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Welcome to our website where we are 100% dedicated to relieving those suffering in pain! Whether you’ve recently had a collision and don’t know where to start or if you have a history of an accident in the past and are experiencing exercises, Acupuncture, Nutritional Supplementation and Diet modification.
Whiplash and the Myths chronic pain, we can help you.
If you are a professional such as an insurance agent or adjuster, attorney or doctor and you are looking for information pertaining to your profession, feel free to browse the professional’s portion of our site.
At Holistic Health & Chiropractic of Frankfort, Dr. Heyer believes in using a whole person, multi method approach. This includes advanced and effective Chiropractic treatments, Active rehabilitative
Delayed onset of symptoms means no injury.
Lack of objective findings means no injury.
Some professionals dismiss injuries as minor.
"No crush, no cash"
There is a myth that one can gauge the potential for injury based on the amount of vehicle property damage. This implies that if there is no visible damage to the vehicle it isn’t possible for the occupant to be hurt. This is incorrect.
In fact, due to bumper dampeners and bumper materials, there could be a good amount of force transferred from one vehicle to another and to the occupant inside with out visible damage showing.
"Delayed onset of symptoms means no real injury"
There is a notion that a delay in onset of symptoms signifies either a minor type of injury or suggests malingering. Again, not true. It took over an hour for both of the World Trade Center buildings to weaken to the point of collapse and fall down AFTER the two airplanes flew into them. An individual may incur a trauma at one moment but deterioration may take days, weeks, or months for symptoms to be felt.
"Lack of objective findings means no injury"
There is a myth that a lack of objective findings exempts the patient from serious injury. Similar to a delay in the onset of symptoms, visible findings may not be noticeable right away on x-rays, MRI or CT films. But with time and deterioration, these weaknesses may develop in to pain with or with out tangible findings.
"Accident reconstructionists ‘prove’ whiplash is trivial"
There is a notion that AR’s supposedly can "prove" that a given accident could not have resulted in injury by incorrectly manipulating mathematical numbers to compare a car crash to the acceleration forces a child experiences in jumping rope or "plopping" down in a chair.
This is faulty thinking for several reasons. One, it is obvious that seat plopping and jump roping soft tissue injuries are uncommon, however the literature is full of evidence of the serious public health problem of whiplash.
Two, the acceleration spikes measured during child’s play have durations of tens of milliseconds or less and can’ and shouldn’t be compared to those measured in crash testing experiments.
Third, no significant change in velocity takes place in these seat plopping types of experiments.
And lastly, research indicates that a change in velocity of just 5 mph has been shown to be enough force to cause trauma.
"Expert doctors dismiss injuries as minor; misquote literature and guidelines"
Frequently doctors who advertise themselves as "experts" will misquote or selectively quote literature on whiplash and treatment guidelines in efforts to discredit or discount a doctor’s necessary care and treatment.
What is Whiplash?
What is whiplash?
Whiplash is a relatively common injury that occurs to a person's neck following a sudden acceleration-deceleration force, most commonly from motor vehicle accidents. The term "whiplash" was first used in 1928. The term "railway spine" was used to describe a similar condition that was common in persons involved in train accidents prior to 1928. The term "whiplash injury" describes damage to both the bone structures and soft tissues, while "whiplash associated disorders" describes a more severe and chronic condition.
Fortunately, whiplash is typically not a life threatening injury, but it can lead to a prolonged period of partial disability. There are significant economic expenses related to whiplash that can reach 30 billion dollars a year in the United States, including: medical care, disability, sick leave, lost productivity, and litigation.
While most people involved in minor motor vehicle accidents recover quickly without any chronic symptoms, some continue to experience symptoms for years after the injury. This wide variation in symptoms after relatively minor injuries has led some to suggest that, in many cases, whiplash is not so much a real physiologic injury, but that symptoms are more created as a result of potential economic gain. Many clinical studies have investigated this issue. Unfortunately, while there will always be people willing to attempt to mislead the system for personal gain, nevertheless, whiplash is a real condition with real symptoms.
