Car Accident

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

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​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.

Trigger points in the suboccipitals.

~ bryancobb ~ Leave a comment

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The suboccipitals are a group or four muscles that attach to the transverse and spinous process of C1 and C2 and the occipital bone.

These muscles provide extension side bending and rotation movements between the occiput and C1 and C2. These muscles are often overloaded due to postural strain. A classic example being sitting in front of a computer all day.

When these muscles are overloaded trigger points can develop. Pain and symptoms of trigger points in the suboccipitals include head pain that penetrates into the skull but is difficult to localize.

Patients are likely to describe the pain as “all over” including the occiput, eye and forehead, but without any clarity. Trigger points in these muscles are often associated with tension head aches

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Trigger points in the sternocleidomastoid muscle. By Bryan Cobb RMT.

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The sternocleidomastoid muscle or “scm” is a strap like muscle located in the front of the neck. It originates on the manubrium of the sternum and the medial clavicle, and inserts on the mastoid process of the temporal bone( the lump or bone behind the ear). When working together the scm flexes the head and neck. The actions of one muscle working by itself is to rotate the face to the opposite side and lift it toward the ceiling.

Trigger points in this muscle usually form due to acute injury or to chronic postural stress. These trigger points can cause a wide variety of symptoms including pain felt in the cheek, temple, forehead, top of the head, and base of the skull. Trigger points in these muscles can also refer deep into the ear and cause postural dizziness.

Whiplash and Your Posture

~ Dr. Robert Speirs DC ~ Leave a comment

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Posture assessment is a key component of the chiropractic examination, and the posture of the head and neck is especially important for a patient recovering from a whiplash injury. Forward head carriage describes a state in which the head sits more forward on the shoulders than it should. In order for the muscles in the neck and shoulders to keep the head upright, they must work harder. This added strain can increase one’s risk for neck pain and headaches, which is why retraining posture is a key component to the management of neck pain and headaches in patients with or without a history of whiplash.

Forward head carriage also increases the distance between the back of the head and the headrest in the seated position, especially when the seat is reclined. In a rear-end collision, a gap greater than a half an inch between the head rest and the back of the head increases the probability of injury due to the greater distance the head can hyperextend as it rebounds backwards into the headrest.  This makes posture correction of forward head carriage an important aspect of treatment from both a preventative and curative perspective.

So this begs the question, can forward head carriage be corrected?  The simple answer is “yes!” One study evaluated the effects of a 16-week resistance and stretching program designed to address forward head posture and protracted shoulder positioning.

Researchers conducted the study in two separate secondary schools with 130 adolescents aged 15–17 years with forward head and protracted shoulder posture. The control group participated in a regular physical education (PE) program while the experimental group attended the same PE classes with the addition of specific exercises for posture correction. The research ream measured the teens’ shoulder head posture from the side using two different validated methods and tracked symptoms using a questionnaire. The results revealed a significant improvement in the shoulder and cervical angle in the experimental group that did not occur in the control group.

The conclusion of the study strongly supports that a 16-week resistance and stretching program is effective in decreasing forward head and protracted shoulder posture in adolescents.  This would suggest that a program such as this should be strongly considered in the regular curriculum of PE courses since this is such a common problem.

Doctors of chiropractic are trained to evaluate and manage forward head posture with shoulder protraction. This can prove beneficial in both the prevention as well as management of signs and symptoms associated with a whiplash injury.

What is Whiplash? 

~ Dr. Robert Speirs DC ~ Leave a comment

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Whiplash is an injury to the soft-tissues of the neck often referred to as a sprain or strain. Because there are a unique set of symptoms associated with whiplash, doctors and researchers commonly use the term “whiplash associated disorders” or WAD to describe the condition.

WAD commonly occurs as a result of a car crash, but it can also result from a slip and fall, sports injury, a personal injury (such as an assault), and other traumatic causes. The tissues commonly involved include muscle tendons (“strain”), ligaments and joint capsules (“sprains”), disk injuries (tears, herniation), as well as brain injury or concussion—even without hitting the head!

Symptoms vary widely but often include neck pain, stiffness, tender muscles and connective tissue (myofascial pain), headache, dizziness, sensations such as burning, prickly, tingling, numbness, muscle weakness, and referred pain to the shoulder blade, mid-back, arm, head, or face. If concussion occurs, additional symptoms include cognitive problems, concentration loss, poor memory, anxiety/depression, nervousness/irritability, sleep disturbance, fatigue, and more!

