WHAT DOES THE LATEST RESEARCH ON NECK PAIN, HEADACHES, AND WHIPLASH REVEAL?
"Neck pain is the most common musculoskeletal pathology second only to low back pain. It is the fourth largest contributor to global disability with its prevalence ranging between 30 to 71% of the general population. Two thirds of adults are affected by neck pain at some time in their lives. Most people with neck pain do not experience a complete resolution of symptoms. Most guidelines related to mechanical neck pain are of poor quality.... Despite an increase in the evidence base, treatment recommendations have not changed significantly over time in their recommendations for interventions used to manage neck pain." From last month's issue of Biomed Central Musculoskeletal Disorders (Comparison of Clinical Practice Guidelines for the Diagnosis, Prognosis and Management of Non-Specific Neck Pain: A Systematic Review)
"Opioids appear to be over-prescribed." From last October's issue of Emergency Medicine Australasia (Use of and Attitudes to the Role of Medication for Acute Whiplash Injury: A Preliminary Survey of Emergency Department Doctors)
"The truth is that, among all diseases, headache is one of the hardest to diagnose and treat. It is, in fact a functional central nervous system disorder and no specific markers or organic alterations occur, except when headache is a symptom of another illness. Moreover, after trying several medical, paramedical, or all-but-medical approaches, most patients continue to suffer from their headache and, being often dissatisfied with the responses obtained, they try self-treatments and thus become pain-killer abusers.... This is even more true if we consider that while headaches can, indeed, be described, their description is hardly objective, and they therefore fall within the domain of subjectivity. The subjectivism of this pathology never fails to strike me. Patients describe their symptoms, but physicians can never verify them directly." CHERRY PICKED words from Dr. Gennaro Bussone a 'headache neurologist,' from this month's issue of Neurological Sciences (Clinical Issues of Headaches: A Personal View)
"Medication-overuse headache (MOH) is a common neurologic disorder with enormous disability and suffering and plays a significant role in the transformation from episodic to chronic headache disorders. Multiple terms have been used to describe MOH such as analgesic rebound headache, drug-induced headache or a medication-misuse headache. Patients with established primary headache disorders like migraine or tension-type headaches excessively overuse medication for their acute headache and inadvertently increase the frequency and intensity of their headache. In this manner, a vicious cycle of further drug consumption and increased headache frequency develops transforming the treatment for their headache to the actual cause of their disease (MOH)." From this month's issue of STAT Pearls (Medication-overuse Headache (MOH)
When looking at the quotes above, it seems that the more things change, the more they stay the same. Medical guidelines are, well, medical guidelines --- trust them at your own peril (HERE). There still are not standard medical tests that do a good job of actually "visualizing" what may be causing people's headaches, unless of course they are being caused by gross pathology such as a brain tumor or aneurysm. The most brutal assessment from the quotes above, however, is how common chronic headaches really are in the general population; affecting somewhere between one and two thirds of everyone.
With costs for managing CHRONIC PAIN (including headaches) continuing to soar on a parallel path with the 'we-just-can't-seem-to-get-a-handle-on-it' OPIOID CRISIS, what else can be done? To help answer that, today we are going to take a look at some of the latest research concerning CHRONIC HEADACHES, CHRONIC NECK PAIN, and WHIPLASH --- all of which are intimately related to the cervical spine.
In a study showing the power of PROPRIOCEPTION, this month's issue of Musculoskeletal Science & Practice (Gait Speed and Gait Asymmetry in Individuals with Chronic Idiopathic Neck Pain) revealed that, "Individuals with chronic idiopathic neck pain had slower gait speed in all walking conditions compared to controls. In preferred walking and walking at maximum speed conditions, gait was found to be asymmetric in individuals with chronic idiopathic neck pain." In other words, the neck cannot be separated from the rest of the body musculoskeletally. It's all one organism, connected by the nervous system (HERE) and fascia (HERE).
As you might guess, there are increasing numbers of studies linking headaches to both stress (SYMPATHETIC DOMINANCE) and Gut dysfunction. While a dysfunctional gut can take on many characteristics, they can essentially be broken down into two; THE LEAKY GUT and THE DYSBIOTIC GUT. Listen to next month's issue of Behavioral Pharmacology (Stress and the Gut Microbiota-Brain Axis). "Stress is a nonspecific response of the body to any demand imposed upon it, disrupting the body homoeostasis and manifested with symptoms such as anxiety, depression or even headache." It's why I've said repeatedly that if you want to restore HOMEOSTASIS, it all starts with GUT HEALTH, which usually takes us back to DIETARY FACTORS and ANTIBIOTIC USE / ABUSE (remember, however, that all drugs have gut-destroying antibiotic-like properties --- HERE).
Speaking of dietary factors; when I have patients with chronic headaches, one of the things I usually suggest trying first --- especially for the person who has seemingly tried 'everything' --- is an ELIMINATION DIET. This lets us see whether or not certain foods might be driving the underlying inflammation / immune system responses, which are frequent drivers of headaches. I've spoken in the past about a brain-destroying "PARKINSON'S-LIKE" phenomenon that ravages the lower brain (cerebellum) called CEREBELLAR ATAXIA. A study from this month's issue of the Journal of Oral & Facial Pain and Headache (Headache in Patients with Celiac Disease and Its Response to the Gluten-Free Diet) not only revealed that 6 of 10 CELIACS had abnormal cerebellar MRI's, but that 42% had chronic headaches related to consuming GLUTEN. The only way to avoid the "white matter lesions" of the brain that these authors talked about? The GLUTEN-FREE diet of course. Just be aware that Non-Celiac Gluten Sensitivity (NCGS) is multiple times more common and can be equally as severe as Celiac Disease, although it's not nearly as easy to test for using standard lab / blood tests.
Another study, this one from the same issue of the same journal (Headache in Patients with Celiac Disease and Its Response to the Gluten-Free Diet) looked at over 1,500 Celiacs with chronic headaches, describing them as mostly female (94%) with an average age of nearly 40.....
"Tension-type headache was the most prevalent headache type (52%), followed by migraine (48%). Of the included participants, 24% reported headache as the main symptom that resulted in the diagnosis of CD. Following initiation of a gluten-free diet, headache frequency and intensity improved significantly more in participants with migraine than tension-type headache. Compliance to the diet was higher among subjects with severe manifestations, and compliant individuals showed a 48% improvement in headache frequency. An association between food transgressions and headache was better recognized by migraineurs."
What this tells me is that not only are headaches a common sequalae of Celiac Disease, but that with Celiacs struggling with tension-type headaches there are more likely to be secondary factors at play --- probably mechanical factors like SUBLUXATION or ADHESED FASCIA. While these can and do play a frequent role in MIGRAINE HEADACHES, they are far more common in the tension headache sufferer. Another study --- this one from the current issue of Pain and Therapy (The Relationship Between Musculoskeletal Pain and Picky Eating: The Role of Negative Self-Labeling) showed that of the more than 4,600 adults looked at, "The prevalence of musculoskeletal pain in every region was seen as consistently higher in subjects who self-identified as picky eaters than those who were non-picky eaters." The number one painful association of picky eating was ---- neck pain.
The latest copy of the journal Pain Medicine (Ingrowth of Nociceptive Receptors into Diseased Cervical Intervertebral Disc Is Associated with Discogenic Neck Pain) described a model almost identical to what you see on my CHRONIC PAIN PAGE, although their model was used to describe deteriorating spinal discs in the neck. There is a buildup or ingrowth of inflammation-sensitive fibers into degenerating discs and soft tissues that can make them absurdly pain-sensitive (FAMED NEUROLOGIST, CHAN GUNN, described this phenomenon as causing a neuro-chemical reactivity that could potentially make these tissues over 1,000 times more pain-sensitive than normal). BTW, this testing was done via biopsy instead of MRI. What about MRI findings for these sorts of patients?
I've previously shown you how futile MRI can be in many --- maybe even the majority --- of lumbar disc cases. This is because study after study has shown that somewhere between half to three quarters of the adult population is walking around with MRI-visible disc herniations in their low backs, but have no idea because they do not hurt (HERE --- and the same thing is true of SHOULDERS AS WELL). Now we see that it's also true of necks. A study from January's issue of the Journal of Magnetic Resonance Imaging (Cervical Spine Findings on MRI in People with Neck Pain Compared with Pain-Free Controls: A Systematic Review and Meta-Analysis) looked at the findings of over 4,000 subjects from 32 studies, coming to these conclusions. Other than the fact that the cross-sectional area of a specific muscle --- rectus capitus posterior --- was smaller in people with chronic pain, "The remaining meta-analysis comparisons showed no group differences in MRI findings. Definitive conclusions cannot be drawn on the presence of MRI findings in individuals with whiplash-associated disorders or non-specific neck pain compared with pain-free controls."
When it comes to chronic whiplash-related neck pain, what are the chief factors that indicate that a poor outcome might be on the horizon? Next month's issue of the Clinical Journal of Pain (Precollision Medical Diagnoses Predict Chronic Neck Pain Following Acute Whiplash Trauma) answered that question after comparing 700 WHIPLASH PATIENTS to 3,600 controls. While I expected to see patients with a list of either AUTOIMMUNE or INFLAMMATORY diseases, what we saw instead was...
As far as treatment of neck pain and headache, whether caused by whiplash or not, numerous studies showed exercise and stretching programs to generally be at least somewhat effective, but not as much so as you would think. The same thing was true of massage, with a study from eight authors found in this month's issue of the Journal of Alternative and Complementary Medicine (Massage for Pain: An Evidence Map). After looking at 49 systemic reviews on the subject, the authors determined that "High quality reviews concluded that there was low strength of evidence of potential benefits of massage for labor, shoulder, neck, low back, cancer, arthritis, postoperative, delayed onset muscle soreness, and musculoskeletal pain." Does this tell us that massage doesn't work? Because the vast majority of those utilizing massage pay out-of-pocket for these services --- something they would not continue if it didn't work --- I would argue that there is something inherently wrong with the study; something I've been hollering about in my EVIDENCE-BASED MEDICINE COLUMN for a decade. BTW, the exact same thing has been said of both chiropractic and physical therapy, which I'll show you momentarily.
