Car Accidents & Future Neck Pain: What You Need to Know | Podcast Ep. 240

Foreign hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. On today's episode, we are talking research and we're going to talk about the association between a lifetime history of a neck injury in a motor vehicle collision and future neck pain. Really interesting study, lot to dive into and and some really important clinical gems for your practice. Before we get started, I will ask you, if you have not left feedback or a review for this show, please do so. If you're listening on your iPhone, you can scroll down and tap how many stars you think this show deserves. That helps us reach more and more docs each and every week. I'd greatly appreciate it. And maybe if you're listening to this on YouTube, hit that subscribe button. Be sure to stay in tune with what we're putting out each and every week. But without further ado, we are talking research today. This study was released by European Spine Journal a couple of years back. And again the title is the association between a lifetime history of a neck injury in a Motor Vehicle collision and future Neck pain. I will link this paper in the show notes if you want to check it out for yourself. But the bottom line is this. We know every single year millions of car accidents happen around the world. And it's estimated that 80% of people involved in a car accident will sustain a whiplash injury. Let me say that one more time. 80% of people involved in a car accident will sustain a whiplash injury. What's a whiplash injury? We've talked about that pretty extensively on this show, right? The flexion, you know, very fast flexion, very fast extension. And it can create challenges to really all the structures that support the spine in a whiplash injury. We can see everything from, you know, disc challenges, facet challenges, and really I think where a lot of the research has gone over the last few years are specifically around transverse ligament and alar ligament damage. Right? The upper cervical spine can be a very challenged situation in a whiplash injury if somebody's wearing their seatbelt. Seatbelts are fantastic to keep people alive. However, it really creates a significant amount of force when your torso is restricted and your head's not right. So even in low impact collisions, talking about vehicles at this point that weigh 2, 3, 4,000 pounds, even when they're only going 10, 15 miles an hour, sometimes even less, it can create an unbelievable amount of transmitted force into the human body. So whiplash injuries, while historically was sort of laughed off, I think that we've seen time and time again there's something we really need to pay attention to. And don't be fooled. Whiplash injuries don't only happen in car accidents, can happen in sports. They can happen in activities, hobbies. Anytime that there's that abrupt flexion and extension type situation going on, there's potential for a whiplash injury. We also know that the American Medical association has deemed many of the injuries that occur as a result of whiplash as permanent. These are things that if we look at the AMA guidelines, they could be permanent disabilities. But those injuries, when the ligaments are damaged, it becomes challenging. Right? Ligaments can be repaired surgically, but typically not. That's a knee ligament, right. We think of knees all the time, ACLs, MCLs, but, but clearly in the upper cervical spine, that's not typically the case. So when they heal, they heal with scar tissue. They heal in a way that produces the potential for challenges down the road. And that's exactly what this paper showcases. The current evidence shows that people who suffer a neck injury during a motor vehicle accident are very likely to experience future neck pain. Neck pain is now known to be a current challenge with periods of fluctuating pain and functional disability. Similar to low back. Right. When somebody has an initial injury, it's very likely that going to come on episodically for years to come. And that's where we see the power of maintenance care is that we've, they've shown that maintenance chiropractic care has the opportunity to not only pull down the intensity when the bouts of pain hit, but that they also have the opportunity to push out the time between bouts. So longer time between bouts of pain, all super important stuff. So what are some of the take home messages? What are some of the quotes from this study? What are. Let's take a look at them. The researchers found, quote, as many as 83% of individuals involved in traffic collisions suffer from whiplash injuries. So overwhelming majority is definitely something you want to keep an eye out for in your practice. Restricted motion pain, obviously if they have radicular symptomatology, all of these things are very, very important to keep in mind. And imaging can play a key role. Pain and trauma are, are indications. Usually everybody's different, but usually pain and trauma are a good indication for imaging. So keeping an eye at what's going on in the imaging world, also critically important. And I'm going to put this back to the context of if this is not taken care of appropriately and in the best manner possible. Right close. Right at the time of acute injury, this can become chronic by nature. And we know that chronic spine pain can lead to a variety of disastrous consequences for a ton of people. Opioids, surgical intervention, potentially multitudes of surgeries. And as a quick aside, we recently saw that 2019, all of the opioid crisis heat that had been placed upon the medical industry for the last couple years. And we saw sort of diminishing deaths due to opioids. All of it wiped out. We saw 2019 was the largest amount of individuals who died due to opioids that's ever been tracked. And over 50% of those stemmed from fentanyl and synthetic opioids, most of those for people who are trying to treat chronic pain. So this is a real, real issue. A couple other quotes from this study. A significant proportion of patients with whiplash associated disorder develop persistent or recurrent neck pain. Specifically, more than 50% of patients report neck pain one year after their injury. Over half of people report neck pain after one year. That means we need to do, I'm gonna say all of us, I'm gonna say