I wanted to include a vlog as part of this blog post. The video (see below) was a chiropractic exam and treatment on a patient in Raleigh experiencing neck and back pain after a recent car accident. She had symptoms associated with whiplash and sought treatment from a car accident doctor in Raleigh, NC.
Common Whiplash Myths
Whiplash is most commonly associated with the rapid, uncontrolled movement of the head as it whips back and forth during a motor vehicle collision. Though different types of injuries are associated with rear vs. front vs. side collisions, the net result is similar: the neck hurts! This month, we will look at several “myths” or untruths associated with the cause of whiplash or WAD, whiplash associated disorders.
MYTH #1: MEN ARE MORE VULNERABLE TO INJURY BECAUSE OF THEIR GREATER NECK MUSCLE MASS: FACT: This is exactly the opposite! Women are more vulnerable because they have LESS muscle mass, and hence, less tissue stopping the neck from going through a greater range of motion during the “crack the whip” process. Woman with long, slender necks are especially more vulnerable. They also take longer to recover and are more likely to suffer permanent residual problems long after their case settles.
MYTH #2: YOU CAN’T HAVE A CONCUSSION UNLESS YOU HIT YOUR HEAD: This seems logical as most concussions occur from direct head trauma. However, during the whiplash process the brain, which is suspended by ligament-like structures inside the skull, bathed in a liquid, can literally smash into the inside wall of the skull resulting in concussion just from the whipping action, without hitting anything. Permanent residuals such as memory problems, articulating thoughts, staying on task, and more can result. This is often called “post-concussive syndrome” or “mild traumatic brain injury.”
MYTH #3: NEGATIVE X-RAYS MEANS NO INJURY: Often, in the ER after a motor vehicle collision, x-rays are taken and read by the radiologist as “…essentially normal.” This can be confused as meaning, “…then there was no injury.” X-rays only show the bones in the neck and head region, not the muscles, tendons, ligaments or nerves. MRI (magnetic resonant imaging) shows more of these “soft tissues,” not just bone. But, due to the high costs of MRI, x-rays are performed first, and only later, if symptoms warrant it, is an MRI ordered. Soft tissue injury to the ligaments (the tissues that strongly hold bone to bone) can be assessed when we take flexion / extension (or bending forwards & backwards) x-rays, but many times these are not ordered in the ER.
MYTH #4: REST AND TIME ALONE WILL HEAL WHIPLASH: Though time for healing plays a role in recovery following all injuries, many patients find this approach fails and their pain persists. In fact, studies suggest that mobilization and manipulation performed as soon as possible after a whiplash injury yields significantly better outcomes than wearing a cervical collar and not moving the neck. Whiplash injuries, when not properly treated, often results in permanent loss of motion, pain, headache, and more. The days of rest and time only should be replaced by the sports medicine model of hot/cold packs, modalities such as interferential, pulsed magnetic stimulation, light or laser therapy, manipulation, massage, traction and guided exercise. Not, “…wait and watch.”
The patient was also experiencing low back pain. This raiser a greater question…
Low Back Pain – Is it on the Rise in Raleigh?
As stated last month, the prevalence of low back pain (LBP) is REALLY high! In fact, it’s the second most common cause of disability among adults in the United States (US) and a very common reason for lost days at work. The total cost of back pain in the US, including treatment and lost productivity, ranges between $100 billion to $200 billion a year! Is low back pain on the rise, staying the same, or lessening? Let’s take a look!
In the past two decades, the use of health care services for chronic LBP (that means LBP > 3 months) has substantially increased. When reviewing studies reporting insurance claims information, researchers note a significant increase in the use of spinal injections, surgery, and narcotic prescriptions. There has been an increase in the use of spinal manipulation by chiropractors as well, along with increased physical therapy services and primary care physician driven non-narcotic prescriptions. In general, LBP sufferers who are chronic (vs. acute) are the group using most of these services and incurring the majority of costs.
The reported utilization of the above mentioned services was only 3.9% in 1992 compared to 10.2% in 2006, just 11 years later. The question now becomes, why is this? Possible reasons for this increase health care use in chronic LBP sufferers may be: 1) There are simply more people suffering from chronic LBP; 2) More chronic LBP patients are deciding to seek care or treatment where previously they “just accepted and lived with it” and didn’t pursue treatment; or, 3) A combination of these factors. Regardless of which of the above three is most accurate, the most important issue is, what can we do to help chronic back pain sufferers?
Chiropractic Care For Back Pain…
As we’ve discussed in the past, an anti-inflammatory diet, exercise within YOUR personal tolerance level, not smoking, getting enough sleep, and obtaining chiropractic adjustments every two weeks are well documented methods of “controlling” chronic LBP (as there really ISN’T a “cure” in many cases). You may be surprised to hear that maintenance care has good literature support for controlling chronic LBP. In the 8/15/11 issue of SPINE (Vol. 36, No. 18, pp1427-1437), two Medical Doctors (MDs) penned the article, “Does Maintained Spinal Manipulation Therapy for Chronic Nonspecific Low Back Pain Result in Better Long-Term Outcomes?”
Here, they took 60 patients with chronic LBP (cLBP) and randomly assigned them into one of three groups: 1) 12 treatments of sham (fake) SMT (spinal manipulation) have over a one month period; 2) 12 treatments, over a one month period but no treatment for the following nine months; or 3) 12 treatments for one month AND then SMT every two weeks for the following nine months. To measure the differences between the three groups, they measured pain, disability, generic health status, and back-specific patient satisfaction at baseline, 1-, 4-, 7-, and 10-month time intervals.
They found only the patients in the second and third groups experienced significantly lower pain and disability scores vs. the first group after the first month of treatments (at three times a week). BUT, only the third group showed more improvement at the 10-month evaluation. Also, by the tenth month, the pain and disability scores returned back to nearly the initial baseline/initial level in group two. The authors concluded that, “To obtain long-term benefit, this study suggests maintenance SM after the initial intensive manipulative therapy.” Other studies have reported fewer medical tests, lower costs, fewer doctor visits, less work absenteeism, and a higher quality of life when maintenance chiropractic visits are utilized. The question is, WHEN will insurance companies and general practitioners start RECOMMENDING chiropractic maintenance care for chronic LBP patients?
Please enjoy the video vlog beloew.
In health…your Raleigh Chiropractor,
Dr. Jeffrey Gerdes, D.C.
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