Speaking of the combination of adjustments and therapy, a study from last month's Journal of Physical Therapy Science (The Effect of Massage Technique plus Thoracic Manipulation versus Thoracic Manipulation on Pain and Neural Tension in Mechanical Neck Pain: A Randomized Controlled Trial) showed that even though "The exact pathology of mechanical neck pain has not yet been fully elucidated but it has been suggested that it relates to various pain-sensitive structures, including the muscles, ligaments, zygapophyseal joints, uncovertebral joints, intervertebral discs, and neural tissue, a significant reduction in resting neck pain was seen in the thoracic manipulation plus massage group, compared to that achieved using thoracic manipulation alone. The use of thoracic manipulation and massage is recommended to reduce resting neck pain and increase pain-free neural tissue extensibility." While it's certainly not massage, I could say the same thing about the TISSUE REMODELING we do in-house.
A French study from this month's issue of Frontiers in Psychiatry (Bright Light as a Personalized Precision Treatment of Mood Disorders) cemented some non-mainstream facts that I wrote about in my recent articles, OBESITY, LIGHT, LEPTIN RESISTANCE, AND THE BRILLIANT MADNESS OF JACK KRUSE and THE IMPORTANCE OF SUNSHINE BEYOND VITAMIN D. After mentioning headaches as a potential "transient, mild and rare" side effect, the authors revealed of bright light therapy.....
"Bright light therapy (BLT) has physiological effects by resynchronizing the biological clock (circadian system), enhancing alertness, increasing sleep pressure (homeostatasis), and acting on serotonin and other pathways. A growing body of evidence has been generated over the last decade about BLT evolving as an effective depression treatment not only to be used in seasonal affective disorder (SAD), but also in non-seasonal depression, with efficiency comparable to fluoxetine [Prozac], and possibly more robust in patients with bipolar disorders (BD). The antidepressant action of BLT is fast (within 1-week) and safe, with the need in BD to protect against manic switch with mood stabilizers."
I brought this up because the latest issue of Current Treatment Options in Neurology (Antidepressants for Preventive Treatment of Migraine) talked about using, just as the title stated, antidepressants, as a "preventative" for MIGRAINE HEADACHES. The authors prefaced this by revealing that (whisper whisper), "SSRIs including fluoxetine [Prozac] are not effective for most patients..." If not using ultra-common SSRI's, what are they using? SNRI's like amitriptyline / nortriptyline (Elavil / Pamelor and Aventyl) --- drugs with common nasty side effects). The authors prefaced their giddiness by letting readers know that "The side effect burden of antidepressants can be substantial. Patients should be particularly counseled about the possibility of a withdrawal effect from SNRIs." Remember that we've seen just how ineffective these drugs really are for solving depression (HERE) as well as their SEXUAL SIDE-EFFECTS. You need to be aware of this (HERE) because "Antidepressants are commonly used as migraine preventives."
But what happens when the medications, as is often the case, don't work? Worse yet, what if your medications were actually causing the very problem you were using them to solve (a common problem with depression --- HERE)? Although side-effects to all drugs are orders of magnitude greater than typically reported (HERE), when it comes to headaches, this particular phenomenon is so common that it has its own special name ---- medication overuse headaches or simply "rebound". How common are rebound headaches? Just days ago, Neurological Science (Epidemiology and Management of Medication-Overuse Headache in the General Population) answered that question by revealing that "Medication-overuse headache is a worldwide challenge as it affects 1-2% of the general population." What do these numbers tell us? 160 million people worldwide --- a number equivalent to about half the US population --- are dealing with rebound headaches. It also means that in my little town of 3,000 people, there are probably 60 people stuck in this vicious cycle.
A title of a study from this month's issue of Nature Reviews Neurology (Complete Withdrawal More Feasible and Effective than Restriction in Medication-Overuse Headache) said it all via it's title --- describing very same thing I promote for breaking sugar addictions (COLD TURKEY). A study from this month's issue of Frontiers in Neurology (Negative Short-Term Outcome of Detoxification Therapy in Chronic Migraine With Medication Overuse Headache: Role for Early Life Traumatic Experiences and Recent Stressful Events) tried to predict which people would succeed with a headache medicine "DETOX PROGRAM" and which would fail.
"Among the most popular and disabling neurological disorders, migraine is at the top of the list. In most sufferers, attacks recur episodically, even if in a small—but significant—portion of migraineurs the disease evolves into a chronic pattern, that is, chronic migraine (CM). Transition from episodic to CM often occurs in association with a progressive increase in the intake of acute medications, so that the large majority of patients with CM also fulfill criteria for Medication Overuse Headache (MOH). Data suggest that early life traumas and stressful events have a negative impact on the outcome of the detoxification program in subjects overusing acute medication for headache. The history of emotional childhood traumas is associated to the failure to cease overuse, whereas recent very serious life events are associated to the persistence of headache chronicity."
Last month's issue of Frontiers in Neurology (Features of Primary Chronic Headache in Children and Adolescents) stated, "Chronic migraine (CM), chronic tension-type headache (CTTH) and new daily persistent headache (NDPH) are classified as CPH. Chronic primary headaches (CPH) are a disabling disorder for children, adolescents, and adults, with a reported prevalence of 2% in adults and .78% in adolescents, while the prevalence rises up to 1.75% when including medication overuse headaches." Another study, this one from the February copy of Cephalgia (The Prevalence of Headache in German Pupils...) provided more detail of just how common and severe headaches are in the pediatric (under 18) population. So; what about treating children with headaches similar to adults with headaches as far as manual therapy is concerned?
This month's issue of BMC Complementary and Alternative Medicine asked the same question of manual therapy for children that they did pertaining children and massage we looked at earlier. After looking at 50 studies on using manual treatment to affect a wide variety of problems, including back pain, neck pain, and headaches, the authors concluded that "Moderate-positive overall assessment was found for 3 conditions: low back pain, pulled elbow, and premature infants. Unfavorable outcomes were found for 2 conditions: scoliosis and torticollis. All other condition's overall assessments were either inconclusive favorable or unclear. Adverse events were uncommonly reported." In other words, sometimes it works and sometimes it doesn't. The super cool thing, however, is the extremely low side effect profile --- an especially big deal after what we've read about the freaky side effect profiles of some of the most commonly used headache and neck pain medications.
"Classical Conditioning" was a phrase coined by Russian physiologist, Ivan Pavlov, back in the late 1800's. In his famous dog experiments he associated feeding time for his dogs with ringing a bell, discovering that even in the absence of food, tinkling his bell would cause the hounds to salivate profusely. Simply Psychology said this of the phenomenon as a form of treatment. "For classical conditioning to be effective, the conditioned stimulus should occur before the unconditioned stimulus, rather than after it, or during the same time. Thus, the conditioned stimulus acts as a type of signal or cue for the unconditioned stimulus." Why is "before" such a big deal when compared to "during or after" --- especially when it comes to headaches? This month's issue of Current Headache Reports (Pavlov’s Pain: The Effect of Classical Conditioning on Pain Perception and its Clinical Implications) explains....
"It has been known for decades that classical conditioning influences pain perception. We first review studies regarding how classical conditioning alters pain perception with an emphasis on two phenomena where conditioning increases pain sensitivity (i.e., conditioned hyperalgesia) or decreases it (i.e., conditioned hypoalgesia). Specifically, we critically examine empirical studies about conditioned hyperalgesia and conditioned hypoalgesia, explore reasons why conditioning leads to these two seemingly opposite phenomena, and discuss the neural mechanisms behind them. We then highlight how conditioning contributes to the development and maintenance of chronic pain, and present neuroscientific evidence for maladaptive aversive conditioning in chronic pain patients. Moreover, we propose a framework for understanding how to exploit conditioning to optimize pain treatment, including minimizing conditioned hyperalgesia, maximizing conditioned hypoalgesia, and eliminating excessive fear and overgeneralization in chronic pain."
I was not going to pay $40 to look at the whole study, but suffice it to say that "conditioning" may be driving your headaches and pain as opposed to being used as a tool against. What are some of the things that we know can adversely condition people's pain levels beyond stress and inflammatory diets? Our national addiction to media (social media, porn, cell phones, computers, TV, etc, etc) has been in the news lately and is proving to be a HUGE PROBLEM in this arena, most particularly for children. It's why I talk on my site so much about getting your mind right. After all, one of King Solomon's proverbs (23:7) tells us that "as a man thinketh in his heart, so is he."
To see our complete (nothing is ever really "complete") ANTI-INFLAMMATION / RESOLUTION PROTOCOL for getting out of pain and starting the process of taking your life back, just click the link. While not everything there will pertain to everyone, there are some great tidbits to be gleaned and digested. And if you appreciate our site, be sure and spread the wealth by liking, sharing, or following on FACEBOOK as it's still a nice way to reach the people you love and value most!
FOUR-PLUS DECADES OF WHIPLASH PAIN SOLVED IN A SINGLE VISIT -- FIVE YEARS AGO
Carolyn is one of those upbeat people you can't help but like --- a go-getter's go-getter. So when she started dealing with progressive hip pain that I was unable to help, I was eager to see if there was some way I could provide her with some guidance. Having recently been to a hip specialist who ran some tests and told that her hips were "bad," I suggested that thirty years of research has repeatedly shown that these so-called 'bad' joints may not matter as much as we've all been conditioned to believe (HERE). I urged her to try a GRAIN-FREE, NO SUGAR / PROCESSED CARB approach; something along the lines of PALEO or KETO after first doing an ELIMINATION DIET.
