Whiplash Injuries: How Chiropractic Can Help with Recovery | Podcast Ep. 204

Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. This week we are talking about car accidents and chiropractic. Even if you do not have a personal injury focused practice, there's no question people in your office are going to get into a car accident at some point in time. At least somebody so understanding some basic behind it, some of the stats and what's out there in the literature super important to taking care of those people at the highest level possible. That's what we'll start to break down on today's episode. Additionally, I want to thank everybody who did come out to last week's happy hour meet and greet in SoCal. That was a ton of fun. Appreciate it and keep your ears open for more of them coming soon. As I said at the top, this week we are talking all about car accidents. So so my question to you to start is do you know how many car accidents happen each year in the U.S. drum roll please. The answer is over 6 million. 6 million car accidents per year. And quite frankly, whether you are the bullet vehicle, AKA the one that is causing the accident so to speak, or whether you are the target vehicle, forces displaced through automobile accidents are significant. So even low impact collisions and can cause pain and dysfunction. I think the days of oh it's just a whiplash injury are thankfully going by the wayside, especially in light of the new research that we're seeing. Right. So in a traditional case when a whiplash injury occurs, a car is rear ended, the neck gets thrown backward at the impact, rebounds by flexing forward so you have a true flexion extension injury. This these types of injuries, a whiplash type injury is estimated to occur in over 25% of auto accidents. Furthermore, if the head is turned left or right, there is an increased prevalence or likelihood of injury. So important questions to be asking on your intake forms for your individuals who have been in car accidents. What's more staggering is over 38% of people with chronic neck pain believe it began at some point with a car accident. So this is really, really staggering. You know, over a quarter starting to approach 50% of people with chronic neck pain believe it began with a car accident. So that tells me that a lot of these individuals probably were not given the best treatment options at the time of the accident and therefore their body healed in the best way it knew how. It healed with adhesions, it healed with scar tissue, there was potential ligament damage, there could have been facet capsule issues going on, all of which probably were unaddressed because it was just a quote unquote, simple whiplash case. What we continue to see in the literature again is that automobiles are big, they weigh a lot and they move really fast, and our bodies are a lot smaller and they're moving at the same speed as the automobile. Right. So whether you are again the target vehicle or the bullet vehicle, there can be a substantial amount of stress placed in the cervical spine, specifically in the disc, but our discs are very tough. So what ends up happening quite often is that the facet capsule and the ligaments supporting the vertebral segment undergo the most stress, strain and or damage. And we can see this coming to fruition with nearly 38% of individuals saying that they believe their chronic neck pain began with a car accident. So it's pretty, pretty staggering. So we look at the numbers as we break that down one step farther. There's estimated to be up to 2 million whiplash injuries, many of these occurring from low impact collisions per year. So let's just break down some of the pathophysiology of that and then we'll talk about potential diagnostics and ways you can go about taking care of it in the best manner possible. So first, when we look at an injury, if it occurs right, a flexion extension injury, a whiplash injury type injury occurs, we can expect that the facet capsule could potentially be damaged. The ligaments supporting that facet capsule, and certainly the ligaments supporting the vertebral segments, anterior and posterior longitudinal ligaments, how do those heal? Well, in the case of no treatment, they're very likely going to heal with adhesions, they're very likely going to heal with scar tissue. They're very likely going to inevitably heal with restricted range of motion and potentially depending upon the end plates, potentially with bone spurring throughout time. Advanced degenerative changes occur in areas of acute trauma. So we've seen that time and time again in the literature. So sometimes I get the question from docs saying, well, getting in there, if an area, let's say, is hyper mobile, the ligament's been disrupted or damaged, how does getting in there with a high velocity adjustment make sense? Aren't you putting even more mobility into it and potentially have the opportunity to damage it even farther? Well, there's always that potential opportunity if you were to overdo it. This is why, in my opinion, the best treatment ultimately is mobilization and or manipulation over time with these type of cases. Because left untreated, if you don't continue to establish a very fair and a very good range of Motion, inevitably, you're gonna heal. With all of the restricted range of motion issues and, and the scar tissue issues, however, you can minimize. In what I've seen, again, the literature is a little sparse on this, but what I've seen at least anecdotally and teased in the literature, is the fact that if you are able to encourage, support decreasing inflammation, if you're able to encourage and support an adequate and proper range of motion through mobilization and manipulation, you give yourself the best opportunity to minimize the amount of scar tissue that's laid down, you minimize the adhesions, and, and ultimately, probably over the course of decades, you minimize the