How often does this happen?
To explain how often something happens, we use the term incidence. This is usually reported as the number of cases occurring each year per 100,000 persons in the population. Although the incidence of 1 million whiplash injuries per year is often quoted, this originated with an outdated and incomplete 1971 dataset. More recently, it has been estimated by Croft that as many as 3 million such injuries occur in the U.S. each year. This figure is expected to be the best currently available because it is based on several government databases and accounts for the expected degree of underreporting reported by NHTSA.
How many people suffer from whiplash?
How prevalent is this problem, or in other words, how many people suffer from this condition at any given time? Self-limiting diseases can have high incidences and low prevalence's. Chronic (incurable) diseases will always have higher prevalence than incidence. For example, during the summer months, the prevalence of the common cold may be low, even though the incidence for the year was high because many people had a cold in the early spring. But every new case of an incurable disease adds to both incidence and prevalence, although the incidence can be low in a disease with high prevalence. (Diabetes, while treatable, is an example of a disease that is incurable.)
In the case of whiplash we attempt to find out how many people who are at risk-which includes just about anyone who travels by car--has chronic neck pain due to whiplash. Research at the Spine Research Institute of San Diego indicates the number is probably as high as 10%. More interestingly, perhaps, is the finding that as much as 45% of persons with chronic neck pain attribute the pain to a past Motor Vehicle Crash (MVC) injury. It is clear that motor vehicle crashes profoundly diminish the nation's health and welfare: this is a scary fact and statistic considering that most MVC's are potentially preventable.
In discussing risk, researchers ask the question: what proportion of the population who is exposed to the putative agent of the disease-in the case of whiplash the agent would be an MVC-actually develops the disease. In very rough terms, in a LOSRIC in the range of 4-10 mph delta V, from an analysis of a fairly large international literature, the risk hovers around 33%. It is higher for rear impact collisions, lower for frontal collisions and intermediate for side impact collisions. Of course, individual risk factors and crash parameters must always be considered. Moreover, the severity of these injuries varies widely, with the more minor not always requiring formal treatment.
Who is more at risk?
Women are at nearly twice the likelihood of suffering from whiplash injury than men. Most indications point to body mass and structural density being the reason. In other words, men tend to have larger upper body and neck musculature than women. Putting women at greater risk.
Awareness: those unaware more likely to be hurt.
Gender; females almost twice as likely to be hurt.
Age: may or may not come into play.
Head rotation/body position.
Taller persons at greater risk.
Duration (how long the problem has been there).
Radicular symptoms (is there numbness, tingling in arms or legs, do they fall asleep).
DJD Degenerative Joint Disease. If there is degeneration/arthritis in the joints.
Deconditioning of the muscles and soft tissues.
What Causes Whiplash?
Whiplash is most commonly caused by a motor vehicle accident in which the car the person is riding in is not moving, and is struck from a vehicle from behind without notice. It is commonly thought the rear impact causes the head and neck to be forced into hyperextension as the seat pushes the person's torso forward - and the unrestrained head and neck fall backwards. After a short delay the head and neck then recover and are thrown into a hyperflexed position.
More recent studies investigating high-speed cameras and sophisticated crash dummies have determined that after the rear impact the lower cervical vertebrae (lower bones in the neck) are forced into a position of hyperextension while the upper cervical vertebrae (upper bones in the neck) are in a hyperflexed position. This leads to an abnormal S-shape in the cervical spine after the rear impact that is different from the normal motion. It is thought that this abnormal motion causes damage to the soft tissues that hold the cervical vertebrae together (ligaments, facet capsules, muscles).
LOSRIC - A Common Collision
LOSRIC - Low Speed Rear Impact Collisions
At crash speeds of 15-20 mph, spinal fractures and spinal cord injuries are not uncommon.
Usually occurs in shorter distances and at lower speeds, which are characteristics of heavy traffic.
