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Many question the reality of whiplash injury, however to those of us who have had the misfortune to experience them, whiplash injuries are all too real. The neck is particularly vulnerable in auto accidents because of the weight of the head and the relative instability of the neck, sacrificed for the sake of mobility. Particularly important is the fact that the neck houses many critical structures in a relatively small and vulnerable region.
How injury occurs:
In the common rear-impact collision whiplash injury, the occupant's vehicle is rapidly pushed forward by the impact. This results in the seatback pushing the occupant's body forward at the same speed. However because the head is not supported like the rest of the body, it stays relatively in place as the body is accelerated forward. This results in the spine being subjected to a number of forces. Initially the mid and upper back is flattened as it is pushed against the seatback. This results in lengthening of the spine as the occupant's body is pushed up by the sloped seatback. This "ramping up" pushes up into the neck, compressing the neck against the weight of the head. When combined with the forward forces, this results in very rapid forward bending (flexion) of upper neck and backward bending (extension) of the lower neck, both beyond it's physiologic limits, creating an S-shaped configuration of the neck and severely compressing the cervical spine. The compressive forces are quickly reversed resulting in severe tension or stretching to the neck. These forces can and do result in significant injury to the muscles, ligaments and joint capsules that support the spine. They often cause significant disk injury with resultant nerve compression, commonly cause concussions and occasionally spinal cord injury. For more detail about the mechanics of whiplash injuries and much more information please visit Dr. Arthur Croft's website "Spine Research Institute of San Diego" at http://srisd.com/consumer_site/
Soft tissue injuries are very real and very significant: The auto insurance industry often attempts to minimize the significance of whiplash injuries as being "only soft tissue" injuries. What does that mean? Soft tissue includes muscles and tendons (muscle strains), ligaments (joint sprains) and other connective tissue including the intervertebral disks between your vertebrae. Injuries that are not soft tissue injuries would be fractures or broken bones. Moderate or severe injury to sprain and strain injuries results in some vascular damage with resultant bleeding into the tissues and often results in some injury to nerves.
So which is worse, a broken bone or a severe sprain. That depends a lot on what bone is broken. A broken skull or broken vertebra is obviously very serious because of the potential damage to the central nervous system. However unless a bone is severely shattered, it will typically heal at least as strong, if not stronger than it was before with little or no residual problems. Torn ligaments in a moderately or severely sprained joint rarely if ever regain full strength, even with ideal treatment. The joints are never quite the same and sometimes not even close. Moderately or severely sprained joints are prone to premature development of arthritis, which in the spine may result in neurologic disorders years later. How about tearing of the ligaments that stabilize your spine or the disk itself, insignificant? Hardly. These injuries are common with whiplash. The attempt to minimize their significance is part of the strategy by the auto insurance industry to ensure that potential jurors are suspicious and unsympathetic toward victims of whiplash injuries, the result, lower settlements.
The first requirement is to evaluate the severity of the injury and ensure that there are life threatening conditions. For many this is initially done at an emergency room. Even if this has been done, it is essential for the treating doctor, including chiropractors to take a very detailed history including the mechanism of injury, whether there was any loss of consciousness or amnesia, initial symptoms, subsequent change in symptoms and pre-existing conditions that may complicate the patient's condition. A thorough examination is then performed including neurologic assessment to rule out nerve damage, orthopedic testing, functional assessment and chiropractic assessment.
Sports Injury Model: It is important that the patient be reassured that despite the reality and significance of their injuries, the likelihood of a good outcome is favorable. The most effective format for injury treatment follows a sports injury model, recognizing that the treatment methods need to change quickly as the stage of healing changes. Appropriate initial Acute Care during the 1st two to three days includes relative rest, application of ice and avoidance of activities that aggravate the pain. Pain medication may be used if necessary with appropriate warnings that pain is a warning to prevent us from doing things that in the acute stage may increase damage.
As important as pain avoidance is in the acute stage (the 1st 48 to 72 hours), it quickly becomes counter- productive and if unchecked is the number one cause of permanent impairment following injury. Beyond this stage, care needs to be focused on recovery of function for optimal results. This includes the hands on treatment rendered by the chiropractor and massage therapist directed at restoring function of injured joints, muscles and other soft tissues. Very importantly, it includes the advice given to the patient regarding a graded return to normal activities and instruction in a progressive program of exercises designed to speed and maximize the functional recovery of the injured structures.
As the patient's condition improves the emphasis of appropriate care progressive shifts from Passive Care (applied by the health care provider) to Active Care (exercise and other forms of self-care) in order to foster patient independence and self-reliance. The patient is continually assessed for signs that they would benefit from concurrent medical care or care by a specialist and is referred to the finest specialist in the region when indicated.
Our goal at Thompson Chiropractic is our patient's speedy and complete recovery.
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