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“The Only Proven Effective Treatment” for Chronic Whiplash

You may havBoise Chiropractore wondered, “If I get hurt in a car accident, who should I go to for treatment of my whiplash problem?”  This can be quite a challenge as you have many choices available in the healthcare system ranging from drug-related approaches from anti-inflammatory over-the-counter types all the way to potentially addicting narcotic medications.  On the other side of the fence, there are nutritional based products such as vitamins and herbs as well as “alternative” or “complementary” forms of treatment such as chiropractic, exercise, and meditation, with many others in between.  Trying to figure out which approach or perhaps combined approaches would best serve your needs is truly challenging.  To help answer this question, one study reported the superiority of chiropractic management for patients with chronic whiplash, as well as which type of chronic whiplash patients responded best to the care.  The research paper begins with the comment from a leading orthopedic medical journal stating, “Conventional [meaning medical] treatment of patients with whiplash symptoms is disappointing.”  In the study, 93 patients were divided into three groups consisting of:

  • Group 1: Patients with a “coat-hanger” pain distribution (neck and upper shoulders) and loss of neck range of motion (ROM), but no neurological deficits;
  • Group 2: Patients with neurological problems (arm/hand numbness and/or weakness) plus neck pain and ROM loss); and,
  • Group 3: Patients who reported severe neck pain but had normal neck ROM and no neurological losses.

The average time from injury to first treatment was 12 months and an average of 19 treatments over a 4 month time frame was utilized.  The patients were graded on a 4-point scale that described their symptoms before and after treatment.  Grade A patients were pain free;  Grade B patients reported their pain as a “nuisance;”  Grade C patients had partial activity limitations due to pain; and  Grade D patients were disabled.

Here are the results:

  • Group 1: 72% reported improvement as follows: 24% were asymptomatic, 24% improved by 2 grades, 24% by 1 grade, and 28% reported no improvement.
  • Group 2: 94% reported improvement as follows: 38% were asymptomatic, 43% improved by 2 grades, 13% by 1 grade, and 6% had no improvement.
  • Group 3: 27% reported improvement as follows: 0% were asymptomatic, 9% improved by 2 grades, 18% by 1 grade, 64% showed no improvement, and 9% got worse.

This study is very important as it illustrates how effective chiropractic care is for patients who have sustained a motor vehicle crash with a resulting whiplash injury.  It’s important to note the type of patient presentation that responded best to care had neurological complaints and associated abnormal neck range of motion.  This differs from other non-chiropractic studies where it is reported that patients with neurological dysfunction responded poorly when compared to a group similar to the Group A patient here (neck/shoulder pain, reduced neck ROM, and with normal neurological function).

Call the Idaho Injury Experts today to set up your free no-obligation consultation. Don’t wait! You can get medical treatment at no cost to you!

Whiplash- What is the Best Type of Treatment?

Boise ChiropractorWhiplash usually occurs when the head is suddenly whipped or snapped due to a sudden jolt, usually involving a motor vehicle collision. However, it can also occur from a slip and fall injury.  So the question on deck is, which of the health care services best addresses the injured whiplash patient?

This question was investigated in a published study titled, A symptomatic classification of whiplash injury and the implications for treatment (Journal of Orthopaedic Medicine 1999;21(1):22-25).  The authors state conventional [medical] treatment utilized in whiplash care, “is disappointing.”  The authors’ reference a study that demonstrated chiropractic treatment benefited 26 of 28 patients with chronic whiplash syndrome.  The objective of their study was to determine which type of chronic whiplash patient would benefit the most from chiropractic treatment.  They separated patients into one of 3 groups:  Group 1: patients with “neck pain radiating in a ‘coat hanger’ distribution, associated with restricted range of neck movement but with no neurological deficit”; Group 2: patients with “neurological symptoms, signs or both in association with neck pain and a restricted range of neck movement”; Group 3: patients who described “severe neck pain but all of whom had a full range of motion and no neurological symptoms or signs distributed over specific myotomes or dermatomes.” These patients also “described an unusual complex of symptoms,” including “blackouts, visual disturbances, nausea, vomiting and chest pain, along with a nondermatomal distribution of pain.”

