Can a low speed crash cause injury?

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There is certainly a lot of interest in concussion these days between big screen movies, football, and other sports-related injuries. Concussion, traumatic brain injury (TBI), and mild traumatic brain injury (mTBI) are often used interchangeably. Though mTBI is NOT the first thing we think about in a low-speed motor vehicle collision (MVC), it does happen. So how often do MVC-related TBIs occur, how does one know they have it, and is it usually permanent or long lasting?

Here are some interesting statistics: 1) The incidence rate of fatal and hospitalized TBI in 1994 was estimated to be 91/100,000 (~1%); 2) Each year in the United States, for every person who dies from a brain injury, five are admitted to hospitals and an additional 26 seek treatment for TBI; 3) About 80% of TBIs are considered mild (mTBI); 4) Many mTBIs result from MVCs, but little is known or reported about the crash characteristics. 5) The majority (about 80%) of mTBI improve within three months, while 20% have symptoms for more than six months that can include memory issues, depression, and cognitive difficulty (formulating thought and staying on task). Long-term, unresolved TBI is often referred to as “post-concussive syndrome.”

In one study, researchers followed car crash victims who were admitted into the hospital and found 37.7% were diagnosed with TBI, of which the majority (79%) were defined as minor by a tool called Maximum Abbreviated Injury Scale (MAIS) with a score of one or two (out of a possible six) for head injuries. In contrast to more severe TBIs, mild TBIs occur more often in women, younger drivers, and those who were wearing seatbelts at the time of the crash. Mild TBI is also more prevalent in frontal vs. lateral (“T-bone”) crashes.

As stated previously, we don’t think about our brains being injured in a car crash as much as we do other areas of our body that may be injured—like the neck. In fact, MOST patients only talk about their pain, and their doctor of chiropractic has to specifically ask them about their brain-related symptoms.

How do you know if you have mTBI? An instrument called the Traumatic Brain Injury Questionnaire can be helpful as a screen and can be repeated to monitor improvement. Why does mTBI persist in the “unlucky” 20%? Advanced imaging has come a long way in helping show nerve damage associated with TBI such as DTI (diffuse tensor imaging), but it’s not quite yet readily available. Functional MRI (fMRI) and a type of PET scanning (FDG-PET) help as well, but brain profusion SPECT, which measures the blood flow within the brain and activity patterns at this time, seems the most sensitive.

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for Whiplash, we would be honored to render our services.

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Those “other” causes of back pain

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Between 80% and 90% of the general population will experience an episode of lower back pain (LBP) at least once during their lives. When it affects the young to middle-aged, we often use the term “non-specific LBP” to describe the condition. The geriatric population suffers from the “aging effects” of the spine—things like degenerative joint disease, degenerative disk disease, and spinal stenosis. Fractures caused by osteoporosis can also result in back pain.

The “good news” is that there are rare times when your doctor must consider a serious cause of LBP. That’s why he or she will ask about or check the following during your initial consultation: 1) Have you had bowel or bladder control problems? (This is to make sure a patient doesn’t have “cauda equina syndrome”—a very severely pinched nerve.) 2) Take a patient’s temperature and ask about any recent urinary or respiratory tract infections to rule out spinal infections. 3) To rule out cancer, a doctor may ask about a family or personal history of cancer, recent unexplained weight loss, LBP that won’t go away with time, or sleep interruptions that are out of the ordinary. 4) To rule out fractures, a doctor may also take x-rays if a patient is over age 70 regardless of trauma due to osteoporosis, over age 50 with minor trauma, and at any age with major trauma.

Once a doctor of chiropractic can rule out the “dangerous” causes of LBP, the “KEY” form of treatment is giving reassurance that LBP is manageable and advise LBP sufferers of ALL ages (especially the elderly) to KEEP MOVING! Of course, the speed at which we move depends on many things—first is safety, but perhaps more importantly is to NOT BECOME AFRAID to do things! As we age, we gradually fall out of shape and end up blaming our age for the inability to do simple normal activities. Regardless of age, we must GRADUALLY increase our activities to avoid the trap of sedentary habits resulting in deconditioning followed “fear avoidant behavior!”