I saw her yesterday and to say she was excited was possibly as big an understatement as her telling me that for much of her life she was "surrounded by testosterone" (she has six sons and no daughters). Just like I have seen hundreds of times before; despite the fact that her hips are quite degenerative and may (emphasis on may) someday need to be replaced, the dietary changes she's made have already REDUCED HER SYSTEMIC INFLAMMATION to a crawl. In other words, she's feeling great (and can immediately tell the difference if she cheats).
Although tissue remodeling was not able to help her with her hips (I had doubts from the beginning), she reminded me of something I had forgotten about ---- the treatment I did on her neck and upper back. Carolyn had been in a WHIPLASH ACCIDENT when she was 18 years old, and had dealt with periods of CHRONIC NECK PAIN ever since, getting much worse once she hit her early thirties. And while chiropractic adjustments were the one thing she could count on to make a positive difference, the pain and HEADACHES always came back in the same place and the same way --- an EXCEEDINGLY COMMON PHENOMENON (or HERE). The video below was shot yesterday regarding the treatment I did about four and a half years ago (Sept of 2014).
For the record, a quick look at our VIDEO TESTIMONIALS (including THIS CRAZY POST ON CHRONIC NECK PAIN) shows that immediate long-term improvements, while certainly not a guarantee, are fairly common in my clinic. Very cool video Carolyn; Thanks and God bless!
If you are one of the multitudes of people struggling with some sort of CHRONIC PAIN issue, I would suggest you take a look at THIS SELF-HELP (MOSTLY DIY) POST. No; it unfortunately won't hold the solution for everyone --- I get that. But, if you can reduce your body's systemic inflammatory load, THE SKY REALLY IS THE LIMIT! Also, if you appreciate the work we are doing here (not to mention the mountains of useful and completely free information I provide you in each and every post), be sure and spread the wealth by liking, sharing, or following on FACEBOOK since it's still as good a way as any to reach the people you love and care about most.
WHAT'S NEW IN THE FIELD OF WHIPLASH,
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Besides seeing her shortly after her original accident 24 years ago, I saw Gretchen two years ago in January for TISSUE REMODELING, and had not seen her since (I originally treated her THORACO-LUMBAR SPINE and HIP AND BUTTOCK AREA). She returned yesterday for treatment of her neck & upper back (I also did a little bit of work on her low
While FASCIAL ADHESIONS are certainly not the only cause of pain that doctors sometimes cannot get a handle on, it is certainly a substantial one. For those of you coping with chronic pain, chronic sickness, or a chronic inability to do the things you love, I have a NIFTY LITTLE PROTOCOL that might help get you back on track. It's certainly not a solution for everyone or everything, but at least take a moment or two to glance at it, as it might prove to be a game-changer for you or a loved one (and best of all, it's completely free).
CHRONIC NECK PAIN
WHAT DOES THE JANUARY 2018
SCIENTIFIC LITERATURE SAY?
- WHAT'S IT LIKE TO LIVE WITH CHRONIC WHIPLASH (WAD)? A month ago, researchers for BMC Musculoskeletal Disorders (Living with Ongoing Whiplash Associated Disorders: A Qualitative Study of Individual Perceptions and Experiences) talked about what it's like to live with chronic whiplash. "Whiplash associated disorders (WAD) are the most common non-hospitalized injury resulting from a motor vehicle crash. Over the past few decades, recovery rates have remained unchanged with approximately 50% of individuals experiencing on-going pain and disability. Results from intervention trials for individuals with chronic WAD are equivocal and optimal treatment continues to be a challenge. ll participants described navigating the healthcare system after their whiplash injury to help understand their injury and interpret therapeutic recommendations. Participants highlighted the need to find the right healthcare practitioner to help with this process. Many participants also described additional complexities in navigating and understanding healthcare incurred by interactions with compensation and funding systems. Participants in this study had been living with WAD for an average of 6.5 years and continued to find it challenging and exhausting." It's called the MEDICAL MERRY-GO-ROUND folks, and unfortunately, it's dog common to watch people going round and round until it literally destroys them. One of the situations that these authors spoke of was the reluctance of doctors to believe these patients, instead, seeing it as a ploy for a legal / financial settlement, or getting their disability.
- WAD SCREWS UP THE BRAIN: In the brain and spinal cord, the gray matter is the inner portion, where most of the nervous system's chief functions take place. The white matter (it's white because it's cells are covered by a fatty substance called myelin) is made up of cells that connect the gray areas to each other. Although there are numerous studies showing that whiplash affects the brain, this month's issue of Human Brain Mapping (Differences in White Matter Structure and Cortical Thickness Between Patients with Traumatic and Idiopathic Chronic Neck Pain: Associations with Cognition and Pain Modulation?), concluded that, "Cortical thinning in the left precuneus was revealed in WAD compared with CNP (chronic neck pain) patients. The extent of white matter structural deficits in the left tapetum coincided with decreased conditioned pain modulation efficacy in the WAD group. This yields evidence for associations between decreased endogenous pain inhibition, and the degree of regional white matter deficits in WAD." Thin the precuneus and you'll end up with memory, visuo-spatial processing, and self consciousness issues. The tapetum is important because it's associated with the Corpus Collosum --- the connection between the brain's two hemispheres. Mess with the tapetum and the two sides cannot communicate properly.
- WAD & NECK PAIN BOTH CAUSE IMPAIRMENT OF MOTOR FUNCTIONS: When there is enough damage to the brain, not only does this affect the sensory side of the brain (PAIN, paresthesias, LOSS OF PROPRIOCEPTION, etc), but it's becoming increasingly clear that it affects the motor side of the brain as well. The journal Spine (Motor Impairment in Patients with Chronic Neck Pain: Does the Traumatic Event Play a Significant Role?) recently concluded that, "Motor impairment was observed in both patient groups (CNP & WAD) with a higher degree in patients with chronic WAD. These impairments were linked to self-reported disability and were in most cases associated with pain, fear-avoidance, and symptoms of central sensitization." Click the link if you are not sure what CENTRAL SENSITIZATION is. This was confirmed visually (DIAGNOSTIC ULTRASOUND) in a study published in the American Journal of Physical Medicine & Rehabilitation (Alterations in the Mechanical Response of Deep Dorsal Neck Muscles in Individuals Experiencing Whiplash-Associated Disorders Compared to Healthy Controls: An Ultrasound Study), which concluded that "the mechanical responses of the deep dorsal neck muscles differ between individuals with WAD and healthy controls, possibly reflecting that these muscles use altered strategies while performing a neck extension task." Just realize that when you start down the road of ALTERED SPINAL / FASCIAL BIOMECHANICS, degenerative arthritis isn't far behind.
- WAD TURNS NECK MUSCLES TO FAT: Although we've known about this phenomenon in the low back for decades (THORACOLUMBAR AREA), not surprisingly, the same thing occurs in necks. After comparing "Thirty-one subjects with WAD and 31 age and sex matched controls, twenty-one (68%) patients had mild/moderate disability and 10 (32%) were considered severe. Statistically significant differences in regional MFI (Muscle Fatty Inflitration) were particularly notable between the severe WAD group and healthy controls." This study was found in the journal Spine (The Qualitative Grading of Muscle Fat Infiltration in Whiplash Using Fat/Water Magnetic Resonance Imaging) and is why strength training is so critical, not just for chronic neck pain, but in general.
- PREDICTING WHO'S GOING TO GET OVER THEIR WAD: As I have shown you in the past, predicting who is going to improve after having a whiplash injury is difficult to determine, although there are a few things we know --- women and the elderly almost universally have a much tougher row to hoe than young, healthy, males. Just days ago, the journal Spine (The Potential and Perils of Prognosticating Persistent Post-Traumatic Problems from a Post-Positivist Perspective) stated that, "Predicting recovery following traumatic neck pain has become an active area of research but is moving in several different directions with currently little consensus on the important outcomes to predict or relevant variables to predict them." The Journal of Physiotherapy confirmed this with a paper that reviewed 46 studies of 99 models used to predict whiplash severity and subsequent improvement. The study's title tells the story, Few Promising Multivariable Prognostic Models Exist for Recovery of People with Non-Specific Neck Pain in Musculoskeletal Primary Care: A Systematic Review.
- WHAT IS THE MEDICAL COMMUNITY DOING ABOUT WAD? Not to sound harsh, but who do you think brought us the opioid epidemic? (Doctors were not the sole culprits; THE GOVERNMENT was in on this as well.) In this vein, we can't be shocked that THE BIG FIVE still rules the day (along with a round-robin of ever-changing novelties). A few weeks ago the journal BMC Musculoskeletal Disorders published a study called Management of Whiplash Associated Disorders in Australian General Practice that stated, "Whiplash Associated Disorders (WAD) are common and costly, and are usually managed initially by general practitioners (GPs). Motor Vehicle Crashes (MVCs) are the cause of 50 million injuries worldwide and nearly four million emergency department (ED) consultations annually in the US. After being medically evaluated, approximately 90% of those who present to ED after MVC return home. Only around 50% of those with WAD will fully recover, with 30% remaining moderately to severely disabled, creating significant personal, economic, and social distress. Worldwide, chronic pain following MVC is a significant burden and a frequent and expensive public health problem. Current clinical guidelines recommend that the most important aspect of management of acute WAD is providing assurance and encouragement to return to normal activities and exercise, but GP provided advice/education was only documented in 5.8 per 100 WAD problems in our study. Local injections, muscle relaxants, anti-convulsants, benzodiazepines and anti-depressants, for which there is no evidence for efficacy and which are not recommended, were overused. Non-recommended treatments were used in a total of 34.4 per 100 WAD cases."