The patients underwent an average of 19.3 adjustments over the course of 4.1 months (mean). The patients were then surveyed and their improvement was reported:

Group 1

24% Asymptomatic

24% Improved by Two Symptom Grades

24% Improved by One Symptom Grade

28% No Improvement

Group 2

38% Asymptomatic

43% Improved by Two Symptom Grades

13% Improved by One Symptom Grade

6% No Improvement

Group 3

0% Asymptomatic

9% Improved by Two Symptom Grades

18% Improved by One Symptom Grade

64% No Improvement

9% Got Worse

These findings show the best chiropractic treatment results occur in patients with mechanical neck pain (group 1) and / or those with neurological losses (group 2).  The exaggerated group (group 3) was the most challenging and, the only group where a small percentage worsened.  The good news is, the number of cases that responded well to chiropractic treatment (groups 1 & 2) far out number those that don’t (group 3).  Hence, most patients with whiplash injuries should consider chiropractic as their first choice of health care provision. Call the Idaho Injury Experts today to set up your no obligation consultation!

Whiplash Facts

Whiplash is a fairly cboise chiropractorommon 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:

 

 

WAD I: Patients have complaints but no objective findings meaning we cannot reproduce your pain during our examinations

  1. 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)
  2. WAD IIb: Same as WAD IIa except here, neck movements are decreased
  3. WAD III: Here, neurological abnormal findings (weakness and/or sensation) are present.
  4. 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. Call the Idaho Injury Experts today to set up your consultation!

What Really Causes Whiplash?

Boise Personal Injury LawyerWhiplash is a non-medical term for a condition that occurs when the neck and head move rapidly forwards and backwards or, sideways, at a speed so fast our neck muscles are unable to stop the movement from happening.  This sudden force results in the normal range of motion being exceeded and causes injury to the soft tissues (muscles, tendons and ligaments) of the neck. Classically, whiplash is associated with car accidents or, motor vehicle collisions (MVCs) but can also be caused by other injuries such as a fall on the ice and banging the head, sports injuries, as well as being assaulted, including “shaken baby syndrome.”

 The History Of Whiplash.  The term “Whiplash” was first coined in 1928 when pilots were injured by landing airplanes on air craft carriers in the ocean. Their heads were snapped forwards and back as they came to a sudden stop. There are many synonyms for the term “whiplash” including, but not limited to, cervical hyperextension injury, acceleration-deceleration syndrome, cervical sprain (meaning ligament injury) and cervical strain (meaning muscle / tendon injury). In spite of this, the term “whiplash” has continued to be used usually in reference to MVCs.

 

Why Whiplash Occurs.  As noted previously, we cannot voluntarily stop our head from moving beyond the normal range of motion as it takes only about 500 milliseconds for whiplash to occur during a MVC, and we cannot voluntarily contract our neck muscles in less than 800-1000 msec. The confusing part about whiplash is that it can occur in low speed collisions such as 5-10 mph, sometimes more often than at speeds of 20 mph or more.  The reason for this has to do with the vehicle absorbing the energy of the collision. At lower speeds, there is less crushing of the metal (less damage to the vehicle) and therefore, less of the energy from the collision is absorbed.  The energy from the impact is then transferred to the contents inside the vehicle (that is, you)! This is technically called elastic deformity – when there is less damage to the car, more energy is transferred to the contents inside the car.  When metal crushes, energy is absorbed and less energy affects the vehicle’s contents (technically called plastic deformity).  This is exemplified by race cars.  When they crash, they are made to break apart so the contents (the driver) is less jostled by the force of the collision.  Sometimes, all that is left after the collision is the cage surrounding the driver.