Here are a few “surprising” reasons your back may be “killing you”: 1) You’re feeling down – That’s right, having “the blues” and more serious mood disorders, like depression, can make it more difficult to cope with pain. Also, depression often reduces the drive to exercise, may disturb sleep, and can affect dietary decisions—all of which are LBP contributors. 2) Your phone – Poor posture caused by holding a phone between your bent head and shoulder (get a headset!) or prolonged mobile phone use can increase your risk for spinal pain. 3) Your feet hurt, which makes you walk with an altered gait pattern, forcing compensatory movements up the “kinetic chain” leading to LBP. 4) Core muscle weakness, especially if you add to that a “pendulous abdomen” from being overweight—this is a recipe for disaster for LBP. 5) Tight short muscles such as hamstrings, hip rotator muscles, and/or tight hip joint capsules are common problems that contribute to LBP. Stretching exercises can REALLY help!

Fibromyalgia: A Whole Body Approach

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Fibromyalgia is a complicated disorder that’s difficult to diagnose because it involves multiple body systems. As a result, there are a myriad of factors in the body that can play a role in a patient’s symptoms. That said, it’s best to take a whole body approach when it comes to treating a complex condition like FM, starting with the nervous system.

When a patient presents to a chiropractor, the initial examination will look at the body as a whole and will not be limited the main area of complaint. This includes a postural examination in regards to individual leg length (to see if one is shorter); the height of the pelvis, shoulder, and occiput (head); and a gait assessment to evaluate the function of the foot, ankle, knee, hip/pelvis, spine, and head.

Because the nervous system is housed in the spine and cranium, chiropractors specifically look at how the spine compensates for abnormal function elsewhere in the body. When spinal segmental dysfunction is present, altered neurological function often coincides, which results in the symptoms that drive people to the office.

The benefits of spinal manipulative therapy (SMT)—the primary form of treatment delivered by doctors of chiropractic—have been recognized by all other healthcare professions including medical doctors, physical therapists, and osteopathic physicians. In fact, referring patients to chiropractors for SMT has become very commonplace in the healthcare environment. Research has proven SMT to be a FIRST course of care and highly recommended for MANY complaints, especially low back, mid-back, and neck pain, headaches, and many more!

Because fibromyalgia (FM) involves the WHOLE BODY—hence its definition of “wide spread pain,” chiropractic offers a unique approach because it too benefits the whole body by restoring function to the nervous system. For example, when balance is off due to a short leg (this affects 90% of the population to some degree), it can tilt the pelvis, which then places stress on the spine so that it must curve (scoliosis) to keep the head level. Correcting the short leg with a heel lift can restore balance to the pelvis, take pressure off the spine, and relieve some of a patient’s pain symptoms.

In prior articles, we have looked at the many benefits chiropractic offers the FM patient in addition to SMT and other manual therapies. Some of these include tips for improving sleep, exercise training (very important in managing FM), diet—specifically an anti-inflammatory diet (rich in anti-oxidants)—and supplementation (such as magnesium, malic acid, omega-3 fatty acids, vitamin D3, Co-enzyme Q10, and more).

Most importantly, studies show that the FM patient is BEST served when a “team” of healthcare professionals work together on behalf of the FM patient. Depending on a patient’s needs, the team can include a doctor of chiropractic, a primary care doctor, a massage therapist, a clinical psychologist, and others.

What is causing my LBP?

SI JointsLow back pain (LBP) can arise from disks, nerves, joints, and the surrounding soft tissues. To simplify the task of determining “What is causing my LBP?” the Quebec Task Force recommends that LBP be divided into three main categories: 1) Mechanical LBP; 2) Nerve root related back pain; and 3) Pathology or fracture. We will address the first two, as they are most commonly managed by chiropractors.

Making the proper diagnosis points your doctor in the right direction regarding treatment. It avoids time wasted by treating an unrelated condition, which runs the risk of increased chances of a poor and/or prolonged recovery. Low back pain is no exception! The “correct” diagnosis allows treatment to be focused and specific so that it will yield the best results.

