropractic before other approaches as it was found to be less expensive, faster in obtaining satisfying results (shorter course of disability), and most effective in terms of long-term benefits.
This comparison discussion is by no means meant to minimize the importance of medical and PT care. However, there appears to be a bias among patients with neck pain to seek medical care first when the studies clearly show chiropractic care is the preferred method. Hence, the purpose of this article is to educate the reader that their choice in treatment for neck pain should favor chiropractic care FIRST, not last. In fact, the sooner manipulation can be applied to the injured joints of the neck, typically the faster the results. For example, long term disability and chronic neck pain can occur from prolonged use of a cervical collar as the structures tighten and stiffen up from being immobile - unable to move because of the collar. Unless there is some unstable condition to the neck (fracture, grade 3 ligament tear, progressive neurological loss, etc.), studies support manipulation / early mobilization of the neck joints after injuries like whiplash verses wearing a cervical collar and rest.
We at Sayville Immediate Chiropractic Care realize that 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.
Thank you for Reading,
Dr. Frank Gomez
www.sayvillechiropractor.com
www.drfrankgomezblog.com
4844 Sunrise Highway
Sayville, NY 11782
(631) 991-3492
Chiropractic Treatment for: Neck Pain, Back Pain, Headaches and Shoulder Pain
No Appointment Necessary, Walk-in Chiropractic Care:
New patients welcome. No Long Term Care Plans
The Chiropractic office that makes it convenient for you to get the care you want in today's busy society! Our practice has a strong working relationship with many local allied health care professionals and primary care MD's.
YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR WHIPLASH!
FOR A FREE NO-OBLIGATION CONSULTATION
CALL DR. GOMEZ AT 631-991-3492
How to Improve Your Odds of Crash Survival
You might ask, what does this headline have to do with chiropractic? It’s often said case management or patient care is much more than just what we do to our patients (such as in chiropractic, applying a spinal adjustment). The patient education portion of our care plan can frequently make or break a successful outcome in a case. It is the goal of this Health Update to potentially save your life by empowering you with the knowledge needed when it’s time to purchase your next car. This is about what specific automobile features contribute to crash survival – hence, saving lives!
Did you know the car you choose can improve the odds of crash survival by 400%? In the popular magazine Consumer Reports, they wrote, “Ultimately, safety is active and passive, balancing the ability to avoid an accident and to survive one.” Typically, the first thing we do as consumers when we consider safety in a particular car is to look at the crash-test results. While this is important, we must first consider the size and weight so we compare crash-test results between cars in the same weight class since statistics show there are two times as many occupant deaths annually in small vs. large cars. Keeping size and weight in the foreground, when evaluating crash-test results, the front and rear end “crumple zone” of the car should be designed to absorb crash forces by buckling and bending in a serious collision. If you’ve ever watched race cars crash, you usually see car parts bend and break off as they bounce off the guard rail or other cars, sometimes to the point where all that is left is the cage surrounding the driver. Amazingly, the race car driver often climbs out of the cage and walks away, seemingly unharmed.
The next important car feature to consider is a car with a structurally superior passenger compartment. Look for a high quality “restraint system” made up of 3 components: seat belts, airbags, and head restraints. These work together to keep us safe and in place during a crash while the outside of the car crumples, absorbing the energy of the crash.
So where do you look to get this information? There are several resources available:
1. The NHTSA (National Highway Traffic Safety Administration) tests front end impacts at 35 mph, and in 1997 added side impact tests at 38 mph. They also test for the rollover potential for SUVs and trucks and grade the results for each category from 1 to 5 stars representing the likelihood of suffering a life-threatening injury in a crash.
2. Since 1995, the IIHS (Insurance Institute for Highway Safety) has used a method reviewed by Consumer Reports as being more realistic by crashing only half of the vehicle at similar speeds into fixed barriers, since most crashes are not direct, whole car strikes.
3. Consumer Reports is a 3rd option. They integrate the data from both NHTSA and IIHS and gives us their “CR Safety Assessment,” and run 40 new cars each year through numerous individual tests.
Other important “accident avoiding” features often overlooked include: Tires - greatly impact braking and emergency handling so REPLACE them as needed; Braking-check for the distance required to stop the car at different speeds- the shorter, the better; Emergency Handling-data about accident avoidance and choosing a vehicle with electronic stability control (ESC), especially in SUVs is wise; Acceleration-the quicker a car can get to highway speeds, the better; Driver position and visibility-a good view of the surroundings, especially the “blind spots” is important. We realize you have a choice in where you go for your health care needs and we truly appreciate your consideration in allowing us to help you.
We at Sayville Immediate Chiropractic Care 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.