 Whiplash Symptoms.  Symptoms can occur immediately or within minutes to hours after the initial injury.  Also, less injured areas may be overshadowed initially by more seriously injured areas and may only “surface” after the more serious injured areas improve. The most common symptoms include neck pain, headaches, and limited neck movement (stiffness). Neck pain may radiate into the middle back area and/or down an arm.  If arm pain is present, a pinched nerve is a distinct possibility. Also, mild brain injury can occur even when the head is not bumped or hit. These symptoms include difficulty staying on task, losing your place in the middle of thought or sentences and tireness/fatigue.  These symptoms often resolve within 6 weeks with a 40% chance of still hurting after 3 months, and 18% chance after 2 years.  There is no reliable method to predict the outcome. Studies have shown that early mobilization and manipulation results in a better outcome than waiting for weeks or months to seek chiropractic treatment. The best results are found by obtaining prompt chiropractic care.

Car Accidents and Mild Traumatic Brain Injury

Boise ChiropractorWhen you woke up today, you thought this was like any other Friday. You’re on your way to work, and traffic is flowing smoother than normal.  Suddenly, someone crashes into the back end of your car and you feel your head extend back over the headrest and then rebound forwards, almost hitting the steering with your forehead. It all happened so fast. After a few minutes, you notice your neck and head starting to hurt in a way you’ve not previously felt.   When the police arrive and start asking questions about what had happened, you try to piece together what happened but you’re not quite sure of the sequence of events.  Your memory just isn’t that clear. Within the first few days, in addition to significant neck and headache pain, you notice your memory seems fuzzy, and you easily lose your train of thought. Everything seems like an effort and you notice you’re quite irritable. When your doctor asks you if you’ve felt any of these symptoms, you look at them and say, “…how did you know? I just thought I was having a bad day – I didn’t know whiplash could cause these symptoms!”

Because these symptoms are often subtle and non-specific, it’s quite normal for patients not to complain about them. In fact, we almost always have to describe the symptoms and ask if any of these symptoms “sound familiar” to the patient.

As pointed out above, patients with Mild Traumatic Brain Injury (MTBI) don’t mention any of the previously described symptoms and in fact, may be embarrassed to discuss these symptoms with their chiropractor or physician when they first present after a car crash.  This is because the symptoms are vague and hard to describe and, many feel the symptoms are caused by simply being tired or perhaps upset about the accident.  When directly asked if any of these symptoms exist, the patient is often surprised there is an actual reason for feeling this way.

The cause of MTBI is due to the brain actually bouncing or rebounding off the inner walls of the bony skull during the “whiplash” process, when the head is forced back and forth after the impact. During that process, the brain which is suspended inside our skull, is forced forwards and literally ricochets off the skull and damages some of the nerve cells most commonly of either the brain stem (the part connected to the spinal cord), the frontal lobe (the part behind the forehead) and/or the temporal lobe (the part of the brain located on the side of the head). Depending on the direction and degree of force generated by the collision (front end, side impact or rear end collision), the area of the brain that may be damaged varies as it could be the area closest to initial impact or, the area on the opposite side, due to the rebound effect. Depending on which part of the brain is injured, the physical findings may include problems with walking, balance, coordination, strength/endurance, as well as difficulties with communicating (“cognitive deficits”), processing information, memory, and altered psychological functions.

The good news is that most of these injuries will recover within 3-12 months but unfortunately, not all do and in these cases, the term, “post-concussive syndrome” is sometimes used.  If you’ve been involved in a car accident, don’t use the “wait and see” approach, instead contact your Idaho Injury Experts today to set up a free consultation with one of our experts.

