Archive for whiplash
Melatonin for Chronic Whiplash Syndrome
I must admit that this seems like quite a novel approach, even coming for a nutrition-oriented physician that treats whiplash patients frequently. A certain percentage of whiplash patients will experience a syndrome, sometimes referred to as post-concussive syndrome; a constellation of symptoms including fuzzy thinking, diffuse headache and poor sleep. I do know that sleep is an essential part of the healing process, and that patients in severe pain to not usually sleep well. This approach may end up being another tool in the toolbox of effectively treating patients after trauma.
As a chiropractor, I have an opinion on this one. Whiplash injuries are common & so is the patient whose chronic neck pain has been present “since that accident.”
Whiplash occurs when the head gets thrown back and forth as a result of a sudden change in momentum of the head relative to the neck, resulting in strains affecting the bones, discs, muscles, nerves, or tendons of the neck.
We used to call them hyperflexion / hyperextension injuries, but more careful evaluation showed that the neck does not always go beyond it’s normal range of motion. Rather, small regions of the cervical spine undergo too much flexion and too much extension. Consider an “S” shaped spring getting crunched down from the top–there will be areas of the spring that get scrunched and areas that get stretched. This is closer to what we understand happens during a whiplash type of injury.
Because of this type of injury, studies have identified multiple problems with patients who suffer this type of injury. Fat deposits in the muscles. Change in the muscular coordination of the neck. Jaw pain. Chronic pain. All are potential outcomes following a whiplash type injury.
This particular study continues to paint a depressing picture for those who have had this type of injury. Researchers found changes in those who are suffering from chronic whiplash pain during exercise.
Normally, exercise stimulates the release of built in pain relievers (endogenous). Everyone’s heard of the experience known as “runner’s high” when these opioid-like compounds are released by the body. However, in the chronic whiplash patients, they did not experience the pain reduction associated with exercise like the normal patients did. They were more likely to have an increase in pain after they exercise rather than improvement.
So what is the solution? I’ve already mentioned my bias. I can tell you, from personal experience over 15 years of practice, that when patients get in to our office for treatment within hours of an accident, they never seem to get to the severe levels of pain that we see when compared to patients who come in days or weeks after the injury.
Regardless of where you go for treatment, make sure that all of the potentially injured tissues (ligaments, tendons, fascia, joints, etc..) are treated. Just exercising or just adjusting or just medications will likely not fully address the nature of the tissue damage that occurs in a whiplash type of injury. Only treatments that encompass both the joints (adjusting) and the soft tissues that are injured is likely to be successful at preventing your injury from becoming chronic.
If you have had a whiplash injury in the past, what did you do to fully recover? Or do you still deal with chronic pain?
Fatty Infiltration in the Cervical Extensor Muscles in Persistent Whiplash-Associated Disorders: A Magnetic Resonance Imaging Analysis
As a chiropractor, I’ve obviously got some unique perspectives on this issue. It is well documented that a large percentage of patients who experience whiplash type injuries have significant pain 10 yrs later. I firmly believe this is the result of imcomplete treatment following the injury. Strengthening and stretching as done by standard physical therapy procedures will NOT address pathology within the muscles, and adjusting alone will also not impact the muscles either. Full recovery requires a strong approach to both the joints and the muscles.
This article probably won’t show up on the desks of insurance adjusters; many would have their injured patients believe they should be all healed up in a few visits.
Comparison of Sensorimotor Disturbance Between Subjects With Persistent Whiplash-Associated Disorder and Subjects With Vestibular Pathology Associated With Acoustic Neuroma
As a chiropractor, I find it unfathomable that a patient involved in a motor vehicle accident would not seek chiropractic care. The known involvement of the facet joints coupled with altered signals being sent up to the brain from the receptors around the joints produces a condition that ONLY manipulation will impact. Rehab exercises, medications, interferential, ultrasound, massage–these will not affect the proprioceptive input to the brain like an adjustment.
This article further supports the idea that dysfunction of the facet joints following whiplash-type injuries are real, and need to be addressed to prevent long term dysfunction.
A distinct pattern of myofascial findings in patients after whiplash injury
As a chiropractor that specializes in soft tissue treatment, studies like this confirm my decision to practice in this manner. Too often following whiplash type injuries patients will seek the care of a PT, their PCP or a DC. The statistics linking long term problems from whiplash injuries is frighteningly high, but I believe this is because few approaches attack the comprehensive nature of these injuries. The joints, soft tissues and the psychological impacts of the injury all need to be addressed. Without this comprehensive approach, it is likely that patients will fall into that category of long term neck pain.
