Vienna Chiropractic Associates

Excerpted from the 12/00 - 3/01 Newsletter

TABLE OF CONTENTS Go Top

Whiplash Myths
Backpack Blues
The Principle Of Time
What Is The Limitation Of Matter?
What Happens If I’m Late?

Whiplash Myths Table of Contents | Go Top

This August, Drs. Todres and Masarsky attended a seminar on the topic of whiplash and spinal trauma. In that seminar, recent research was reviewed which explodes some common myths about whiplash:

You Can Only Get A Whiplash Injury In An Auto Accident.

Whiplash is a generic term for any injury which involves putting the head and neck into motion, and then suddenly stopping that motion. (This is why whiplash is often called, “acceleration/deceleration injury.”) Obviously, this happens in automobile accidents, but it can also result from slip-and-fall injuries, sports injuries, and even violent coughing and sneezing.

If Your Car Damage Is Minor, Your Injuries Must Be Minor.

Insurance claims adjustors make this sound like down-home common sense.

“Shucks, that little old fender-bender didn’t wreck your car, so how could it wreck your spine? Claim denied!”

This may be good rhetoric, but it’s bad physics. Using equations that go back to the time of Galileo, an automotive engineer recently demonstrated that vehicle damage is not closely correlated to human damage¹. This study provided a “hard science” basis for previous research by Swiss neurologists and British trauma surgeons, who found little correlation between vehicle damage and the injuries sustained by their patients^2,3.

The automotive engineer drew an interesting analogy between car crashes and pole vaulting. If a pole vaulter lands on a pile of foam, the foam is very dramatically crushed. In the process of crushing, the foam dissipates the energy of the landing, preventing injury to the athlete. Similarly, when a state-of-the-art racing car crashes, the car is often so severely damaged that it almost appears to shed its body structure. This dissipates the energy of the crash, often saving the racer’s life.

On the other hand, if a pole vaulter lands on concrete, the concrete will not be crushed—it may not even be dented. As a result, the athlete’s body will be shocked by almost all of the energy of the landing. Similarly, when a very rigid car crashes, it will sustain little damage. This causes much of the energy of the crash to be absorbed by the people inside.

If the X-rays are normal, a psychologically sound person will recover from whiplash injury in six to eight weeks.

This line of reasoning is understandably popular in the insurance industry, yet it has no basis in biological reality. Two of the world’s most prominent researchers in this field have found that some 20% of whiplash patients are symptomatic after six months, and that these symptoms are based on physical damage, not psychological distress⁴. Yet, these patients often have normal x-rays and even normal MRIs immediately after the accident.

However, when x-rays are taken years later, whiplash victims are much more likely to show signs of degenerative disease (osteoarthritis) than people who have not been in auto accidents⁵. Even ten years after the trauma, neck pain is eight times more frequent in accident victims than non-whiplash patients, and headache is eleven times more frequent.

For years, researchers have acknowledged that whiplash patients with chronic pain suffer from depression, anxiety, and other forms of psychological distress. Unfortunately, the insurance industry has used this data to argue that the psychological distress is the cause of the pain, rather than the physical injury. A devastating blow to this argument was dealt by a carefully designed study in which some chronic neck pain patients underwent palliative neurosurgery, and some were given a sham treatment⁶.

Before and after treatment, questionnaires were administered to measure levels of pain and psychological distress. All of the patients who received the real treatment were temporarily pain-free and experienced relief of their psychological distress. Among the patients receiving the sham treatment, only one experienced psychological relief, and none of them reported relief from pain.

Chiropractic care is not required for whiplash; standard medical care and physical therapy will do the job.

Sometimes, insurance claims adjusters will not object to covering “standard” medical care, but will cut off chiropractic coverage. These decisions have no scientific basis.

In a recent study, a group of whiplash patients who failed to respond to physical therapy, soft collars and anti-inflammatory drugs were referred to doctors of chiropractic⁷. These patients were already chronic; chiropractic care was delayed until an average of 15.5 months after the accident. In spite of this, 93% of the patients responded to chiropractic care.

A later study concluded that no “conventional” treatment of chronic whiplash has proven to be successful, but chiropractic care often is⁸.

Please feel free to ask us about the health implications of whiplash and other forms of spinal trauma.

References

¹ Robbins, M.C. “Lack of Relationship Between Vehicle Damage and Occupant Injury.” Journal of the Society of Automotive Engineers, 1997; 2(1): 117-119.

² Sturzenegger, M., B. Radanov, et al. “The Effects of Accident Mechanism and Initial Findings on the Long-Term Course of Whiplash Injury.” Journal of Neurology, 1995; 242: 443-449.

³ Parmar, H., R. Raymakers “Neck Injuries from Rear Impact Road Traffic Accidents: Prognosis in Persons Seeking Compensation.” Injury: The British Journal of Accident Surgery, 1993; 24(2): 75-78.

⁴ Bogduk, N., R. Teasell “Whiplash: The Evidence for an Organic Etiology.” Archives of Neurology, 2000; 57(4): 590-591.

