Headache

What evidence do we have of whiplash?

~ Dr. Robert Speirs DC ~ Leave a comment

​Cervical Strain

Whiplash, or WAD (Whiplash Associated Disorders), refers to a neck injury where the normal range of motion is exceeded, resulting in injury to the soft-tissues (hopefully with no fractures) in the cervical region. There are a LOT of factors involved that enter into the degree of injury and length of healing time. Let’s take a closer look!

Picture the classic rear-end collision. The incident itself may be over within 300 milliseconds (msec), which is why it’s virtually impossible to brace yourself effectively for the crash as a typical voluntary muscle contraction takes two to three times longer (800-1000 msec) to accomplish.

In the first 50 msec, the force of the rear-end collision pushes the vehicle (and the torso of the body) forwards leaving the head behind so the cervical spine straightens out from its normal “C-shape” (or lordosis). By 75-100 msec, the lower part of the neck extends or becomes more C-shaped while the upper half flexes or moves in an opposite direction creating an “S” shape to the neck. Between 150-200msec, the whole neck hyper extends and the head may hit the head rest IF the headrest is positioned properly. In the last 200-300 msec, the head is propelled forwards into flexion in a “crack the whip” type of motion.

Injury to the neck may occur at various stages of this very fast process, and many factors determine the degree of injury such as a smaller car being hit by a larger car, the impact direction, the position of the head upon impact (worse if turned), if the neck is tall and slender vs. short and muscular, the angle and “springiness” of the seat back and relative position of the headrest, dry vs. wet/slippery pavement, and airbag deployment, just to name a few.

Some other factors that can predict recovery include: limited neck motion, the presence of neurological loss (nerve specific muscle weakness and/or numbness/tingling), high initial pain levels (>5/10 on a 0-10 scale), high disability scores on questionnaires, overly fearful of harming oneself with usual activity and/or work, depressive symptoms, post-traumatic stress, poor coping skills, headaches, back pain, widespread or whole body pain, dizziness, negative expectation of recovery, pending litigation, catastrophizing, age (older is worse), and poor pre-collision health (both mental and physical).

Research shows the best outcomes occur when patients are assured that most people fully recover and when patients stay active and working as much as possible. Studies have shown it’s best to avoid prolonged inactivity and cervical collars unless under a doctor’s orders. It’s also a good idea to gradually introduce exercises aimed at improving range of motion, postural endurance, and motor control provided doing so keeps the patient within reasonable pain boundaries. Chiropractic manipulation restores movement in fixed or stuck joints in the back and neck and has been found to help significantly with neck pain and headaches, particularly for patients involved in motor vehicle collisions. A doctor of chiropractic may also recommend using a cervical pillow, home traction, massage, and other therapies as part of the recovery process.

It is important to be aware that fear of normal activity and not engaging in usual activities and work can delay healing and promote chronic problems and long-term disability. It’s suggested patients avoid opioid medication use due to the addictive problems with such drugs. Ice and anti-inflammatory herbs or nutrients (like ginger, turmeric, and bioflavonoids) are safer options. Your doctor of chiropractic can guide you in this process!

How can I calm down my WAD symptoms?

~ Dr. Robert Speirs DC ~ Leave a comment

Cervical Strain

​Whiplash is really a slang term for the rapid back and forth whipping of the head on the neck, usually associated with motor vehicle accidents. The title “Whiplash Associated Disorders”, or WAD, describes it best because it includes ALL of the MANY signs and symptoms of the disorder.

WAD basically comes in three sizes based on the degree of injury. A WAD I is present when there is pain but no physical examination findings; WAD II occurs when there are exam findings but no neurological loss (numbness or weakness); and WAD III includes loss of neurological function.  There is also a separate WAD level that includes fractures and dislocations (WAD IV).

There are many things that can be done by the patient to assist in the healing process for WAD. The first well-studied recommendation is to “continue with your usual activities.” Try to keep active and not change your routine. The good news is that WAD (especially types I and II) usually resolves without complication, and recovery is even more likely to occur if you don’t deviate much from your routine.

For those whose symptoms are more severe and/or not resolving, mobilization and manipulation of the neck and back are very effective treatment options. In addition to treatments you’d receive in a chiropractic office, there are MANY things you can do at home as “self-help strategies.” Some of these include (“PRICE”):

1)  PROTECT: Though it’s important to continue with your usual daily activities, this is dependent on both the degree of tissue injury and your pain tolerance. So do as many of your usual daily activities as possible, but AVOID those that result in a sharp, lancinating type of pain or those where recovery from the pain is delayed.  Therefore, this category may require modifying your ADLs (activities of daily living). A cervical collar (hard orsoft) should NOT to be used UNLESS you have an unstable injury (fracture or a grade III sprain).

