In a particular study, researchers utilized MRI (magnetic resonance imaging) technology on sixty-one patients who had been admitted to the hospital with a cervical spine trauma. The writer discovered that “total disruption of blood circulation through the vertebral artery was shown… in 12 out of 61 people (19.7% of the patients).” Flexion injuries were discovered to be the most frequent kind of injuries in people who had vertebral artery injury. Blurring of vision that was transient is the symptom that is most commonly reported by these twelve patients.

These are all serious injuries since all of the people involved were admitted into the hospital. People with whiplash injuries have also reported vertebral artery injury as well. According to the study’s authors, the patients who showed neurological symptoms of insufficiency of the vertebral artery (symptoms not correlating with the soft-tissue and bone injuries with which they are presenting via standard imaging techniques) may actually have sustained an injury to the vertebral artery.

Whiplash Accidents Injuries Treated, Short North Columbus, Ohio
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In this very interesting article, a noteworthy point is made. Occupants of a car that is involved in a collision may experience neck pain, no matter which direction the impact comes from; however, this is far more likely to occur when the impact comes from the rear.

An eight mile per hour rear-end collision that has a 2-g acceleration (2-g = 2 times the gravitational force of earth) of the vehicle could cause a 5-g acceleration of the head. Experiments that used volunteers showed that a ten mile per hour rear-end collision could generate a 9-g acceleration of the neck and 23-g of the frontal cortex.

It has been shown that 10-60% of people in a car accident suffer from sprains in the neck. The ones that did not wear seatbelts have less sprains of the neck than those wearing them.

The incidence of whiplash caused by rear end impacts can be significantly reduced by the use of head restraints. In fact, the reduction is as much as ten percent in cars that have adjustable head restraints and seventeen percent in those with fixed head restraints. Additionally, the authors give good evaluations of the effectiveness of the various imaging techniques.

• Plain Radiographs: They say that plain radiographs should be used first when evaluating a whiplash injury. This is in order to obtain an image for reference of the cervical spine when injured, and in addition, to evaluate possible lesions that are traumatic. Using this method, secondary symptoms like degenerative disease can be assessed objectively, even when they are noted some length of time after the trauma. Additionally, the authors caution that plain radiographs may not be entirely effective in the identification of traumatic cervical spine injuries. In a large series of patients with cervical injuries, the combination of cross-table lateral (CTL), AP and OM-views had the following results: Sixty-one percent of all fractures were missed. Thirty-six percent of subluxations and dislocations were also missed. Additionally, injuries in twenty-three percent of the patients were falsely identified. Half of these patients had unstable cervical injuries, and some had normal cervical spines.

• CT scans: For this reason, when a trauma victim has a plain film that shows cervical injury or a high clinical suspicion of injury, the patient should have an MRI (magnetic resonance imaging) or a CT (computed tomography) scan. This will give a clearer and more definitive evaluation of the condition of the cervical spine. A CT (computed tomography) scan is a good choice for all patients who have experienced acute trauma. This is especially true when the cervical spine cannot be seen well utilizing plain film. This is also true when there is focal neck pain that cannot be explained, or there is a neurological deficit that does not show up on plain film. Additionally, if there is unexplained soft tissue swelling in the pre-vertebral region or if the plain film is abnormal for any other reason, a CT (computed tomography) or MRI (magnetic resonance imaging) is advised. These tests can reveal soft tissue problems like herniated disks, ruptured ligaments, and soft tissue hematoma. However, CT is limited when it comes to its ability in evaluating cervical trauma. It is not as easy to see dislocations, subluxations, abnormal angulations, and intervertebral distances using CT as it is using old-fashioned radiography or the newer, tomography. In one research experiment(3) CT just detected 54% of dislocations and subluxations of trauma victims.

