SEVERE MOTOR VEHICLE ACCIDENT LEAVES PATIENT IN CHRONIC PAIN
OPTIONS & POTENTIAL SOLUTIONS
A patient I'll call "Brenda" sent me the following history in response to a recent post on CHRONIC LOW BACK PAIN. I told her I would answer her publicly so that everyone could read, since what she is dealing with is extremely common (I do this ON OCCASION). Scenarios like Brenda's are not only dog common, but have the potential to take a person who has worked hard to be active, fit, and healthy, and destroy their life. Thus, the biggest question on the table is whether there is anything Brenda can do at this point to potentially help her cause? I guess another way of putting it might be, what would I do if I were in a similar situation? My responses are in between her paragraphs.
"I was in a car accident just short of 2 years ago and I'm still getting treated. I was hit by someone who ran a red light traveling at least 55mph while I was stationary. I was hit on the front passenger side of my vehicle. The whiplash I incurred went sideways. My accident happened on a Sunday, I was sore afterwards, but on the following Wednesday I woke up in pain from head to toe."
The first thing I want you to understand is that every study that comes out, shows that healing takes longer than the study that came out before it. Although insurance companies love to tell their insured that "research says" healing of soft tissues takes no more than 4-6 weeks, this is patently untrue as seen in the latter part of THIS LINK. Although the FIBROSIS (the medical word for SCAR TISSUE) is laid down in that amount of time, your body must remodel said tissue into something functional, which takes much longer --- current research says as long as two years or more. Furthermore, Brenda has at least two of the biggest factors that potentially make WHIPLASH INJURIES worse working against her --- she's female and her impact was from the side as opposed to coming from either the front or the back (both found HERE). On top of everything else, having pain show up days or even weeks after the accident is not at all an uncommon phenomenon (HERE).
"I suffered from daily migraines, blurred vision, sensitivity to light, could not sit, stand or lay comfortably. My whole body felt like I was plugged into an electrical outlet. The immediate care doctor I saw the day after my accident prescribed muscle relaxants and ibuprofen. By Friday I was at my doctors office. He is an integrative medicine doctor, therefore no more muscle relaxants, no pain meds prescribed. As much as I laid wishing I had them, I'm grateful I did not. The amount of pain I was in I'm sure I would have become addicted. I saw a chiropractor 3 times a week for 3.5 months with a 1/2 hour massage once a week. My eyebrows were so tight on my face you couldn't pull them away. I was told the muscles in my back were like ropes with knots underneath. I have bulging discs from T4-5 to T10 and broad base to moderate disc bulges in my lumbar/sac."
The first sentence tells me that you had a MTBI / TBI, as all symptoms you list --- including MIGRAINES --- are well known sequelae of such. It is extremely common for people who are in these sorts of accidents become heat-intolerant as well. Typical pharmacological fare for these sorts of injuries includes THE BIG FIVE (with the ANTI-DEPRESSANTS usually coming a bit later). In the acute part of the injury, you'll need lots of care, including massage. As for your "tight eyebrows," make sure you look at my articles on FACIAL FASCIA. As for the discs, some of these may or may not be a source of your pain. And as to the argument that they were pre-existing (invariably this is what the insurance company will say), how can this be proven one way or another without a previous MRI? Even if these disc injuries were pre-existing, the accident took a stable situation (HERE) and destabilized it (HERE).
"Still to this day my legs still buzz. I can feel it in the back of my upper legs and then it encompasses both lower legs from the knee to my toes with my left side worse. Sometimes I also have tingling on the back of my left arm and into my last 2 fingers. I also have issues with my left knee that comes from my tight hip flexors. After seeing the chiropractor for so long and eventually being told, "I can't fix you (and it's not because he didn't give it 125%) I saw a myofascial release therapist. I finally starting getting some relief. The treatments were painful; I screamed at times, had tears from the pain but the next day I felt relief."
Let me take this time to address your low back pain. Many insurance companies will tell you that low back pain after motor vehicle accidents is rare. Hogwash! According to any number of studies (not to mention notes from Dr. Dan Murphy's 24 hr Whiplash Seminar), it's the third leading symptom of these sorts of accidents, just behind NECK PAIN and HEADACHES. Also, RADICULAR PAIN and SCIATICA can take on many forms, often leading to paresthesias ("abnormal nerve sensations"). As for the tight HIP FLEXORS, adjustments, while extremely important, don't, in and of themselves, have the ability to solve this or any of the other major "SOFT TISSUE" components of the injury. The soft tissue parts of the injury will almost always require some sort of bodywork.
