Health Update: Whiplash Injury Guide

This guide has been carefully prepared to educate those who have suffered-whiplash types of injuries of the neck and spine. The information presented is for general health education only. Individual health concerns should be addressed with a knowledgeable health care provider.

The Severe
“Whiplash Injury Guide”
INCLUDING… The Four
Dangerous Whiplash Myths

Whiplash injury is a very real type of problem that costs communities billions in health care and disability dollars.

Studies have recently shown that about 10-20% of the population suffers from neck pain, and car accidents/traumas are a big cause of this type of pain.

But you've probably wondered how something so minor as a fender-bender to your bumper could be such a pain in neck.

    Maybe your doctor told you, "give it a couple of weeks"..."you'll be fine."

But you're not fine.

Your neck hurts when you work at the computer, when the dog pulls too hard on the leash... maybe sleep has become more difficult with a lot of tossing and turning, or you've become dizzy...or always tired when you used to be full of energy and pep.

Maybe you've noticed how your neck moves differently since the accident. Looking over the shoulder perhaps isn't as easy as before.

Does all of this sound familiar?

It's quite surprising when you look at whiplash research and its global impact-the entire body is affected. You probably didn't think that headaches or fatigue were part of the whiplash bargain, but they are.

Your Bumper Doesn't Tell the Whole Story…

    You can't look at a dent in the bumper and conclude that the neck wasn't injured.

For instance, they're called 5 mph bumpers for a reason-designed to not be damaged in very low speed collisions. 

This is good for the bumper, but not necessarily for your neck!

What researchers have discovered is that when collisions are of enough force, this causes the vehicle to crumple and absorb energy.

Low speed collisions will often not cause the crumple zones to be engaged.

    If you have a rigid fixed bumper (seen on many older cars and trucks), that does not crumple-this can make the whiplash injury even more severe.

For the above reasons, you might be even more injured in an accident below 20 mph than one above that speed.

There are of course limits to this effect. Collisions at very high speeds (above 40 mph) will often cause the occupants to suffer severe injuries, even though the crumple zones are absorbing some of the energy.

You may have heard someone profess skepticism for your whiplash injury.

Maybe they thought you were gaming the system or out to make a fast buck.

Where does this perception come from?

Probably the insurance companies, who seem to have a profit-motive for denying the realty of whiplash injuries.

Some physicians are simply ignorant about whiplash trauma, perform cursory spinal examinations, or offer treatments that have little or no scientific evidence to back them up.

But is there really such a thing as “Whiplash?”

The science says “YES!”

Whiplash- a soft tissue injury to the neck-is also called neck sprain or neck strain.
It is characterized by a collection of symptoms that occur following damage to the neck, usually because of sudden extension and flexion.
The disorder commonly occurs as the result of an automobile accident and may include injury to the joints of the spine, disks, and ligaments, cervical muscles, and nerve roots.
Symptoms such as neck pain may be present right after the injury or may be delayed for several days.

In addition to neck pain, other symptoms may include:

• Neck Stiffness
• Injuries To The Muscles And Ligaments (Myofascial Injuries),
• Headaches
• Dizziness
• Abnormal Sensations Such As Burning Or Prickling (Paresthesias)
• Shoulder Pain
• Back Pain

In addition, you may be experiencing cognitive, somatic, or psychological conditions such as:

• Memory Loss
• Poor Concentration
• Nervousness/Irritability
• Sleep Disturbances
• Fatigue, or Depression.

Video: Whiplash Injury

Special Thanks to Dr. Nabil Ebraheim, M.D.

But Why Can Whiplash
    Be So Devastating?

Your head and neck is simply not designed to be accelerated three times the acceleration of gravity....or come in contact with an air bag deployed at 190 mph. 

When these injuries occur, muscles and ligaments of the neck cannot resist the force, which then tears tissues apart.  This then sets the stage for degeneration/osteoarthritis years later.

        The basic principal in a rear-end whiplash, is anything that makes your vehicle not accelerate as fast when hit, is going to make the injury less damaging to your neck.

        If your car is small, it will accelerate much more quickly than a larger vehicle.

        If you're hit on a low friction surface such as rain-drenched pavement, or ice, the car will accelerate very quickly…and some of the worse injuries occur when your vehicle is slightly rolling when hit, because it's easier to get a vehicle moving that is not stopped.