Whiplash associated disorders can be broken down into three categories: WAD I includes symptoms without any significant examination findings; WAD II includes loss of cervical range of motion and evidence of soft-tissue damage; and WAD III includes WAD II elements with neurological loss—altered motor and/or sensory functions. There is a WAD IV which includes fracture, but this is less common and often excluded.

Treatment for WAD includes everything from doing nothing to intensive management from multiple disciplines—chiropractic, primary care, physical therapy, clinical psychology, pain management, and specialty services such as neurology, orthopedics, and more. The goal of treatment is to restore normal function and activity participation, as well as symptom management.

The prognosis of WAD is generally good as many will recover without residual problems within days to weeks, with most people recovering around three months after the injury. Unfortunately, some are not so lucky and have continued neck pain, stiffness, headache, and some develop post-concussive syndrome. The latter can affect cognition, memory, vision, and other brain functions. Generally speaking, the higher the WAD category, the worse the prognosis, although each case MUST be managed by its own unique characteristics. If the injury includes neurological loss (muscle strength and/or sensory dysfunction like numbness, tingling, burning, pressure), the prognosis is often worse.

Chiropractic care for the WAD patient can include manipulation, mobilization, and home-based exercises, as well as the use of anti-inflammatory herbs (ginger, turmeric, proteolysis enzymes (bromelain, papain), devil’s claw, boswellia extract, rutin, bioflavonoid, vitamin D, coenzyme Q10, etc.) and dietary modifications aimed at reducing inflammation and promoting healing.

* 83% of those patients involved in an MVA will suffer whiplash injury and 50% will be symptomatic at 1 year.
* 90% of patients with neurologic signs at onset may be symptomatic at 1 year.
* 25- 80% of patients who suffer a whiplash injury will experience late-onset dizziness
* Clinicians should be observant for radiographic signs of instability, including interspinous widening, vertebral subluxation, vertebral compression fracture, and loss of cervical lordosis.
* Horizontal displacement of greater than 3.5 mm or angular displacement of more than 11 degrees on flexion/extension views suggests instability.

Chiro & Concussions

~ Dr. Robert Speirs DC ~ Leave a comment

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​Whiplash Associated Disorders (WAD) is the appropriate terminology to use when addressing the myriad of symptoms that can occur as a result of a motor vehicle collision (MVC). In a recent publication in The Physician and Sports Medicine (Volume 43, Issue 3, 2015; 7/3/15 online:1-11), the article “The role of the cervical spine in post-concussive syndrome” takes a look at the neck when it’s injured in a car accident and how this relates to concussion.

It’s estimated about 3.8 million concussion injuries, also referred to as “mild traumatic brain injury” (mTBI), occur each year in the United States. Ironically, it’s one of the least understood injuries in the sports medicine and neuroscience communities. The GOOD NEWS is that concussion symptoms resolve within 7-10 days in the majority of cases; unfortunately, this isn’t the case with 10-15% of patients. Symptoms can last weeks, months, or even years in this group for which the term “post-concussive syndrome” (PCS) is used (defined as three or more symptoms lasting for four weeks as defined by the ICD-10) or three months following a minor head injury (as defined by the Diagnostic and Statistical Manual of Mental Disorders).

There have been significant advances in understanding what takes place in the acute phase of mTBI, but unfortunately, there is no clear physiological explanation for the chronic phase. Studies show the range of force to the head needed to cause concussion is between 60-160g (“g” = gravity) with 96.1g representing the highest predictive value in a football injury, whereas as little as 4.5g of neck acceleration can cause mild strain injury to the neck. In spite of this difference, the signs and symptoms reported by those injured in low-speed MVCs vs. football collisions are strikingly similar!

Research shows if an individual sustains an injury where the head is accelerated between 60-160g, it is HIGHLY likely that the tissues of the cervical spine (neck) have also reached their injury threshold of 4.5g. In a study that looked at hockey players, those who sustained a concussion also had WAD / neck injuries indicating that these injuries occur concurrently. Injuries to the neck in WAD include the same symptoms that occur in concussion including headache, dizziness/balance loss, nausea, visual and auditory problems, and cognitive dysfunction, just to name a few.

The paper concludes with five cases of PCS that responded well to a combination of active exercise/rehabilitation AND passive manual therapy (cervical spine manipulation). The favourable outcome supports the concept that the neck injury portion of WAD is a very important aspect to consider when treating patients with PCS!

This “link” between neck injury and concussion explains why chiropractic care is essential in the treatment of the concussion patient! This is especially true when the symptoms of concussion persist longer than one month!

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 honoured to render our services.