When it comes to bodywork, there are two different kinds. There is what I call rub-a-dub, which is the feel-good stuff you can get at the spa to help you relax. This is great for people not experiencing any majorly painful problems. However, as I have talked about previously (HERE, HERE, HERE, and HERE), bodywork often needs to be harsh, because if it's not, the threshold for breaking the adhesed fascia is not being met. Thus, sub-threshold treatment is not breaking down the Fibrosis / Scar Tissue, which is why I sometimes say of this sort of treatment, 'a whole lot of nothing is still nothing' (see links).
"I tried working for the 1st three months after my accident, but sitting all day (and trying to learn a new job), I eventually had to go on Medical Leave for six months, or risk losing my job due to call offs. Since I had no pain meds prescribed, I would take 3 ibuprofen upon waking, then 2 extra strength Tylenol at noon, followed by 3 more ibuprofen early evening and then 2 Tylenol pm's to fall asleep. I did this for 9 months, before I said enough."
In many cases, especially cases where you are able to constantly move around without having to do heavy or repetitive jobs (especially on CONCRETE), the best thing you can do is go back to work. However, so many jobs require people to spend their days hunched over a desk or computer screen (or an assembly line) that it creates it's own set of problems (CHRONIC TRUNK FLEXION and FORWARD HEAD POSTURE). And as for the TYLENOL and NSAIDS (Ibuprofen), clicking on the links reveals their own unique sets of associated problems, many of which can be deadly or at least debilitating.
"The myofascial release was helping until insurance said no more visits. What do they know? And how could they judge me and my condition sitting at desk wherever they are? I eventually ended up back with my myofascial therapist a few months later for another 12 visits they OK'd. Once again, I was getting better, then insurance stopped it. I tried going back to the activities I enjoyed prior to my accident. Aquatic exercises. Tried riding my bike, and would have mid back spasms later in the day. I have a horse and have enjoyed riding for 45 years. I got back to the barn again to enjoy everything that comes with caring for a horse, mucking stall, brushing, riding and once again back spasms and soreness. I love hiking/walking. I'm a photographer."
What do they know? Insurance is evil. In our society it's a necessary evil, but an evil nonetheless, whether run by private enterprise or our government (a government that has proved time and time again that they are incapable of most of what they are charged with --- HERE for instance). Sounds like there was a huge amount of ADHESED FASCIA created by this accident. This is a good time to mention that as unfortunate as it is, a significant number of those injured in MVA's (some studies actually say as great as 25%) never fully recover, being left to deal with varying degrees of CHRONIC (TYPE III) PAIN. My goal is always to keep my patients from falling over that precipice into the pit of despair.
"I now felt as if my ovaries hurt, my left knee was bothering me, I would get up all stiff and sore and limp for several steps. I saw my PCP and asked him should my ovaries hurt if I'm in menopause? My left knee is bothering me too and I still have the buzz in my legs. He has me get up on the table and raises my legs up and down. The left leg was turned "on" I experienced a large electrical current throughout my whole leg with buzzing, pins & needles and tingling all the way to my big toe. He said you might have piriformis syndrome. That leg raise must of woke up a nerve somewhere. Within a couple of days I experienced daily headaches again, culminating into a migraine, my knee hurt worse and the buzzing was worse. I ended up seeing a different chiropractor that specializes in Active Release Technique (ART). It's working and I'm getting a full body deep tissue massage weekly. I'm feeling better but still have the same issues."
Depending on how much nerve irritation you have (PIRIFORMIS SYNDROME can certainly be a factor), this could not only cause the radicular symptoms, but the abdominal pain as well since nerves from your LOW BACK control your sex organs (HERE). Also be aware that right along with the hip flexor issue, it's not uncommon to end up with FASCIAL ADHESIONS of the lower abdomen (HERE). By the way, ART is fantastic stuff for lots and lots of people.
"The buzzing in the legs to my toes is still here but my knee does feel better most of the time. Forgot to mention along with the knee pain I was also experiencing plantar fasciatis too. My chiro thinks I should get an EMG. I go to a 3rd neurologist and he tells me he thinks my issues go deeper than any of the medical equipment locally could read and suggests I try a university setting. Do I need a referral? No; well yes I do, or insurance will not pay. Three weeks later I'm still waiting on the referral."