Women are more injured by whiplash, because they generally have less neck musculature development. The ratio of their head size to their neck size is much greater than in a man. There's a very good reason why professional football players have those massive necks.

   

The Four Dangerous Whiplash Myths:

Myth #1: Car Damage = Occupant Injury
It might seem intuitive that if a car is smashed, the neck will be badly injured, and conversely if it's a simple fender bender, then the neck was spared. Some low speed collisions can be even more damaging than high-speed accidents, within certain limits.  The kinds of things that may be more important are if your head is turned, or the size of the vehicle that is hitting you.

Before the accident, was the vehicle was rolling or stopped, how was the headrest positioned? Other factors include getting hit from behind vs. a head-on impact.

Research shows that people are not as badly injured from frontal impacts. It could be the airbag, anticipating the collision and tightening up, or the chin hitting the chest. All other factors being equal it's worse to get hit at the side and behind, than at the front.

Airbags have done a lot to save lives from frontal collisions. Unfortunately, side and rear impacts are less protected by an airbag. Seatbelts also save lives by keeping the occupants inside of the vehicle. Although they save lives, they tend to actually accentuate whiplash injuries in low speed collisions where the torso is more restrained relative to the head and neck.

Even car seats can be a factor in how badly you're injured.  Cars with soft thick seats will cause the head to whip more than occupants in a thin firm seat.  If the headrest was placed too low, it will act as a fulcrum and make the neck injury much worse.  That's why your headrest should always be positioned at the very highest level, and just touching the back of the head. 

Myth #2: No Pain = No Injury
I don’t feel pain so I’m ok. Most people who get in an accident will feel flustered and shook up. In low speed collisions, it is more rare to have pain right after accident. Usually symptoms develop over days, and it is not uncommon for the pain to come on two weeks post trauma. Conversely if you feel immediate pain, then substantial tearing and damage has occurred.

Another thing to consider is that the spine can be injured and yet may not cause much neck pain.  However, these patients usually have tender spines to the touch, even if there are no outward symptoms.  Less than 20% of the nerves that come through bundles between your vertebrae carry pain signals.  That means it's important to examine for more than just pain, such as neurological and muscle function. A doctor needs to carefully palpate the tissues of the neck, check range of motion, and examine the flexibility of individual spinal joints.  With this type of comprehensive exam you will be able to know if you've been injured. 

Myth #3: Kids Don't Get Whiplash
Kids aren’t injured in whiplash. Maybe you thought little Johnny wasn't injured in the car seat, or since kids tumble around when they play, they couldn't possibly be injured. This couldn't be further from the truth. Infants and young children have very undeveloped spines with much less muscle strength. This makes their ability to resist the forces lessened. You have to also consider the size of the head compared to the size of the neck. This difference is greatest in young children. When infants are injured they can show behavioral changes such as irritability and disrupted sleep patterns or nursing difficulties.

Myth #4: X-rays Always Show Whiplash Injury
If you've had a severe whiplash, you may have taken a trip to the emergency room where an x-ray was taken. If you're like many patients, the x-ray was read as normal. The problem is the x-ray you received, probably taken with you in one position, does not show injuries to the soft tissues such as ligaments and muscles, unless massive injury has occurred. Only if motion x-rays are obtained, can you see how the joints are moving in the neck. Since the injury is a sprain of ligaments, and x-rays show only bones-they do not give the complete picture.

Unfortunately for some whiplash victims
neck trauma will lead to arthritis of the spine

Don't be too alarmed, but concern is helpful.

People hear the word arthritis and think of rheumatoid arthritis and crippling joints.

What I'm talking about is osteoarthritis, or degenerative joint disease. 

Osteoarthritis is one of most common diseases afflicting humans, more common in people over age 55 than any other health condition.

Billions of dollars are spent each year on drug treatments that really do nothing to prevent degeneration of the joint.

In fact, some scientists suggest that injuries do not heal properly when patients take NSAIDs such as ibuprofen. 

This is in addition to the known rare side effects such as stomach bleeding, liver, and kidney problems.

    Arthritis occurs in spinal joints that have damage to the ligaments and disks. As degeneration progresses, the mobility of vertebrae are altered. The stretched out ligaments will allow excessive motion and after injury, scar tissue develops. Over months and years, the scar tissue contracts and the disk size decreases. This will make the mobility of the neck abnormally low (more stiffness). This scar is also not as elastic as tissue that has not been injured. Persons who have pre-existing degeneration and arthritis at the time of impact, will suffer whiplash more frequently (lower threshold) and with more severity when it does occur. Since older adults are most likely to have this type of degeneration arthritis, they are put more at risk in whiplash accidents.