Mechanical low back pain is the most commonly seen type of back pain, and it encompasses pain that arises from sprains, strains, facet and sacroiliac (SI) syndromes, and more. The main difference between this and nerve root-related LBP is the ABSENCE of a pinched nerve. Hence, pain typically does NOT radiate, and if it does, it rarely goes beyond the knee and normally does not cause weakness in the leg.

The mechanism of injury for both types of LBP can occur when a person does too much, maintains an awkward position for too long, or over bends, lifts, and/or twists. However, LBP can also occur “insidiously” or for seemingly no reason at all. However, in most cases, if one thinks hard enough, they can identify an event or a series of “micro-traumas” extending back in time that may be the “cause” of their current low back pain issues.

Nerve root-related LBP is less common but it is often more severe—as the pain associated with a pinched nerve is often very sharp, can radiate down a leg often to the foot, and cause numbness, tingling, and muscle weakness. The location of the weakness depends on which nerve is pinched. Think of the nerve as a wire to a light and the switch of the nerve is located in the back where it exits the spine. When the switch is turned on (the nerve is pinched), and the “light” turns on—possibly in the outer foot, middle foot, inner foot, or front, back or side of the thigh. In fact, there are seven nerves that innervate or “run” into our leg, so usually, a very specific location “lights up” in the limb.

Determining the cause of your low back pain helps your doctor of chiropractic determine which treatments may work best to alleviate your pain as well as where such treatments can be focused.

What Is Facet Syndrome?

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As stated in previous articles, low back pain (LBP) can arise from many different structures. Lumbar facet syndrome is one that involves the facet joint and includes both acute (new) and chronic (old) varieties. The facet joint is synonymous with the zygapophyseal joint, so if you hear that word, don’t let it throw you off! Approximately 45% of patients with chronic low back pain suffer from “facet syndrome” (FS) in which the facets are the low back pain generator.

There are many conditions that give rise to FS. Some of these include the straining of the surrounding joint capsule (the capsule holds the joint securely together), joint hypomobility (reduced motion in the joint), a synovial cyst (similar to a ganglion on the back of the wrist but its located inside the joint), and degeneration (also called osteoarthritis—the wearing out type of arthritis).

Because facet syndrome can accompany other conditions, a doctor of chiropractic must evaluate each patient individually and manage each person appropriately. In “pure” facet syndrome, pain rarely ever passes the level of the knee and does not cause neurological loss (weakness, loss of reflex, etc.). It can create numbness but usually NOT beyond the knee. Pain is usually not worsened by hip movements such as straight leg raise or hip rotation.

The facet joint’s “job” (at least in part) is to limit or guard twisting movements in the upper lumbar/low back region, and the lower lumbar facets are shaped to limit motion when bending forwards and backwards. Facet joints are unique because they are innervated by specific nerves that can be blocked by injecting an anesthetic agent to determine if the facet (and its innervating nerve) is the main source of pain. The surrounding capsule around the facet joint contains mechanoreceptors (cells that detect movement) and nociceptors (cells that detect pain) that fire when the facet joint is compressed/jammed or over-stretched. These nociceptors can become “hypersensitized” (very irritable) when they remain inflamed over time.

In many patients, injury to a facet joint is the result of many microtraumas over a period of time and not one single isolated event. For example, repeatedly bending backwards, twisting, and leaning to one side can stretch the joint capsule and fatigue it until some capsular tissues finally “give” and it inflames which generates pain.

These joints commonly become arthritic with age, which is one reason people over 50-60 years old commonly present with FS. Osteoarthritis results in a narrowing of the joint space and causes a more permanently “jammed” joint. This is one reason many elderly people walk partially bent over—as bending forwards opens the facet joints and “feels good!”

The good news is that chiropractic manipulation is a highly effective treatment for facet syndrome, and most patients feel much better within the first or second week of care (often within three to five visits).