Your neurologist is probably a fantastic individual. He / she is also likely leading you on about your local university having "special" equipment that is going to show this problem. Unfortunately, the most abundant, pain-sensitive, and commonly injured tissue in the body does not show up with standard imaging, including MRI (HERE). And as for an EMG providing an "ah ha" moment.... Not to be a party-pooper, but after 25 years of practice, I would go "all in" betting against it. As far as a neurologist is concerned, because you are so close to Chicago, you should have no problem finding a Functional Neurologist trained by DR. TED CARRICK to at least evaluate you. DR. JAY ROHLEDER is in your state and I would consider him to be tops in his field. I've sent patients to him with great results, and know him personally as he was the Valedictorian of our chiropractic class of 1991. Great guy; great doctor.
"The last couple of my massage visits she could feel my knots or lumps whatever you call them. She tried working them out, and it was painful. My right side of my back still has the stringy rope going down it and I could feel it all the way into my elbow. The lump of tissue on the left side of thoracic is still here 2 years later and is very stubborn. I would really like to get to the root of these problems, I don't want a doctor to tell me 10 years from now, that you should have done this or that. Is there any hope for me? By chance do you have any insight on what I should do next? I'm going to be 57 in a couple of months, prior to my MVA I was very active, limber, felt as if I could do anything I wanted. I wanted to go into my senior life with a younger body. You know the saying "move it or lose it"."
The knots you are referring to Brenda are called TRIGGER POINTS and are miserable by anyone's definition. I commend you for wanting to get to the root of the situation. However, it can be tough to do --- even if you know exactly what's wrong. Which brings me to the next part of this post; what would I do if I were in your shoes?
Firstly, because head injuries are associated with crazy things like LEAKY BRAIN SYNDROME, INFLAMMATION, and autoimmunity (HERE), I would take a long hard look at doing an ELIMINATION DIET, which I think is far more accurate than any sort of sensitivity testing. Secondly, a middle-of-the-road WBV MACHINE might prove invaluable as far as a way to both exercise and stretch (it actually provides exercise to your brain). Thirdly, because the cost of virtually all technology continues to plummet, a LASER for home use might prove invaluable for you. Otherwise, I would read THIS POST (as well as looking at the links I provided for you today). Certainly, not everything I've included is going to pertain to you, but some of it will. If you can possibly find a hidden source of inflammation, it could prove highly beneficial as far as getting to that "root cause" of your problem.
"I was in a car accident just short of 2 years ago and I'm still getting treated. I was hit by someone who ran a red light traveling at least 55mph while I was stationary. I was hit on the front passenger side of my vehicle. The whiplash I incurred went sideways. My accident happened on a Sunday, I was sore afterwards, but on the following Wednesday I woke up in pain from head to toe."
The first thing I want you to understand is that every study that comes out, shows that healing takes longer than the study that came out before it. Although insurance companies love to tell their insured that "research says" healing of soft tissues takes no more than 4-6 weeks, this is patently untrue as seen in the latter part of THIS LINK. Although the FIBROSIS (the medical word for SCAR TISSUE) is laid down in that amount of time, your body must remodel said tissue into something functional, which takes much longer --- current research says as long as two years or more. Furthermore, Brenda has at least two of the biggest factors that potentially make WHIPLASH INJURIES worse working against her --- she's female and her impact was from the side as opposed to coming from either the front or the back (both found HERE). On top of everything else, having pain show up days or even weeks after the accident is not at all an uncommon phenomenon (HERE).
"I suffered from daily migraines, blurred vision, sensitivity to light, could not sit, stand or lay comfortably. My whole body felt like I was plugged into an electrical outlet. The immediate care doctor I saw the day after my accident prescribed muscle relaxants and ibuprofen. By Friday I was at my doctors office. He is an integrative medicine doctor, therefore no more muscle relaxants, no pain meds prescribed. As much as I laid wishing I had them, I'm grateful I did not. The amount of pain I was in I'm sure I would have become addicted. I saw a chiropractor 3 times a week for 3.5 months with a 1/2 hour massage once a week. My eyebrows were so tight on my face you couldn't pull them away. I was told the muscles in my back were like ropes with knots underneath. I have bulging discs from T4-5 to T10 and broad base to moderate disc bulges in my lumbar/sac."