Biomechanics of LOSRIC
Sequence of events in LOSRIC:
Bumper contact; seat strikes occupant
Flattening of spinal curves; axial compression and ramping
Head lag (retraction) phase; high shear, axial tension
Head/neck extension phase; hight bending moments possible
Forward (reentry) phase; head acceleration peaks, shear reverses
Forward bending moments possible.
What are the symptoms of whiplash?
The most common symptoms related to whiplash include:
Neck pain and stiffness
Shoulder pain and stiffness
Jaw pain (temporomandibular joint symptoms)
Ringing in the ears (tinnitus)
In the more severe and chronic case of "whiplash associated disorder" symptoms can include:
Post-traumatic stress syndrome
Sleep disturbance (insomnia)
Cognitive complaints (fatigue, forgetfulness, irritability, inability to concentrate)
Spinal cord injury
Herniation of cervical discs; rupture of ligaments and adjacent tissues
Tremor and movement disorders
Rim lesions (disc/bone interface)
And many others…
What Actually Causes Whiplash Symptoms?
Injuries near the spinal cord:
Internal Disc Disruption
All of these lead to a negative effect on the nerves supplying these areas, which leads to the symptoms felt.
Evaluation of Whiplash Injuries
The most important first step is to make sure there is no major injury to the neck, head or the rest of the body requiring emergency treatment by seeking care at a hospital or appropriate clinic. Once this is established, conservative care can begin.
Unfortunately, if there seems to be no emergency attention needed, many people do not seek medical attention after they experience a MVC. Whether they do this out of embarrassment or because they feel that their crash was not significant enough to cause any injury, not doing so can be a mistake.
This is important because statistics show that symptoms may not be noticed for several hours, days or even weeks after the crash.
Those that do seek attention frequently are written off as having an insignificant problem and may or may not have appropriate tests performed.
Ideally what should happen is the patient should have a full detailed history taken of the event so to better understand the mechanism of injury and how to best address it. Other tests, such as orthopedic tests, neurological, and muscle function tests should be performed and of course a comprehensive x-ray series of the neck should be performed to check for abnormal changes.
If need be an MRI (magnetic resonance imaging study) or CT (Computer Tomography) scan may be ordered so as to detect injuries to the soft tissues (muscles, ligament, tendons, discs) of the neck.
Treatment of Whiplash
Treatment of whiplash depends on the wide variety of symptoms present. Unfortunately, most treatments of whiplash have not been well tested to determine their effectiveness.
The most important issue in the management of whiplash is optimal education of the patient about their injury. This includes information on the cause, potential treatments, and likely outcomes. Patients should understand that this is a real injury, but that nearly all patients have the ability to fully recover. Patients that do not receive this information are much more likely to develop the more chronic "whiplash associated disorder."
Often the initial treatment recommended by a MD or hospital will be the use of a soft cervical collar. This can be a sign of a physician who does not fully understand the condition. The goal of the collar is to reduce the range of motion of the neck and to prevent any additional injuries. While this may be useful in some rare instances, more recent studies have shown that prolonged periods of immobilization actually slows the healing process.
It seems that excessive rest and immobilization have been shown to have greater chances of chronic symptoms. This is explained by loss of range of motion leading to increased pain and stiffness. Immobilization also causes muscle atrophy (muscle wasting) and decreased blood flow and healing of damaged muscles.
Patients who seek appropriate care early after the MVC tend to fair better than those who do not. The reasons being:
A rational therapeutic intervention, during the initial two weeks (after the injury), can greatly reduce the likelihood of long-term symptoms.
Practitioners can have the greatest impact on inflammation.
It is important to monitor the nervous system, should the patient’s condition worsen.
Practitioner must make every effort to minimize the patient's pain as quickly as possible.
Early implementation of treatment helps to speed recovery and minimize scar tissue formation.
There is much to communicate to patients (e.g., information about activities of daily living).
As we will discuss: appropriate forms of care include:
A complete and thorough examination with tests performed by a doctor well trained to understand the mechanisms of injury, the nature of the injury, and the most effective types of care for the injury.
