Monday, April 8, 2013

Risk Factors For Acute Injury and Long-Term Symptoms Associated With Whiplash

I often get asked questions regarding why some people in the same car, when exposed to the same forces of a crash, get injured, while other occupants of the vehicle do not suffer injuries. It is important to understand that forces and acceleration alone do not dictate risk for whiplash injury. Certain risk factors such as a person's age, height, previous health condition and head restraint geometry all play a role, even in instances of lower property damage crashes.

According to Dr. Arthur Croft in his book "Whiplash and Mild Traumatic Brain Injuries: A Guide for Patients and Practitioners" Dr. Croft notes the following factors as being predictive of experiencing whiplash from an auto accident (page 22).
  • Female sex
  • Females weighing less than 130 lbs in front crashes
  • Tall females
  • History of prior neck injury
  • Head restraint below head's center of gravity
  • History of whiplash injury
  • Poor head restraint geometry/tall occupant
  • Rear vs. other vector impacts
  • Use of seat belts/shoulder harness
  • Body mass index/head neck index (decreased risk with increasing mass and neck size)
  • Out-of-position occupant (i.e. leaning forward/slumped posture)
  • Having the head turned at impact
  • Non-awareness of impending impact
  • Increasing age (middle age and beyond)
  • Front vs. rear seat position
  • Impact by vehicle of greater mass 
  • Crash velocity under 10 mph (paradoxical, but true!)
If you or anyone you know has been injured as a result of an auto accident and has suffered from a whiplash injury in Baltimore, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500 or email us. We would be happy to help!

Friday, April 5, 2013

Physical Therapy Vs. Chiropractic
            The most obvious difference between doctors of chiropractic (DC's) and physical therapists (PT's) is virtually all chiropractors utilize some form of manipulation to restore joint function, whereas only a very small percentage of physical therapists utilize manipulation and virtually none of them have nearly as much experience "adjusting" patients or, the training to determine how and when to adjust for ultimate results go beyond just pain relief. Another very important difference is the education curriculum of chiropractors includes many class hours in physiology, pathology, clinical examination, radiology, laboratory testing and interpretation and diagnosis - these are not included in the PT educational process (although they are quickly expanding to learn these things).
            Perhaps even more important, chiropractors are accessible to the general public - that is, a referral from a medical doctor is not required in most cases. This is not the case for physical therapy as a medical referral is required and, the medical doctor can limit the amount of care rendered. This is an area that the physical therapy groups are currently working hard to change with many debated issues being presented. There are now some states that allow direct access of patients to doctors of physical therapy (DPT's), a new program created to improve the limited accessibility to PTs.
            With the debate raging on about health care reform, a pilot study indicating chiropractic care and other physical medicine approaches may reduce costs is VERY TIMELY!
            In 2008, Welllmark Blue Cross and Blue Shield conducted a 1-year pilot program designed to study the patient quality of care. The researchers concluded that the use of chiropractic and other physical medicine services significantly improved clinical outcomes and reduced health care costs. The 2008 Iowa and South Dakota pilot study included 238 chiropractors, physical therapists and occupational therapists that provided care to 5500 Wellmark patients with musculoskeletal disorders. They reported 89% of all patients receiving physical mediilne services improved at least 30% within 30 days. These statistics were so impressive that they decided to continue the program.
Supporters of chiropractic treatment praised the findings, saying that the cost-effectiveness of the method has been documented in several studies.
             The past president of the American Chiropractic Association, Glenn Manceaux, referred to a 2005 study published in the Journal of Manipulative and Physiological Therapeutics that found chiropractic and medical care have comparable costs for treating chronic low-back pain, with chiropractic care producing significantly better outcomes. Similarly, a study published in a 2003 edition of Spine medical journal found that manual manipulation provides better short-term relief of chronic spinal pain than a variety of medications, he said - "Especially during the health care reform debate, it's important that chiropractic and other conservative care methods are taken into serious consideration as a cost-effective alternative to the utilization of expensive surgery and hospital-based care." 

If you have tried physical therapy for neck or lower back pain and have not gotten the response to therapy you were hoping for, feel free to reach out to a Baltimore Chiropractor. You can email us or call us at (443) 842-5500. Mid-Atlantic Spinal Rehab & Chiropractic would be glad to help!

The above was reproduced with permission from Dr. Ben Altadonna and "The Practice Building Alliance."

Monday, April 1, 2013

Whiplash in Baltimore, MD 
            Whiplash is a 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 tiredness/fatigue.  These symptoms often resolve within 8-12 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.
          Whiplash injuries are common for those injured in auto accidents in Baltimore. If you or anyone you know may need the help of a local Baltimore Chiropractor for whiplash with or without associated concussion/mild traumatic brain injuries, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500 or email us. We would be happy to help!

The preceding was reproduced with permission from Dr. Ben Altadonna and "The Practice Building Alliance."

Monday, March 25, 2013

Car Accidents and Mild Traumatic Brain Injury

            When 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 chiropractor 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.

Concussions and mild traumatic brain injuries are common findings for people injured in auto accidents in Baltimore. Dr. Gulitz routinely co-treats his concussion patients with local neurologists for patients that require additional treatment.  If you or anyone you know may need the help of a local Baltimore Chiropractor for whiplash with or without associated concussion/mild traumatic brain injuries, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500 or email us. We would be happy to help!

The preceding was reproduced with permission from Dr. Ben Altadonna and "The Practice Building Alliance."

Saturday, March 23, 2013

Patient Attitude Predicts Outcome of Neck Surgery for Pain

A recent study reviewed by the American Association of Neurological Surgeons (AANS) at their 79th Annual Meeting: "The Effects of Preoperative SF-36 Mental Component Summary Scores and Patient Pain Expectations on Clinical Outcomes Following Anterior Cervical Discectomy and fusion" discovered that patients who predicted that they would be experiencing little to no neck and arm pain following cervical fusion surgery generally realized lesser neck and arm pain as compared to subjects expecting to still experience neck and arm pain following surgery.  These findings are interesting because they suggest that a positive mental outlook on pain can lead to lesser degrees of realized pain. 

If you or anyone you know may need the help of a local Baltimore Chiropractor for neck pain with or without associated arm pain, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500 or email us. We would be happy to help!  


Tuesday, March 19, 2013

Osteopathic Manipulation vs. Ultrasound for Chronic Lower Back Pain

A recent study from the Annals of Family Medicine set out to study whether osteopathic manipulation was more or less effective than ultrasound therapy for chronic lower back pain in patients. They found that manipulation was "safe, parsimonious, and well accepted by patients" as compared to the ultrasound therapy. While the authors did not specifically define osteopathic manipulation, it does speak to what the patients of Mid-Atlantic Spinal Rehab & Chiropractic already know- that spinal manipulation (a mainstay of chiropractic care) for chronic lower back pain can help with lower back pain.

Ann Fam Med. 2013;11:122-129

If you or anyone you know may need the help of a local Baltimore Chiropractor for lower back pain, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500 or email us. We would be happy to help!

Sunday, March 17, 2013

Exercise and Spinal Manipulation for Chronic Neck Pain

Here is a link to a research article from Spine which talks about responses to care for patients with chronic neck pain. They found that patients had more positive outcomes when neck exercises were combined with spinal manipulation as compared to just manipulation alone. Mid-Atlantic Spinal Rehab & Chiropractic utilizes both manipulation and exercises to help our acute and chronic neck pain patients recover from their injuries.

If you or anyone you know may need the help of a local Baltimore Chiropractor, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500 or email us. We would be happy to help!