_________________________________________  

    Hello.

    My name is Dr. Cilea, D.C.,


    One of the mainstays of medical treatment of whiplash is to immobilize the neck with a collar. Except in rare cases, it is something that I never use in practice.

    While good in theory, it just weakens the muscles and fails to preserve movement, which the neck needs to heal properly. 

    I am glad to see that many medical physicians are using them less and less, and promoting more active rehabilitation. Neck collars/braces are needed for fractures or dislocations, but strains/sprains are generally made worse with this treatment.

    I have spent years studying the mechanics of neck problems, and effective treatments, and I've successfully cared for many patients over the years, getting their quality of life back and reducing pain. But I'm still surprised by how many still take the medical approach-hot packs, collars and pain pills.

    Treatments ideally should be mechanical, not chemical, and not just cover up or mask the pain.

    I'm not saying my approach is scientifically proven to be the best...or that I have all the answers.

    But I do think there is a general lack of appreciation for the seriousness of these types of neck injuries, and that people are often convinced by insurance companies and others, that no injury occurred.

    This can sometimes result in no examination, no professional treatment, or the patient self medicates with various over-the-counter drugs or maybe you were required to see a "gatekeeper," that didn't appreciate the complexities of whiplash injuries and never referred you to the appropriate doctor.

    In any case, I'm not surprised if you're going through a health care maze-most of my patients do so.

    Not seeking proper treatment when indicated can lead to more problems down the road.

I WANT TO OFFER YOU ANOTHER WAY, AN APPROACH

BASED ON EVIDENCE AND THE MECHANICS OF THE BODY.

The most crucial point I want you to get from this Guide, is that it may be important for you to get a Comprehensive Whiplash Examination to determine if you've been injured.
Call our office at 732-719-8148 and schedule a FREE* consultation.



Don’t forget…it is important for your treatments to make your spine more flexible where it is not, and restrict movements where it is unstable.

Conventional MRIs immediately after the accident will not show these mobility changes and X-ray cannot show the disks of the spine. Only tests of mobility can show you where mechanical treatment is needed.

I strongly recommend that you have me evaluate your condition. There is ABSOLUTELY NO OBLIGATION for care. It is merely a chance to document any injuries and to find out if you need additional treatment.

*The free consultation offered here does not apply to patients who participate in a Federal program such as, but not limited to, Medicare.

Health Update: Carpal Tunnel

Musicians and
Carpal Tunnel Syndrome

Dart Fine-Art

  
  There are many jobs that place people at risk for carpal tunnel syndrome (CTS), but I bet you wouldn’t have thought of musicians.  First and most important, I don’t want to scare anyone from playing a musical instrument as many of us find music to be a very important “release mechanism” or, an escape from reality (at least for a while) in our busy lives. Playing music uses part of the brain that doesn’t get enough stimulation and has been found to improve learning skills in children and can improve (as well as prevent) Alzheimer’s Disease in the more mature sector of the population. So PLEASE, continue playing your instrument or if you don’t play, start taking lessons on your favorite instrument – something an increasing number of adults are beginning to do!

Ok, now that the “disclaimer” is over, we can discuss why musicians are at risk for developing CTS and how you and I can prevent CTS from becoming a “monster!” Playing a musical instrument utilizes our fingers in a rapid, repetitive way, similar to a typist or keyboard worker. Also, some instruments require the hands and wrists to be placed in awkward positions, which is bad because the tendons, as they rub against each other inside the tunnel, create friction, heat and swell up, thus pinching the median nerve. If the wrist is bent, the pressure inside the carpal tunnel goes up a lot more than when it’s kept straight, and this is especially true if there are already problems present like a mild case of CTS. In brief , the anatomy of the carpal tunnel includes 9 tendons, some blood vessels, and the median nerve which are, in a sense, jammed into a tight, confined space. Think of pulling a napkin through a napkin ring that is just a little bit too small – you REALLY have to work to pull the napkin through, right?  Well, this is kind of what happens when one develops CTS. Instead of having a napkin and ring that match so the napkin easily pulls through, those with CTS have a tight, constricted tunnel (napkin ring) which really squeezes the contents, including the median nerve.  The result of pinching a nerve is numbness, tingling, burning, and/or a “half-asleep” feeling in fingers 2, 3, and 4 (that is, the index, middle and ring fingers).