The types of tests include; Structural analysis, postural analysis, a palpatory exam of the spine, neurological tests, orthopedic tests, kinesiological tests (muscle strength), and a series of x-rays to assess for abnormal findings. Some doctors use a painless stress test for the muscles of the spine called a surface electromyography scan, or sEMG for short. This is different from a needle EMG in as it uses little pads, not needles, to measure the tension of the muscles of the spine. Or in other words, to measure the hyperactivity of irritated or injured tissues.
Types of care include; Chiropractic, ROM exercises, Acupuncture and proper nutrition.
The focus of these types of care is to:
Restore normal joint movement
Provide appropriate nutrients for repair
And to strengthen and stabilize the spine.
If the patient begins to develop psychological symptoms including anger, anxiety or depression following an injury, prompt treatment of the emotional condition is recommended. This can help the patient better understand the good chances for successful recovery and reduce the chances of chronic symptoms.
Research shows the most effective type of care
for this problem is CHIROPRACTIC CARE!
Whiplash Chiropractic Care
Research shows the most effective type of care
for this problem is CHIROPRACTIC CARE!
Chiropractic physicians utilize spinal adjustments, physical medicine and rehabilitation approaches.
As well as traditional modalities such as ultrasound, electric muscle stimulation, laser therapy, traction, and heat and cold applications in addition to spinal adjustments.
According to a recent randomized trial:
“After 9 weeks of care, spinal manipulation had achieved asymptomatic status in 27%, compared to 9.4% for acupuncture and only 5% for medicine.”
According to another research article;
“In the study of late whiplash it was reported that chiropractic care was effective in 93% of cases.”
Late whiplash refers to chronic whiplash, not late onset of symptoms. Late whiplash is considered more difficult to treat than acute whiplash because of the scar tissue that is formed from previous injuries.
There are few studies of the efficacy of the various treatment approaches to acute whiplash, but there are two studies in which the effectiveness of chiropractic care for chronic whiplash injury has been demonstrated. In the study of late whiplash it was reported that chiropractic care was effective in 93% of cases. In a subsequent study, the authors classified the 93 late whiplash patients into three groups:
Group 1, with 50 patients, was roughly the equivalent to grade 2 CAD by definition;
Group 2, with 32 patients, was roughly equivalent to grade 3 CAD;
Group 3, described as having an unusual complex of symptoms that included blackouts, visual disturbance, nausea, vomiting, chest pain, and non-dermatomal pain distributions, did not really conform to any of the CAD grades.
Following treatment, improvement was noted in 72% of the patients in Group 1, 94% of the patients in Group 2, and 27% of Group 3, with one patient made worse. Most practitioners would concede that managing late whiplash patients is a more challenging than managing acute cases.
What is really sad is that Chiropractic treatment is the best treatment shown to be effective for whiplash, according to research, yet most MD’s, hospitals and insurance companies won’t even talk about it. You can’t even find it advised on their websites.
Chiropractors usually have a four-year undergraduate degree in addition to their four-year Doctor of Chiropractic (DC) degree. Many also go on to continue study’s in various specialties, such as whiplash and brain traumatology, Auto Crash Reconstruction, nutrition, Acupuncture and other courses.
“Our mission of holistic health care in our office is to provide sufficient care to restore
health, maintain it, and prevent the recurrence of injury or illness.”
Acupuncture Whiplash Treatment
Traditional needle acupuncture is often helpful in relieving the pain of an acute cervical spine injury such as whiplash. It has also been shown to be of benefit for chronic neck pain. Western healthcare interprets acupuncture to be able to alleviate pain by releases endorphins and enkepholons which are the body’s natural pain relieving chemicals.
Shortcomings of Traditional Medicine
Physical therapy and pain medication are the most commonly used treatments that are prescribed. Although these maybe helpful in their own way, research has shown they are not the most appropriate course of action.
I use physical therapy methods as a part of a well thought out treatment plan and I do not have any problem with stretches and exercises used in an appropriate way. The problem lay’s with the medication.