• MRI:

o MRI data of whiplash injuries vary greatly and differ considering the time period between the x-rays and the accident.

o During the chronic phase, the first year after the trauma, usually findings will be non-specific. They will include degenerative disk disease as well as disk protrusions and/or herniation. Very few patients show bony or ligamentous lesions.

o While experiencing the subacute phase, within four months of the whiplash incident, more characteristic results such as separations of the disk from the vertebral end plate, as well as ligamentous lesions are typically reported. When comparing the anterior longitudinal ligament (ALL) and the posterior longitudinal ligament (PLL) or interspinous ligament, the ALL is more frequently injured.

o Often no specific findings will be made during the fifteen days following the original injury. This phase is often referred to as the acute phase.

o If the patient experiences neurological deficit, myelopathy, spinal cord injury, or radiculopathy, an MRI (magnetic resonance imaging) may be indicated. This is especially true if the symptoms surpass what should be expected from findings revealed by a standard radiograph. In cases of whiplash injury, it is wise to use MRI (magnetic resonance imaging) as standard procedure. This is especially true when the patient complains of symptoms specific to whiplash injury or if other investigation reveals significant findings.

Whiplash Accidents Injuries Treated, Short North Columbus, Ohio
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Rear-end collisions, even at low speed, can be extremely violent. Through the use of live subjects in crash tests involving rear-end collisions, scientists discovered that persons who experience head accelerations can experience up to nine G-forces, which is a speed nine times that of the force of gravity. What this implies is a person’s head, which usually weighs approximately 10 pounds, all of a sudden weighs 90 pounds. In its most basic version, whiplash is explained as: a person’s body is pushed one way, while the person’s head is pushed the opposite way. It comes as no surprise that much of the injury occurs in the ligaments that join the vertebrae that lie in-between the torso and the head, in the neck. The truth is, the pressures on the ligaments of the spine are in the upper area.

This issue was viewed specifically by Ivancic and colleagues(1) at Yale University. They discovered that while performing an example collision, the pressure in the lower part of the neck was 269.5 Newtons, or nearly 60 pounds of pressure, in approximately 1/20 of a second. This is the fact: when the strains are concentrated in such a small area, the human spine is not built to handle it. Research has shown that these forces are much more powerful than those that would normally act on the ligaments holding the spine together. There was a closer look at whiplash effects on the ligaments of the spine with a new study(2) by the same researchers at Yale.

The investigators began with 12 spines from cadavers: six of these spines had experienced a simulation of whiplash acceleration, while the others served as the control group. Each facet joint was then tested after being removed from the spines, in order to determine if the laxity of the joints varied between the two groups. This attached graph displays the contrast in joint stretch in the two sections. It’s apparent that the whiplash-damaged ligaments were severely weaker than non-injured ligaments.

Whiplash Accidents Neck Injuries Treated, Short North Columbus, Ohio
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In my  Short North, Columbus, the scientific literature indicates the vast majority of healing will take place during the first three weeks following the traumatic event. In addition, the majority of the injuries seen are limited to muscular injuries and treatment of patients over 90 days, in our experience, often hinders the solving of the legal matters.

This is not to say that all soft tissue injuries need 90 days of care. Care, like the patient’s injuries, are individual. But, if treatment is longer than 90 days, it should be stressed that the clinical necessity for care should be justified even more.

It is the doctors responsibility to prove the care is needed, not the insurance company’s responsibility to prove it’s not needed.

In our experience and opinion, documenting only the patient’s subjective complaints, is insufficient criteria for the continuation of care.

To support the need for continued care, the documentation within the file should show timely re-examinations which demonstrate objective physical examination findings.

In addition, these objective signs would need to be reasonably “weighed” against the clinical potential for further healing.

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I hear this question often in my chiropractic office.  Of course the answer is easy – if you have back pain, back pain is definitely worse than neck pain.  If you have neck pain, neck pain is definitely worse than back pain.

Another common question that I hear regarding low back pain is why sitting makes it hurt more than standing.

This is a good question, which can be answered through physics.  I remember seeing a diagram in one of my office ergonomic books that exposed the different stress levels on the spinal disks with various body positions.

The diagram had drawings of a person standing, lying down, sitting and then sitting while hunched forward with very poor posture.  The disk pressure differences with these different postures was given as follows:

1)    Standing upright 100%
2)    Lying down          24%
3)    Sitting upright     140%
4)    Sitting hunched   190%

The explanation of the much higher disk pressures while sitting is explained by examining the structural changes that occur when we change from a standing to a seated position.