- WHAT IS THE MEDICAL COMMUNITY DOING ABOUT CHRONIC WHIPLASH PART II? LYRICA is a terrible drug (not my opinion, but verified by studies and the majority of those who have tried it). It is essentially second generation Neurontin (gabapentin) --- one of the FOUR DRUGS that Pfizer was fined 2.3 billion dollars for promoting "OFF LABEL" (they were fined 430 million dollars for the same thing with Neurontin itself). Just last week, Australian officials announced plans for a study to see if Lyrica could prevent chronic WAD if given in a prophylactic manner in the ER, post-accident (Pregabalin Versus Placebo in Targeting Pro-Nociceptive Mechanisms to Prevent Chronic Pain After Whiplash Injury in At-Risk Individuals - A Feasibility Study...).
WHAT'S BEING DONE TO SOLVE
CHRONIC WHIPLASH PAIN (WAD)?
- THE RIGHT KIND OF PATIENT EDUCATION: One thing we are seeing again and again in peer-review is the need for quality patient education (by "patient education" I do not mean trying to convince patients they will require MASS QUANTITIES OF ADJUSTMENTS). In a Disability and Rehabilitation study from a year ago (What Information do Patients Need Following a Whiplash Injury? The Perspectives of Patients and Physiotherapists), the consensus seemed to be that those with WAD need to be reassured as well as educated. "Reassurance can be an effective communication tool to decrease patients concerns about their injury and help strengthen the patient-health practitioner relationship. Although clinical guidelines for the management of whiplash injuries recommend that individuals must remain physically active post-injury, statements from the patient group indicate that this information is not always provided and clearly explained to patients." A brand new study from Physiotherapy Theory and Practice (The Effects of Pain Neuroscience Education and Exercise on Pain, Muscle Endurance, Catastrophizing and Anxiety in Adolescents with Chronic Idiopathic Neck Pain) talked about the need for both pain neuroscience education (PNE) and exercises for those with chronic neck pain. What is PNE? It's essentially explaining to patients that their pain may no longer be arising from damaged tissue, but might be coming from the brain itself. In other words, the pain may have become "centralized" (CENTRAL SENSITIZATION), which is never a good thing.
- EXERCISES PLUS MOBILIZATION / MANIPULATION IS BETTER THAN EITHER ONE ALONE: Yet another study (The Effects of Neck Mobilization in Patients with Chronic Neck Pain), this one from Monday's issue of the Journal of Bodywork and Movement Therapies, provided evidence to this thought process. Stick around and in just a moment I will show you why ADJUSTMENTS work like magic for many sufferers of WAD --- but only under certain specific circumstances.
- DIRECTION-MOVEMENT CONTROL TRAINING MAY PROVE EFFECTIVE FOR CHRONIC NECK PAIN: It's unsettling when a journal (in this case, this month's issue of the Journal of Bodywork and Movement Therapies) makes this sort of statement. "There is low level evidence that cervical interventions are effective on pain and range of motion at the immediate follow up, but no evidence on the effectiveness of the direction movement control intervention especially on the effectiveness of long term follow up." The study (Long-Term Effect of Direction-Movement Control Training on Female Patients with Chronic Neck Pain) concluded, however, that "Direction-movement control training is likely to be an effective training program to enhance body functionality through improvement of pain, function, endurance, head repositioning accuracy, range of motion, and cervical flexor endurance." If you want to see what Direction-Movement Control Training looks like, the study is free online.
- PILATES FOR CHRONIC NECK PAIN: Earlier this week, the same journal published yet another study on chronic neck pain (Is Pilates an Effective Rehabilitation Tool? A Systematic Review) showing that after reviewing 23 studies on the subject, "The majority of the clinical trials in the last five years into the use of Pilates as a rehabilitation tool have found it to be effective in achieving desired outcomes, particularly in the area of reducing pain and disability." I've shown you in the past that the same thing is true of yoga.
What kind of conclusions can we make from this mish mash of research? I'm honestly not quite sure. As the very first study discussed stated, part of the process is about each individual figuring out their own unique situation and what works for them. "A process of trial and error by participants was used to identify suitable strategies. Specific but different strategies were employed to prevent pain or to alleviate pain. Establishing these strategies took time, and several participants felt that an early lack of awareness of the potential for on-going pain led them to underestimate the importance of early management and ultimately contributed to their chronic condition. Individuals with acute WAD have also expressed a desire for more realistic expectations of recovery." What makes it so darn difficult is that when it comes to the tests, you're not likeely to have anything to show for them (all tests and imaging are usually normal / negative after whiplash-like injuries; even the more serious ones).
My opinion, especially when it comes to those dealing with chronic or long-term WAD, is that there are frequently some missing links. One of these is dealing with SYSTEMIC INFLAMMATION. And related to it, dealing with SCAR TISSUE as well (inflammation always leads to formation of scar tissue that the medical community refers to as "fibrosis" --- HERE). As I wrote about a couple of years ago, the first step in solving chronic neck pain is to restore normal cervical range of motion (HERE), which must involve both sectional and segmental motion of the neck (HERE). These points provide the basis for PHASE I and PHASE II of effectively addressing chronic neck pain and/or issues related to WAD.
Bear in mind that when I talk about dealing with inflammation, I am not simply talking about (as is usually the case with the medical community) making sure you have plenty of the "BIG FIVE" class of drugs on hand. I am talking about the need to effectively deal with whole body inflammation that can arise from numerous sources and be magnified by the effects of the WAD. To get a better idea of what I mean, take a look at THIS POST.
CHRONIC NECK PAIN
COULD THERE BE A SOLUTION FOR YOU?
If you are wanting to solve your chronic neck pain, there is a STEP-WISE PROTOCOL that must be followed (HERE is the second part of the protocol). Firstly, you will have to deal with any underlying SCAR TISSUE (FIBROSIS). It's no wonder this young man (early twenties) was told his neck was like that of a dead person. Trying to get good adjustments without first dealing with the FASCIAL ADHESIONS is an exercise in futility that will never bear any fruit other than possibly some temporary relief. However, once the Scar Tissue has been dealt with properly, adjustments will work, and you can start to address FORWARD HEAD POSTURE (FHP) and any SYSTEMIC INFLAMMATION that might be present (the latter of which should be done anyway).
I kick myself because I actually thought about doing a before / after video on both of these individuals, but we were swamped and I didn't feel I had the time. Both of these men came in with terrible ROM and left with ROM that was nearly normal. That's what it's about in my clinic --- LESS VISITS INSTEAD OF MORE. And the only way to get results like this is to deal with the TETHERING effects of the Scar Tissue, which unfortunately, are neglected by way too many practitioners, most of which try and convince you that if you just get more treatment (adjustments, THERAPY, massage, DRUGS), everything is going to eventually resolve itself and be OK. If you simply play the odds (HERE), you realize that this at best a crapshoot.
Interestingly, on the same day that these two gentlemen came in, I saw another person who had been in the same boat. Near-zero range of motion in his cervical spine (neck) despite lots and lots of adjustments. Since last week was his second visit and he had done so well after his first (his first was the day after Halloween, and remember that I'm the guy who rarely makes patients a follow-up appointment after their first visit -- HERE), I asked if he would do a video for us. Although Gaylon is not the sort of person who gets very worked up, his was a very cool case, with thus far an excellent outcome. And for those of you who enjoy similar testimonials, I have a boatload of them HERE.
STRUGGLING WITH CHRONIC HEALTH ISSUES?
HAVE YOU HAD A HEAD INJURY OR WHIPLASH?
- Traumatic Brain Injury: Otherwise known as TBI or sometimes an MTBI (Mild Traumatic Brain Injury), this problem affects millions upon millions of Americans (be aware that WHIPLASH INJURIES are categorized as MTBI even though large numbers are severe enough they could easily be categorized as TBI).
- Induces: I'm not trying to be a smart ass here but induces means "causal". This is important to understand because what it means is that what studies have been increasingly showing for decades --- that head injuries are directly related to a host of symptoms that have been described as "bizarre and seemingly unrelated" in relationship to the initial injury --- is even more true than previously imagined.
- Genome-Wide: The genome consists of all the genetic material of an organism, including DNA, RNA, Mitochondrial DNA, Genes, Chromosomes, etc, etc. It's the whole shebang.
- Transcriptomic: This is referring to RNA and the fact that in order to copy DNA, the process must involve "transcription" via the nucleic acid RNA (there are many forms of RNA --- mRNA, rRNA, tRNA, etc, etc.
- Methylomic: This refers to mutations of the METHYLATION PATHWAYS (DETOX / BIOTRANSFORMATION) of the DNA / RNA that make up an organism's genome.
- Network Perturbations in Brain and Blood: Dozens upon dozens of biomarkers are fouled up in the blood and brain of those who underwent TBI, affecting "the network". This just means that everything has the potential to be screwed up after a head or neck injury.
- Predicting Neurological Disorders: Specifically fouled up biomarkers reveal specific neurological diseases / disorders. The problem is that most of these biomarkers are not commonly used or known outside of very specialized trauma facilities or within acedemia. Most likely this is because there are not currently good treatment options (i.e. drugs) for changing these markers. Bottom line; if certain biomarkers are present, you are more likely to develop or exacerbate certain neurological disorders we'll talk about momentarily.
In plain English, head injuries not only cause brain damage that can be measured via blood work and as shown in this study, technologically advanced imaging studies, but these injuries can actually cause an array of issues that lead to genetic material going haywire, which in turn lead to an almost unlimited number of potential diseases or health-related dysfunctions. Although I have written about this phenomenon in the past --- particularly as it relates to AUTOIMMUNITY (HERE, HERE, and HERE) --- let me give you a few high points of this study.
The CDC says that, "An estimated 1.7 million people sustain a TBI annually. Of them 52,000 die, 275,000 are hospitalized, and 1.365 million, nearly 80%, are treated and released from an emergency department. About 75% of TBIs that occur each year are concussions or other forms of mild traumatic brain injury (MTBI)." According to this study, the 80% number above is actually 90%, and about 1 in 5 of those that survive their TBI go on to develop long-term or even lifetime symptoms.
