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!

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."

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."