Thank you,
Dr. Frank Gomez
www.sayvillechiropractor.com
www.DrFrankGomezBlog.com
YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR WHIPLASH!
FOR A FREE NO-OBLIGATION CONSULTATION
CALL DR. FRANK GOMEZ @ 631-991-3492
Whiplash and Work
Does this sound familiar? It’s fictional but a rather typical scenario affecting thousands of American drivers:
“Last week, I was waiting at a red light and a car came up from behind and ran into the back end of my car. It was a low speed collision without a lot of damage to either of our cars. Surprising, I felt quite a jolt and my head even hit the headrest. I didn’t bother getting the name or phone number from the person that hit me because I didn’t hurt at the time and besides, there was no real damage that I could see to my car or the other person’s car.
“About a half hour later, I noticed my neck felt stiff when I turned to check traffic on my right and I felt really sharp pain before I could turn the whole way. The pain was bad enough to make me yell and when I brought my head back to the front, the pain didn’t go away – in fact it felt worse. When I woke up the next day, I could hardly turn my head at all and, I had a terrible headache. The pain was so bad that even 4 Advil didn’t touch it.
“I couldn’t decide what type of doctor to see for this. I knew if I went to my family doctor, he’d put me on a bunch of pills but I have to drive forty five minutes to my job and I have two small kids that require my attention. I had seen an ad for a chiropractor a while back and I wondered what they would do for something like this. I knew I had to do something and fast!
“So I decided to go to a chiropractor a friend of mine recommended and I was really surprised when I got there. The doctor was really attentive and seemed to know exactly what was going on. It was explained to me that I may have been hurt MORE than I might have been had the speed of the other car been going even faster because crushing metal absorbs the shock where in my case, no car damage resulted in more shock to me. This made sense because I had some books on the other seat that flew off when I was hit, which I forgot about until we were talking. I also learned that even if I knew I was going to get hit, I wouldn’t have been able to brace myself enough to avoid injury as the speed of the force moves the head and neck quicker than what I can tighten my muscles. The chiropractor showed me some charts that helped explain all this and why my neck hurt and where the headaches come from. I also learned NEVER assume no car damage means no injury.
“The best part was right after the adjustment, I felt immediate improvement with better movement and less pain. I also was told to put ice on my neck, which helped a lot more than heat did. I’m now doing exercises and really feel good! I can’t tell you how happy I am that I chose a chiropractor to help me!”
Patients who have similar experiences are afraid of having a long, drawn out problem and missing work. You have many choices when it comes to choosing a health care provider for your injury and other health care needs. I truly appreciate your trust and confidence in our service when choosing to visit my clinic when you need help!
We at Sayville Immediate Chiropractic Care realize you have a choice in who you choose to provide your healthcare services. If you, a friend or family member requires care for low back pain, 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.
Thank you,
Dr. Frank Gomez
www.sayvillechiropractor.com
www.drfrankgomezblog.com
Please contact our office if you, your family or friends are suffering with injuries sustained in a motor vehicle collision.
The Whiplash Syndrome: Cervical Traction
Whiplash injuries include damage to the soft tissues of the neck such as muscles, tendons, ligaments, and myofascial tissues. The degree of injury is typically graded on a 1-3 scale from least to most tissue damaged, respectively. A grade 1 sprain (ligament injury) or strain (muscle or muscle tendon injury) includes minimal tissue disruption or tearing while grade 3 sprains and strains include significant tissue tearing and subsequently longer healing times with greater chance of long-term residual problems. More severe whiplash injuries can result in fracture but those types of injuries are not indicated for traction forms of therapy until after the fracture heals and stability is restored to the neck. So, the question is, what role does cervical traction play in the management of neck pain associated with whiplash?
In whiplash injuries, when it feels good to the patient to have someone pull on their neck, that person is a candidate for cervical traction. The amount of weight or traction force and length of time are based on patient comfort and are highly variable. Therefore, it is important to start with a low enough weight so injury to the patient from the traction therapy is avoided. Typically, 5#/15 minutes is a safe starting point, gradually increasing the weight to a maximum tolerated level.
Many insurance companies, based on the published literature regarding cervical traction, regard it as a “medically necessary” form of treatment and hence, a covered service. There are many different cervical traction devices available for home use of which the over-the-door traction unit is typically the least expensive and in some cases mandated prior to insurance allowance for a more expensive pneumatic cervical traction device. Unless there are reasons that over-the-door traction is not tolerated such as jaw pain (due to the chin strap pressure), this approach is commonly utilized. This device includes a water bag that is calibrated for water weight and can be done multiple times a day, depending on each case. There is also a collar-type of traction unit which allows the patient to move around rather than sit in one place. However, the amount of weight is better regulated with the water bag/sitting type. There are laying down types of neck traction which can also be regulated accurately for weight. These tend to be more expensive and insurance companies may require use of the less expensive over the door type first, unless there is a medical reason that a chin strap is not tolerated. Below are pictures of the different types of units available.
