Dr. Glenn Hyman’s Denver Chiropractic Center: Car Accident Injuries (Whiplash) Self-Care: Part 2

 

Last month, we started the discussion of self-care options in the management of car accident injuries: whiplash or CAD (cervical acceleration-deceleration) or WAD (whiplash associated disorders). In this series, we are describing various treatment methods that you can be taught to help facilitate in the management process during the four stages of healing (acute, subacute – discussed last month; remodeling and chronic – addressed this month).

 

Like in the acute and subacute stages, many of the same self-care techniques can be applied here as well. You will NEVER “hurt” yourself with ice or ice/heat combinations (done properly), so they can be continued indefinitely. Many patients find this helpful. Using the analogy of a cut on the skin, in the acute stage, the cut is fresh and new. It is quite pain sensitive and unstable and it will continue to bleed if you don’t take it easy. After 72 hours (entering the subacute stage), the wound has an immature scab on it and it can still easily be re-injured, and if this occurs, especially by NOT self-managing properly, the recovery time can be significantly prolonged. So, “DON’T PICK AT YOUR CUT!!!” As we enter the later subacute phase (fourteenth week), the wound’s scab is quite mature, and self-care can be appropriately more aggressive. Think strengthening and activity restoration!

 

Stage 3 – REMODELING phase (14 weeks to 12 months or more): In this stage, we are now three months to a year out from the injury date and hence, we SHOULD now be more “aggressive” with care. During the late acute and subacute stages, you would have been performing exercises focused on movement restoration (range of motion / ROM exercises with LIGHT resistance) in addition to self-applied myofascial release techniques using foam rolls, tennis balls, TheraCane, and/or the Intracell (and possibly others). It is NECESSARY to continue the use of these methods, as they help reduce the chances for any scar tissue to become permanent. In this stage, we will guide you into more advanced exercises that include aerobics (walking, walk/run combinations, etc.) as studies show that whole body aerobic exercise helps MANY specific area injuries, including WAD/CAD injuries.

 

Stretching short/tight muscles, working on balance-challenging exercises (rocker or wobble boards, balance beams, gym balls, eyes closed specific action movements) are VERY IMPORTANT, as they retrain your neuromotor system and reintegrate neural pathways that have been disrupted by the injured tissues and retrain faulty movement patterns you’ve developed from compensating due to pain. Strengthening exercises will include the core since the head sits on the neck, the neck on the trunk, the trunk on the legs, and ALL of this sits on the feet (so we’ll even consider stabilizing the sub-talar joint at the ankle and if pronation is excessive, foot orthotics can help whiplash patients)!

 

Stage 4: CHRONIC (Permanent): ALL OF THE ABOVE can be employed after the one to two year point to “maintain” your best level of function. If you still have pain, try to “ignore it” and KEEP MOVING, stay active, stay engaged in work, family activities, and DON’T let the condition “win.” AVOID CHRONIC DISABILITY by staying active and fit!

 

We realize you have a choice in whom you consider for your health care. If you or someone you know needs help recovering from car accident injuries, call us at 303.300.0424, or use the “Make an Appointment” function on our website www.denverback.com.

Dr. Glen Hyman’s Denver Chiropractic Center: Whiplash Self-Care: Part 1

 

Whiplash is a condition that can occur from MANY causes – in fact, anything that results in a sudden change in the head/neck position. Usually, there is a rapid acceleration that injuries the soft tissues around the neck area by stretching them beyond their limits. Hence, the more accurate terms for whiplash are, “cervical acceleration-deceleration” or CAD as it describes the mechanism of the injury and “whiplash associated disorders” (WAD) describing the degree of injury.

 

Most commonly, when we think about whiplash, we immediately envision a motor vehicle collision (MVC), but prior to the invention of the automobile, the term “railroad spine” was coined to describe injuries to the neck from crashes that occurred between trains. Since then, due to pilots landing planes on aircraft carriers, sports injuries, and the rise of the automobile, this once rare condition has affected MOST of us at some point in time!

