081- New Chiropractic Guidelines for Whiplash

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Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. This week we are back with more research and it is all about whiplash. We are going to talk about a paper, the treatment of neck Pain Associated Disorders and Whiplash Associated Disorders, a clinical practice guideline. This was released by JMPT in October 2016. If you take care of any patients that suffer from automobile accidents, MVAs and or have whiplash associated disorders from automobile accidents or not, then you are definitely gonna wanna listen to this episode where we dive into the clinical practice guideline that JMPT released in 2016. Before we do, I'll say a few words as I do it each and every week about Rock Tape. Rock Stock is coming up in September in beautiful Huntington Beach, California. Peace, love and movement. The schedule's been released. It's un, unbelievably killer. The activities are unbelievably top notch. I will be out there, microphone, lights, video camera in tow and interviewing people, talking shop, making sure that we get your message out there. Uh, but if you have not checked out, booked your tickets yet for Rock Stock, you gotta do so. I'm pumped to get out there. Huntington beach, if you haven't been there, that's worth it on its own. You had Rock Tape premier, premier company within the chiropractic space and more and maybe even a little bit of me in there as well. And that should be enticing for you to get out there. I'm pumped. It's the third weekend in September. Check it out. Rocktape.com rockstock rocktape.com rockstock and one other bit of housekeeping. If you have not left a feedback, feedback, review or rating for the Evidence Based Chiropractor podcast, you can do so directly from your iPhone. I appreciate everybody, including you out there who's listened to the Evidence Based Chiropractor podcast each and every week. I would love to have more feedback, more ratings and more reviews because that helps us reach even more people with the message of chiropractic care and the research behind it. So if you could take one moment, you would absolutely make my day if you took one moment and, and left some feedback, some ratings or review regarding this podcast on itunes. So let's dive into the research. I said the research paper at the top I will repeat the title and then we will dive in. The treatment of Neck Pain Associated Disorders and Whiplash Associated A Clinical Practice Guideline JMPT October 2016 so again, if you treat people who have been in automobile accidents or anybody that's had a whiplash disorder, then this is going to be an episode that you do not want to miss. So many of us out there take care of people and patients that have suffered from automobile accidents. Quite frankly, the reimbursement for auto cases is probably some of the best out there currently, regardless of what state you reside in. And we all hear horror stories of kind of these personal injury mills and everything else like that. But today we're gonna talk about the ethical care, the correct care, the best care for for patients that have suffered from a whiplash associated disorder. And this paper has a couple key items that I wanted to touch on right off the top. So this paper gives us three key bits that we'll talk about right now. The researchers in the paper found, quote, the majority of adults with traffic injuries report pain in the neck and upper limb. Other common symptoms of whiplash associated disorders include headache, stiffness, shoulder and back pain, numbness, dizziness, sleeping difficulties, fatigue and cogn deficits, end quote. Now, if you've ever taken care of anybody that's been in an automobile accident, they probably check all those boxes. Headache, stiffness, shoulder pain, back pain, numbness, dizziness, sleeping difficulties are very, very common findings for people who are suffering from a whiplash injury. The researchers also found, quote, More than 85% of patients experience neck pain after a motor vehicle accident, often associated with sprains and strains to the back and extremities, headache, psychological symptomatology and mild traumatic brain injury kind of going hand in hand with the first quote there. So nearly 85% of patients will experience neck pain after a motor vehicle accident. Pretty much if they have neck pain, they have a sprain strain injury at the most minimal, but they're falling into a whiplash case. 85% of people in a motor vehicle accident doesn't matter. The speed doesn't matter, whether you're the bullet or the target vehicle side, back, front impact. 85% of people will have neck pain and whiplash associated disorder when they're involved in a motor vehicle accident. That's important to note. And finally, the third bit, which is perhaps the most important for us, the researchers found, quote, a multimodal approach including manual therapy, self management advice and exercise is an effective treatment strategy for both recent onset and persistent neck pain. So let's dive into that a little bit. A multimodal approach. And when they define multimodal, in this study they defined the commonly used multimodal treatments as manual therapy, spinal manipulation, home exercise and medication. Three of those four, we do manual therapy, spinal manipulation and home exercise. Now let's dive in. That's the commonly used multimodal treatments, those four items. But the researchers found a multimodal approach including manual therapy, self management advice and exercise is the effective strategy. There's one thing missing from there and if you were paying close attention, then you know it was medication. And that goes hand in hand with more and more studies coming out saying spinal manipulation, chiropractic care, chiropractic adjustments before opioids, spinal manipulation, chiropractic care, conservative care before NSAIDs. This paper just further reinforces that point. The other thing that the