Some of the specific diseases mentioned in this study included PARKINSON'S, ALZHEIMER'S, memory loss, cognitive dysfunction, behavioral problems, PTSD, CTE (think NFL football players here), Huntington's Chorea, cardiomyopathy (HEART DISEASE), problems with metabolic pathways for glucose, lipid and lipoproteins, fatty acids and triglycerides (DIABETES, OBESITY, HBP, HIGH CHOLESTEROL, etc, etc), psychiatric disorders (ADD / ADHD, ANXIETY, DEPRESSION, Bipolar, SCHIZOPHRENIA, eating disorders, BRAIN ATROPHY, etc), poor energy management (CHRONIC FATIGUE), poor ECM regulation (SCAR TISSUE / FIBROSIS), a tendency toward both SMOKING and alcoholism, problems with general homeostasis (HERE), and a propensity toward OUT-OF-CONTROL INFLAMMATION (an important method of cellular communication).
"We found genes modulating important cellular functions such as inflammation, metabolism, and cell communication. The gene regulatory mechanisms uncovered from the current study span from epigenetic regulation and alternative splicing to gene network regulation. Alterations of these regulatory mechanisms could explain how the incidence of TBI alters the course of brain homeostasis and increases the risk of related brain pathologies. In summary, our comprehensive systems investigation shows that concussive injury affects fundamental aspects of gene regulatory mechanisms that maintain brain homeostasis."
One last note. Although this study had to do with genes and various sorts of TBI-driven genetic aberrations, it also mentioned the word "EPIGENETICS" in one form or another a whopping 26 times. For instance, "An increasing body of evidence indicates that predisposition to various neurological and psychiatric disorders are saved as epigenetic modifications." This sentence will not make much sense to you unless you understand the difference between genetics and epigenetics (click the link for a very short read --- one of the most important, yet least read articles I've written).
I bring this up because almost every disease process imaginable (including CANCER) is being shown to be driven far more by these "epigenetic factors" than by raw genetics. In other words, not only are you not bound by your genetics to the degree you've always been taught (it's called brainwashing), you have the potential to actually change your health by changing some of these factors. Allow me to show you a very cool example from a study that came out earlier today in Development and Psychopathology (Epigenetic Correlates of Neonatal Contact in Humans).
In this study, scientists correlated the amounts of hugging and cuddling that parents gave their infants, to the amount of DNA methylation (or lack thereof), which manifested itself in genes related to immune system function, metabolism, and even physical / mental / social development in said child --- five years after the fact. Not so surprisingly, the authors concluded that, "Early post-natal contact has lasting associations with child biology." Understanding the difference between genetics and epigenetics is why if you have a doctor who is constantly blaming or scape-goating your various health issues on "bad genes," it may be time to find a new doctor. At the very least, it is critical to figure out what it will take to lessen the inflammatory burden on your body and brain. The good news for you is that I have already done this for you in the form of a generic protocol (HERE).
There is no doubt that some of you reading this will have to undergo some specific testing and / or treatment. With the funky neurological issues that are seen with TBI, it may mean you need to see a CARRICK-TRAINED FUNCTIONAL NEUROLOGIST. Or it may mean you need to undergo some FUNCTIONAL TESTING. However, in most cases, a great deal of epigenetic alteration can be made on your own via the lifestyle changes I talk about in the link from the last paragraph. And let's be honest with each other for a moment; what have you got to lose? You've tried every drug imaginable, and so far they've done nothing other than make you feel like crap.
WHIPLASH, NECK PAIN,
& POST-SURGICAL ARTHRITIS
A POTENTIAL BREAKTHROUGH FOR HANNAH
I was diagnosed with loss of cervical curve years ago. I have had multiple car accidents (not my fault - went through a windshield head first as a 4 year old in 1974, whiplash from a rear end accident at age 9, then again at age 18). I have DDD in lumbar spine - failed back surgery x2. I also have idiopathic peripheral polyneuropathy (maybe from Lyme) in my hands, arms, legs and feet. I tend to fall a lot. I tripped the other day and landed head first into a dresser. This of course did nothing for my chronic neck pain!
Anyway I had to change pain management people and my current one is claiming that nothing is ever done for a reverse neck curve and that I am exaggerating the pain from my C5, C6, C7 osteophytes and diagnosed cervical DDD. I have had cervical facet rhizotomy in the past and can no longer look up to the top shelf in the grocery store, nor tip my head all the way back to get the last drop when taking a drink. I have limited side to side movement (being blind in right eye from car accident - I often have to turn my entire upper body around to the right to see out of my left eye). I can't watch TV or sit for too long without using a pillow to prop my head up.
Years ago I used to use a cervical foam collar on occasion for support. I can no longer get it under my chin. I also used to use an inflatable pump collar for traction (over the door traction made me nauseous and dog ate pump). Current provider won't do anything for me (order new collars, etc). She states "it is what it is". I currently get pain medication from her - which is being restricted all over the country so I'm limited in my choices of providers/doctors. (Although her office hung up on me the other day so maybe I should go elsewhere.)
Can you just tell me if indeed I should be concerned with the pain, symptoms and limitations with my neck? I'm 47 and I don't want to spend the rest of my life looking down. Thank you so much for your time.
Firstly, yes you should be concerned about the limitations in your neck because any time there is chronic pain, there is a chance of you ending up with CENTRAL SENSITIZATION. And with the kind of chronic restriction you are describing, there's a 100% probability of ending up with DEGENERATIVE ARTHRITIS (DJD / DDD). Secondly, females are much more prone to most disease processes, and particularly most AUTOIMMUNE DISEASE PROCESSES, when compared to their male counterparts (BLEEDING EVERY MONTH can be problematic as well). Add to this the fact that HEAD INJURIES ARE HEAVILY-LINKED TO AUTOIMMUNITY (a fact seen by the three severe MVA's in her youth), and you can see why this needs to at least be discussed --- especially in relationship to IPP.
IPP (Idiopathic Peripheiral Polyneuropathy) is a NEUROPATHY at multiple sites of the body, with an "officially" unknown cause. The NIH's Periphrial Neuropathy Fact Sheet (What is Peripheral Neuropathy?) shows why various forms of PN can be so devastating, "An estimated 20 million people in the United States have some form of peripheral neuropathy, a condition that develops as a result of damage to the peripheral nervous system. Damage to nerves that supply internal organs may impair digestion, sweating, sexual function, and urination. In the most extreme cases, breathing may become difficult, or organ failure may occur. Peripheral nerves send sensory information back to the brain and spinal cord, such as a message that the feet are cold. Peripheral nerves also carry signals from the brain and spinal cord to the muscles to generate movement. Damage to the peripheral nervous system interferes with these vital connections. Peripheral neuropathies may also be caused by a combination of both axonal damage and demyelination."
Although there were many reasons for said neuropathy listed in this article, the most common was said to be trauma ("such as from automobile accidents..."), while the one with the biggest entry was autoimmune ("Autoimmune diseases can lead to nerve damage. When the tissue surrounding nerves becomes inflamed, the inflammation can spread directly into nerve fibers. Over time, these chronic autoimmune conditions can destroy joints, organs, and connective tissues, making nerve fibers more vulnerable to compression injuries and entrapment."). Relief of neuropathy symptoms can often be accomplished with LOW LEVEL LASER THERAPY. However, long-term regeneration of almost any neuropathy and/or autoimmune condition is going to require a change of diet (be aware that many neurological issues --- including some kinds of neuropathy --- respond quite well to a KETOGENIC APPROACH.
Not sure from her history whether Hannah actually has Lyme Disease or not, but Lyme is certainly a wildcard. Even though there are many claims out there, I am not aware of anyone consistently getting great results with Lyme patients. If she has had Lyme, the standard therapy is to give many months (3-15) of ANTIBIOTICS, hoping that the antibiotics kill the bacteria before it BEFORE THEY MESS YOU UP TOO BADLY (remember that 4/5ths of your body's immune system resides in the Gut in the form of bacteria --- HERE). If I see a patent who has autoimmunity (whether the disease has been named or not --- in many cases they are not because no one knows for sure what the auto-antigen is or how to test for it) or been on hardcore antibiotics, it is time to start thinking about the most potent treatment that few people are familiar with --- FMT. Now for the arthritis.
What we are seeing over and over again in the practice of medicine (I just saw a study on this topic on KNEES yesterday) is that it is almost impossible to look at the results of an imaging test, whether for DISC HERNIATION, DEGENERATIVE ARTHRITIS, or ROTATOR CUFF PROBLEMS, and in most cases, have any real idea whether or not the problem you see on the film is causing the patient's symptoms. This is because said symptoms correlate very poorly (emphasis on poorly) with imaging studies --- yet another of the MANY DIRTY LITTLE SECRETS that Big Medicine doesn't want you to know about. Would I be surprised that Hannah's pain doctor told her that FHP (FORWARD HEAD POSTURE) doesn't mean anything? Certainly not --- no more than I am surprised by dentists who claim that a mouthful of CAVITIES is kind of like death and taxes; just another one of life's unfortunate inevitabilities.
So, beyond addressing these issues systemically (this is done by addressing INFLAMMATION), you'll need to address the neck issue itself. This could be a challenge for you Hannah because if you can no longer get a soft collar under your chin, it tells me that you have a whale of a case of FHP. How do I suggest you deal with this? You cannot start with adjustments. Neither can you start with stretching or strengthening exercises. You will have to go through both PHASE I and PHASE II of the simple rehab protocol I suggest for people with these sorts of issues.