 

Today’s topic will focus on self-care. What can you and I do for ourselves WHEN we suffer a CAD injury? Since there are different levels of injury severity, keep in mind that EACH CASE IS UNIQUE and we will ONLY be discussing general options. So ALWAYS let your symptoms guide you in the process of care – that is, if you feel a sharp, piercing/stabbing, activity or movement stopping type of pain, STOP!!! Don’t further injure your tissues!!! We will discuss a common WAD II injury (soft-tissue injury limiting motion but not injuring nerves) and we’ll look the acute and sub-acute stages of the injury.

 

Stage 1 – ACUTE: The inflammatory phase (up to 72 hours). ICE is necessary to decrease swelling (inflammation). Limit motion but try NOT to use a collar unless you have no choice as even small movements that avoid the sharp/knife-like pain are better than no movement at all. A collar may be needed when driving (especially if the roads are bumpy)! Anti-inflammatory herbs like ginger, turmeric, boswellia, bioflavonoid, and others reduce inflammation WITHOUT irritating the stomach, liver, kidneys, and will NOT inhibit the chemicals needed for healing (like NSAIDs do!). Chiropractic care with Active Release Techniques Soft Tissue Treatment SHOULD begin ASAP after an injury. We may only use gentle manual traction and/or mobilization, also staying within reasonable pain boundaries. It’s been well proven that early movement is best!

 

Stage 2 – SUB-ACUTE: The repair phase (72 hours to 14 weeks). Ice can continue if it helps control pain. You can also alternate ice and heat at 10/5/10/5/10 minutes, starting and ending with ice (it “pumps” the tissues). Cervical range of motion (ROM) exercises with LIGHT resistance (use 1 or 2 fingers against the head and push in a forward, backward, sideways, and rotating directions first with “isometrics” – not moving the head, and when tolerated, “isotonic” – moving the head against the LIGHT pressure applied in BOTH directions within the range that avoids sharp/knife-like pain. Movement, strength, pain, and coordination are ALL better managed when light resistance + motion is used vs. not moving (isometrics). Self-applied methods of performing “myofascial release” (which we will teach you) include: Self-massage, the use of a tennis ball and/or foam roll and others. During this repair phase, chiropractic adjustments and Active Release Techniques Soft Tissue Treatments REALLY help!!! We will continue this discussion on the next page…

 

Can Chiropractic Help the Post-Surgical Patient?

Low back pain (LBP) accounts for over 3 million emergency department visits per year in the United States alone. Worldwide, LBP affects approximately 84% of the general population, so eventually almost EVERYONE will have lower back pain that requires treatment! There is evidence dating back to the early Roman and Greek era that indicates back pain was also very prevalent, and that really hasn’t changed. Some feel it’s because we are bipedal (walk on two legs) rather than quadrupedal (walk on four limbs). When comparing the two, degenerative disk disease and spinal osteoarthritis are postponed in the four-legged species by approximately two (equivalent) decades. But regardless of the reason, back pain is “the rule,” NOT the exception when it comes to patient visits to chiropractors and medical doctors. Previously, we looked at the surgical rate of low back pain by comparing patients who initially went to spinal surgeons vs. to chiropractors, and we were amazed! Remember? Approximately 43% of workers who first saw a surgeon had surgery compared to ONLY 1.5% of those who first saw a chiropractor!  So, the questions this month are, how successful IS spinal surgery, and what about all those patients who have had surgery but still have problems – can chiropractic still help them?

A review of the literature published in the Journal of the American Academy of Orthopaedic Surgeons showed that in most cases of degenerative disk disease (DDD), non-surgical approaches are the most effective treatment choice (that includes chiropractic!). They report the success rate of spinal fusions for DDD has been only 50-60%. The advent of artificial disks, which originally proposed to be a “cure” for symptomatic disk disease, has fared no better with possible worse long-term problems that are not yet fully understood. They state, “Surgery should be the last option, but too often patients think of surgery as a cure-all and are eager to embark on it.” They go on to write, “Also, surgeons should pay close attention to the list of contraindications, and recommend surgery only for those patients who are truly likely to benefit from it.” Another study reported that, when followed for 10 years after artificial disk surgery, a similar 40% of the patients treated failed and had a second surgery within three years after the first! Similar findings are reported for post-surgical spinal stenosis as well as other spinal conditions.