Meridian Chiropractor Shares the 3 Phases of Healing

As a Meridian Chiropractor, I see a lot of patients who have suffered from whiplash injuries.  One of the most common frustrations that people often have when seeing a chiropractor is why the process can sometimes take a while.  This is understandable when you consider that patience isn’t an American forte.  In addition to this it seems that impatience is only reinforced when you look at all the “quick fixes” that are often sold to the public.  Injections, pills or surgeries are often presented as magic bullet cures but more often than not these merely mask symptoms and don’t provide any sort of long lasting solution.  The time it takes to heal isn’t just a “chiropractic” thing, its a “science” thing.  People need to understand that true tissue healing  can at times be a slow process and it can often be hindered by things we do or fail to do, medications we take, and even foods we eat.  There are 3 primary phases of tissue healing.

The 3 Phases of Tissue Healing

Phase 1-Acute Infammatory Phase:  Immediately following an injury the body produces special cells that target the site of injury and begin preparing that area for the healing process.  It is this inflammatory response that causes pain, redness and swelling.  This is the bodies way of protecting itself.  Unfortunately the body doesn’t have a very good way of ratcheting the inflammatory response level according to the extent of injury.  The response is usually pretty overwhelming.  A large part of the swelling is also due to damage of blood and lymph vessels at the site of injury.  The reason ice is typically recommended at the onset of an acute injury is because it helps to control much of the swelling.

Phase 2-Repair Phase:  This is the process just after the inflammatory phase where the body begins to lay down repair cells that will be transformed into new healthy tissue.  Unfortunately these cells can often result in the development of scar tissue if the injury is not properly managed from the onset of injury.  It is critical for the body to get optimal amounts of vitamins and minerals to assist in providing the essential nutrients needed for tissue healing.  It is also critical that you immediately see a trusted health care professional who will begin you on an actual treatment plan rather than simply “waiting it out”.  This phase can last anywhere from 72 hours to 6 weeks depending upon the extent of injury.

Phase 3-Remodeling Phase:  Once these repair cells have settled into place they will begin to remodel.  This process is largely determined by the types and direction of stresses placed on them.  This is exactly why rehabilitative exercises are so important to help correctly remodel these tissues.  This process can last anywhere from 3 weeks all the way to 2 years depending again upon the extent and area of injury.

As you can see here the repair process is anything but quick but what the public needs to understand is that the time it takes to truly heal from injuries can be greatly reduced if injuries are managed properly from the beginning.  As a Meridian Chiropractor I have seen times when patients have immediately sought out care for their injuries and in these instances the prognosis is greatly improved.  But I have also seen patients who have waited to get proper care and often times these patients suffer delays and setbacks in their care and their overall prognosis is not as good.

If you have been injured in an auto accident and are looking for help, Dr. Woolner is a Meridian Chiropractor and has advanced training in the proper management of auto injuries.  You can contact him here.

Proper Head Restraint Positioning Can Help Prevent Whiplash

One of the most basic yet effective things that people can do to help prevent whiplash injuries is to properly position the head restraints in their vehicles.  As a Meridian Chiropractor, I am often helping patients who have sustained whiplash injuries.  I often wonder how many of these injuries could be less severe if not altogether prevented through proper steps such as correct positioning of head restraints.

A study conducted in 2005 that was published in the journal Injury Precention surveyed a group of over 4,000 drivers in Portland, Oregon.  The survey examined differences in types of head restraints and head restraint positioning.  What the study found was that over 93% of the group surveyed had head restraints that were poorly positioned to help prevent whiplash injuries.

What this tells us is that there is a tremendous lack of awareness when it comes to the role that these head restraints play in preventing whiplash injuries.  So what exactly do people need to know about proper head restraint positioning?  Here is what the experts say when it comes to proper head restraint geometry:

Fig. 1:  Optimal head restraint positioning is achieved when the head restraint is positioned just above the ears (vertical height) and touching the back of the head (horizontal gap).