a better job evaluating, diagnosing, taking care of these injuries to limit that as much as possible. And finally, the researchers found, our analysis provides the public, clinicians and insurers with evidence that a past neck injury in a motor vehicle collision may have a significant role in the development of future episodes of pain and disability. That is a powerful statement. I don't think insurers are going to pay attention to much anytime soon because historically we see they don't pay attention to anything except their bottom line. But the public and the clinicians, you know, that is, that's what we refer to, I guess in some ways as the sacred trust. Right. It's what the care that you're providing. But more importantly, it all centers around what's going on with that individual that drove them into your practice. So understanding that neck injuries in previous motor vehicle accidents can have a significant role is super, super important for you and for your patients. I'm gonna flip this telescope around, so to speak, and look down the other end and say it's also important when you have patients that come in that maybe say, well, I'm coming in because of X, Y or Z, that's not related to a motor vehicle accident right now to in their past history. Make sure you're getting that information. Hey, have you ever been involved in motor vehicle accident? Oh, I was involved in a rollover. Nothing? No. Well, are you sure? Well, I did have that rollover when I was 16 years old. Okay, well, that's something that we need to be in tune with now. Future studies are gonna help showcase to us. Exactly. And we'll go through some of these studies over the next few weeks and months here on this podcast. But what is the best evidence based, clinically informed way to take care of these individuals? That's the next step. Right? But step number one is identifying the fact that whiplash happens to an overwhelming majority of individuals that suffer a car accident. The second portion of that is understanding that over 50% of those individuals ultimately are going to have continued neck pain one year after that collision. Those are really important facts because now we get down to taking it really seriously when somebody comes in, really doing the best job that we can as healthcare providers and clinicians, understanding what's going on, understanding the mechanisms of injury. Were they seated in the front seat of the vehicle, the back seat of the individual vehicle, Were they looking left, straight ahead or right? Because there's also research that showcases it. When individuals are looking one direction, left or right, and there's a whiplash, there's additional force that's sheared into the cervical spine that can create additional challenges. All of this very, very important. And when we talk about ligament injury, a lot of times it goes into the cervical instability realm. Aoms the alteration of motion, segment integrity. All true and all important. But I want you to keep in mind as a conservative care provider, that every time that there is cervical instability, it doesn't mean that that there is surgical cervical instability. Right? We see 5 millimeters or more of translation in the cervical spine is a clinically unstable spine that is going to warrant for sure the potential for surgical intervention. But the threshold levels for what's deemed alteration of motion, segment integrity, or deemed cervical instability could play down to 2.5 to 3 millimeters of motion. So really important as you go through your examination, as you go through your imaging studies and as you diagnose things, that you do it in the best manner possible and in the most complete manner possible. Because that moment of time may just may affect that patient for decades, for the rest of their life, for decades to come. When we see that there's an association between a lifetime history of neck injury with a motor vehicle accident, and again, this study focused on the motor vehicle collision. But I'm gonna say anytime that you're analyzing and checking out whiplash in your pract and if you have a sports related practice, I'm telling you, you're going to see a lot of whiplash injuries. We don't think of them as classic whiplash because it wasn't a motor vehicle collision. But man, you start dealing with high impact sports, you are going to see whiplash injuries time and time again. You're going to see concussions, mild traumatic brain injury, all of those things time and time again. So keep an eye out for it. A lot of times I think we become so myopically focused on rehab, getting the patient back in, really doing great clinical work. But sometimes, sometimes that comes at the expense of really diving into the documentation and diving into the diagnosis portion on the front in the most robust and accurate way. And that can be critically important for patients down the road just to reemphasize that. So if you have any questions about this whatsoever, feel free to shoot me an email. Jeff the evidencebasedchiropractor.com Additionally, I have had for years doctors be asking about, you know, research tools, marketing to be able to improve their personal injury side of their practice. So keep an eye out. I'm gonna have some personal injury tools coming out soon to help. I'm involved in a spinal imaging company down here in and around the floor, Tampa, Florida and beyond for that matter. We do a lot of studies with this. We have talked to hundreds of attorneys and it's sort of a niche area of opportunity that I haven't talked about a lot. But I want to explore more within the evidence based chiropractor as time goes on. So if you have any interest in what we're going to be putting out in the personal injury space, you can shoot me an email. Jeffenousbasedchiropractor.com I'll give you an early look. Leave us rating or review on this show. I would love it if we could get to 175 reviews and ratings on itunes. And believe me, I look at the stats, I know we have thousands and thousands of listeners each and every week. Thank you for tuning in. Thank you for listening and if 1% of you go and leave rating or review, we will hit our goal which would be super awesome. Make it a great week in practice. Take care, stay safe and I'll talk to you soon.

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