researchers found, which I think is really, really important are the last few words of the paper. It's both for recent onset and persistent neck pain. So these are patients that are acute, subacute and or chronic. That's very important because many people that we see, they might have had an auto injury many months ago, maybe that we weren't the first place that they came into. Maybe they were a past patient who got diverted somewhere else after the accident, but they're still suffering months and months later. Well, this paper indicates, and it's a clinical practice guideline that came out just last year, that manual therapy, self management advice and exercise, manual therapy, including spinal manipulation, mindy, is an effective strategy for recent onset and persistent acute, subacute and chronic neck pain. So that is a really, really stunningly important piece of information and paper to know. I'm going to have the direct link to this paper in the show notes. And you know, this paper was also released. You know, quite frankly, this paper was released just last month to all the members of the evidence based chiropractor. So if you're out there listening and you take care of patients who have motor vehicle accidents, who've been involved in motor vehicle accidents, maybe patients who have whiplash injuries, and you're not a member of the evidence based chiropractor, you might be doing yourself a little bit of disservice. So I'd encourage you to check us out. The evidencebasedchiropractor.com we take this research, put it in a way that is engaging, that's interesting for other healthcare providers in your community. It's about building those referral relationships with medical doctors, with other care providers, getting the referrals coming in from a new source, a new opportunity. And for many of us, that really is reaching across the aisle and reaching out to our MDs and DOs in our community. I'll tell you, you don't need to be a technology whiz. You don't need to be the most outgoing doc in the world or this charismatic leader to do wonderful things with building referral relationships. But when you have a process, when you have a system, it makes it so much easier and the rewards are so great. So if that interests you at all, check out the evidencebasedchiropractor.com but with the persistent neck pain, the other thing that I'd like to talk about as we finish up is kind of the imaging regarding this. So a lot of chiropractors out there, you know, let's just clarify the imaging. Let me put it that way. So proton density or proton neutral scans are some of the best scans you can use to determine whiplash type injuries. Whiplash type injuries can affect the Alar ligaments. The Alar ligaments go from the dens of C2. They go from the dens right up onto those occipital condyles on the occiput. So they're kind of what attaches the toothpick to the bowling ball there. The Alar ligaments are extremely important, but they also are basically never visualized on a traditional mri. So shooting at six to eight weeks post injury shooting at six to eight weeks. Six to eight weeks is when the inflammation has died down enough to get the clearest picture possible. Shooting an upper cervical specific proton density proton neutral MRI scan can be very, very valuable because it focuses really on taking a look at those ALR ligaments and seeing if there's been any disturbance. Has there been any injury, has there been any trauma to those ligaments? Because if there has, that could indicate an alteration of motion segment integrity. And that gives, as a treating physician, as their chiropractor, as a trusted healthcare professional, that gives you the ability, when that's been diagnosed, to treat them at a higher level. It's gonna open up a little bit more care and justifiably so, because when you go from a sprain or a strain injury to a whiplash type injury that injures ligaments, then the care needed to recover from that and get well needs to be a little bit longer and a little bit more intense. Now, the wonderful thing again is regardless of the grade of whiplash injury, regardless of the conservative care, that seems to be the best that the clinical practice guidelines Stand behind ultimately is exactly what you and I do in our practice, which is adjust patients, do some manual therapy, give some home exercises and some guidance. And you are absolutely following the clinical practice guidelines to a T. And now when you combine that with accurate documentation in your clinic, the right imaging at the right time, then you are serving your patients at the highest levels and bar none. And if you want to take the next step in your practice, learn how you can use research to build referral relationships, the strongest relationships that you can build in your community. And you want the support, the system and the exact tools to do so that hundreds of chiropractors worldwide have had unbelievable success with. Check us out. Check out what we're doing. The evidence basedchiropractor.com is it's something new for your practice, it's something new for your patients, it's something new for your community. It's gonna give you a bigger impact, better standing and also more new patients exposed to what you are doing in your practice each and every day. The second half of this week I am headed out to Hustlecon in San Francisco, California. I'm gonna see Tristan from Kairo Sushi. I'm gonna see Jason Deutsch out there. I am pumped to get out to the Bay Area. If you are listening to this and you are a doc practicing in either o San Francisco, I'm gonna be staying in the Mission District. Hit me up Jeff. The evidencebasedchiropractor.com I would love to meet up, chat, grab a coffee when I am out there again. San Francisco, I'm coming for you. I will be there this Thursday through Monday and I'm looking forward to it. So I hope you have a fantastic weekend practice Doc and I will talk to you soon.

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