2)  REST: Doing too much is like picking at a cut (which can delay healing) and doing too little can lead to a delayed healing response as well. Staying within reasonable pain boundaries is a good guide.

3) ICE > HEAT: Ice reduces swelling, and your doctor will typically recommend it over applying heat, especially on a recent injury. Heat draws fluids in, and while it may feel good, it can make your symptoms worse.

4)  COMPRESS: We can basically ignore this when referencing neck pain. This pertains better to wrapping an ankle, knee, wrist, or elbow with an elastic compression orthotic or brace.

5)  ELEVATE: This too is meant for the acute stages of an extremity injury like a foot or ankle.

Exercises unique for neck pain in the acute, subacute, and chronic stages of healing are perhaps the most important of the self-help approaches. In the ACUTE phase, try these…

1)  Range of Motion: Once again, stay within “reasonable pain boundaries” as you move your head forwards, backwards, side to side, and rotate left and right. These can be done either with or without LIGHT resistance applied using one or two fingers placed against your head. Limit the repetitions to three slow reps in each direction and emphasize the release of the movement.

2)  Chin/head Glides: Tuck in the chin (think of creating a double or triple chin) followed by poking the chin/head out.

In the SUBACUTE and CHRONIC phases of healing, the importance of strengthening the deep neck flexors cannot be over emphasized. Please refer to last week’s article for a description of this (see #3 of the 6 recommendations listed).

Trigger points in the trapezius muscle.

~ bryancobb ~ Leave a comment

The trapezius muscle is a large diamond shaped muscle in you mid/upper back and neck. This muscle is one of the most common sites where trigger points can form. This muscle originates on the Nuchal ligament and the spinous processes of C6-T12. It inserts on the spine of the scapula, the acromion process, and the distal clavicle. The upper fibres elevate the shoulder and rotate the glenoid fossa (shoulder socket) upward. The lower fibres assist this motion as well as help depress the shoulder. The middle fibres of this muscle strongly adduct the scapula. This muscle is susceptible to postural overload such as sitting at desk all day. Trigger points on the lateral upper edge refer into the lateral neck and temples, causing “tension neck ache”as well as headache pain.Trigger points in the middle and lower fibres refer pain into the posterior neck and shoulder.

How long does Whiplash last?

~ Dr. Robert Speirs DC ~ Leave a comment

​watch

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!!!

Trigger points in the Levator scapula

~ bryancobb ~ Leave a comment

The Levator scapula is a muscle in your neck that originates on the transverse processes of C1-C4 and inserts on the superior part of the medial border of the scapula. The primary actions of this muscle are to elevate the scapula and rotate the glenoid fossa downward. It also rotates the neck to the same side and assists in extension. When this muscle is tight it restricts neck rotation resulting in the classic “stiff neck”. With a forward head position the Levator is often stretched and over worked. To help combat this you must get the head back by releasing the anterior chest and neck muscles. Trigger points in this muscle refer pain into the angle of the neck and down the shoulder blade.

How can a low speed crash cause injury?

~ Dr. Robert Speirs DC ~ Leave a comment

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.

A Few Sleep Tips From Us To You

~ Dr. Robert Speirs DC ~ Leave a comment

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Your mattress and the position you sleep in may affect your spine.

✓ Choose a mattress that provides medium or firm support, such as a traditional coil spring or adjustable airbed. Avoid waterbeds, thick pillow tops and soft, sagging mattresses.
✓ Always sleep on your back with a pillow either underneath your knees or on your side with a pillow between your knees. Avoid sleeping on your stomach.
✓ Keep your neck and back covered while sleeping to avoid drafts that could cause potential muscle spasms.

Here are a couple of tips to help you get in and out of bed more comfortably:
✓ To lie down: Sit on the edge of the bed, pull your arms to your sides and tilt your body into the bed, maintaining the bend of your knees at 45 degrees. Finally, bring your feet into in a lying position or roll onto your back.
✓ To get up: From a side-lying position with your knees bent, push your body upright into a sitting position, swinging your legs over the edge of the bed as you rise.

If you find that you wake up sore then you may be suffering from any number of conditions that get worse overnight.