Here is an example of what the ideal head restraint positioning should look like

Now take this information and make the necessary adjustments to your own head restraint to help reduce the likelihood of sustaining whiplash injuries if not altogether preventing them.  If you have any further questions contact Meridian Chiropractor, Dr. Chad Woolner at 208-639-1397 begin_of_the_skype_highlighting            208-639-1397      end_of_the_skype_highlighting

Whiplash Injuries 101

This video explains the basic mechanism behind whiplash injuries.  Although there are different ways in which people can sustain these types of injuries, most commonly they are caused by car accidents.  If you have sustained whiplash injuries from a car accident you should immediately have a thorough evaluation performed by a trusted Meridian Chiropractor or Boise Chiropractor.

Did You Know… that One in Five Whiplash Victims, Experience Shoulder Injury?

Shoulder “Impingement” After the Read End Collision

One all-too-common consequence of whiplash injury is shoulder impingement after rear-end collisions. Although symptoms may be present, some estimates suggest that one in five patients will ultimately experience shoulder problems.  That statistic is alarming to say the least.  Let’s now get into what the literature has to say about this pervasive problem so as to shed some light.

Monique B. Harriton, author of The Whiplash Handbook, has this to say about the body:

“As bones, muscles, cervical nerves, blood vessels and the spinal cord are in such close proximity, they all impinge on one another whenever they are traumatized, creating a kind of “domino effect.”

“It is not always possible to pinpoint the precise ligament or muscle responsible for a particular symptom; muscles and joints work together in such a way that if there is a loss of normal motion in one muscle, other joints will eventually be forced to position themselves abnormally to compensate. For instance, a forward dislocation of the 4th and 5th cervical vertebrae may cause referred pain to the front of the shoulder. The reason for this phenomenon is that there is a close continuity between the deep cervical tissues, the enveloping muscles and the nerves that penetrate the back of the head, the neck and the shoulders.”

The Domino Effect of Impingement, Revealed:

Shoulder injuries seldom present themselves immediately after an accident. In one study 34 patients with pain in the superomedial area of the scapula and with abnormal radiographs showing trabecular atrophy were studied.

71% of the subjects reported that the onset of symptoms occurred after a motor vehicle collision. And none of the 34 patients reported shoulder pain. After an injection of anesthetic in the shoulder joint, 30 of the 34 patients or 88% reported immediate “improvement” in their neck pain. The remaining four patients reported substantial pain relief three weeks after the injection. Twenty of the 34 patients all reported long-term relief from symptoms seven years later. The conclusion: In this case, the authors concluded that the neck pain symptoms were actually “referred” pain from the shoulder.

In a second study, 524 patients with whiplash were surveyed to gather information on shoulder impingement. Of those, 43 met the criteria for true shoulder impingement. All 43 were treated by the authors of the study with injections and physical therapy. The conclusion: Of the 43 patients, 56% showed significant improvement, 23% reported moderate improvement and 21% reported no improvement after the treatments.

How Does Shoulder Impingement Actually Occur in an Auto Accident?

  • One researcher suggests that shoulder impingement is the result of direct trauma from a rear-end collision.
  • It is suggested that collision forces are transferred to the shoulder from the arm while the individual is holding the wheel.
  • Another researcher suggests based on clinical observation that whiplash injuries cause neck pain that produces dysfunction of the trapezius muscle ultimately leading to shoulder pain.

As you can see, even the experts don’t agree on this issue. However there is much chiropractic literature to suggest that the Domino Theory is the correct one. And that has well been my own experience.

One thing is clear: Doctors choosing to work with whiplash cases must have a thorough understanding into issues as subtle as aggression indications.  Doctors can often fumble an important case simply because they lack the experience to detect such subtleties that can exist and are so unique to whiplash trauma.

This is precisely why you should only trust an expert.  IdahoInjuryExperts.com is your trusted resource for helping individuals who have been involved in auto accidents.

Dr. Woolner is a Meridian Chiropractor and can be reached at his clinic www.BoiseChiropracticGroup.com

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