Car Accident injuries – Whiplash Facts

Whiplash is a slang term for cervical acceleration, deceleration syndrome, or CAD. There are facts and myths surrounding the subject of whiplash. Let’s look at some of the facts.

The origin of CAD. The history of CAD dates back to a time prior to the invention of the car. The first case of severe neck pain arose from a train collision around the time of 1919 and was originally called “railroad spine.” The number of whiplash injuries sharply rose after the invention of cars due to rear-end crashes.

Whiplash synonyms. As stated previously, the term “cervical acceleration-deceleration disorder, or CAD, is a popular title as it explains the mechanism of injury, where in the classic rear-end collision, the neck is initially extended back as the car is propelled forward, leaving the head hanging in space. Once the tissues stretch enough in the front of the neck, the head and neck flex forward very rapidly, forcing the chin towards the chest. This over stretches the soft tissues in the back of the neck. Another term for whiplash is WAD or, Whiplash Associated Disorders. In 1995, the Quebec Task Force categorized injuries associated with whiplash by the type of tissues that were found to be injured. Here, WAD Type I represents patients with symptoms/pain but normal range of motion and no real objective findings like muscle spasm. Type II includes injuries to the soft tissues that limit neck motion with muscle spasm but no neurological loss (sensation or muscle strength). WAD Type III includes the Type II findings plus neurological loss, and type IV involves fractures of the cervical spine.

Head rest facts: Prior to the invention of head rests, whiplash injuries were much more common and more serious because the head was propelled in a “crack-the-whip” like fashion. However, headrests are frequently not adjusted correctly; they are either too low and/or too far away from the head. If the seat back is reclined, this further separates the head from the headrest. The proper position of the head rest should be near the center of gravity of the head, or about 9 cm (3.5”) below the top of the head, or at minimum, at the top of the ears. Equally important is that it should be as close as possible to the back of the head. When the distance reaches 4” away from the head, there is an increased risk of injury, especially if it’s also set too low. When the headrest is properly positioned, the chances of head injury are decreased by up to 35% during a rear-end collision.

Seat back angle. The degree of incline of the seat back can also contribute to injury of the cervical spine. As stated above, as the seat is reclined, the head to headrest distance increases, furthering the chance for injury. A second negative effect is called “ramping.” Here, the body slides up the seat back resulting in the head being positioned over the top of the head rest. Also, the degree of “spring” of the seatback contributes to the rebound of the torso during the CAD process.

Concussion: The notion that the head has to hit something to develop a concussion is not true. Also, the idea that a loss of consciousness is needed to develop a concussion is also false. Simply, the rapid forward/backward movement of the head is enough force for the brain (which is suspended by ligaments) to literally slam into the inner walls of the skull and can result in concussion. The symptoms associated with concussion are referred to as post-concussive syndrome or, mild traumatic brain injury.

We realize you have a choice in where you receive your healthcare services.  If you, a friend or family member requires care for whiplash, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

Neck Pain Treatment Options

Neck pain is a very common problem. In fact, 2/3rds of the population will have neck pain at some point in life. It can arise from stress, lack of sleep, prolonged postures (such as reading or driving), sports injuries, whiplash injuries, arthritis, referred pain from upper back problems, or even from sinusitis! Rarely, it can be caused from dangerous problems including referred pain during a heart attack, carotid or vertebral artery injuries, or head or neck cancer, but these, as previously stated, are very uncommon. However, since you don’t know why your neck hurts, it’s very important to have your neck pain properly evaluated so the cause can be properly treated and not just covered up from the use of pain killers!

Barring the dangerous causes of neck pain listed above, treatment methods vary depending on whom you elect to consult. Classically, if you see your primary care physician, pharmaceutical care is usually the approach. Medications can be directed at reducing pain (Tylenol, or one of many prescription “pain killers”), at reducing inflammation and pain (Aspirin, Ibuprofen, Aleve, etc.), to reduce muscle spasms (like muscle relaxers) or, medications may be directed to reduce depression, anxiety, or the like. When a sinus infection affects the 2 deep sinuses (ethmoid and sphenoid sinuses which are located deep in the head), the referred pain is directed to the back of the head and neck. Here, an antibiotic may be needed and/or something specifically directed at allergies when present. In general, in cases that do not respond to usual chiropractic care, co-management with the primary care physician is a good option.