Our spines are supposed to have curves when viewed from the side.  The neck should have a nice sweeping forward curve, the mid-back should carry a backward curve and the low back should have a sweeping forward curve.  When these curves are present, the weight of your body is carried evenly across several different structures of the spine.  These curves help provide stability for your spine.

Once we assume a seated position, the natural forward curve in our low backs reverses which increases the pressure on the disks and either increases back pain or causes back pain.  If we stay in that seated position but flex our bodies forward at the waist (think bad posture – slumping over your keyboard or desk) the pressure in the disks elevates causing more damage and more pain.

Limiting the time that you sit will help your back pain in most instances.  This is advice that I hand out to my San Diego chiropractic patients everyday of the week.  I hope that it helps you as well.

Injuries Treated, Short North Columbus, Ohio

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A Personal injury case and offer what we consider are reasonable points of view which are supportable in the literature when possible.

In our experience, failure to follow a reasonable approach often leads to close scrutiny of the claim. It is our hope this discussion will bring the two different levels of expectation a bit closer and result in a higher level of cooperation between the two sides.

Additionally, if the case you manage as the treating practitioner can pass through the medical/legal system, your relationship with the plaintiff attorney can only flourish. However, if the attorney representing the patient loses a potential award as a result of many of the topics mentioned in this article, how likely could an expanding relationship be?

Scope of Care

Obviously, the correct diagnosis is paramount in treating any patient following trauma. We will assume, for the purposes of this discussion, the case being treated represents an uncomplicated soft tissue injury. Specifically, injuries that are absent fractures neurological deficits, dislocations, disc herniations or vascular complications.

Treatment rendered for these injuries should represent the standard of care for the geographic area serviced.

The “scope of practice” or treatment rendered should be designed to make passage through the medical/legal system easier.

For example, performing reflexology on a patient’s feet for cervical spine injuries will draw more attention than the well accepted treatment course of manipulation, moist heat, ice, ultrasound, and other therapies.

This is not to say that payment will be denied, but the road to reimbursement and settlement would be much easier if a more traditional approach to care is rendered.

Injuries Treated, Short North Columbus, Ohio
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Patients who were a part of the study had pain for over 13 weeks. Each of the three groups of participants were treated with one type of care. There was acupuncture given to one group, medication to another, and chiropractic care was given to another group.

Questionnaires that were standardized were used to evaluate the participants. Participants completed these questionnaires when they started the study and again after 9 weeks of care. There was a comparison to the same questionnaires, of the results, that were administered to the same patients one year later.

Chronic Spinal Pain Syndromes Treated, Short North Columbus, Ohio
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Researchers took great pains not to include those who were receiving a number of forms of care for their affliction. The aim was to have the results show the benefits of one type of care. Using this method, external factors would be minimized and the outcome should be completely based on the kind of care the patient had.

It was found that after one year, only those that received chiropractic care still noted significant improvement. Researchers found that patients in all three groups realized some short term benefits from whatever care they received. The group that received medication did not do as well as the group that received acupuncture.

The best results, however, were produced in the group that was the recipient of chiropractic care. The conclusion of the authors was that broad-based, beneficial short-term and long-term outcomes were enjoyed by patients with chronic mechanical pain syndromes who received spinal manipulation.

Whiplash Accidents Injuries Treated, Short North Columbus, Ohio
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I see a variety of clients with injuries and pain of the back, neck and headaches. The reason for the symptoms, in many cases, are related to car accidents, or other types of personal injuries. Frequently, the questionable auto accidents happened in the previous years but the early signs were not considered important by the patient.

Most people try to get their cars fixed as soon as possible, but they don’t bother to see if they are alright themselves. Examples of this reasoning can be found in other scenarios, also. I used to know a woman who was proud of the fact that although she was a smoker, she never allowed smoking in her car since she wanted to keep it smelling fresh!

I’m not sure what the reason is for having these kind of thoughts. Many people dismiss the slight neck or back pain and headaches after they experience an auto accident. This thought process is flawed. Imagine if we didn’t care about other health problems like this.

The injuries resulting from whiplash type accidents are not simple. Muscles are pulled and ripped, sometimes ligaments can break partially or completely, a herniated disc can occur and the spine could be fractured as well.