The first sentence tells me that you had a MTBI / TBI, as all symptoms you list --- including MIGRAINES --- are well known sequelae of such. It is extremely common for people who are in these sorts of accidents become heat-intolerant as well. Typical pharmacological fare for these sorts of injuries includes THE BIG FIVE (with the ANTI-DEPRESSANTS usually coming a bit later). In the acute part of the injury, you'll need lots of care, including massage. As for your "tight eyebrows," make sure you look at my articles on FACIAL FASCIA. As for the discs, some of these may or may not be a source of your pain. And as to the argument that they were pre-existing (invariably this is what the insurance company will say), how can this be proven one way or another without a previous MRI? Even if these disc injuries were pre-existing, the accident took a stable situation (HERE) and destabilized it (HERE).
"Still to this day my legs still buzz. I can feel it in the back of my upper legs and then it encompasses both lower legs from the knee to my toes with my left side worse. Sometimes I also have tingling on the back of my left arm and into my last 2 fingers. I also have issues with my left knee that comes from my tight hip flexors. After seeing the chiropractor for so long and eventually being told, "I can't fix you (and it's not because he didn't give it 125%) I saw a myofascial release therapist. I finally starting getting some relief. The treatments were painful; I screamed at times, had tears from the pain but the next day I felt relief."
Let me take this time to address your low back pain. Many insurance companies will tell you that low back pain after motor vehicle accidents is rare. Hogwash! According to any number of studies (not to mention notes from Dr. Dan Murphy's 24 hr Whiplash Seminar), it's the third leading symptom of these sorts of accidents, just behind NECK PAIN and HEADACHES. Also, RADICULAR PAIN and SCIATICA can take on many forms, often leading to paresthesias ("abnormal nerve sensations"). As for the tight HIP FLEXORS, adjustments, while extremely important, don't, in and of themselves, have the ability to solve this or any of the other major "SOFT TISSUE" components of the injury. The soft tissue parts of the injury will almost always require some sort of bodywork.
When it comes to bodywork, there are two different kinds. There is what I call rub-a-dub, which is the feel-good stuff you can get at the spa to help you relax. This is great for people not experiencing any majorly painful problems. However, as I have talked about previously (HERE, HERE, HERE, and HERE), bodywork often needs to be harsh, because if it's not, the threshold for breaking the adhesed fascia is not being met. Thus, sub-threshold treatment is not breaking down the Fibrosis / Scar Tissue, which is why I sometimes say of this sort of treatment, 'a whole lot of nothing is still nothing' (see links).
"I tried working for the 1st three months after my accident, but sitting all day (and trying to learn a new job), I eventually had to go on Medical Leave for six months, or risk losing my job due to call offs. Since I had no pain meds prescribed, I would take 3 ibuprofen upon waking, then 2 extra strength Tylenol at noon, followed by 3 more ibuprofen early evening and then 2 Tylenol pm's to fall asleep. I did this for 9 months, before I said enough."
In many cases, especially cases where you are able to constantly move around without having to do heavy or repetitive jobs (especially on CONCRETE), the best thing you can do is go back to work. However, so many jobs require people to spend their days hunched over a desk or computer screen (or an assembly line) that it creates it's own set of problems (CHRONIC TRUNK FLEXION and FORWARD HEAD POSTURE). And as for the TYLENOL and NSAIDS (Ibuprofen), clicking on the links reveals their own unique sets of associated problems, many of which can be deadly or at least debilitating.
"The myofascial release was helping until insurance said no more visits. What do they know? And how could they judge me and my condition sitting at desk wherever they are? I eventually ended up back with my myofascial therapist a few months later for another 12 visits they OK'd. Once again, I was getting better, then insurance stopped it. I tried going back to the activities I enjoyed prior to my accident. Aquatic exercises. Tried riding my bike, and would have mid back spasms later in the day. I have a horse and have enjoyed riding for 45 years. I got back to the barn again to enjoy everything that comes with caring for a horse, mucking stall, brushing, riding and once again back spasms and soreness. I love hiking/walking. I'm a photographer."