So what about the success rate of chiropractic management for patients who have had low back surgery? In a 2012 article, three patients who had prior lumbar spinal fusions at least two years previous were treated with spinal manipulation (three treatments over three consecutive days) followed by rehabilitation for eight weeks. At the completion of care, all three (100%) had clinical improvement that were still maintained a year later. Another study reported 32 cases of post-surgical low back pain patients undergoing chiropractic care resulted in an average drop in pain from 6.4/10 to 2.3/10 (that means pain was reduced by 4.1 points out of 10 or, 64%). An even larger drop was reported when dividing up those who had a combination of spinal surgeries (diskectomy, fusion, and/or laminectomy) with a pain drop of 5.7 out of 10 points!

Typically, spinal surgery SHOULD be the last resort, but we now know that is not always practiced. IF a patient has had more than one surgery and still has pain, the term “failed back syndrome” is applied and carries many symptoms and disability. Again, to NOT utilize chiropractic post-surgically seems almost as foolish as not utilizing it pre-surgically!

GIVE US A CALL 303.300.0424

The United States Government Supports Chiropractic Care.

“The Agency for Health Care Policy and Research—a federal government research organization—recommended that low back pain sufferers choose the most conservative care first. It recommended spinal manipulation (chiropractic) as the only safe and effective, drugless form of initial professional treatment for acute low back problems in adults.”
U.S. Department of Health and Human Services, December 1994

Chiropractic outperforms drugs (NSAIDs) and Acupuncture.

A pilot study involving 77 patient with chronic spinal pain received either nonsteroidal anti-inflammatory drugs (NSAIDs), acupuncture, or spinal manipulation. After 30 days, spinal manipulation was the only intervention that achieved statistically significant improvements according to outcome assessments.
Journal of Manipulative Physiologic Therapeutics, July 1999

Chiropractic for Sacroiliac Joint Pain.

Located in the pelvis, the sacroiliac joint (SI joint) can be the cause of sciatica, resulting in back pain that radiates down the leg. A recent study compared physical therapy, chiropractic manual therapy, and joint injections of corticosteroids. The study found that manual therapy was the best choice for sacroiliac joint dysfunction. The success rate for chiropractic manual therapy was 72%, 50% for corticosteroid injections, and 20% for physiotherapy. Researchers found manual therapy resulted in significant improvement in pain severity, while neither physical therapy nor injections resulted in significant pain relief. In our experience, adding Active Release Techniques treatment makes the chiropractic work even more effective for treating SI joint pain.
European Spine Journal, August 2013

Carpal Tunnel Syndrome – Are There Other Tunnels?, by the Active Release certified doctors at Denver Chiropractic Center

Carpal Tunnel Syndrome – Are There Other Tunnels?

Carpal Tunnel Syndrome (CTS) refers to the median nerve being pinched in a tunnel at the wrist. As the name implies, “carpal” refers to the 8 small bones in the wrist that make up the “U” shaped part of the tunnel and “syndrome” means symptoms that are specific and unique to this condition. As we learned last month, CTS can be affected by nerve pinches more proximal to the wrist, such as at the forearm, elbow, mid-upper arm, shoulder or neck.

To make matters more complex, there are two other nerves in the arm that can also be pinched in different tunnels, and the symptoms of numbing and tingling in the arm and hand occur with those conditions as well. This is why a careful clinical history, examination, and sometimes special tests like an EMG/NCV (electromyogram/nerve conduction velocity) offer the information that allows for an accurate diagnosis of one or more of these “tunnel syndromes” in the “CTS” patient. Let’s look at these different tunnels and their associated symptoms, as this will help you understand the ways we can differentiate between these various syndromes or conditions.