We at Sayville Immediate Chiropractic Care realize you have a choice in who you choose to provide your healthcare services. If you, a friend or family member requires care for low back pain, 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.
Thank you,
Dr. Frank Gomez
www.sayvillechiropractor.com
Thank you for your time in reading my article.
Please check out the links below for further reading.
www.SayvilleChiropractor.com
www.DrFrankGomezBlog.com
www.HelpYourDiabetes.com
www.SayvillePainRelief.com
www.TheChiropracticImpactReport.com
www.uschirodirectory.com
Whiplash: Where’s the Pain Coming From?
Whiplash commonly occurs as a result of a motor vehicle collision when, typically, there is hyper-motion in one direction followed by motion in the opposite direction in a crack the whip like manner.
The direction of the strike typically dictates the direction of movement of the head so in a rear end collision, the strike is from behind, whipping the head forwards and then backwards. In a side-on collision, a side-to-side motion results. Pain can occur anywhere around the neck, upper back, arms, chest and/or head, depending on the tissues that are injured. Soft tissues including the muscles, their tendon insertions, ligaments that securely tie bone to bone, the shock absorbing disk in the front of the vertebral column, and/or the nerves that pass through the holes of the spine that innervate the arms and hands can be affected by these injuries.
There can be jaw pain, difficulty in swallowing, balance / dizziness problems, fatigue, as well as concussion or mild traumatic brain injury which can lead to poor concentration, sleep interference, and memory loss. Low back pain and/or trunk pain can occur from the seatbelt and/or airbag deployment.
The injuries associated with whiplash can lead to disruption of normal daily activity, depression and anxiety. There can be immediate symptoms or a delay in the onset and pain with its associated disability can last for days, weeks, months, or longer, depending on each case.
Last month, we discussed the grades 1, 2, and 3 or, mild, moderate, severe sprains (ligament injuries) and strains (muscle injuries). Previously, we discussed methods of prognosing the lasting effects of the injury in a reported classification system called whiplash associated disorders or WAD I, II, III. & IV. Here, the differentiating feature is pain with no objective exam findings (WAD I), the presence of objective loss of motion but negative neurological findings (WADII) or, the presence of measurable neurological dysfunction (WAD III). Studies have shown that the likelihood of prolonged injury increases with each WAD grade.
A side-to-side or front-to-back mechanism of injury can result in damage to the ligaments in the back of the spine called the supra- and inter- spinous ligaments, the disk and/or nerve root that exits the spine allowing the arm and hand to sense and be strong (when it’s not pinched or damaged like in a WAD III) and/or, the bone which can compress when the force is hard enough (WAD IV). A concussion can occur when the brain bounces against the inside of the skull.
We at Sayville Immediate Chiropractic Care 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.
Thank you,
Dr. Frank Gomez
www.sayvillechiropractor.com
www.DrFrankGomezBlog.com
Whiplash and Your Ligaments
Most people who get a whiplash-like injury think it is caused by a problem in their muscles. It’s easy to see this why this may be the case since muscle pain following car accidents is so common. Deep pain and even spasm can occur after severe trauma resulting in daily pain and even headaches. Since our 10-12 pound head is attached to our necks by muscles that go into the shoulder region, whiplash can feel like a muscle pull and taking muscle relaxants seems a reasonable approach.
Although tears of muscles fibers do occur in whiplash, these can heal rather quickly due to the rich blood supply. The ligaments hold the joints of the neck together keeping the nerves from being pressed upon and stretched. These are the structures that are critically injured during whiplash. The muscles that contract to protect the joints from moving too much are generally less of a problem than when the ligaments are injured. A recent study (BMC Musculoskelet Disord 2006;21:103) showed that after whiplash, the strength of the neck ligaments is further reduced. This means that you are more susceptible to getting injured if you previously suffered a trauma.
To detect ligament injuries you can look at MRIs immediately after the trauma. In many cases they can show small tears or the inflammation and swelling that goes with tears of these important structures.
You can also have stress x-rays taken in the positions of forward and backward bending. These types of x-rays can show which ligaments have been traumatized and are allowing the bones of the neck to move too much. When this increased motion is severe, this is called instability. Some newer MRI machines can scan in different positions so that the tears and their motion effects are seen with one test. Some people may find the MRI scanner to be a bit restrictive or claustrophobic. X-rays are usually the most practical and least costly choice.
