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."

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!  


 

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!

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!

Neck Pain – Can Chiropractic Really Help?

            Neck pain is a very common problem affecting up to 70% of the adult population at some point in life.  Though there are specific causes of neck pain such as arising from a sports injury, a car accident or “sleeping crooked,” the vast majority of the time, no direct cause can be identified and thus the term nonspecific is applied. There are many symptoms associated with patients complaining of neck pain and many of these symptoms can be confused with other conditions.  Wouldn’t it be nice to know what neck related symptoms are most likely to respond to chiropractic manipulation before the treatment has started?  This issue has been investigated with very favorable results!

            The ability to predict a favorable response to treatment has been termed, “clinical prediction rules” which in general, are usually made up of combinations of things the patient says and findings from exams. In a large study, data from about 20,000 patients receiving about 29,000 treatments, was collected and analyzed to find out what complaints responded well to chiropractic treatment.  The results showed that the presence of any 4 of these 7 presenting complaints predicted an immediate improvement in 70-95% of the patients: 1. Neck pain; 2. Shoulder, arm pain; 3. Reduced neck, shoulder, arm movement; 4. Stiffness; 5. Headache; 6. Upper, mid back pain, and 7. None or one presenting symptom.  Items not associated with a favorable immediate response included “numbness, tingling upper limbs,” and “fainting, dizziness and light-headedness in 4-12% of the patients.  The “take-home” message here is that was far more common to see a favorable response (70-95%) of the patients compared to an unfavorable response (4-12%), supporting the observation that most patients with neck complaints will respond favorably to chiropractic treatment.

            So, what do we do as chiropractors when a patient presents with neck pain?  First, after gathering preliminary information such as name, address and insurance information, a history of the presenting complaint is taken. This consists of information including what started the neck complaint (if you know), when it started, what makes it worse, what makes it better, the quality of pain (aches, stiff, numb, etc.), the location and if there is radiating complaints, the severity (0-10 pain scale), timing (such as worse in the morning, evening, etc.), and if there have been prior episodes. Various questionnaires are included that are scored so improvement down the road can be tracked and a past history that includes a medication list, past injuries or illnesses, family history and a systems review are standard.  The exam includes vital signs (BP, pulse, height, weight, temperature and respiration), palpation, range of motion, orthopedic and neurological examination.  X-ray and/or other “special tests” may also be included, when needed. A review of all the findings are discussed and after permission to treat is granted, a chiropractic adjustment may then be rendered.  A list treatment options may include:

1.      Adjustments;

2.      Soft tissue therapy (trigger point stimulation, myofascial release);

3.      Physical therapy modalities;

4.      Posture correction exercises and other exercises/home self-administered therapies;

5.      Education about job modifications;

6.      Co-management with other health care providers if/when needed. 

 

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! 

The preceding was reproduced with the permission of Dr. Ben Altodonna and The Practice Alliance.

Here's a link to the 60 minutes report on the New England Compounding Center that released vials of steroids tainted with a fungus that went on to kill 48 people. There's obviously a time and a place for interventional anesthesia/pain management, but why not try Chiropractic first?


Link

What are your thoughts?