advanced degenerative changes that could occur based upon the acute trauma to the area. So that got a little bit technical there, but the gist of it is, is that getting the accurate care, getting the best care for a whiplash type injury as early as possible is very, very important. And going hand in hand with that, ultimately are the extremities as well. So. So what we've seen is that after a whiplash injury, nearly one quarter of individuals who have a whiplash injury also suffer a shoulder injury within the same incident or accident. So important to keep in mind. Again, I think it's important regardless of whether the patient is a personal injury patient or whether they are just coming in on cash insurance. To me, that doesn't matter. It's always important to look at least one body region away. So if you have a cervical spine issue, be sure to check out the shoulders. If the person has a shoulder issue, be sure to check out the elbow. If they have a lumbar spine issue, be sure to check out the hips and pelvis. If they have a hip or pelvis issue check, be sure that you are checking the next adjacent joint. Because a lot of times, not only can there be potential for additional injury in those locations, but clearly there can be compensations if time has gone by and passed. So I know for a lot of docs out there, if we take the next step and talk about really objective proof of injury, how do you see these things? Flexion extension X ray to date has been probably one of the most heavily utilized tools, right? Flexion extension films, typically taken on the first day and then an MRI might happen somewhere between two to eight weeks after the injury occurred. But what we see lately, in an area that I have a lot of interest in, is with vertebral motion analysis. So vertebral motion analysis is not digital motion X ray by any stretch of the imagination. What it is, it's Really a surgical tool. So vertebral motion analysis was developed originally as a surgical tool to determine if the surgeon should do a fusion or a decompression procedure. So it's a very, very highly specific, reliable and valid tool, peer reviewed that showcases transvertebral translation, angulation and disc height and all of it is measured to a tenth of a millimeter. So there is nothing on the planet currently that is more objective, that is more accurate, that's more specific or more reliable than vertebral motion analysis. Super, super important part of the puzzle. I'm gonna drop a link in the show notes to it's actually a company that I'm involved in. Full disclosure, AOMZ Diagnostics, where we've seen a lot of success in the personal injury space using vertebral motion analysis. I don't think I've ever talked about it on the podcast before or through the evidence based chiropractor, but advanced spinal imaging, functional weight bearing imaging post injury is an area that I think there is a massive amount of opportunity in because the bottom line is flexion extension films. What the research shows us is 30% of the time there's a false negative that's absolutely staggering. If you think about one third of the individuals you see that shoot flexion extension films on probably have an area of concern or injury that's not picked up on that flexion extension film and that's because it's uncontrolled. There's a lot of factors that we won't get into on today's episode. But the bottom line is vertebral motion analysis eliminates a vast majority of those fact factors. It comes from the surgical world, it's peer reviewed, it's validated and it can be a great, great tool to utilize for objective proof of injury in your practice and ultimately to get the patient the best information and the most accurate diagnosis of what's going on. But the gist of it is whiplash is a big issue. Taking care of these issues and injuries early on is super important and from a kinematic perspective, really keep an eye on facet mediated pain. That is an area that I think is, it's just a highly injured area, specifically in the cervical spine. Looking at that C4, 5, C5, C6 level, very, very important from a facet capability. Additionally, your all and pll, your anterior and posterior longitudinal ligaments really keep a keen eye on the translation at those levels because small disruption to those ligaments can increase the amount of motion you want to be aware of that, you want to document that. And then you want to pick and choose the best way to help get your patients on the road to recovery, help get them back to 100%. In my opinion, there's probably nothing better than chiropractic care to do that. But that doesn't mean that we get the easy street. It means you still need to document well. It means you need to do a proper evaluation and complete evaluation. And it also means you need to make sure you pick the correct modalities at the right time to do so. So bottom line is low impact collisions can cause injury. Six million auto accidents happen each and every year. Nearly 2 million have whiplash injuries. Nearly a quarter of those have shoulder injuries with them. Those are the take home stats that you can bring, implement and utilize in your practice. Additionally, this is material in the Smart Chiropractor. October has been, excuse me, November has been all about car accidents. So if you've been wanting to get out there and really build the personal injury portion of your practice, then visit the smartchiropractor.com right now. Hop on board so you can have all of November to get our car accident whiplash all of that material out to your community. Super, super important from a relationship building standpoint. And hey, if you're interested in advanced imaging technology and you want to really dive into some research, you can check out aomzdiagnostics.com I'll drop a link for that as well and hope you have a great week in practice and I will talk to you soon.

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