We at Sayville Immediate Chiropractic Care realize that you have a choice in where you choose your healthcare services.
If you, a friend or family member requires care for headaches, 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.
Thank you For Reading,
Dr. Frank Gomez
www.sayvillechiropractor.com
Whiplash Facts
Whiplash is a fairly common condition that occurs when the neck is suddenly forced forwards and backwards, usually from motor vehicle collisions. Before 1928, whiplash was sometimes called “railway spine” as it was used to describe injuries that occurred to people involved in train accidents. Since 1928, much has been studied and reported about this condition and in 1995, the term, “whiplash associated disorders” or WAD, was introduced. The WAD classification of whiplash patients includes 3 main category (WAD I, II and III) and a few years later, WAD II was broken into 2 sub-categories (WAD I, IIa, IIb, III). This occurred because some patients in WAD II took a longer time to heal than others. Here are the basic definitions of WAD I, II, III:
1. WAD I: Patients have complaints but no objective findings meaning we cannot reproduce your pain during our examinations
2. WAD IIa: Patients have complaints with objective findings but a normal range of movement of the neck and no neurological findings (normal strength and sensation ability)
3. WAD IIb: Same as WAD IIa except here, neck movements are decreased
4. WAD III: Here, neurological abnormal findings (weakness and/or sensation) are present.
5. WAD IV: Includes fractures and dislocations. Because of this unique difference, this category is often left out of the research that uses this category system to determine prognosis of the WAD case.
This system is very useful as it has the ability to predict the results in a case long before the conclusion of the case.
We have discussed the cause of whiplash in previous articles and what happens when we are hit from behind unexpectedly. In essence, we cannot guard against the abnormal forces that occur in the neck as it all happens faster than we can voluntarily contract our muscles. Also, the myth about no car damage = no injury is just that – a myth! In fact, in low speed impacts, less damage to the car transfers greater forces to the contents inside because the energy of the force is not absorbed by crushing metal (elastic vs. plastic deformity).
Symptoms of whiplash vary widely. Most common symptoms include neck pain and stiffness, headache, shoulder pain/stiffness, dizziness, fatigue, jaw pain, arm pain, arm weakness, visual disturbances, ringing ear noises, and sometimes back pain. If symptoms continue and chronic WAD occurs, depression, anger, frustration, anxiety, stress, drug dependency, post-traumatic stress syndrome, sleep disturbance, and social isolation can occur.
Diagnosis is based on the history, physical exam, x-ray, MRI, and if nerve damage occurs (WAD III), an EMG. Treatment includes rest, ice and later heat, exercise, pain management and avoiding prolonged use of a collar. Chiropractic includes all of these as well as manipulation, mobilization, muscle release methods, and patient education. Prompt return to normal activity including work is important to avoid the negative spiral into long term disability.
We at Sayville Immediate Chiropractic Care 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.
Thank you for your time in reading my article.
Please check out the links below for further reading.
www.SayvilleChiropractor.com
www.DrFrankGomezBlog.com
www.HelpYourDiabetes.com
www.SayvillePainRelief.com
www.TheChiropracticImpactReport.com
www.uschirodirectory.com
Whiplash Avoidance
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 at Sayville Immediate Chiropractic Care 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 and Side Collisions
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 at Sayville Immediate Chiropractic Care 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.
Vehicle Damage and Whiplash Injury
It has been documented in both medical and scientific studies that the damage to the vehicle is not related to the whiplash injuries suffered by the passengers of the vehicle. Vehicle damage is not proportional to passenger injury. Vehicle damage does not predict the degree of whiplash injury, the severity of symptoms, the duration of required treatment, the probability of suffering from chronic pain, or the acceleration of arthritis to the joints of the neck.
Research has proven that vehicles that do not bend (sustain damage) in a collision will move more. The more a vehicle moves during a collision, the greater the inertial loads to the cervical spine. The larger the inertial loads to the cervical spine, the greater the soft tissue injuries to the joints of the neck.
(American Journal of Orthopedics, 1964
The Spine, 1982
Orthopedic Clinics of North America, 1988
Society of Automotive Engineers, 1990
Injury, 1993
Trial Talk, 1993
Injury, 1994
American Journal of Pain Management, 1994
Society of Automotive Engineers, 1995
Society of Automotive Engineers, 1997
Archives of Physical Medicine and Rehabilitation, 1998
Journal Of Whiplash & Related Disorders, 2002
Spine, 2004
Journal of Neurology, Neurosurgery, and Psychiatry, 2005
Spine, 2005
Whiplash Injuries, 2006)
Whiplash and Side Collisions
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.
