Category Archives: Auto Accidents / Whiplash

Auto Injury Diagnosis and Treatment

In treating patients who have been injured from a Motor Vehicle Collision (MVC), I frequently end up discussing treatment frequency and durations with the patient’s attorney and/or insurance adjustors.  This subject does not have to be subjective or confusing as there are guidelines that have been adopted by the national clearing house and have also been adapted by both the International Chiropractic Association and the Colorado Chiropractic Association.

Before we dive into the specifics about treatment guidelines for chiropractic care, including both frequency and duration, we need to realize that guidelines are “simply guidelines” and each case needs to be dealt with on an individual basis.  Guidelines are simply guidelines and the treating providers should make clinically appropriate recommendations for each individual patient.

Probably the most important determining factor in a patient’s treatment regimen depends on the exact injuries the patient has received.  I can’t count the number of times I’ve been told by an insurance adjustor or an IME (Independent Medical Evaluator) that the patient simply has soft tissue injuries that should heal in a few weeks; to which I usually reply:  “Can you send me some research that backs up that statement?” or “Which specific soft tissue injuries are you talking about?”  I have yet to receive one piece of research to support such claims.

All treatment plans need to be driven by a proper diagnosis of the exact injuries the patient has.  A soft tissue injury could mean a muscle strain that will heal in a few weeks or it could mean a severe ligament instability that will never heal and is a permanent whole body impairment.  Additionally, the brain is soft tissue; how long does it take for a traumatic brain injury to heal?

Point being a specific diagnosis will lead to a more appropriate treatment plan and better outcome.

Grades of Severity of Injury

The Management Guidelines for Whiplash Associated Disorders by the International Chiropractic Association (which as been adopted by the Colorado Chiropractic Association), has met the stringent criteria of the Federal Agency for Healthcare Research & Quality (AHRQ), located at www.guidelines.gov.  The NGC is a comprehensive database of evidence-based clinical practice guidelines and related documents produced by the Agency for Healthcare Research and Quality (AHRQ), in partnership with the American Medical Association and the American Association of Health Plans.  The purpose of the NGC database is to provide healthcare professionals and providers access to objective, detailed information on clinical practice guidelines and to further the dissemination, implementation and use of those guidelines.

Grades of Severity

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Guidelines for Frequency and DurationScreen Shot 2017-12-17 at 9.29.40 PM

Guidelines for both treatment frequency and duration can be determined once the severity of the injury is established.  Keep in-mind these are just guidelines and each patient may need less or more care.

Regardless of treatment frequency all patients should have a re-evaluation every 30 days to monitor patient’s progress.  If patients are not improving as fast as the treating doctor would like or he/she continues to have symptoms such a radiculopathy the treating provider may decide additional diagnostics are needed such as an MRI.  This is also an excellent time to decide if additional treatment from other healthcare providers or specialists is needed.

When it comes to treatment frequency and duration each patient needs to be dealt with on a case-by-case basis but proper diagnosis  and routine re-evaluations are critical to ensure the patient gets the most appropriate treatment.  There are established guidelines to help guide the treating doctor, but they do not replace clinical excellence and experience.  There are many factors that complicate the case and make recovery more difficulty such as old age, obesity, degenerative disc disease, osteoarthritis, etc.

Chris Gubbels D.C.

Learn more about Square ONE.

Get more info on treatments for injuries related to a car crash.

 

Is Chiropractic The Right Treatment After A Car Crash? | Square ONE

 Is Chiropractic The Right Treatment After a Car Crash?

Being involved in a motor vehicle collision (MVC) can be a stressful event for individuals involved.  Not only can the actual trauma and initial loses be stressful, but the recovery process including:  time involved with doctors visits and medical treatments, going pain and suffering, loss of income from missed work, medical expenses and possible permanent injuries or disabilities can weigh on the patient.

What Treatment Should I get?

With all the different treatment options available:  Chiropractors, Physical Therapist, Massage Therapist, Pain Managements Centers, Orthopedic Specialist, etc., who is the best provider to go to after being in a car crash?

While all of these providers have value and are appropriate at times, chiropractors play a role in the healing process that no other provider can.  To understand a chiropractors specific roll in the healing process one needs to understand what happens to tissues after injuries.