The good news for you Hannah is that this does not have to be one of those scenarios that always seems to end like this --- "the normal cost is fifteen grand, but if you sign up today, we'll give it to you for half that". By the way, it is my experience that medications from the BIG FIVE FAMILY, or procedures like Radio Frequency Ablations (RFA's are otherwise known as Facet Rhizotomies), rarely work for the long-term because they do absolutely nothing to address underlying causes (unfortunately the ablated nerves always grow back, many times with a vengeance).
The cool thing for many of you in the same situation as Hannah is that I have put together a general protocol that will help at least some of you (HERE is the link to our Case Studies). Don't get me wrong, as much as I with it would, I did not say it would help all of you, but best guess is that it's better than a 50/50 --- and it's not going to make you worse. Furthermore Hannah, you are going to have to step out of the box. Making healthcare decisions based largely on what your insurance provider will pay will get you in trouble in way too many cases (the DAKOTA TRACTION UNITS, for instance, are dirt cheap).
To see my GENERAL PROTOCOL for relieving inflammation in those of you struggling with chronic pain, chronic inflammatory degenerative diseases, autoimmunity, or even some conditions that you have probably been told are "GENETIC," simply follow the link and start reading.
HOW THE PAIN AND DYSFUNCTION
OF THE WHIPLASH-INJURED NECK
AFFECTS THE BRAIN
"That people can experience neck, head, and back pain after a car accident, or some other kind of neck energy transfer is not in doubt. What is unclear is whether such an energy transfer can cause chronic, long-lasting pain, and if so, how. And there is still no established physical reason why a whiplash injury would cause chronic pain. Given that, and given the involvement of insurance companies in car accidents, it would be easy to think a lot of these ongoing whiplash cases are scams fabricated to get a payout. But Ferrari thinks only a very small percentage are malingering. The difference, Ferrari thinks, is whether the country in question has a whiplash culture. Whiplash cultures are those cultures in which there is the expectation that if you’ve been in a motor vehicle collision, you’ll probably have some significant problem as a result."
So basically, this article from a huge national publication is saying that yes, you're not making it up. The pain is real (at least to you it's real). But it's all in your head. While I would never say that there is not at least some degree of psychosomatic issue with whiplash (an illness or injury caused or aggravated by mental factors such as worry or stress), the truth is, there's arguably some degree of psychosomatic with every disease or injury. So today I want to take a look at how WHIPLASH INJURIES might by causing the far-reaching and seemingly unrelated symptoms that so often get suffering individuals labeled as scam artists, malingers, or money-grubbers by the other party's insurance company (and quite frequently --- at least in an unspoken fashion --- by their own attorney).
One of the things that you will almost always find with people who have been in WHIPLASH ACCIDENTS is that their cervical ranges of motion are diminished --- often times very dramatically (but occasionally not at all --- HERE). A study from earlier this summer (published in the Archives of Physical Medicine and Rehabilitation) asked a question via its title; To What Degree Does Active Cervical Range of Motion Differ Between Patients With Neck Pain, Patients With Whiplash, and Those Without Neck Pain? The authors, six European researchers and physicians, looked at 27 studies that pertained to 2,700 subjects, concluding that "Patients with neck pain have a significantly decreased active cervical ROM compared with persons without neck pain, and patients with whiplash-associated disorders (WAD) have less active cervical ROM than those with nontraumatic neck pain." While this is nice to see in black and white, any practicing chiro or bodyworker could have told you this.
Any time there are decreases in ranges of motion, there will be a corresponding loss of proprioception (HERE). While this might not seem like a big deal up front, it's a huge deal because loss of proprioception is not only intimately associated with spinal degeneration (HERE), it's directly linked to most chronic disease processes (HERE) as well as chronic pain. Speaking of chronic pain and whiplash; earlier this month a practicing anesthesiologist wrote a scientific paper for Anesthesia & Analgesia (Whiplash Injury: Perspectives on the Development of Chronic Pain) that concluded....
"Whiplash is largely a compression injury when the trunk is forced upwards into the cervical spine. Most frequently due to motor vehicle collision and often associated with considerable pain, suffering, disability, and cost, whiplash-associated injury is a debilitating and common form of neck pain with a range of clinical manifestations including neck, shoulder, and back pain, numbness, fatigue, nausea, cognitive deficits, and low self-reported physical and mental health. The complex neurobiological interplay between intraarticular nociception [pain from various pathways] and the neuroimmune and neuroplastic effects of ongoing joint injury are illustrated with a pathway approach. Myriad motor and sensorimotor dysfunctions can manifest from WAD... WAD is used as a model for other pain syndromes in which imaging studies prove negative even though patients suffer profound disability."
Although this sounds somewhat disjointed because I cherry-picked it due to time and space requirements as I do many quotes I use, notice some of their conclusions. Most of us tend to think of whiplash as a stretching / tearing sort of injury -- this guy says it's compressive (the facets in the rear of the spinal column are undoubtedly compressed as the body is driven out from under the head --- the facets make up the IVF which is the small window the spinal nerves exit from). Also note that there are numerous pathways to chronic pain. And finally, realize that the author mentions the whole imaging conundrum --- soft tissues and connective tissues (fascia included) don't show up will with standard advanced imaging (although that is SLOWLY IMPROVING at least with fascia, although I am not sure about CERVICAL FASCIA). But it doesn't end here. Not by a long shot. As we got a small taste of in this study, chronic pain leads to some rather funky sensory and motor problems.
A study from earlier this summer was published in JOSPT (Dizziness, Unsteadiness, Visual Disturbances, and Sensorimotor Control in Traumatic Neck Pain) dealing with this very issue. "There is considerable evidence to support the importance of cervical afferent dysfunction in the development of dizziness, unsteadiness, visual disturbances, altered balance, and altered eye and head movement control following neck trauma, especially in those with persistent symptoms.... The evaluation of potential impairments (altered cervical joint position and movement sense, static and dynamic balance, and ocular mobility and coordination) should become an essential part of the routine assessment of those with traumatic neck pain, including those with concomitant injuries such as concussion and vestibular or visual pathology or deficit." The study goes on to talk about these factors in relationship to proprioceptive loss, as well as the extensive manner they adversely affect motor function, coordination, and control.
"Joint position sense (JPS) is defined as the ability to relocate the natural head position without the assistance of vision. Greater errors have been shown in individuals with both idiopathic neck pain [not sure which tissue the pain is originating from or why it's there] and persistent WAD, although errors are greater in those with neck trauma, especially in those with moderate to severe pain and disability. Further, persistent WAD and symptoms of dizziness had greater errors than those not complaining of dizziness, suggesting that these symptoms may be due to greater abnormal cervical afferent [sensory] input."
What do these people do with the pain and what is the single biggest factor in determining outcomes? Can anyone say "Pain Avoidance"? According to April's issue of Acta Anesthesiologica Scandinavica (Pain Avoidance Predicts Disability and Depressive Symptoms Three Years Later in Individuals with Whiplash Complaints), "Longstanding symptoms due to whiplash are commonly associated with decreased levels of emotional and physical functioning. Psychological inflexibility, and more specifically avoidance, was a unique predictor of pain disability and depressive symptoms, also when controlling for background variables, pain related variables and psychological distress. Level of education was also found to predict both pain disability and symptoms of depression. Lastly, pain variability predicted pain disability, and anxiety predicted depressive symptoms. Pain avoidance significantly predicted pain disability and depressive symptoms 3 years later. Although tentative, results warrant more studies to further explore the importance of pain avoidance for future health." What exactly are "pain avoidance" and "psychological inflexibility"?
Pain avoidance is just what it sounds like --- trying to avoid pain. People in chronic pain, however, are forced to make daily decisions like this; I really should be a good dad and go play basketball with my son, but I know that it will fire up my chronic foot issue and I will suffer for three days. Psychological inflexibility is loosely defined as being so rigid in our thoughts, feelings, and emotions that we cannot change them for the longer term good. Psychological inflexiblity goes along with pain avoidance and is heavily associated with things like ANXIETY, DEPRESSION, SICKNESS & DISEASE, learning disabilities, poor work performance, WORRY & STRESS, SUBSTANCE ABUSE, as well as a lower quality of life. All of these things and others can potentially lead people into something known as Central Sensitization.
WHERE CHRONIC PAIN'S RUBBER MEETS THE ROAD
"Central sensitization is a condition of the nervous system that is associated with the development and maintenance of chronic pain. When central sensitization occurs, the nervous system... gets regulated in a persistent state of high reactivity. This persistent, or regulated, state of reactivity lowers the threshold for what causes pain and subsequently comes to maintain pain even after the initial injury might have healed. Central sensitization has two main characteristics. They are called allodynia and hyperalgesia. Allodynia occurs when a person experiences pain with things that are normally not painful. Hyperalgesia occurs when a stimulus that is typically painful is perceived as more painful than it should. Chronic pain patients can sometimes report sensitivities to light, sounds and odors. Central sensitization is also associated with cognitive deficits, such as poor concentration and poor short-term memory. Central sensitization also corresponds with increased levels of emotional distress, particularly anxiety. Lastly, central sensitization is also associated with sick role behaviors, such as resting and malaise, and pain behavior. Central sensitization can occur with chronic low back pain, chronic neck pain, whiplash injuries, chronic tension headaches, migraine headaches, rheumatoid arthritis, osteoarthritis of the knee, endometriosis, injuries sustained in a motor vehicle accident, and after surgeries. Fibromyalgia, irritable bowel syndrome, and chronic fatigue syndrome, all seem to have the common denominator of central sensitization as well."
In other words, pain and neurological reactivity can get locked into the brain so that even though the original insult / injury is long gone, a "recording" of the pain continues to play on a loop. Thus, even though this pain is technically in people's head, it is very real. The pain of Central Sensitization is not psychosomatic. Despite lots of theories as to why this occurs, no one really knows for sure, although the commonest of the common denominators seems to be INFLAMMATION --- yet another reason to live an anti-inflammatory lifestyle (more to come on this shortly).