The Whiplash Syndrome: Cervical Traction
Whiplash injuries include damage to the soft tissues of the neck such as muscles, tendons, ligaments, and myofascial tissues. The degree of injury is typically graded on a 1-3 scale from least to most tissue damaged, respectively. A grade 1 sprain (ligament injury) or strain (muscle or muscle tendon injury) includes minimal tissue disruption or tearing while grade 3 sprains and strains include significant tissue tearing and subsequently longer healing times with greater chance of long-term residual problems. More severe whiplash injuries can result in fracture but those types of injuries are not indicated for traction forms of therapy until after the fracture heals and stability is restored to the neck. So, the question is, what role does cervical traction play in the management of neck pain associated with whiplash?
In whiplash injuries, when it feels good to the patient to have someone pull on their neck, that person is a candidate for cervical traction. The amount of weight or traction force and length of time are based on patient comfort and are highly variable. Therefore, it is important to start with a low enough weight so injury to the patient from the traction therapy is avoided. Typically, 5#/15 minutes is a safe starting point, gradually increasing the weight to a maximum tolerated level.
Many insurance companies, based on the published literature regarding cervical traction, regard it as a “medically necessary” form of treatment and hence, a covered service. There are many different cervical traction devices available for home use of which the over-the-door traction unit is typically the least expensive and in some cases mandated prior to insurance allowance for a more expensive pneumatic cervical traction device. Unless there are reasons that over-the-door traction is not tolerated such as jaw pain (due to the chin strap pressure), this approach is commonly utilized. This device includes a water bag that is calibrated for water weight and can be done multiple times a day, depending on each case. There is also a collar-type of traction unit which allows the patient to move around rather than sit in one place. However, the amount of weight is better regulated with the water bag/sitting type. There are laying down types of neck traction which can also be regulated accurately for weight. These tend to be more expensive and insurance companies may require use of the less expensive over the door type first, unless there is a medical reason that a chin strap is not tolerated. Below are pictures of the different types of units available.
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: Where’s the Pain Coming From?Whiplash commonly occurs as a result of a motor vehicle collision when, typically, there is hyper-motion in one direction followed by motion in the opposite direction in a “crack the whip” like manner.
The direction of the strike typically dictates the direction of movement of the head so in a rear end collision, the strike is from behind, whipping the head forwards and then backwards. In a side-on collision, a side-to-side motion results. Pain can occur anywhere around the neck, upper back, arms, chest and/or head, depending on the tissues that are injured. Soft tissues including the muscles, their tendon insertions, ligaments that securely tie bone to bone, the shock absorbing disk in the front of the vertebral column, and/or the nerves that pass through the holes of the spine that innervate the arms and hands can be affected by these injuries.
There can be jaw pain, difficulty in swallowing, balance / dizziness problems, fatigue, as well as concussion or mild traumatic brain injury which can lead to poor concentration, sleep interference, and memory loss. Low back pain and/or trunk pain can occur from the seatbelt and/or airbag deployment.
The injuries associated with whiplash can lead to disruption of normal daily activity, depression and anxiety. There can be immediate symptoms or a delay in the onset and pain with its associated disability can last for days, weeks, months, or longer, depending on each case.
Last month, we discussed the grades 1, 2, and 3 or, mild, moderate, severe sprains (ligament injuries) and strains (muscle injuries). Previously, we discussed methods of prognosing the lasting effects of the injury in a reported classification system called “whiplash associated disorders” or WAD I, II, III. & IV. Here, the differentiating feature is pain with no objective exam findings (WAD I), the presence of objective loss of motion but negative neurological findings (WADII) or, the presence of measurable neurological dysfunction (WAD III). Studies have shown that the likelihood of prolonged injury increases with each WAD grade.
A side-to-side or front-to-back mechanism of injury can result in damage to the ligaments in the back of the spine called the supra- and inter- spinous ligaments, the disk and/or nerve root that exits the spine allowing the arm and hand to sense and be strong (when it’s not pinched or damaged like in a WAD III) and/or, the bone which can compress when the force is hard enough (WAD IV). A concussion can occur when the brain bounces against the inside of the skull.
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 and Muscle Weakness
Published on 30 June 2012 under Whiplash
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.
For more information visit: www.thechiropracticimpactreport.com for any and all questions regarding auto accident injuries.
4844 Sunrise Highway, Sayville, NY 11782 - (631) 991-3492.
Hours- Monday, Wednesday, Thursday -10 to 12:30 & 3:30 to 7pm - No Appointment Necessary
Hours- Monday, Wednesday, Thursday -10 to 12:30 & 3:30 to 7pm - No Appointment Necessary