If Its Not Moving Its Dying

After an injury has occurred the spine splints because of the injury.  If this splinting is prolonged, fixations between normal spinal segments occur.  These fixations further decrease the overall range of motion (ROM) in the spinal joints and increases stress on damaged intersegmental units that are trying to heal.  By reducing these unnecessary fixations with spinal adjustments, we restore the spine to a more normal biomechanics and this in turn relieves the tension at injured segments, thereby, providing an environment more conductive to healing.

A study was published in Spine that illustrates one of the reasons spinal adjustments are needed.  In this study the researchers produced mechanical fixations in the spines of dogs.  They found that when they fixated one segment the segments above and below began to get disc degeneration and spondylosis (arthritic changes), and these irreversible changes occurred in only two months! (1)

This exact same thing happens to human spines that have fixated spinal segments.  Chiropractors and osteopaths are the only health care providers in this county licensed and trained to perform spinal manipulations, and many osteopaths do not practice manipulations and osteopaths training in adjusting the spine is usually quite brief in comparison.  In fact, chiropractors provide over 94% of the spine manipulations delivered in this country (2)

Another article published in the Clinical Biomechancis  states that immobilization not only causes arthritis but it delays the healing process.

“It (evidence) shows beyond a reasonable doubt that immobilization is not only a cause of osteoarthritis but that it delays healing.”

“If immobilization, irrespective of its cause, cannot be avoided, it would be therapeutically logical to take every possible step to limit its extent and duration.”

“Scar tissue begins to be deposited immediately upon immobilization and serve to further decrease mobility.  Within two weeks eburnation (bone depositing) in bone is detectable and radiographic evidence of joint space narrowing, osteophyte formation (bone spuring), and subchondral sclerosis is apparent.”  (2)

Importance Of Being Compliant With Care

Frequency of treatment is another topic that is often comes up.  Patients do not always realize the necessity of why they need to stick to a strict treatment schedule in the beginning of treatment and many attorneys, other health care professionals and insurance adjustors additionally may not understand why the frequency of treatment is required and also why the length of treatment may be necessary.

I have had countless attorneys tell patients that too much chiropractic care will hurt their case and I regularly receive letters from insurance adjustors stating that the patient just received a soft tissue injury they and they should completely heal in about 6 weeks. There is zero research to support such statements and claims and the research literature on clinical treatment guidelines actually state the opposite.

A paper published in the Journal of Manipulative Therapy (JMPT)  Structural rehabilitation of the spine and posture:  Rationale for treatment beyond the resolution of symptoms answers this.

“Chiropractic is primarily aimed at restoring proper spinal mechanics, which will, in turn, influence the function of the nervous system.”

“Because correct spinal mechanics and the health of the whole neuromusculoskeletal system are interdependent, chiropractic management involves the analysis of all sites of spinal joint dysfunction.  Consequently, chiropractic rehabilitation is driven by the restoration and rehabilitation of normal structure and function and not merely the relief of symptoms and/or pain.”

“Also, the regimen of care must proceed for a sufficient length of time so as to address the chronicity of the remodeling stage of the healing process (i.e. 3wk-12months or more).”

“To concentrate on pain or other symptoms as the primary method to assess efficacy of treatment is not only evidence of a superficial understanding of chiropractic principles, but is also evidence of a superficial understanding of the workings of the biological organism.”  (3)

Now I’m clearly not saying that chiropractic care is the only care needed to help individuals recover from injures related to a whiplash trauma or a motor vehicle collision but chiropractic certainly does play a vital roll in a patients recover from soft tissue injuries and a chiropractor trained in traumatology and biomechanics should certainly be consulted and be part of a patients health care team.

I’m going to post on the exact science of the healing process in subsequent post, so if you are interested to learn how the tissue actually heal over time stay tuned.

If you’ve been in a car crash and would like a FREE consultation call 970-207-4463 or click on the box bellow.