 

However, the good news is that chiropractic care usually works well, and the need for medication can be avoided since the side effects of medication can sometimes be worse than the benefits. Recently, The Bone and Joint Decade Task Force on Neck Pain published arguably the best review of research published between 2000 and 2010 regarding neck pain treatment approaches. They concluded that spinal manipulation and mobilization are highly effective for many causes of neck pain, especially when arising from the muscles and joints – the most common cause. Therefore it would seem logical to consult with a Chiropractor FIRST since manipulation and mobilization are so effective and safe. When we add neck exercises, the results are even better, according to some studies.

 

As chiropractors, we will often use different modalities including electric stimulation, ultrasound, hot and/or cold (which are usually given as a good home-applied remedy), and others. In particular, low level laser therapy (LLLT) has been shown, “…to reduce pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients with chronic neck pain” [Lancet, 2009; 374(9705)]. LLLT is a commonly used modality by chiropractors and when combined with spinal manipulation, the results can be even faster! We will also evaluate your posture, body mechanics, and consider “ergonomic” or work station problems and offer recommendations for improving your work environment. We also frequently utilize anti-inflammatory nutrients including vitamins, minerals, herbs, and more to avoid the negative side effects to the stomach, liver, and kidney negative that can result from using non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, or Aleve. Make chiropractic along with Active Release Techniques (ART) your FIRST choice when neck pain strikes, NOT last resort!

We realize that you have a choice in where you receive your healthcare services.  If you, a friend or family member requires care for neck pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

Dr. Stripling from Denver Chiropractic Center shows you hamstring stretches!

Carpal Tunnel Syndrome – Natural Treatment Options

Carpal Tunnel Syndrome (CTS) is a condition characterized by pain, numbness and/or tingling in the hand. This includes the palm and the 2nd, 3rd, and half of the 4th finger, usually sparing the thumb. Another indication of CTS is weakness in grip strength such as difficulty opening a jar to even holding a coffee cup. CTS can occur from many different causes, the most common being repetitive motion injuries such as assembly line or typing/computing work.

Here is a PARTIAL list of potential causes of CTS: heredity (a small sized tunnel), aging (>50 years old), rheumatoid arthritis, pregnancy, hypothyroid, birth control pill use, trauma to the wrist (especially colles fractures), diabetes mellitus, acromegaly, the use of corticosteroids, tumors (benign or malignant), obesity (BMI>29 are 2.5 more likely), double crush (pinching of the nerve in more than 1 place such as the neck and the carpal tunnel), heterozygous mutations in a gene (associated with Charcot-Marie-Tooth), Parvovirus b19, and others. Again, repetitive trauma is still the most common cause. Once the cause(s) of CTS has been nailed down, then treatment options can be considered.

From a treatment perspective, we’ve previously discussed what chiropractors typically do for CTS (spinal and extremity joint manipulation, muscle/soft tissue mobilization, physical therapy modalities such as laser, the use of a wrist splint – especially at night, work task modifications, wrist/hand/arm/neck exercises, vitamin B6, and more). But, what about using other “alternative” or non-medical approaches, especially those that can be done with chiropractic treatment? Here is a list of four alternative or complementary treatment options:

  1. Anti-inflammatory Goals: Reducing systemic inflammation reduces overall pressure on the median nerve that travels through the limited space within the carpal tunnel at the wrist. An “anti-inflammatory diet” such a Mediterranean diet, gluten-free diet, paleo-diet (also referred to as the caveman diet) can also help. Herbs that can helps include arnica, bromelain, white willow bark, curcumen, ginger, turmeric, boswellia, and vitamins such as bioflavinoids, Vitamin B6 (and other B vitamins such as B1 and B12), vitamin C, and also omega 3 fatty acids.
  2. Acupuncture: Inserting very thin needles into specific acupuncture points both near the wrist and further away can unblock energy channels (called meridians), improve energy flow, release natural pain reducing chemicals (endorphins and enkephlins), promote circulation and balance the nervous system. For CTS, the acupuncture points are located on the wrist, arm, thumb, hand, neck, upper back and leg. The number of sessions varies, dependant on how long the CTS has been present, the person’s overall health, and the severity of CTS.
  3. Laser acupuncture: The use of a low level (or “cold” laser) or a class IV pulsed laser over the same acupuncture points as mentioned above can have very similar beneficial effects (without needles)! One particular study of 36 subjects with CTS for an average of 24 months included 14 patients who had 1-2 prior surgeries for CTS with poor post-surgical results. Even in that group, improvement was reported after 3 laser treatments per week for 4-5 weeks! In total, 33 of the 36 subjects reported 50-100% relief. These benefits were reportedly long-term as follow-up at 1-2 years later showed only 2 out of 23 subjects had pain that returned and subsequent laser treatment was again successful within several weeks.
  4. Active Release Techniques (ART): ART releases scar tissue in the muscles that surround the median nerve. This release takes the pressure off of the nerve, and often resolves CTS. We’ve been treating Carpal Tunnel with ART successfully since 2000, and Dr. Hyman is the only ART provider in Denver who is also an ART instructor. Call us today to schedule your CTS evaluation. 303.300.0424

Carpal Tunnel Syndrome- try Active Release techniques at Denver Chiropractic Center before surgery

In many cases, Carpal Tunnel Syndrome (CTS) results strictly from overuse activities though, as we have discussed previously. Other conditions such as, pregnancy, etc. can also be involved as a contributor and / or the sole cause. When these conditions are present, they must be properly treated to achieve a favorable result. However, the majority of cases are the result of a repetitive motion injury. So, the question remains: What is the role of the patient regarding activity modification during the treatment process of CTS? How important is it?

To answer this question, let’s look at a fairly common type of CTS case. The patient is female, 52 years old, moderately obese (Body Mass Index 35 where the normal is 19-25), and works for a local cookie packing company. Her job is to stand on a line where cookies are traveling down a conveyor belt after being baked and cooled. She reaches forwards with both arms and grasps the cookies, sometimes several at a time, and places them into plastic packaging which are then wrapped and finally removed from the belt and placed into boxes located at the end of the line. Each worker rotates positions every 30 minutes. A problem can occur when other workers fall behind or when there aren’t enough workers on the line, at which time the speed required to complete the job increases.

So now, let’s discuss the “pathology” behind CTS. The cause of CTS is the pinching of the median nerve inside the carpal tunnel or muscles of the forearm, located on the palm side of the wrist. The tunnel is made up of 2 rows of 4 carpal bones that form top of the tunnel while a ligament stretches across, making up the tunnel’s floor. There are 9 tendons that travel through the tunnel and “during rush hour” (or, when the worker is REALLY moving fast, trying to keep up with production), the friction created between the tendons, their sheaths (covering) and surrounding synovial lining (a lubricating membrane that covers the tendons sheaths), results in inflammation or swelling.

When this happens, there just isn’t enough room inside the tunnel for the additional swelling and everything gets compressed. The inflamed contents inside the tunnel push the median nerve (that also travels through the tunnel) against the ligament and pinched nerve symptoms occur (numbness, tingling, and loss of the grip strength). The worker notices significant problems at night when her hands interrupt her sleep and she has to shake and flick her fingers to try to get them to “wake up.” She notices that only the index to the 3rd and thumb half of the 4th finger are numb, primarily on the palm side.

At this stage, the worker often waits to see if this is just a temporary problem that will go away on its own and if not, she’ll make an appointment for a consultation, often at her family doctor (since many patients don’t realize Active Release Techniques Soft Tissue Treatments REALLY HELP this condition). In an “ideal world,” the primary care doctor first refers the patient to the ART provider for non-surgical management. Other treatment elements include the use of a night wrist splint and (one of the MOST IMPORTANT) “ergonomic management.” That means work station modifications, which may include slowing down the line, the addition 1 or 2 workers, and reducing the reach requirement by adding a “rake” that pushes the cookies towards the worker/s. Strict home instructions to allow for proper rest and managing home repetitive tasks are also very important. Between all these approaches, our office is quite successful in managing the CTS patient, but it may require a workstation analysis.

It all starts with the initial examination. Call our office at 303.300.0424 right now to schedule yours.

