233- Headaches, Neck Pain, and Car Accidents

Welcome to the Evidence Based Chiropractor where each week we deliver the latest chiropractic research and marketing strategies all in the time it takes to get to your office. Now here's your host, Dr. Jeff Langmaid.

Hello and welcome to the Evidence Based Chiropractor. I am your host, Dr. Jeff Langmaid. And on today's episode we are talking car accidents, headaches and neck pain. We're gonna take a look at a recent study that came out that ties it all together including what are the non pharmacological measures that people can take to find relief. It's a great research paper. I think you're really gonna like it, especially if you have any piece of your practice that is PI related. Before we get started, I'll say a few words about Roc Tape. Rock Tape is proud to be a sponsor of the Evidence Based Chiropractor. Please head over and check out rocktape.com they have online educational course courses. They also have all of the tools. And when I say all the tools, I mean including my favorite which is Mohawk. We recently put up a thread in the Smart Chiropractor Facebook group asking about favorite clinical tools. And you know, I had to give a shout out to Mohawk. I love the fact that it fits great in my hand, it saves my thumbs and ultimately the carrying case makes it super easy to get around the practice or when I am traveling. So be sure to check out Rock Tape. As I said at the top, we are talking headaches, neck pain, car accidents and more on today's episode. The research study that we're going to talk about, you're going to find it linked in the show notes. It is called non pharmacological management of persistent Headaches associated with neck Pain. A clinical practice guideline from the Ontario Protocol for Traffic Injury Management and Collaboration. Long title there bottom line, they were taking a look at persistent headaches and neck pain after an automobile accident. And what is the best management strategy? What are some of the best management strategies to help people find relief? So we know persistent headaches often occur after whiplash injuries sustained in auto crashes. You know, trauma to the bones, the discs, soft tissue in the neck during whiplash has been shown to result in cervicogenic headaches. And nearly 20% of the population report to have at least four headaches per month. For a lot of these people, these headaches began after a car accident, right when we have an acceleration deceleration type injury. When there is a whiplash injury, it affects a variety of tissues, not only tissue, the brain Mild traumatic brain injury. But it definitely can affect the ligaments, it can affect the disc, it could even, ultimately, if the crash is severe enough, affect the bone. So this is really important stuff to keep in mind because it's been shown in the literature time and time again that there's a big predisposition for recurrent symptomatology after an auto crash. Right. You have to remember the vehicles that we travel in, they weigh thousands of pounds, we weigh hundreds, maybe, maybe less. But these are big, strong, fast vectors and that creates unbelievable amount of force anytime there's an impact. So being able to diagnose these things properly, being able to document them appropriately, and then being able to care for them are sort of three different things in the same bucket. Then the, then the next piece is, how do you explain this to the people in your community, other physicians, urgent care centers, attorneys, where you can actually utilize it to build and grow your practice To a certain extent. There's a lot underneath the tree and the arm of personal injury, and a lot of it stems back to acceleration, deceleration injuries, whiplash associated disorders, wads or whiplash in and amongst itself. So taking a look at studies like this is really, really important from a chiropractic sense because just of the sheer volume of individuals that get involved in, in accidents. So in Canada, for instance, individuals with disabling neck pain are 10 times more likely to suffer from comorbid headaches than those without neck pain. And over 80% of individuals who experience headaches after a motor vehicle collision also experience neck pain. So this is unbelievably high correlation between neck pain and headaches. Now, cervicogenic headaches specifically are caused by a disorder of the cervical spine. So that could be bone, disc and, or soft tissue and, and they're usually accompanied by neck pain. Cervicogenic. Right. It's coming from the neck. This is what we see time and time again after auto crashes, collisions, and after whiplash type injuries. So the researchers found a couple interesting things that I wanna break down before we talk about practical application. Number one is they found existing guidelines recommend that exercise, quote, spinal manipulation and cervical mobilization can be considered for the treatment of cervicogenic headaches. So that is within the clinical practice guideline that mobilization, spinal manipulation and exercise, all things that can happen within a chiropractic practice, are recommended and should be considered for the treatment of cervicogenic headaches. They also found cervicogenic headaches, again are caused by a disorder of the cervical spine by nature, therefore mobilizing treating, ex, strengthening, all of those things, getting rid of the inflammation around the area or controlling and managing the inflammation is probably a better way to say it really, really important in the recovery of those individuals who have experienced a traumatic incident, AKA in this context, ultimately a car accident. They also found, quote. For chronic tension type headaches, clinicians can consider general exercise, warm up neck and shoulder stretching and strengthening and aerobic exercises, low load endurance, craniocervical and cervical scapular exercises, multimodal care, which they define as spinal mobilization, exercise and postural correction or clinical massage. For persistent cervicogenic headaches, clinicians should consider low load endurance, craniocervical and scapular exercises or manual therapy such as manipulation with or without mobilization to the cervical and thoracic spine. So a couple things I want to dive into there that are really, really important. Number one, they are talking about all things, basically all of this care regarding headaches and neck pain. If let me take one step back. Anybody who's been involved in an automobile accident, there's a very high likelihood that they are going to have some sort of neck pain, some sort of cervical spine pain. We also know that there's an 80% likelihood that they're gonna have headaches associated with them. So that's really the starting point. That's a lot of people. We know there's millions upon millions of these exact type of crashes each and every year. So whether or not it's a focus of your practice or not, if you've been in practice more than a few months, you probably have had a patient