As a chiropractor, I obviously have seen many whiplash patients. And sooner is always better. I’ve found that the sooner I see a patient after the trauma (even the same day of the accident) that better the outcome. But not everyone seeks care after an accident.
There are multiple reasons why not seeing a chiropractor after trauma is a bad idea. The obviously one is that the damage from the trauma needs to be controlled and then the healing process needs to be guided. There are clearly long term problems that occur following improperly treated whiplash injuries. These include:
- Trigger points in the muscles of the neck
- Fatty deposits in the muscles of the neck
- Chronic neck pain that can last for years
Even if you do not have more than some minor stiffness after the accident, it is still wise to get an evaluation. This does not mean that you need extensive care, but a few visits can go a long way towards fixing any imbalance that occurred as a result of the trauma.
If someone does not seek an evaluation after trauma, it is possible that problems will creep up months later, again because of an imbalance created. This particular study lends support to this idea.
The jaw (temporomandibular joint, or TMJ) generally does not get directly injured in a car accident. However, it is very susceptible to imbalance between the muscles in the back of the neck (injured during whiplash) and the muscles that open the jaw.
24% of the patients in this small study developed jaw pain some time after the accident. Even more interesting, those who experienced low-speed accidents were more likely to suffer jaw pain. Is this because they chose NOT to get care immediately after the trauma??
Effects of Intensive Glucose Lowering in Type 2 Diabetes.
This study demonstrates what is likely the most profound mistake in research that occurs. There is a concept called “surrogate end markers.” The idea is that, for Disease X, patients with lower values of Blood marker B live longer or are less likely to get the disease. So, we create a drug that lowers Blood marker B synthetically, thinking that we will have an impact on Disease X. We don’t measure Disease X directly, because that would take too long. The mistake here is that, what if Blood marker B being low and leading to lowered rates of Disease X is a reflection of the health of the patient, and NOT because Blood marker B itself is low? Time and time again we see that the use of surrogate end markers in research leads to WORSE outcomes when we artificial lower Blood marker B. The ACCORD trial here is no different. Basically, in diabetics, we want HbA1C levels to be between 7 and 7.9%. In this large trial, the patients used aggressive insulin therapy to artificially drive that number down to below 6%. Sounds like a good thing, right? The trial was halted because there was a 22% increased risk of death in the intervention group. Now, we can bet that, with lifestyle changes lowering A1C levels to 6% that there would’ve been nothing but reduced death. Welcome to medical research. Read More.
Increased Colorectal Epithelial Cell Proliferation and Crypt Fission Associated with Obesity and Roux-en-Y Gastric Bypass.
The concept of bariatric surgery has become so accepted that many now view this as a procedure with only positive outcomes. However, messing with the way our bodies digest and assimilate food is never a good thing, and the long term safety of these procedures have never been demonstrated. We have, however, seen a variety of research studies finding adverse outcomes following bariatric procedures. This study adds to the weight of this evidence, suggesting that, after this procedure, there is an increased risk of colorectal cancer. Read More.
The Relationship of Coffee Consumption with Mortality.
While the idea of a protective mechanism of coffee on chronic disease is not a big surprise given the low calorie and high polyphenol content, the risk reductions for all cause mortality were a little higher than I would have expected and demonstrated somewhat of a parabolic curve, with higher intakes have less protection. In men, greater than 6 cups / day led to a large 20% reduction in death. In women, 4-5 cups / day led to an 26% reduction, while greater than 6 cups / day led to a reduced (but still great) 17% reduction. These are pretty large numbers for something that had been viewed as detrimental for many years. So much for dogma. Read More.
Effect of Soy Nuts on Adhesion Molecules and Markers of Inflammation in Hypertensive and Normotensive Postmenopausal Women.
Here’s another one of those article talking about how dangerous that deadly soy is. Seriously though, I remain confused as to how many websites talk about how dangerous soy is for our health, and yet, from a research standpoint, the outcomes are overwhelmingly positive. This particular study adds further weight to the positive evidence, finding that the addition of soy nuts resulted in improvement in markers of the health of our blood vessels. Keep in mind that, when we talk about soy we are NOT talking about veggie burgers and tofu hot dogs and tofu turkey, but rather less processed forms of soy like soy nuts, soy milk and tofu. Read More.
A distinct pattern of myofascial findings in patients after whiplash injury.
As a chiropractor that specializes in soft tissue treatment, studies like this confirm my decision to practice in this manner. Too often following whiplash type injuries patients will seek the care of a PT, their PCP or a DC. The statistics linking long term problems from whiplash injuries is frighteningly high, but I believe this is because few approaches attack the comprehensive nature of these injuries. The joints, soft tissues and the psychological impacts of the injury all need to be addressed. Without this comprehensive approach, it is likely that patients will fall into that category of long term neck pain. Read More.