Barefoot Running: The Dirty Secret

Last year, I treated a pro runner who would train barefoot in a park. She would come in with the most horrendously dirty feet you’ve ever seen. The dirt and grass stains were literally ground into her skin. She told me that no matter how much she scrubbed them she couldn’t get them clean. Awful. But that’s not the dirty little secret we’re here to discuss today (though it is true).

The dirty secret behind barefoot running is that a lot of people get hurt. The theory, made stylish by popular books like Born To Run, can be summarized like this: Our feet evolved to function without shoes. We have lots and lots of little muscles that should provide natural support for our feet. By wearing highly supportive and cushioned shoes, we are cheating our feet of the the work required to make them strong.

“Throw away your shoes and thrive!” seems to be the underlying message. It makes sense, and I’m a proponent. But must of us aren’t ready for it.

Running barefoot, or running in minimalist shoes as most of us prefer (Nike Free, Vibram 5-fingers, Terra Plano Evos, etc) requires a little remedial work. For some people, those small muscles in their feet aren’t ready for it. Ditto the calf muscles and Achilles Tendons. As a result, I’m seeing quite a bit of plantar fasciitis, Achilles tendonitis, and shin splints in barefoot runners.

If you’re thinking about taking the Barefoot plunge, or maybe have already been dipping your minimally clad toes into the proverbial pool, your best bet is to ease into it. If you’re used to putting in 10 miles or more on a Sunday, don’t put on your brand new Nike Frees and run 10. Walk for a mile and then run slow mile. Repeat that for a week or two before slowly upping the miles.

But before you even get that far, do a few barefoot drills in the safety and comfort of your house. Of course, if you have underlying conditions that would be aggravated by these, don’t do them (herniated discs, pre-existing foot or ankle problems, etc).

1. Hops. Simply stand with your feet together and do some 2-legged hops. Just jump a few inches off of the ground. Land on the balls of your feet, and as soon as your heels touch, hop back up. This will start to get your Achilles Tendons ready for the recoil required when running barefoot.

2. Side to side hops. Hop from your left foot to your right foot, moving side-to-side. Again, land on the ball of each foot, and as soon as your heel touches, hop onto the other foot. This will strengthen your calves and ankles.

3. Foot switchers. Stand with one foot in front of the other. Hop up and switch positions. This gets the smaller muscles of your feet ready to push off.

left foot forward

right foot forward

If you want, you can progress to barefoot indoor skipping. When doing these exercises, start with a set or two that lasts for 10 seconds. Slowly work up to a minute, but be mindful of any soreness. Give your feet, ankles and calves a chance to get stronger before heading out to get the dirt and grass stains embedded in your own feet.

By the way, we treat plantar fasciitis, ankle sprains, Achilles tendonitis, shin splints, and calf injuries at Denver Chiropractic Center. Our approach combines and Active Release Technique with rehabilitative exercises. We can help you get rid of the pain.

Back from the USAT certification

I just finished up at the USA Traithlon Coaching
Certification clinic in Colorado Springs. Had a great
room for 2 nights at the Broadmoor. What a place.

But that’s not why I’m writing. During one of the breaks,
a coach from New York asked if I could take a look at
her shoulder. Somehow she had been googling Active
Release and found my website. It was kind of strange that
she knew who I was.

Anyway, she had been dealing with shoulder pain while
swimming for over a year. It hurt to raise her arm
over her head, hurt to put a shirt on, hurt at night,
etc.

Fear of needing surgery had kept her from saying
anything about the pain to anyone. She was hoping
maybe I could give her an opinion.

I put her through some ranges of motion and her
problem was obvious. Scar tissue in her subscapularis
was keeping that muscle from firing. This was causing
her humerus to ride a little too high in the joint.
Classic impingement syndrome.

I treated her during the first two days at the clinic,
mostly breaking up the scar tissue in the subscap.
On the third day she swam and reported it was
about 90% better. I referred her to an ART doc in
NY to finish up. She was so excited that she cried.
I love that kind of case.

This was no miracle. Many shoulder problems start in
the subscap. They can usually be fixed. The first step
is finding the right person to help. I’ve treated
hundreds, probably over a thousand.

So, I’m back in the office after the certification.
If you or anyone you know is having shoulder pain,
I can probably help. Call 303.300.0424.

You can read more about shoulder pain here:
http://www.denverback.com/q_shoulder.html