Auto Accidents

I WAS IN A CAR ACCIDENT, SHOULD I SEE A CHIROPRACTOR?

Yes! Whatever impact your car takes, your spinal frame takes too. No blood does not mean no injury. If your car is "totaled", how can you be okay? If metal bends, then that is a considerable impact. If you try to drive your car away, after reporting the accident of course, the car will pull or brake improperly. Over time the car will show excessive wear to the tires, brakes, etc. Your body will do the same thing if left uncorrected. Standard treatment methods cause many simple problems to become chronic. Early active mobilization and chiropractic manipulation have been shown to decrease pain and hasten a return to normal function. The spine will not move like it was designed to and may lead to early degeneration and pain.

Spinal Manipulation: Effective Treatment of Acute Sprain/Strain Injury.

Research indicates that only about half of all whiplash patients can expect to achieve full recovery.(123) Macnab(4) has conservatively estimated that 45% of those injured in a whiplash, or hyperextension/hyperflexion trauma, continue to be symptomatic 2 years after settlement of claims. Some researchers feel the number could be as high as 3-5 years after settlement. Add to this the inestimable amount of long term suffering from osteoarthritis and its symptoms, which had its beginnings with biokinetic alterations. This is secondary to acceleration/deceleration trauma resulting in soft tissue disruption or tearing and ligament instability as described by Jackson(5) , Turek(6) and Ehni.(7) As demonstrated in the research of Hohl (8) , it becomes clear that this problem is of great magnitude.

More studies are being performed in every health field on how to better provide for these people, but none have shown results like spinal manipulation. As standard treatment methods for these injuries cause a high number of mild to moderate injuries to become chronically painful, the apparent success with spinal manipulation has caused a closer assessment of this treatment. A chiropractor's systematic approach to treatment consisting of spinal manipulation and rehabilitative exercise can achieve better-than-average results for many patients.(9)

The cervical spine plays an important role in neurological, vascular, postural and reflexive functions, necessitating aggressive treatment of the area.(10) Early active mobilization(11) and chiropractic manipulation(12) have been shown to decrease pain and hasten return to function, marked by reduced disability and symptoms.(13)

Spinal manipulation is the main therapeutic tool used by chiropractors, in treating acute sprain/strain injuries such as whiplash. It involves manipulating specific joints to restore normal alignment and mobility.

Recently, immobilization was compared to manipulation in whiplash injuries by Drs. Mealy and Fenelon, both orthopaedic surgeons from Ireland.(14) One group received standard conservative care consisting of immobilization and analgesic medication, while the other group received spinal manipulation and exercises. Both concluded that standard care gives rise to prolonged symptoms whereas more rapid improvement is achieved with manipulation.

Lehto(15) also found that extended immobilization resulted in a poorly organized scar and regenerated muscle that was of inadequate tensile strength.

Immobility interferes with tissue nutrition and thus ultimately with healing, while active treatments enhance the process. This was noted by Robert B. Salter, M.D. as he documented continuous passive motion to injured joint soft tissues speeds up and increases healing significantly.(16) Manipulation of the spine has been advocated by many researchers for their findings of less pain and more complete healing when compared to standard treatment of soft cervical collar, rest and oral analgesics.(17)

Chiropractors treat primarily soft tissue injuries and thus use methods that both a long history of empirical findings and current research are proving to be the treatment of choice in soft tissue sprain/strain injuries. They are evolving into the most popular and adept practitioners to treat spinal strain/sprain injuries.

The future will find treatment for these injuries will emphasize early mobilization and spinal manipulation.

References:

Beutler C, England D, Masse J: Basic Examination and Documentation for Whiplash Injury. Today's Chiropractic 1992;21(6)50-52.

Lewkovich GN, Wallenius R; Legal Duty of Doctors Treating Whiplash Trauma. Digest of Chiro Econ 1990;33(1)20-22.

Croft AC: Treatment Paradigm for Cervical Acceleration/Deceleration Injuries(Whiplash). ACA J of Chiro 1993;30:41-45.

Macnab I: Acceleration extension injuries of the cervical spine. In Rothman RH, Simeone FA (eds): The Spine, ed 2. Philadelphia, WB Saunders, 1982, vol 2, p 653.

Jackson R: Etiology. In Jackson R (ed): The Cervical Syndrome, ed 4. Springfield, IL, Charles C Thomas, 1977, p 121.

Turek SL: The cervical spine. In Orthopaedics: Principles and Their Application, ed 3. Philadelphia, JB Lippincott, 1977, p 742.

Ehni G: Degenerative motion segment encroachments. In: Cervical Arthrosis: Diseases of the Cervical Motion Segments. Chicago, Year Book, 1984, p 54.

Hohl M: Soft tissue injuries of the neck. Clin Orthop Rel Res 109:42-49, 1975.

Cassidy JD, Lopes AA, Yong-Hing K: Immediate Effect of Manipulation versus Mobilization on Pain and Range of Motion in the Cervical Spine: A Randomized Controlled Trial. J Manip Physiol Ther 1992;15(9) 570-575.

Fitz-Ritson D: Chiropractic Management and Rehabilitation of Cervical Trauma. J Manip Physiol Ther 1990;13:17-25.

McKinney LA: Early Mobilization and Outcome in Acute Sprains of the Neck. Br Med J 1989;299:1006-1008.

Osterbauer PJ, Dickerson KL, Peles JD, et al.: Three-dimensional Head Kinematics and Clinical Outcome of Patients with Neck Injury Treated with Spinal Manipulative Therapy: A Pilot Study. J Manip Physiol Ther 1992;15(8)501-511.

Guidelines For Chiropractic Quality Assessment and Practice Parameters. Proceedings of the Mercy Center Consensus Conference. Gaithersburg: Aspen Publishers, 1993.