When you watch a piano player, their palms are pointing down towards the floor while they play.  The two long bones in the forearm, the ulna and radius, are parallel when the palms are up and cross over one another when the palms are down. The median nerve travels down from the neck, axilla, upper and lower arm and finally through the carpal tunnel to innervate the middle three fingers.  There is more pressure on the median nerve when the palms are pointing down compared to up, but it would be impossible to play the piano palms up!  Other instruments like the flute, trombone, trumpet, and many others require the arms and hands to be raised up to around the head level while the instrument is played.  This places more pressure on the median nerve in the axilla area, referred to as the thoracic outlet. Many musicians practice multiple hours a day and the repetitive motion can really irritate the median nerve, and can result in CTS.

Again, please understand we are not inferring for you to stop playing your musical instrument! Rather, take multiple breaks when practicing, do carpal tunnel stretch exercises, and seek chiropractic care as we can usually manage CTS successfully without the need for surgery.

We realize you have a choice in who you choose 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 require care for CTS, we would be honored to render our services

Health Update: Whiplash

Interesting Facts
About Whiplash

We all know the most common causes of “whiplash” are injuries that typically arise from automobile accidents or, motor vehicle collisions (MVC’s) although whiplash can also occur from slip and fall and virtually, any injury where your head is whipped backwards. But there are many things about whiplash you may not be aware of, which is the reason for this month’s Heath Update on whiplash.

For example, did you know the effect whiplash has on public health (in general) is tremendous? The number of cases occurring annually is frequently quoted as 1,000,000 per year, but this is based on an outdated (1971) and incomplete dataset. A more recent figure of 3 million per year is considered to be more accurate because it’s based on several governmental databases and it accounts for the expected number of unreported cases by the NHTSA (National Highway Traffic Safety Administration).  That’s a huge difference!  The updated figure accounts for whiplash victims not attended to by emergency medical services. In less catastrophic accidents, the injured party may not appear to be significantly injured at the scene of the MVC and decline emergency care and hence, the MVC will to unreported to a governmental data collection center.

Video: Whiplash Health Update




Another interesting study surveyed over 3500 chiropractors who were asked if they commonly applied cervical (neck) spinal manipulation to patients who had known herniated discs or protruded discs (in their neck). Over 90% of the chiropractors indicated they found it safe and effective to utilize cervical adjustments (manipulation) in this patient population. It is VERY important for you to know this as frequently, you may be told by your medical doctor (or next door neighbor), “…don’t let anyone crack your neck!” Now, you can rest assured that in the experience of MANY chiropractors (not just me), significant benefits can be achieved by this treatment approach.  Moreover, the sooner neck adjustments are applied, the better the results - so don’t wait to get a chiropractic treatment after an MVC!

Another interesting study investigated the “proper” or “best” seated position in a car during a rear-end collision, based on an analysis of many previously published studies on this topic.  Because the seated position of the person involved in a MVC is related to the degree of the injury, the factors studied included the angle of the seat back, seat-bottom angle, the density of the foam in the seatback, the height above the floor [of the knees], and the presence of armrests in cars.  They found that the seat back angle of 110-130 degrees reduced disc pressure and low back muscle activity but 110 degrees – MAX. – was found to minimize the forward positioning of the head. A 5 degree downwards tilt of the seat bottom further reduced the pressure in the low back discs and muscle activity as measured by an EMG Test (electromyography).  The use of armrests and the use of a lumbar support were also found to be important to reduce injuries associated with MVCs.  This combination was reported to be optimum for all of us to use in order to minimize the bodily injury in a rear-end MVC. Other important factors included firm dense foam in the seat back, an adjustable seat bottom (for angle, height, and front to back distance), horizontal and vertical lumbar support adjustments (…best if they pulsate to reduce the static load encountered in a crash), seat shock absorbers, and seat adjustments for front to back to adjust for different patient heights.

We hope this information is helpful. We realize you have a choice in where you go for your health care needs.  We truly appreciate your consideration in allowing us to help you through this potentially difficult process.

Visit us at www.newjerseypainmanagement.net or call us directly 732.719.8148 for more information and a Free consultation.