that's gotten into an accident, even if you're not out there looking or accident patients. So important to keep that in mind. Second piece of this is, okay, once that occurs, what are some of the best ways to go about taking care of this? And what they're highlighting here are things that take place in your office each and every day, right? Exercise, they're talking about multimodal care, which they're including exercise, postural correction and mobilization. And they're also talking about manual therapy, which includes manipulation. And, and here's an interesting part, that last piece of that was to the cervical and thoracic spine. So as somebody has cervical spine pain, as an individual comes in post accident and they have headaches, they have neck pain, it's very, very important to always be at least evaluating the next, the region closest to. So for somebody that has a cervical spine issue, be sure to examine at least in a cursory fashion. But I'd Say, really take a good look and at the thoracic spine. If somebody has a shoulder issue, for instance, as a result of an accident, be sure to check the cervical spine and the elbow, right? So be sure that you are checking the body regions that are adjacent to the primary issue. That's a very, very important point because as somebody undergoes trauma, if they have an acceleration deceleration injury, they're going to be changing their biomechanics real quick. I can tell you that if they have muscle spasms, if they have reduced range of motion, you know, 99% of people don't just go home and stay in bed 24, seven, you're still getting up and doing things and trying to make it through the day. And how do you do that? Well, you do that by compensating. That's gonna create or has the potential to create imbalances. And those compensation patterns in some cases can practically become more detrimental than the original injury. Because now the body is adapting, which it does a great job of, but it's adapting in a way that it hasn't before. And those changes in biomechanics that, you know, their body has never worked that way before, and now they're changing biomechanics due to an injury. Really, really important to look at those adjacent joints, those adjacent body regions, to really get a feel for what's going on. And how can you correct not only the primary issue, but any of the compensation patterns that have come into play as a result of that primary issue? Sometimes those things can be cleaned up, quote, unquote, really, really simply and easily. It doesn't take a lot. Sometimes it takes more work. Right? But it's really important to analyze and evaluate those things. And it's also really important to document. Right. We know documentation is critically important in all aspects of practice, but specifically in the personal injury realm, documentation is super, super critical. You absolutely wanna make sure that you are linking the diagnosis to obviously, the symptomatology and the challenges and also to the treatment that you're offering. So if you are adjusting the cervical spine and thoracic spine due to neck pain, be sure in your notes that you're outlining why you're doing so and what findings led you to that very, very, very important. Nobody wants to get into a situation where obviously, number one, that we're doing anything that's not completely patient centric and in the best interest of the patient. But number two, nobody wants to be sweating it out in a deposition going, oh, my gosh, my notes. I wish I would Have Doc, I know why I was doing it, but I didn't document it. And now in a deposition, you're sweating bullets and never a good position to be in. So just make sure that you're really honing in and keeping an eye on your documentation as you go through this. The bottom line with all of this is that this is a clinical practice guideline that came out in the European Journal of Pain just last year in 2019. And there's no question that when people have headaches and neck pain as a result of an auto accident, one of the best ways to go about taking care of that in lieu of yellow and red flags is non pharmacological care. And within that bucket, which is the largest bucket, there is no question that based upon the symptoms that they present with, you have the ability to offer them solutions in your practice. So when we're talking against cervicogenic headaches, spinal manipulation, manual therapy, low load exercise, critically important, when we flip over to the chronic tension headaches, these are gonna be people that come in later on, or maybe they had that accident years ago, they have chronic tension headaches, spinal mobilization, clinical massage, or medical massage, I guess I should say, and exercise. All very, very important pieces of the puzzle. And it's really also important to have be to kind of bone up on these clinical practice guidelines because it just gives you a lot of legs to stand on with your practice. Not only can you feel more confident as you have conversations with attorneys, as you have conversations with other physicians in your community, that you are right in line with the clinical practice guidelines, but these are great tools also to share in terms of research briefs, et cetera, with those other colleagues and potential referral partners in your community because it opens their eyes to exactly who you are, what you do, and that you fall completely in line with what the, what the latest CPGs say. So all things to keep in mind as you kind of get out there. Bottom line with this, a majority of people who undergo motor vehicle or involved in motor vehicle collisions, majority of them are going to have either neck or back pain. Those that have neck pain, 80% of them are gonna have concurrent headache. So be sure that you are obviously evaluating the cervical spine, be sure that you are evaluating the joints that are next door to it, and make sure that you're staying in practice within the clinical practice guidelines. Great way to be save you a lot of stress later on. And also you can be confident to know that if you're listening to this as a chiropractor, you probably have all of the service offerings that these clinical practice guidelines recommend. Already in your practice today. So get out there, have productive conversations, get have a great week in practice. If you haven't left feedback for this podcast, please swipe down a little bit, give us a rating or review. That is what helps more and more docs Find this podcast. I really appreciate you tuning in, listening, trusting that we're going to give you research and marketing in the time it takes to get to your practice each and every Monday. And I would love it if you gave us some feedback or ratings and took a moment. If you're listening on an iPhone through the Apple podcast, you can just literally scroll down a little bit, tap that button and you are good to go. So thanks for tuning in. Have a fantastic week in practice and I will talk to you soon.

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