Some of the common medications used include Celebrex and Vioxx. Both of which have had controversy surrounding their use.
Ibuprofen, Advil, Children's Advil/Motrin, Medipren, Motrin, Nuprin, PediaCare Fever, etc. Acetaminophen, Tylenol and Others
Naproxen, Naprosyn, Naprelan, Anaprox, Aleve Hydrocodone/Acetaminophen, Vicodin, Vicodin ES, Anexsia, Lorcet, Lorcet Plus, Norco
In emergency rooms around the country, common advice is to go home, apply an ice pack, take anti-inflammatory medication, and to consult with the family doctor if symptoms persist beyond two weeks. Unfortunately, this advice is probably responsible for at least some of the more than 30% of whiplash victims who never fully recover or the 10% or more who become disabled. Rational therapeutic intervention during that initial two weeks can greatly reduce the likelihood of long-term symptoms.
A Recent Comparison of Medicine, Acupuncture, and Chiropractic care
Comparing, in a randomized trial, medication (Celebrex, Vioxx, or paracetamol) to acupuncture and spinal manipulation over the course of 9 weeks in persons with chronic spinal pain (neck to low back pain included), the authors demonstrated a rather profound superiority in chiropractic spinal manipulation. The exception was for neck pain in which acupuncture was found to be superior on the basis of Neck Disability Scores. The average period of chronicity was 4.5 years in the medicine group; 6.4 years in the acupuncture group; and 8.3 years in the chiropractic group. After 9 weeks of care, spinal manipulation had achieved asymptomatic status in 27%, compared to 9.4% for acupuncture and only 5% for medicine. Patients were allowed to change therapy groups if they perceived a lack of effectiveness in their current treatment group. Over the course of the 9 weeks, nine from the medical group, five from the acupuncture group, and two from the chiropractic group changed treatment types.
Self-Treatment of Whiplash
What can you do to help the healing process?
Certain activities are clearly going to be counterproductive to the healing/recovery process.
Examples of counterproductive activities:
Lifting heavy objects
Improper sleep position
Overuse of injured area
Improper lifting techniques
Sometimes just changing the way you perform one task can make a big difference in how well you feel at the end of the day
Simple modifications, such as how you sleep or sit in a chair can prevent further injury
Maintaining a neutral position, while standing, sitting, or sleeping will help keep vertebrae in alignment
A proper sleeping position is shown below
Nutritional support, stretching, and exercise are all excellent for injuries
Certain vitamins and minerals are essential for your body during an injury
General body stretches and even cervical traction (shown below) help maintain function
Exercise, of any kind, should be done under the supervision of a medical professional
What can be done to prevent whiplash?
From a Public Health point of view, it warrants we pay attention to:
Looking for ways to reduce crashes altogether.
Working to improve the crashworthiness of current vehicles--both in terms of low speed crashes and the high speed range.
And to continue to research ways to improve the efficacy of treatment for those injured in these crashes.
While it is not always possible to prevent accidents, advances in automobile safety have attempted to reduce the associated risks. Many advances in seat belts and head restraints have been able to reduce the risk of whiplash injury. The proper use of these devices is crucial to their success in preventing injury. Head restraints are designed to prevent the head from moving into hyperextension when struck from behind.
In order for this to work properly, the head restraint should be optimally positioned directly behind the head. If the head restraint is lowered below the level of the head it could actually force the head into further hyperextension after an impact. Many automobiles have additional safety equipment including air bags and air curtains to further protect drivers and passengers from injury.
Safety Systems Used To Prevent Injury
The bag deployment and inflation should be complete before the occupant makes contact with the bag.
Shoulder and lap belts reduce the risk of fatal injury by 45% and the risk of moderate to critical injury by 50%.
The Antilock Brake (ABS) was designed to allow maximal brake application under emergency conditions, and thereby preserving steering and vehicle control.