Canada’s Pain Crisis

~ Dr. Robert Speirs DC ~ Leave a comment

In a nation of only 36 million people, over 5 million people turned to opioid use for their pain despite the availability of better options. Opioids should never be the first step in pain management; preventing overuse takes education of both the public who are using and the professionals prescribing these drugs.

At Aberdeen Chiropractic we are proud to be part of the solution to Canada’s opioid crisis by providing safe, effective care for back pain, neck pain and headaches. Our goal is to assess, correct and prevent your pain with a variety of interventions including Chiropractic, Acupuncture, Laser, Exercise Rehabilitation and Trigger Point Therapy.

 

Pain Crisis

How does my neck cause headaches?

~ Dr. Robert Speirs DC ~ Leave a comment

Cervicogenic

 

Headaches can arise from many different causes. A partial list includes stress, lack of sleep, allergies, neck trauma (particularly sports injuries and car accidents), and more. In some cases, the cause may be unknown.

 
A unique common denominator of headaches has to do with cervical spine anatomy, in particular the upper part of the neck. There are seven cervical vertebrae, and the top three (C1-3) give rise to three nerves that travel into the head. These nerves also share a pain nucleus with the trigeminal nerve (cranial nerve V), which can route pain signals to the brain.

 
Depending on which nerve is most irritated, the location of the headache can vary. For example, C2—the greater occipital nerve—travels up the back of the head to the top. From there, it can communicate with another nerve (cranial nerve V or the trigeminal nerve), which can refer pain to the forehead and/or behind the eye.

 
When C1—the lesser occipital nerve—is irritated, pain travels to the back of the head, while irritation to C3—the greater auricular nerve—results in pain to an area just above the ear. When a nerve is pinched, the altered sensation can include pain, numbness, tingling, burning, itching, aching, or a combination of these sensations.

 
These are classified as cervicogenic headaches (CGH), and as the name implies, the origin of pain/altered sensation arises from the neck.

 
A 2013 study reviewing the literature on CGH found that manipulation and mobilization improved pain, disability, and function. The most effective approach included manipulation combined with neck-upper back strengthening exercises.

 
But what about migraine headaches? Migraines are vascular headaches, and some (but not all) are preceded by an aura or a pre-headache warning that may include blurry vision, tingling, strange olfactory sensations, etc. One study of 127 migraine sufferers reported fewer attacks and less medication required by those who received chiropractic care.

 
The good news is that spinal manipulation is very safe, and a trial is often very rewarding for many types of headaches.

Whiplash Injury? Get Help Now!

~ Dr. Robert Speirs DC ~ Leave a comment

whiplash

 

Should I seek treatment for whiplash right away?

Even though whiplash or whiplash associated disorders (WAD) is very common, it remains poorly understood. Recent studies report that up to 60% of people may still have pain six months after their injury. Why is that?
Investigations have shown there are changes in the muscle and muscle function in the neck and shoulder regions in chronic WAD patients. Symptoms often include balance problems as well as increased sensitivity to a variety of stimuli including pressure, light vibration, and temperature.
Interestingly, this hypersensitivity not only occurs in the injured area, but also in areas away from the neck such as the front of the lower leg or the shin bone. This can only be explained by some type of neurobiological processing of pain within the central nervous system, which includes the spinal cord and brain.
It’s not surprising that when pain continues for lengthy time frames, people with these symptoms may also experience psychological distress. The confusing thing is that not every WAD injury case has this “central sensitization” and when it’s present—its intensity is highly variable.
Current research into WAD is focused on the following: 1) developing better treatments in the early or acute whiplash injury stage with the goal to PREVENT development of these chronic symptoms; 2) determining what factors can PREDICT slower recovery following a WAD injury; 3) investigation into how the stress response associated with motor vehicle crashes influence pain, other symptoms and recovery, and how to best address and MANAGE the stress response; 4) research into the effect a WAD injury has on daily life function; and 5) developing improved assessment methods for healthcare providers so that EARLY treatments can be more targeted and effective.
A Swedish study is currently looking at the importance of reducing the acceleration of the occupant during an automobile collision by redesigning the body of the vehicle and its safety systems. In rear-end crashes, the main issue is to design a seat and head restraint that absorbs energy in a controlled way and gives support to the whole spine. In frontal crashes, the air bag, seat belt pretensioner, and load limiter must work together in a coordinated way to reduce the acceleration between the vertebrae of the spine and occupant.
What is known is that a “wait and watch” approach may NOT be appropriate in a lot of cases. It appears there is a relatively short window of time, the first three months, when treatment seems to be most effective. Doctors of chiropractic are trained to identify and treat these types of injuries, so PLEASE, don’t delay your initial visit—time is truly of the essence.  Don’t waste it!