Some of you might remember that I spent some time discussing the fact that current research is showing that as many as half of all people (especially women) who are injured in a whiplash accident progress to chronic. This is borne out by a study from the January 2016 issue of BMC Public Health (Five Years After the Accident, Whiplash Casualties Still Have Poorer Quality of Life in the Physical Domain than Other Mildly Injured Casualties). After factoring out all sorts of confounders such as PTSD, socioeconomic status, and psychological factors, these authors determined that, "deteriorated quality of life in the physical domain remained 5 years after the accident, specifically in the grade-2 whiplash group, pain playing a predominant intermediate role, which may be in line with the hypothesis of neuropathic pain." Neuropathic pain? Can anyone say Central Sensitization?
March's issue of Physical Therapy went on to talk about the differences in pain and recovery between the sexes (I've shown you before but will show you again just how big the difference really is). In a study called Differences Between Women With Traumatic and Idiopathic Chronic Neck Pain and Women Without Neck Pain: Interrelationships Among Disability, Cognitive Deficits, and Central Sensitization, the authors concluded.....
"Pain-related disability, reduced health-related quality of life, and cognitive deficits were present in participants with CWAD (chronic whiplash-associated disorders) and, to a significantly lesser extent, in participants with CINP (chronic idiopathic neck pain). Local hyperalgesia was demonstrated in participants with CWAD and CINP but not in women who were healthy. However, distant hyperalgesia and decreased conditioned pain modulation efficacy were shown only in participants with CWAD; this result is indicative of the presence of central sensitization. Moderate to strong correlations among disability, cognitive deficits, and hyperalgesia (local and distant) were observed in participants with CWAD."
One of the things I noticed as I read studies on the subject is that TRIGGER POINTS (especially Trigger Points in the UPPER TRAPS & LEVATOR) were frequently associated with Central Sensitivity, which was seen in a recent study from Frontiers in Neurology (An Attempt of Early Detection of Poor Outcome after Whiplash). The 12 French authors of this study were attempting to figure out what characterized the people who didn't really recover --- the people who ended up chronic. Beyond chronic TP's, "All chronic patients exhibited high level of catastrophizing at the acute stage and/or PTSD. Their head and trunk motor control values, and in some cases vestibular tests, are far from the healthy group. Practically speaking, the results of this study are in line with previous results and suggest that low-grade whiplash patients should be submitted as early as possible after the trauma to neuropsychological and motor control tests in a dedicated consultation. In addition, they should be sent to a neuro-otologist for a detailed examination of vestibular functions, which should include cVEMP (cervical vestibular evoked myogenic potentials). Then, if diagnosed at risk of WAD, these patients should be submitted to an intensive preventive rehabilitation program, including vestibular rehabilitation if required." Although there are undoubtedly medical neurologists doing this sort of work for patients suffering from WAD, I have yet to see it.
When people are injured, if they even go to the doctor, they will be told something like, "Thank God Mrs Smith, everything looks fine. You'll be sore for a few days, but you'll be OK." Since there were no blood, guts, or broken bones, you assume they have a clue what they are talking about. You are given some drugs from the "BIG FIVE" category, sent home, and told to call your family physician if you have any problems. The problem is that simple math tells us that half of these people are walking out of the ER and into a world where pain will become their overriding thought process --- the thing they think about all the time --- the thing they cannot get away from (HERE is an example).
A similar study was published just last month in the journal, Pain Physician (What Are the Predictors of Altered Central Pain Modulation in Chronic Musculoskeletal Pain Populations? A Systematic Review), the reviewers said that, "Existing studies have investigated predictors of poor outcomes associated with musculoskeletal pain, including disability and failure to return to work. However, there remains little consensus. Common to a significant proportion of chronic musculoskeletal pain populations is the phenomenon of sensitization of the central nervous system pain pathways. A strong clinical predictor of altered central pain modulation is disproportionate, non-mechanical, unpredictable pattern of pain provocation in response to multiple/non-specific aggravating/easing factors. Altered central pain modulation is associated with many non-specific chronic musculoskeletal pain conditions and the etiology is poorly understood. It is considered by some that altered central pain modulation is a disease in itself rather than a disease of the particular presenting musculoskeletal condition. Premorbid and acute stage high sensory sensitivity and/or somatization are the strongest predictors of altered central pain modulation in chronic musculoskeletal pain to date." What is somatization? It's essentially recurrent and often multiple medical symptoms that have no detectable cause. Somatization is what caused the most renowned whiplash research team on the planet (Gargan & Bannister) well over two decades ago, to say that (I am loosely quoting from memory here) "whiplash injuries often lead to bizarre and seemingly unrelated symptoms".
And here's just one of the many problem with all of this. If you are coming to see me for chronic hardcore WAD symptoms from one or two hours away, it's not really a big deal. I treat you and you either get better or you don't. If you don't, there are any number of reasons, including Central Sensitization, that might explain why (HERE). However, if you are flying HALFWAY ACROSS THE COUNTRY --- or EVEN THE WORLD --- for treatment, I do an email history in order to see if I think I can even help you, and to make your visit as productive as possible (HERE). As you have seen so far, the "consensus" is that there is not really a great way to diagnose Central Sensitization --- to know for sure whether your pain is locked into your brain like an old cassette tape playing on auto-reverse. The situation, however, might be getting better.
Just five short weeks ago, a group of researchers and physicians from the orthopedics department at Duke University published a paper in Pain Practice (Measurement Properties of the Central Sensitization Inventory: A Systematic Review) where they looked at something called the CSI (Central Senstitization Inventory --- a system created to determine whether or not a person has CS). In this study, they looked at CS as related to "several medical diagnoses, including post-cancer pain, low back pain, osteoarthritis, whiplash, and fibromyalgia, comparing the results of 14 different studies to what they determined the CSI should be, trying to figure out its predictive ability to determine whether or not a person might be centralizing. Their results suggest the tool generates reliable and valid data that quantifies the severity of several symptoms of CS. Only time will tell if this is true of not, or if the tool proves to be the real McCoy.
This discussion about the brain being the source of pain is highly intriguing in light of an editorial that was published in August's issue of a Greek journal called the Hellenic Journal of Nuclear Medicine (Whiplash Syndrome: A Disorder of the Brain?). In this paper, the authors --- German engineers / MD's --- dealt with the fact that despite mountains of research from the past two decades, we still have more questions than answers. They then discussed the three main theories concerning whiplash.
- IT DOESN'T REALLY EXIST: This comes from studies published in other countries --- mostly third-world countries --- that claim that people who are injured in societies where no one really knows much about car crashes and are not expecting some sort of financial settlement, don't really have chronic neck pain or WAD after motor vehicle accidents (this was roughly the assertion seen in the very beginning of today's post). This group really does believe that the pain is all in one's head (somatization), with zero physiological reason.
- THE NOCICEPTIVE-VASCULAR HYPOTHESIS: Remember that inflammation is always the result of some sort of tissue damage, whether caused by injury, diet, exposure to reactive foods, parasites, black mold, EMF's, etc, et, etc. Research has shown that when soft tissues tear, INFLAMMATORY MEDIATORS are released not just locally, but into the general circulation, hypersensitizing sensory nerves, and leading to Chronic Pain (HERE).
- THE MIDBRAIN HYPOTHESIS: This theory says that there is a "mismatch between aberrant information from the cervical spinal cord and the input from the vestibular [balance / inner ear] and visual systems," that are then integrated into different parts of the midbrain. The authors go on to expound that functional MRI imaging techniques of the central nervous system consistently light up specific areas of the brain as seen with new 3-D technology (this phenomenon could be partially explained by the second bullet point in relation to something called LEAKY BRAIN SYNDROME).
"The most frequent symptoms in patients with whiplash syndrome are neck pain and headache, followed by visual and vestibular problems, cognitive limitations, and emotional disturbances. These symptoms were mostly caused by rear-end vehicle collisions while only 50% of the injured recover from initial symptoms within one year after the accident. Interestingly, the most frequent clinical symptoms of whiplash (i.e. visual problems such as impaired spatial ability or blurred vision, or cognitive limitations such as the difficulty forming thoughts and difficulties not in attending but in disengaging once the subject has focused on an object of attention) fit with hypoperfusion of the posterior parietal occipital region."
What is this saying? For starters, it's reiterating what I have shown you repeatedly from peer review; that if you are injured in a whiplash-type accident, whether you fully recover or slip into chronic is essentially a coin toss --- a 50/50 proposition. It also talks about the posterior occipital region of the brain (this region is in the far back area of the brain, as well as slightly in front of it). Gordon Johnson of Brain Injury Help simplifies things nicely in an article called Parietal Lobes and Occipital Lobes.
"The parietal lobes are areas for the reception and organization of language functions. The parietal lobes integrate sensory data from other parts of the body. They also play a big role in understanding numbers and their relations. Further, they have an important role in the manipulation of objects and in the processing of information relating to the sense of touch. The parietal lobes have both the left and right hemispheres. The left side is concerned in symbolic functions in language and mathematics. The right hemisphere is more focused on images and spatial relationships. The Occipital Lobes are divided into different functional visual areas. Each area contains a map of the visual world. The Occipital Lobes are the area where specialized neurons which receive and process visual information reside. The visual pathways run from the retina to the primary visual cortex, contained within the Occipital Lobes."
While this is certainly a bit oversimplified, it does a good job of showing why a BRAIN ISSUE in this area could affect both balance and vision (vision is critical for balance). With numerous recent medical studies calling for multidisciplinary and interdisciplinary treatment of WAD (HERE is one of many), we should be seeing more of the testing that was discussed in this study as well as earlier. However, the only group of physicians I am aware of are doing this sort of work on a consistent basis are CARRICK-TRAINED FUNCTIONAL NEUROLOGISTS. Which brings me around to one final point; what about the settlement money at stake?