What do they know? Insurance is evil. In our society it's a necessary evil, but an evil nonetheless, whether run by private enterprise or our government (a government that has proved time and time again that they are incapable of most of what they are charged with --- HERE for instance). Sounds like there was a huge amount of ADHESED FASCIA created by this accident. This is a good time to mention that as unfortunate as it is, a significant number of those injured in MVA's (some studies actually say as great as 25%) never fully recover, being left to deal with varying degrees of CHRONIC (TYPE III) PAIN. My goal is always to keep my patients from falling over that precipice into the pit of despair.
"I now felt as if my ovaries hurt, my left knee was bothering me, I would get up all stiff and sore and limp for several steps. I saw my PCP and asked him should my ovaries hurt if I'm in menopause? My left knee is bothering me too and I still have the buzz in my legs. He has me get up on the table and raises my legs up and down. The left leg was turned "on" I experienced a large electrical current throughout my whole leg with buzzing, pins & needles and tingling all the way to my big toe. He said you might have piriformis syndrome. That leg raise must of woke up a nerve somewhere. Within a couple of days I experienced daily headaches again, culminating into a migraine, my knee hurt worse and the buzzing was worse. I ended up seeing a different chiropractor that specializes in Active Release Technique (ART). It's working and I'm getting a full body deep tissue massage weekly. I'm feeling better but still have the same issues."
Depending on how much nerve irritation you have (PIRIFORMIS SYNDROME can certainly be a factor), this could not only cause the radicular symptoms, but the abdominal pain as well since nerves from your LOW BACK control your sex organs (HERE). Also be aware that right along with the hip flexor issue, it's not uncommon to end up with FASCIAL ADHESIONS of the lower abdomen (HERE). By the way, ART is fantastic stuff for lots and lots of people.
"The buzzing in the legs to my toes is still here but my knee does feel better most of the time. Forgot to mention along with the knee pain I was also experiencing plantar fasciatis too. My chiro thinks I should get an EMG. I go to a 3rd neurologist and he tells me he thinks my issues go deeper than any of the medical equipment locally could read and suggests I try a university setting. Do I need a referral? No; well yes I do, or insurance will not pay. Three weeks later I'm still waiting on the referral."
Your neurologist is probably a fantastic individual. He / she is also likely leading you on about your local university having "special" equipment that is going to show this problem. Unfortunately, the most abundant, pain-sensitive, and commonly injured tissue in the body does not show up with standard imaging, including MRI (HERE). And as for an EMG providing an "ah ha" moment.... Not to be a party-pooper, but after 25 years of practice, I would go "all in" betting against it. As far as a neurologist is concerned, because you are so close to Chicago, you should have no problem finding a Functional Neurologist trained by DR. TED CARRICK to at least evaluate you. DR. JAY ROHLEDER is in your state and I would consider him to be tops in his field. I've sent patients to him with great results, and know him personally as he was the Valedictorian of our chiropractic class of 1991. Great guy; great doctor.
"The last couple of my massage visits she could feel my knots or lumps whatever you call them. She tried working them out, and it was painful. My right side of my back still has the stringy rope going down it and I could feel it all the way into my elbow. The lump of tissue on the left side of thoracic is still here 2 years later and is very stubborn. I would really like to get to the root of these problems, I don't want a doctor to tell me 10 years from now, that you should have done this or that. Is there any hope for me? By chance do you have any insight on what I should do next? I'm going to be 57 in a couple of months, prior to my MVA I was very active, limber, felt as if I could do anything I wanted. I wanted to go into my senior life with a younger body. You know the saying "move it or lose it"."
The knots you are referring to Brenda are called TRIGGER POINTS and are miserable by anyone's definition. I commend you for wanting to get to the root of the situation. However, it can be tough to do --- even if you know exactly what's wrong. Which brings me to the next part of this post; what would I do if I were in your shoes?
Firstly, because head injuries are associated with crazy things like LEAKY BRAIN SYNDROME, INFLAMMATION, and autoimmunity (HERE), I would take a long hard look at doing an ELIMINATION DIET, which I think is far more accurate than any sort of sensitivity testing. Secondly, a middle-of-the-road WBV MACHINE might prove invaluable as far as a way to both exercise and stretch (it actually provides exercise to your brain). Thirdly, because the cost of virtually all technology continues to plummet, a LASER for home use might prove invaluable for you. Otherwise, I would read THIS POST (as well as looking at the links I provided for you today). Certainly, not everything I've included is going to pertain to you, but some of it will. If you can possibly find a hidden source of inflammation, it could prove highly beneficial as far as getting to that "root cause" of your problem.
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