More On LBP In Young Athletes

Lumbar Strain

A very good summary of low back injuries in young athletes from physiology-pedia.com:

According to the literature low back pain occurs in 10-15% of young athletes[9]. However studies exhibit great variability in prevalence rates, with estimates ranging from 1.1%[11] – 66%[5], the variability in the studies may be due to:
• Age of the sample
• Sample size
• The authors definition of low back pain
• The low back pain recall period
• Strategy of extracting data and methodology used

The prevalence of low back pain varies between sports and, in some cases, the speciality of the position[5].
In young athletes the prevalence of low back pain increases with age and females are more likely to suffer from low back pain compared to males of the same age group[11]. The literature suggests that the physical changes that occur during puberty could increase the prevalence for low back pain[12]

Injuries encountered to the lower back in young athletes occur from either an acute traumatic event or repetitive trauma (overuse injury) and are commonly seen in individuals participating in sports such as football, rugby, gymnastics, ice skating and dancing[9]. Evidence has shown LBP occurs is as much as 27% of college football players and between 50% and 86% of gymnasts[13]. Overuse injury can be as a result of repeated flexion, extension and torsion which is performed frequently in gymnastics, ice skating and dancing[9].

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WRD: How long does this last?

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First, what is whiplash? It’s a lot of things, which is why the term WAD or Whiplash Associated Disorders has become the most common term for the main signs and symptoms associated with a whiplash injury. WAD is usually associated with a motor vehicle collision, but sports injuries, diving accidents, and falls are other common ways to sustain a WAD injury.

To answer the question of the month, in most cases, the recovery rate is high and favors those who resume their normal daily activities. The worse thing you can do when you sustain a WAD injury is to not do anything! Too much rest and inactivity leads to long-term disability. Of course, this must be balanced with the degree of injury, but even when the injury requires some “down time,” stay as active as possible during the healing phase.

Many people recover within a few days or weeks while a smaller percentage require months and about 10% may only partially recover. So what can be done to give you the best possible chance to fully recover as soon as possible?

During recovery, you can expect your condition to fluctuate in intensity so “listen” to your body, let it “guide” you during activity and exercise, and stay within “a reasonable boundary of pain” during your activity. Remember, your best chance for full recovery FAVORS continuing a normal lifestyle. Make reasonable modifications so you can work, socialize, and do your “normal” activities!

The KEY: Stay in control of your condition – DO NOT let it control you! Here are some tips:

1)  POSTURE CONTROL: Keep the weight of the head back by gliding your chin back until you “hit” a firm end-point. Then release it slightly so it’s comfortable—this is your NEW head position!

2)  FLEXIBILITY: Try this range of motion (ROM) exercise… Slowly flex your neck forwards and then backwards, then bend your neck to the left and then the right, and then rotate it to the left and to then to the right. THINK about each motion and avoid sharp, knife-like pain; a “good-hurt” is okay! Next, do the same thing with light (one-finger) resistance in BOTH directions. Try three slow reps four to six times a day!

3)  MUSCLE STRENGTH: Try pushing your head gently into your hand in the six directions listed above to provide a little resistance. Next, reach back with both hands or wrap a towel around your neck and pull forwards on the towel while you push the middle of your neck backwards into the towel doing the chin-tuck/glide maneuver (same as #1). Repeat three to five times slowly pushing, and more importantly, release the push slower! This is the MOST IMPORTANT of the strengthening exercises in most cases! Next, “squeeze” your shoulder blades together followed by spreading them as far apart as possible (repeat three to five times).

4)  PERIODIC BREAKS: Set a timer to remind yourself to do a stretch, get up and move, to tuck your chin inwards (#1) and do some of #2 and #3 every 30-60 minutes.

5)  LIFTING/CARRYING/WORK: Be SMART! Do not re-injure yourself. Change the way you handle yourself in your job, in the house, and while performing recreational activities.

6)  HOUSEHOLD ACTIVITIES: Use a dolly to move boxes and keep commonly used items within easy reach (not too high or low).

Be smart, stay educated, work within the range your body tells you is “safe” and most importantly, STAY IN CONTROL!!!