Let’s start at the neck. There are seven cervical vertebrae and eight cervical spinal nerves that exit the spine through a small hole called the IVF (intervertebral foramen). Each nerve, like a wire to a light, goes specifically to a known location which includes: the head (nerves C1, 2, 3), the neck and shoulders (C4, 5), the thumb side of the arm (C6), the middle hand and finger (C7) and the pinky side of the lower arm and hand (C8). If a nerve gets pinched at the spinal level (such as a herniated disk in the neck), usually there is numbness, tingling, and/or pain and sometimes, usually a little later, weakness in the affected part/s of the arm and hand (or numbness in the scalp if it’s a C1-3 nerve pinch).

So, we can test the patient’s sensation using light touch, pin prick, vibration, and/or 2-points brought progressively closer together until 1-point is perceived and then comparing it to the other arm/hand. Reflexes and muscle strength are also tested to see if the motor part of the nerve is involved in the pinch. The exam includes compression tests of the neck to see if the arm “lights up” with symptoms during the test.

Next is the shoulder. Here, the nerves and blood vessels travel through an opening between the collar bone, 1st rib and the chest muscles (Pectorals). As you might think, the nerves and blood vessels can be stretched and pinched as they travel through this opening and can cause “thoracic outlet syndrome.” Symptoms occur when we raise the arm overhead.

Hence, our tests include checking the pulse at the wrist to see if it reduces or lessens in intensity as we raise the arm over the head. At the shoulder, the ulnar nerve is the most commonly pinched nerve, which will make the pinky side of the arm and hand numb, tingly, and/or painful. A less common place to pinch the nerves is along humerus bone (upper arm) by a bony process and ligament that is usually not there or resulting from a fracture. Here, an x-ray will show the problem.

The elbow is the MOST common place to trap the ulnar nerve in the “cubital tunnel” located at the inner elbow near the “funny bone” which we have all bumped more than once. Cubital tunnel syndrome affects the pinky side of the hand from the elbow down. The median/carpal tunnel nerve can get trapped here by the pronator teres muscle, thus “pronator tunnel syndrome.” This COMMONLY accompanies CTS and MUST be treated to obtain good results with CTS patients. The radial nerve can be trapped at the radial tunnel located on the outside of the elbow and creates thumb side and back of the hand numbness/tingling.

Any or all of these nerve can get “trapped” by the muscles that run near them. This is where Active Release Techniques (ART) treatment separates itself for other modalities. ART is the only system that trains providers how to check these entrapment spots muscle by muscle. Once identified, the trained and certified ART provider knows how to release the muscles and remove the pressure. This goes way beyond standard chiropractic treatment or basic physical therapy.

So now you see the importance of evaluating and treating ALL the tunnels when CTS is present so a thorough job is done (which is what we do at Denver Chiropractic Center). Try the LEAST invasive approach first – non-surgical treatment – as it’s usually all that is needed!

Do the Chiropractors at Denver Chiropractic Center Help Patients With Headaches?

This seems like an easy question to answer, doesn’t it? The answer of course being, YES!!! However, there are many people who suffer with headaches who have never been to a chiropractor or have not even ever considered it as a “good option.”

So, rather than having me “reassure you” that chiropractic works GREAT for headache management, let’s look at the scientific literature to see if “they” (the scientific community) agree or not.

In a 2011 meta-analysis, researchers reviewed journals published through 2009 and found 21 articles that met their inclusion criteria and used the results to develop treatment recommendations. Researchers discovered there is literature support utilizing Chiropractic care for the treatment of migraine headaches of either episodic or chronic migraine. Similarly, support for the Chiropractic treatment of cervicogenic headaches, or headaches arising from the neck region (see last month’s Health Update), was reported

In addition, joint mobilization (the “non-cracking” type of neck treatment such as figure 8 stretching and manual traction) or strengthening of the deep neck flexor muscles may improve symptoms in those suffering from cervicogenic headaches as well. The literature review also found low load craniocervical mobilization may be helpful for longer term management of patients with episodic or chronic tension-type headaches where manipulation was found to be less effective.