Many mild to severe symptoms can be caused by these injuries of the neck and back. It’s bad enough when you experience pain in the back and neck over the short term, but over the long term it’s unbearable.

Even though there is a complex mechanism of injury in cases of whiplash, the usual spinal injuries that occur are following a well established path. Irritation of the ligaments and muscles within the injured area is the first symptom presented. Inflammation results from the irritation. Inflammation is not just to blame for a lot of the beginning symptoms that you feel, but it is also to blame for scar tissue development which causes your symptoms to be permanent or last forever.

Ongoing aches and pains as a result of an accident occur in roughly one out of four auto accident injuries.

In my chiropractic office in Columbus, Ohio I see the statistics become reality. Chiropractors can be of great help in treating back pain, neck pain and headaches that are caused by motor vehicle accidents. You should be examined, and treated if necessary, by your chiropractor if you want to make sure that you are not one of the 25% of people that do not recover from injuries sustained in a car accident.

Whiplash Accidents Injuries Treated, Short North Columbus, Ohio
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A feeling of spinning with dizziness characterizes the condition of vertigo. Light-headedness, nausea, and problems with balance are experienced by many sufferers due to the feeling of rotation or movement. There are no lab tests for vertigo, so diagnosis is normally based on the symptoms that patients describe. The study investigated a causal link between vertigo and the nervous system.

Vertigo Treated by Dr. Smith at Short North Columbus Chiropractic Office in Ohio
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The vast majority of patients reported having incurred a physical trauma before the spells of vertigo started. The patients in the study reported their injuries were incurred by auto accidents, sports injuries (such as skiing or bicycling), or slipping on ice. A notation was made that head or neck area trauma was suffered by all of these individuals.

Initial examinations of the 60 patients revealed that all had vertebral subluxations. So that there would be a consistent method of measuring subluxation findings and correction progress, analysis procedures were performed utilizing paraspinal digital infrared imaging.

All of the sixty subjects in this study received chiropractic care that was specific for subluxation correction. There was a positive response from all of the patients included in this study to that care, as shown by the results. There was a one- to six-month variation in the time frame for the responses. Within a half a year, 48 of the original 60 patients had no more symptoms. There was also better improvement shown by the twelve patients that were remaining with either frequency or severity in vertigo episodes.

There is a definite causal relationship between neck injury and spells of vertigo, as reported by the author of the study. It seems that utilizing IUCCA protocol, which is a form of chiropractic care, to correct the injury to the upper cervical spine, improves and/or reverses vertigo disorders.

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In my Short North, Columbus, based Chiropractic Clinic we provide treatment for those patients involved in auto accidents on a regular basis. The most common injury resulting from car accidents is whiplash.

Whiplash is most frequently associated with rear-end auto accidents in which the heads of those in the front car are suddenly snapped backward and forward by the acceleration caused by the impact.

The more descriptive medical phrase used to convey this type of injury is cervical acceleration/deceleration (CAD) trauma or syndrome. CAD accurately describes the rapid movements that can injure the vertebrae of the neck and the muscles and ligaments that support them.

Anyone can be subjected to whiplash at almost any speed, even in a minimal-force auto accident at speeds as low as 5mph. Incidents that cause whiplash can also be related to other incidents or mishaps in which the head is pushed or jerked beyond its normal range of motion. Whiplash commonly causes serious and chronic neck pain, as well as back pain, headaches blurred vision, ringing in the ears, nausea, numbness and dizziness. More serious injuries such as bruising of the brain can sometimes occur in auto accidents.

The sudden accident that caused the initial whiplash injury may fade into memory, but the physical and psychological damage of whiplash can become chronic, severely eroding the victim’s quality of life. Chiropractic techniques are particularly well-suited to relieving the neck pain and other debilitating effects of whiplash because they can
• restore movement lost after the accident,
• overcome muscle weakness and enhance muscle tone,
• speed recovery, and
• diminish chronic symptoms that can persist or recur over many years.

Chiropractic adjustments and supportive treatment have proved successful for many thousands of patients. Chiropractic care significantly reduce patients’ distress and allow them to return to their normal activities.

Whiplash Accidents Injuries Treated, Short North Columbus, Ohio

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