⁵ Gargan, M.F/, G.C. Bannister “The Comparative Effects of Whiplash Injury.” The Journal of Orthopaedic Medicine, 1997; 19(1): 15-17.

⁶ Wallis, B.J/, S.M. Lord, N. Bogduk “Resolution of Psychological Distress of Whiplash Patients Following Treatment by Radiofrequency Neurotomy: A Randomized, Double-Blind, Placebo-Controlled Trial.” Pain, 1997; 73: 15-22.

⁷ Woodward, M., J. Cook, et al. “Chiropractic Treatment of Chronic Whiplash.” Injury, 1996; 27(9): 643-645.

⁸ Khan, S., J. Cook, M. Gargan, G. Bannister “A Symptomatic Classification of Whiplash Injury and the Implications for Treatment.” The Journal of Orthopaedic Medicine, 1999; 21(1): 22-25.

Backpack Blues Table of Contents | Go Top

A few years ago, everyone was hailing the backpack as the ideal tool with which to transport school books or hiking equipment. Even a great idea can be badly implemented, and we are now seeing an ever increasing number of people, particularly students, who are having their spines damaged by backpacks that are too heavy or inappropriately worn.

These people are experiencing back pain, headaches, paresthesias (numbness or tingling) in arms or legs, poor posture, plus a nice (not!) assortment of related health problems. It’s becoming common to see a 90-pound student walking as though she or he were carrying a load of bricks.

Please, make sure your backpack (or your child’s, if you are a parent reading this) weighs no more than 10% of your own weight (100-pound student should carry a 10-pound load). Take a moment to empty your pack onto a table and take an inventory of its contents. What can you do without? The CD player can stay home, as can any other non-essential items. Some things can be hand carried—yes, we know the idea was, at least partially, to free your hands, but it’s not working out that way! While you’re at it, use both straps instead of carrying the pack and yourself lopsided. Petition your principal and school board for scheduling that actually gives you enough time to get to your locker between classes.

If there’s a possibility that you’re becoming a backpack casualty, come in and have your spine evaluated. What happens to your spine during your pre-teens and teens can make a huge difference in your future health and comfort.

The Principle Of Time Table of Contents | Go Top

We realize that around here, no one seems to have enough time to really do the things they need, including resting and taking care of ourselves. The problem is, our bodies do not necessarily accept that as a workable situation. “All processes require time,” is one of the original chiropractic principles. While you may or may not feel an immediate change from an adjustment, your body is using it to help itself heal. Please give it time to do so by resting, keeping your appointments and maybe curtailing or changing some of your activities for a while. Once we’ve removed the interference from your nervous system, your body has a much better capacity to solve its problems, most of which probably developed over time.

If your concerns are financial, please talk to us so we can make arrangements for you to get the help you need when you need it, not a year down the road when you problem has had the time to more or less marinate. If time is the problem, we can’t get you more, but we can remind you of our evening and Saturday hours, designed for busy people and their overtaxed nervous systems.

What Is The Limitation Of Matter? Table of Contents | Go Top

This is another of the original chiropractic principles. It speaks to the individuality of each of us, both in “construction” and ability to deal with challenges to our health. Chiropractic, used to its best advantage, allows a maximum of healing according to each body’s limitations, be they genetic or the result of time, wear and exposure. The good news is, where there’s life, chiropractic, in one form or another, can help improve its quality by removing interference to the normal function of our nervous systems, which are, after all, running all of our other systems.

What Happens If I’m Late? Table of Contents | Go Top

Traffic patterns have been particularly unpredictable recently and this can result in making people late for their appointments. While the obvious answer is to leave yourself enough time to get here, there’s no guarantee that will work. In case it doesn’t, this is what we can do:

If you arrive after your appointment time, you will be offered the next available, if one exists. This may involve seeing a different doctor than you had planned on, if that’s the only slot there is. It will, of course, be your choice to take the proffered appointment or reschedule.

If the schedule is full, and there is no other appointment available, you will be offered a time on another day.

We realize that it can be frustrating to rush only to find on arrival that you’ve missed your time and there is no other slot immediately available, especially if your schedule is already tight. The person at the desk knows this too, but she or he can’t make an appointment where none exists. Depending on who else is on the schedule, sometimes we can squeeze you in, but this depends very heavily on the anticipated time requirements of those whose appointments are coming up. (This is one of the reasons why, if some new injury has occurred, including an auto crash that you don’t really expect to claim, we need to know. It’s important for us to be able to apportion appointment time fairly and efficiently.)

If you arrive 10 or 12 minutes into a standard 15-minute appointment, you may be asked to wait, since there may not be time to see you appropriately in the time left. Sometimes people in this situation will say things like, “Well, just give my neck a quick fix on the left,” but we really have to check you and fix what’s wrong, rather than just move around the area that hurts. That may not be the source of the problem, or it may be only part of a larger picture. Please don’t ask us to deliver a lower standard of care. If you arrive late into your appointment, please work with the front desk staff. They want to get you in and will come up with the best possible arrangement according to your care requirements and those of the other patients.