We add Active Release Techniques to this treatment arsenal to release tension in the muscles in the neck and at the base of the skull. These tight muscles are often the overlooked culprit in people with headaches,

Okay, we realize this is all fairly technical, so sorry about that. But, it is important to “hear” this so when people ask you why are going to a chiropractor for your headaches, you can say that not only that it helps a lot, but there are a lot of scientific studies that support it too!

Bottom line is that it DOES REALLY HELP and maybe, most importantly, it helps WITHOUT drugs and their related side effects. Just ask someone who has taken some of the headache medications what their side-effects were and you’ll soon realize a non-drug approach should at least be tried first since it carries few to no side effects.

We realize that you have a choice in where you choose your healthcare services.  If you, a friend or family member requires care for headaches, 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. Jeff Stripling from Denver Chiropractic Center demonstrates a hip flexor stretch for Office workers, crossfitters, and everyone in between

What happened in Vegas, Dr. Stripling’s Self-Help video for Neck Pain, and this week’s 1-Page Health News, from Denver Chiropractic Center

This weekend Meredith and I (Glenn) jetted off to Las Vegas so I could teach at the Active Release Techniques seminar there, and so we could hang out at night. Meredith saw (or almost saw, I never did get the story straight) the Victoria Secret models and Magic Johnson (not together). I did not. Anyway, as always Vegas was fun for a couple of days and then got really old really quickly.

Dr. Stripling and Keri held down the fort here at the office, and shot a video on a great neck stretch for those of you who work at a desk all day. The link is below.

Next week is the last week of the year for us, and we’ll be closed from December 22 through January 1, opening back up on January 2. Dr. Hyman will be on call in case of emergency. His cell phone # will be on our voicemail.

Mental Attitude: Reaction To Stress. How people react to stress determines how that stress will affect their health. Study volunteers were separated in two groups: 1) those who let their troubles affect their emotional state and 2) those who didn’t let stress bother them at all. At a 10-year follow up, those who let stress affect them (group 1) were more likely to suffer from chronic health problems. Penn State, November 2012

Health Alert: Hip Replacement and Stroke Risk. Hemorrhagic stroke and ischemic stroke risk is ~4% higher within 2 weeks of total hip replacement surgery. A hemorrhagic stroke is brought on by bleeding in the brain, while an ischemic stroke is brought on by arterial blockage. Total hip replacement is extremely common in the United States. Around 1 million hip replacement surgeries are done around the world every year, 300,000 in the United States alone. Stroke, November 2012

Diet: Vitamin D Levels Decreasing? Women with health issues such as arthritis, hypothyroidism, cancer, high blood pressure, and osteoporosis are much more likely to have inadequate levels of vitamin D during seasons with decreased daylight. 28% of women had deficient levels and 33% had insufficient levels of vitamin D. Women taking supplements were able to significantly elevate their vitamin D levels.
American Society for Clinical Pathology, November 2012

Exercise: Exercise When You’re Sick? The choice to exercise or not sometimes depends on the sickness or disease. Our bodies work harder and use more energy when we are fighting an illness. If symptoms are above the neck (sore throat, runny nose), it is probably okay to exercise. If you’re sick but still want to exercise, simply reduce your intensity and duration. You should not exercise if you have body aches, fever, diarrhea or vomiting, shortness of breath or chest congestion, dizziness or light-headedness. When resuming your regular exercise routine, try starting with 50% effort and 50% duration. Loyola University Health System, November 2012

Active Release Techniques: Sliding Nerves? Nerves need to slide past muscles and other structures in your body. As tight muscles put pressure or pinch nerves, they interrupt the blood’s circulation to the nerve. This can cause symptoms like carpal tunnel in the wrist sciatica in the hip and thigh, and many more problems. Active Release Techniques is the only system that specifically includes treatment protocols for releasing nerve entrapments. Note: Dr. Glenn Hyman is still the only Active Release Techniques instructor practicing in Denver.

Wellness/Prevention: Staying Healthy! “Check out Dr. Stripling’s Self-Help video for Neck Pain:
http://www.denverback.com/?p=966

Quote: “So many people spend their health gaining wealth, and then have to spend their wealth to regain their