Mealey K, Brennan H, Fenelon GCC: Early Mobilization of Acute Whiplash Injuries. Br Med J 1986;191:656-657.

Lehto M, Jarvinen M, Nelimarkka O: Scar formation after skeletal injury. A historical and autoradiographical study in rats. Arch Orthop Trauma Surg 104(6):366-370, 1986.

Ebbs SR, Beckly DE, Hammonds JC, Teasdale C: Incidence and duration of neck pain among patients injured in car accidents. Br Med J 292:94-95, 1986.

Whiplash/Neck Sprain Injuries Are Becoming More Common.

The anatomical relation of the head and highly mobile spine are easily susceptible to any injury involving motion, like whiplash. The human head weighs around 10 pounds and is unsupported, staying at rest during impact of motor vehicles. The car's seat and the human body move forward as the head starts to hyperextend during a typical rear-end collision. When the head is maximally extended, the seat recoils and throws the individual forward causing greater acceleration of the body and arching of the neck.

A rear-end impact which causes the struck vehicle to accelerate instantaneously only 10 mph will produce a 5g force( gravity = 1g) on the vehicle and a 12g force of extension of the head and a 16g force of flexion of the head during recoil.(1) Also known as "Traumatic Cervical Syndrome"(2), the whiplash injury occurs when the body reacts to a deceleration or acceleration force by hyperflexion or hyperextension of the neck.

Most Traumatic Cervical Syndromes result from rear-end collisions, although frontal or side impacts, as well as other types of accident, may induce similar injuries.(3) It has been suggested by Olney and Marsden(4) that previous neck sprain injuries were less noted due to preoccupation of more serious injuries. As more people use seat belts they restrict their upper torso, causing greater whipping of the unrestrained neck and head.

Often, drivers and passengers have their head restraints too low, allowing increased hyperextension at impact. However, even if raised to the proper height, the head rest is usually too far behind the person's head, about 4-5 inches, to minimize the damage caused. It has been shown. If the person's head is within 1 inch or direct contact with the head rest, it can limit excessive motion.

The immediate future appears to hold an increased number of neck sprain injuries with which the medical legal communities must deal. As chiropractors evaluate and treat primarily soft tissue injuries rather than fractures, they will be in increasing demand in this area. It would be of benefit to those who handle these cases to understand the trends occurring in motor vehicle injuries and to be abreast of changing treatment patterns such as increased chiropractic utilization.

References:

Bogduk N, The Anatomy and Pathophysiology of Whipleash, Clinical Biomechanics. 1986:1:99-100.

Bland JH: Disorders of the Cervical Spine. Philadelphia, WB Saunders, 1987.

Newman PK: Whiplash Injury. Br Med J 1990;300:395-396.

Olney DS, Marsden AK. The Effect of Head Restraints and Seat Belts on the Incidence of Neck Injury in Car Accidents. Injury, 1986;17:365-367.

An Approach to Care and Symptoms.

Appropriate treatment depends upon an accurate diagnosis. The first step in evaluating a whiplash patient is a thorough history and extensive review of symptoms. A comprehensive physical examination, including orthopedic, neurologic and sensory evaluation, is also performed. Range of motion testing is mandatory and is most revealing when the examiner compares joint mobility and pain during active, passive and resisted movements.

Neck pain is the most commonly reported symptom following acceleration/deceleration trauma. It may be immediate, but is generally delayed in its onset, occurring usually within several hours. It is not uncommon for pain to appear several days and occasionally weeks after the injury.(1) Neck pain is generally followed by a myospasm of the cervical paraspinal musculature, either from reflex or from muscular rupture or tear.

The incidence of neck pain following acceleration/deceleration injury has been reported as 62%(2) and as more than 98%.(3) One study found women have a higher incidence of neck injury than men.(4) A possible explanation may be men have stronger musculature in the neck and back.

Soft tissue injuries have to be treated, but so do the neck or cervical bones attached to the muscles that contract violently, as they too can lose their normal biomechanical relationships. If unattended, as with standard treatment and therapy, this can lead to increased joint stress, decreased motion, future disc problems and osteoarthritis.(567)

Headache is the second most frequently reported symptom in the whiplash injury. Norris and Watt(8) noted headache complaints in virtually all of the patients in their study. In the '92 Journal of Manip Physiol Therapy; Cassidy, Vernon and Bogduk found most headaches like migraine, tension and whiplash have a bone out of place or subluxated. Although it may not be the only contributing factor, it makes sense that if you remove the subluxation and muscular involvement, it would help the pain and prevent further problems. Studies agree.

Other symptoms from a car accident may include radiating pain into the shoulder, elbow, wrist or hand. This pain can arise from subluxated vertebrae, nerve root pressure, disc problems and referred pain from damaged tissues.(9)

Low back pain is a very common complaint following acceleration/deceleration trauma. Croft and Foreman(10) have described low back pain occurring in 57% of cases involving moderate to severe injury from rear-end collisions and 71% resulting from side to side impact.

Furthermore, many individuals involved in car accidents who suffer neck or whiplash injuries also often sustain damage to the Temporal Mandibular Joint (TMJ), of the mouth. This type of injury can cause long-term discomfort as well as headaches, ear, neck or shoulder pain.

Doctors of Chiropractic are well-trained in detecting muscular problems as well as areas of joint dysfunction. It has also been shown that chiropractic treatment methods are preferred over the standard, conservative approach. It is owed to all those involved in acceleration/deceleration injuries that they be allowed to get the best, most up to date care possible to ensure a quick recovery of their health.

References:

Bocchi L, Orso CA: Whiplash injuries of the cervical spine. South Ital J Orthop Traumatol Suppl 171-181, November 9, 1983.