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By Dr Chris Gubbels D.C., C.C.W.P

(1)  Kahanovitz N, Arnoczky SP, Levine DB, Otis JP:  The effects of internal fixation on the articular cartilage of unfused canine facet joint cartilage.  Spine 9(3):268-272, 1984

(2)  Videman, T.  Experimental models of osteoarthritis: the role of immobilization.  Clinical Biomechanics 1987; 2 (also reviewed in Chiropractic Report)

(3)  Videman, T.  Experimental models of osteoarthritis: the role of immobilization.  Clinical Biomechanics 1987; 2 (also reviewed in Chiropractic Report)

 

Fort Collins Personal Injury Doctor Explains Why You May Be More Likely To Be Injured In a Low Speed Crash

Why you may be more likely to be injured in low speed crash than high speed.

I decided to write this blog as a result of a standard letter we have been seeing presented to both patients, attorneys and our office from insurance companies, in which the insurance companies state that their should be minimal if any injuries related to the crash based on the amount of property damage of the vehicles involved and the estimated speed of travel of the vehicles involved. We have to say estimated because the actual speed is usually not known.

Letters like this are intended to persuade patients not to seek treatment for injuries following an LOSRIC (low speed rear impact collision)

One of the biggest reasons people are frequently injured in low Fort Collins auto accidentspeed car crashes, specifically rear end collisions is because cars are designed to stiffer than they use to be.  Cars are designed to crumple and absorb much of the impact at higher speeds.  However, vehicles are designed to withstand impacts at lower speeds to avoid having to repair excessive property damage with low speed rear impact collisions.

What is the risk of being injured in a Cervical Acceleration/Deceleration Crash

French Study:  Foret-bruno et al. reported that 27% of occupants in rear end collisions sustained cervical injuries, with women being injured in 42% of rear impact collisions and men in 21% of.  With velocity change (delta V) 9.3mph, the injury rate was 36%  compared to 20% in velocity change greater than 9.3 mph, this is because of more seat back failures at higher speed collisions.

American Studies:  Chapline et al. reported that in crashes where there were no damages to the vehicles reported, 38% of females and 19% of males had symptoms following the crash.  When damage was rated as minor, 54% of women reported symptoms and 34% in men.

Japanese Studies:  The Japanese Automobile Insurance Rating Association reported that 50% of crashes result in neck injury, and that is increasing head year.

Australian Study:  A study done by Dolinis found that 35% of drivers in motor vehicle collisions were injured and passengers were more likely to be injured.

Canadian Study:  This study found that volunteers were found to be injured at 29% and 38% in 2.5 mph and 5 mph change in velocity low speed rear impact collisions.

Scandinavian Studies:  In one the authors used Crash Pulse Recorders to record peak acceleration and compared peak acceleration and occupant injury.  The peak accelerations in 22 cases were all within the range of a 2.7 mph crash.  Thus it was likely that the majority of these crashes occurred with little or only minimal property damage.   Of all the rear impact crashes, 59% resulted in initial symptoms of the occupants.

This is only a fraction of the research that could be presented on the risk of being injured in low speed collisions but enough to get the point across that injuries can occur when there is little or no property damage.

Only considering the speed the vehicles where traveling when a crash occurred and the visible damage of the vehicle involved (gives little impute on the likelihood of the people in being injured.

There are many other risk factors that determine the likelihood of being injured in a car crash.  Below is a list of risk for injury:

  1. Female sex: Women are twice as likely to be injured than men.
  2. Females weighing less than 130 lb.
  3. History of neck injury. If you have a prior injury, you are 4.5 times more likely to be injured in a rear impact collision than if you had not had a prior injury.
  4. Head restrain below head’s center of gravity.
  5. Poor head restrain geometry/tall occupant.
  6. Rear impact.
  7. Use of seat belts/shoulder harness.
  8. Body mass index/head neck index.
  9. Out-of-position (leaning forward/slumped).
  10. Non-failure of seat back.
  11. Having head turned at impact.
  12. Non-awareness of impending impact.
  13. Impact of vehicle of greater mass.
  14. Crash speed under 10 mph.
  15. Being the driver of the vehicle.
  16. Having a toe hitch.

This is not a complete list and further writing are needed to explain the details of the impact each of these factors may have on the risk of being injured but you get the idea.

To hear Dr Chris Gubbels talk about this topic click on the video.

To learn more about Square ONE click here.

If you have been in a car crash and would like a free consultation with a doctor call 970-207-4463 or click on the box bellow.

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Dr Chris Gubbels D.C., C.C.W.P