In a recent study, 95.6% of all participants had at least one error which could reduce the seat's protection of its occupant from injury in a crash.
Reduce the differential motion between the head and the torso in the event of a rear impact crash. There are correct and incorrect ways of adjusting headrests. Proper and improper positions are shown below. The first picture illustrates how an individual’s head could extend over the top of the headrest. The ideal position shows how the head would be supported if it were to extend back.
Definitions and Grading Systems
Definitions of commonly used whiplash terms
Crashworthiness- the ability of a vehicle to protect its occupants in a crash.
Head lag- the rearward motion of the head relative to the torso during the first phase of whiplash.
Late whiplash- chronic whiplash
LOSRIC- low speed rear impact collision
Re-entry- the forward phase of whiplash.
Whiplash- a term which is variously described in the literature as an injury to the cervical spine and/or supporting soft tissues resulting from motor vehicle trauma: the term, as most often used, excludes fractures or dislocations of vertebrae, and some authors limit the term to rear impact crash vectors, while others consider it to include an injury from any type of crash scenario.
Grading is used to determine the severity of a collision.
Many different systems exist, although each system has its own strong and weak points.
The AIS, ISS, and KABCO are just a few of the systems used by professionals today.
For example, the AIS system (shown below) is very useful in research collection, but is not capable of predicting impairment or disability.
Abbreviated Injury Scale (AIS):
1 = minor
2 = moderate
3 = serious
4 = severe
5 = critical
6 = maximal injury; virtually not survivable
9 = unknown
Questions about Whiplash
Q: Is there a threshold below which injuries cannot occur?
A: There is no known threshold crash exposure below which injury is not possible. There is no known crash speed below which injuries cannot occur.
Q: Why was there a delay in the onset of my symptoms?
A: Intervertebral discs are thought to have very little nerve innervation for pain; pain chemicals, like prostaglandins do not reach peak levels until 12-72 hrs.
Q: Are males and females at equal risk of injury?
A: Females have long been known to be at just about twice the risk for injury as males in whiplash type exposures. From this we can assume that males simply have a higher tolerance for trauma.
Q: Is whiplash a “disease” of the western world?
A: Outcome literature shows that about 35% of persons injured acutely will have some degree of long-term complaints and 10-14% of these victims will become disabled. The answer is NO. It is a legitimate injury that occurs everyday.
Contact Whiplash Holistic Frankfort
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Whiplash for Professionals
Attention Insurance Adjusters, Attorneys, and Medical Doctors
Why should you consult or refer patients to a Doctor of Chiropractic?
1) There are some who feel having a DC on a MVC case could make it less valuable, that MD's have more credibility than a DC or that DC's are too vulnerable to attack by defense.
When in fact it is a DC who wrote THE book on CAD. (Dr. Arthur Croft).
Chiropractors have the most comprehensive postgraduate training in CAD.
Chiropractors are the only ones to conduct ongoing human subject crash testing.
And many undergo postgraduate training to provide effective direct examination at trial.
2) There are some who question the effectiveness of Chiropractic or alternative treatment.
When in fact alternative treatments have been shown to be very effective for this problem. According to a study which compared the use of some common pain medication (Celebrex or Vioxx) to acupuncture and spinal manipulation; that patients receiving chiropractic after 9 weeks noticed a superior amount of relief compared to other methods. Patients receiving chiropractic care reached 27% asymptomatic levels, acupuncture 9.4% and only 5% for medicine.
In another study chiropractic care showed it could be effective up to 93% of the time for chronic whiplash pain.
3) Some individuals are of the impression that Chiropractors treat for indefinite amounts of time and would see a patient forever if they could.
It was a Chiropractor (A. Croft) who developed the most widely used guidelines to assist physicians of all types to better categorize the injury and patient status so as to enable better treatment protocols and standardize a level of injury that improves communication between doctor, patient, attorney and insurance adjuster.
The DC is the expert
DC's are willing to dot the i's and cross the t's
DCs can serve in several capacities
Attending physician/case manager
New Patients Welcome
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