Workstation Ergonomics

~ Dr. Robert Speirs DC ~ Leave a comment

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Ergonomics is the science of adjusting your workstation to minimize strain in the following ways:

✓ Maintain proper body position and alignment while sitting at your desk – Hips, knees and elbows at 90 degrees, shoulders relaxed, feet flat on floor or footrest.
✓ Wrists should not be bent while at the keyboard. Forearms and wrists should not be leaning on a hard edge.
✓ Use audio equipment that keeps you from bending your neck (i.e., Bluetooth, speakerphones, headsets).
✓ Monitors should be visible without leaning or straining and the top line of type should be 15 degrees below eye level.
✓ Use a lumber roll for lower back support.
✓ Avoid sitting on anything that would create an imbalance or uneven pressure (like your wallet).
✓ Take a 10-second break every 20 minutes: Micro activities include: standing, walking, or moving your head in a “plus sign” fashion.
✓ Periodically, perform the “Brugger relief position” (See video below) -Position your body at the chair’s edge, feet pointed outward. Weight should be on your legs and your abdomen should be relaxed. Tilt your pelvis forward, lift your sternum, arch your back, drop your arms, and roll out your palms while squeezing your shoulders together. Take a few deep cleansing breaths.

Trigger points in the masseter muscle

~ bryancobb ~ Leave a comment

The masseter is the main muscle that moves your jaw. It originates on the zygomatic arch and maxilla, and inserts on the coronoid process and Ramus of the mandible. It’s actions are to elevate the mandible and close the jaw. The deep fibres of this muscle also retrude the mandible. This muscle commonly harbours trigger points as a result of teeth grinding. Trigger points in this muscle are often also associated with tmj dysfunction. Trigger points in the upper part of this muscle will refer pain to the upper molars and maxilla often felt as sinusitis. Trigger points in the lower portion of this muscle refer to the lower molars and temple. All trigger points can cause tooth sensitivity

So I’ve got Whiplash; now what?

~ Dr. Robert Speirs DC ~ Leave a comment

WRD 2

​Whiplash, or “Whiplash Associated Disorders” or WAD, is the result of a sudden “crack the whip” of the head on the neck due to a slip and fall, sports injury, a violent act, or most commonly, a motor vehicle collision (MVC), particularly a rear-end collision. In describing “what can I expect” after a whiplash injury, one thing is for certain, there are many faces of whiplash, meaning the degree of injury can range from none to catastrophic depending on many factors, some of which are difficult or impossible to identify or calculate. Let’s take a closer look!

Even though the good news is that most people injured in a car crash get better, 10% do not and go on to have chronic pain, of which about half have significant difficulty working and/or doing desired everyday activities. There is a “great debate” as to the way experts describe “chronic whiplash syndrome” (CWS) as well as how these cases should be managed. Some feel there is something PHYSICALLY wrong in the CWS patient, especially if severe neck or head pain persists for more than one year. There is some proof of this as Dr. Nikolai Bogduk from the University of Newcastle in Australia and colleagues have used selective nerve blocks to anesthetize specific joints in the neck to determine exactly where the pain is generated. The patient then has the option to have that nerve cauterized or burned and pain relief can be significant in many cases. Dr. Bogduk and his group admit that these CWS patients have more psychological symptoms, but they feel this is the result of pain, not the CAUSE.

On the other hand, experts such as Dr. Henry Berry from the University of Toronto report the EXACT OPPOSITE. He argues that it’s not JUST the physical injury that has to be dealt with but also the person’s “state of mind.” Dr. Berry states that when stepping back and looking at all the complaints or symptoms from a distance, “…you see these symptoms can be caused by life stress, the illness ‘role’ as a way of adjusting to life, psychiatric disorders, or even [made up by the patient].” Berry contends that it’s important to tell the patient their pain will go away soon, advises NO MORE THAN two weeks of physical therapy, and sends people back to work ASAP.

Oregon Health Sciences University School of Medicine’s Dr. Michael D. Freeman, whose expertise lay in epidemiology and forensic science, disagrees with Dr. Berry stating that the scientific literature clearly supports the physical injury concept and states, “…the idea that it is a psychological disturbance is a myth that has been perpetuated with absolutely no scientific basis at all.” Dr. Freeman states that 45% of people with chronic neck pain were injured in a motor vehicle crash (which includes three million of the six million of those injured in car crashes every year in the United States).

Here’s the “take home” to consider: 1) CWS occurs in about 10% of rear-end collisions; 2) Some doctors feel the pain is physically generated from specific nerves inside the neck joints; 3) Others argue it’s a combination of psychological factors and care should focus on preventing sufferers from becoming chronic patients.

Many studies report that chiropractic offers fast, cost-effective benefits for whiplash-injured patients with faster return to work times and higher levels of patient satisfaction.

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.