Effect of Long-term Corticosteroid Use on Bone Mineral Density in Children.
This study look at the use of chronic and short burst use of inhaled steroids in children w/ mild to moderate asthma. Frighteningly, this pattern of use was associated with reduction in bone mineral accrual at a very important time of there bone forming years. I guess the frustrating aspects of this study is that asthma treatment in children rarely takes a comprehensive course. You can bet that, in many of these children, both food allergies and poor gut health are contributing if not causative factors. Prolonged courses of antibiotics without any thought of the importance of normal, healthy flora, will lead to imbalances of immune function and Th2 dominance of cytokine expression (consistent w/ asthma and allergies). Add into this nasty mix the new research that gut inflammation negatively impacts bone health and you’ve got a recipe for diminished bone health. Read More.
Fish oil intake compared with olive oil intake in late pregnancy and asthma in the offspring.
Wow. At some point we will really, really stand up and start to realize the critical importance of the in utero environment on the short and long term health of that developing infant. Some effects won’t be realized for decades after birth; some noted within a few years. This particular study, while small, showed a massive 63% reduction in asthma and an 87% reduction in allergic asthma in pregnant women given 2.3 g of omega 3 fatty acids during pregnancy. These number may be even lower because they were compared to an olive oil group, and olive oil might be expected to have a positive impact on asthma development as well. Talk about a simple, safe intervention that could have a massive impact on healthcare utilization. Too bad the mass healthcare media isn’t interested in prevention. Read More.
Short- and Long-Term Safety of Weekly High-Dose Vitamin D3 Supplementation in School Children.
It is funny to be in the middle of the research on just how much vitamin D we really need for optimal health. The research is incredibly supportive on the safety and efficacy of dosages in the 1,000-4,000 IU / day range, and yet the RDA sits solidly at 400 IU. I wonder just how long it will take before those numbers start to budge. 1 year? 10? 20? This will be a great indicator of just how delayed implementation of the research is at the public health level. Read More.
Low Serum 25-Hydroxyvitamin D Levels Associated With Falls Among Japanese Community-Dwelling Elderly.
This is another of those no-brainers. Vit D has been shown to help with bone mass as well as preventing falls. And yet this hormone is still kept at the above mentioned 400 IU dosage recommendations despite volumes of research on efficacy and safety. In addition, the costs of the liquid forms of Vit D are incredibly inexpensive, usually on the range of only a few dollars per month, if that. What I have not seen, however, is the mechanism by which Vit D contributes to increase musculoskeletal performance and reduce falls. Read More.
Differential effect of sulfonylureas on production of reactive oxygen species and apoptosis in cultured pancreatic ß-cell line, MIN6.
This is not the first study to find damaging effects of the class sulfonylureas on the beta cells of the pancreas. The information has probably been known for at least 5 years now, and yet this class of drugs for diabetes is widely used. How many diabetics were informed that the drug their doctor gave them will ultimately increase the risk for them to be on insulin? I can’t say I’ve ever come across one in my office or in the community. All of this points to the overwhelming conclusion that lifestyle changes are the ONLY answer to managing this deadly condition. Every pharmaceutical approach has risks that can outweigh the benefits. This is NOT the case with lifestyle changes. Read More.
The statistics on the persistance of neck pain following a whiplash-type injury are pretty disheartening. Depending on the study you read, up to 90% of patients may experience some type of symptoms 10 years later. This leads to a few comments from me.
First, I think this stresses just how important it is to address both the soft tissue AND the articular components of any type of injury. Physical therapists stress exercises to strengthen the muscles injured. Chiropractors generally address the movement of the joints in the neck following the injury. Quite frankly, as someone who addresses the fascial, muscular and tendonous as well as the joint problems that occur after an injury, I feel that almost all cases are not treated with a comprehensive approach that addresses all aspects. If all a chiropractor does is adjust, you miss the soft tissue component. If all that is done is strengthening, you miss the articular component as well as the soft tissue pathology that occurs!! (strengthening does NOT address the problems that develop in the fascia as a result of the injury).
The other aspect of this is that you should never, ever wait to get treatment after an injury. The longer you wait, the more difficult that problem is going to be to fix.
This particular study confirms what anyone that deals with residual problems from a car accident. If you do the right tests, you do indeed find problems. Researchers found increased activity in the area of the 2nd cervical vertebrae that indicated inflammation was present. This was years after the injury.
If you’ve had an injury recently, or have been dealing with a problem that started years ago, find a chiropractor that has a strong