With attorneys advertising for crash victims by way of the internet, billboards, printed ads, radio, television, and any number of others (including the proverbial "ambulance chasing"), it's clear that there is a lot of money at stake. July's JOSPT (The Nature of Whiplash in a Compensable Environment: Injury, Disability, Rehabilitation, and Compensation Systems) revealed that, "compensation schemes have, however, been subject to a common set of interrelated concerns, chiefly concerning the incentives, behaviors, and outcomes that may arise when financial compensation for injuries is available to injured party." I would assume the same thing. What's interesting, however, is that studies on whether or not settlement dollars "affect" the severity of a person's injury are all over the place, with the insurance industry naturally claiming that it makes a big difference, while numerous other sources consistently show that it doesn't. "Information asymmetries between insurers and claimants, claimants and clinicians, clinicians of different types, and other dyadic interactions complicate the insurance arrangements that apply in injury compensation schemes." My experience after a quarter century of practice is that patient's problems frequently continue long after the claim has been settled, regardless of the outcome of litigation. In other words, people don't all of a sudden get well because their attorney won them a settlement (which btw, is usually far less than people are led to believe it will be).
A QUICK ANECDOTE ABOUT DIET SODA OR MSG
AND WHIPLASH-INDUCED CHRONIC NECK PAIN
For this study 57 people with both Fibromyalgia and IBS went on an excitotoxin-free diet for a month (no MSG, aspartame, hydrolyzed protein, etc, etc, etc). The 37 people who actually made it through all four weeks were then assessed via questionnaires and pain scales. In only four weeks, one third of their symptoms resolved (that's resolved as in bye-bye). This group was then divided into two different groups that were double-blindedly either given excitotoxins in their food three times a week for two weeks, or not. "The MSG challenge, as compared to placebo, resulted in a significant return of symptoms; a worsening of fibromyalgia severity; decreased quality of life in regards to IBS symptoms... These findings suggest that dietary glutamate may be contributing to FM symptoms in some patients. Future research on the role of dietary excitotoxins in FM is warranted."
I bring this issue up because I recently had a patient who had largely gone PALEO, but had not given up either NutraSweet (aspartame) or flavoring their food with an MSG-based "spice" powder. Once I convinced them to make a clean break, the results were remarkable and rapid. Within a matter of days this individual had relieved almost all the chronic pain they were having --- pain that while diagnosed as Fibro, had started shortly after a rather serious MVA. Over the years I have seen many similar cases. If you are looking for other tricks to help relieve (or better yet, reverse) inflammation and restore mechanical and neurological function to the body, HERE is the post to look at.
WHIPLASH INJURY WITH NEUROLOGICAL SIGNS AND SYMPTOMS OF TBI or MTBI?
A STEP-WISE PROCESS FOR GETTING YOUR LIFE BACK!
Hello, I'm sorry this is a really long read. I had a rear-end collision a little over a year ago, my head had been turned to the left looking at the driver from the passengers seat. We were at a complete stop and this truck rammed our small car going the speed limit from behind. I had my seat belt on, but my head swung really far forward as I slammed into the seat belt, and then slammed right back. I was crying and in pain, though my boyfriend was fine. I went to the emergency room and they ran some x-rays and said I was fine, that it was a "low-impact" collision and I'd be sore for a few days.
They gave me some muscle relaxants for two days and said I'd be ready to go to work after that. I had been laying down those two days so I didn't feel too bad, then I went to work and it was excruciating. I had to leave work and call out for the week. I went back to work and worked REALLY slow, sitting down a lot and not bending my neck. It was painful but I figured I was still sore. Then the pain in my neck and head continued for the next year but I figured it was tension headaches from stress since they said it was low impact and I'd be fine.
But after almost a year it got so bad, I'd constantly find excuses to go to the bathroom or stand in a dark place to lean on stuff. Light and sound became so overwhelming I'd feel like I was having a panic attack. I ended up quitting my job and went into the hospital for a mental breakdown, again thinking this was all just stress. The pain has progressively got worse, and over a month ago it got so bad when I went shopping that my vision was blurry, I was dizzy and disoriented and in so much pain in my neck and head that I couldn't walk straight or see.
I ended up going to the chiropractor figuring I was just really out of alignment and needed adjusted. It helped somewhat though I was extremely dizzy and nauseous and in pain after the adjustment, they told me I'd just be a bit sore the next few days. And it did seem to be somewhat better, the huge knots in my neck lessened, but it got bad again real quick. After my third visit he took some x-rays to see what was up and he said... something was torn (he motions at a tendon/ligament or something that went across my neck at the base of my skull) The curvature in my spine/neck was completely gone, though nothing was deteriorated since I am still young. He also told me I've had two "pseudo seizures", after the pain in my neck and head got so excruciating.
My body and mind can't focus on anything else (it feels like blades from my neck to the front of my head, and like a hydraulic presser is squeezing the front part of my brain). I went to the ER again and again they said it was stress induced and I just needed to "relax and calm down", and that it wasn't a medical emergency, ignoring my indication that my head and neck hurt so bad. I've been hopping around clinics and hospitals ever since trying to find who I need to go to about fixing this this.
Do I need physical therapy? Is there some specialist I need to see? I'm so lost and everywhere I go seems to send me somewhere else. I'm on muscle relaxers and take a friends Fiorinal (to try to keep the headaches at bay), I've resorted to rubbing in cannabis oil in my neck/back, I'm using lidocaine roll on from the drugstore, and have a $50 neck/back heating pad, but all I'm doing is scrambling to treat the symptoms and want to fix the root of it. What should I do?
You certainly hit the nail on the proverbial head when you said that all you are currently doing is treating symptoms. Recognizing this is the first part of actually getting better --- getting to the root of your problem. Be aware that what you've been through is typical --- tests, x-rays, SCANS / MRI, etc.... And then the drugs --- lots of drugs, usually from the family I call THE BIG FIVE.
There are several factors that make this impact worse for you. Firstly, I am not sure how hard the impact was, but the fact that you were stopped and they were doing the "speed limit" suggests that they were going between 35-45 mph, give or take, if the accident occurred in town. Everyone knows that high speed rear-enders cause severe problems --- it's not news. However, the internet is replete with studies on these "low speed impacts" as yours was described --- many of which pertain to impacts of 10 mph or less; the sort of thing that occurs in a parking lot. Just remember that it's not just about the speed differential between your vehicles, it's about the mass differential as well. In other words, a big pickup truck hitting a Toyota Prius is likely to cause much more injury than the other way around, even if the accidents occurred at identical speeds.
Also, it is important to realize that the two biggest injury-magnifiers are being female (especially a tiny female) and not being aware of the impending impact. This is widely reported throughout the peer-reviewed literature, and has been for at least twenty five years. And while seat belts can certainly save your life, they can actually make the whiplash worse by holding your body in place while your neck and head whip violently. In other words, the biggest part of the impact is forced through your neck instead of being dissipated by the rest of your body.
Let's not forget about still another of big injury-magnifiers taking place in this accident --- L's head was turned at impact. The head is designed to be put into a great deal of flexion and extension (forwards and backwards movements) as well as rotation (the ability to turn both right and left). However, it is not nearly as adept at lateral flexion (the ability to tip your ear toward your shoulder). To see why this is a big deal, first tip your head backwards. Now turn your head as far as you can either right or left and then tip it backwards. Bottom line, everything else being equal, a rear-end impact when the head is turned is going to potentially tear lots more tissue than if the occupants are looking straight ahead.
Speaking of tearing tissue; part of the problem is that in most cases the damage ("tearing") done is subclinical. What do I mean by this? Only that because there is often times no overt damage seen in imaging studies it is assumed (at least by many doctors and all insurance companies) that you are malingering --- faking to garner a settlement. When you tear connective tissues such as LIGAMENTS, TENDONS, and especially FASCIA, (or for that matter, MUSCLES), the tearing is not usually "tearing" as we think of the word being used. What I mean is that the tissue is not typically torn in half; it's torn microscopically --- at the cellular level. The medical community actually has a name for the process that occurs after the tear. FIBROSIS. If you want to actually see what this looks like, HERE is a short video.
Fibrotic tissue (I usually refer to this as SCAR TISSUE rather than fibrosis) is bad news because despite the fact it cannot be imaged with MRI (HERE), it's potentially more than 1,000 times more pain sensitive than normal tissue --- this from a tissue that when healthy is widely touted as the most potentially pain-sensitive in your body. And from here it gets even more interesting. If you look at my COLLAGEN SUPER PAGE you'll see that I have included the various phases of healing. Even though insurance companies will tell you that the healing process takes place in 6-8 weeks, you can see for yourself that this is absolutely false. The final stage of healing --- the remodeling phase, where the tissue is made more elastic and stronger --- lasts as long as two years or more.
Beyond the obvious tissue damage, L has obvious neurological damage as well. The tipoff? Language like blurry vision, dizziness, disoriented, couldn't see, couldn't walk straight, can't focus, seizures, light sensitivity, sound sensitivity, headaches, panic attacks, and nervous breakdown that she uses to describe her problem. Just for the heck of it, I plugged these terms into Google as is, and after articles about temporal lobe epilepsy, Valium withdrawal, and brain cancer, I came to a page called Facts About Concussion and Brain Injury. Needless to say, her list encompasses many of the classic symptoms of TBI (TRAUMATIC BRAIN INJURY), sometimes referred to as MTBI (Mild Traumatic Brain Injury).
As far as where to go from here, I must start by saying that post-adjustment extreme dizziness and nausea are both red flags. There are probably certain kinds of adjustments you could tolerate very well (Atlas Orthogonal, Activator, various soft tissue techniques, etc, etc, etc), but any kind of adjustment that heightens the symptoms of your head injury more than very briefly should be discarded for something else. As to the whole "something is torn at the base of the skull" thing; not really sure what your chiro is talking about there (if it were the Transverse Ligament of the posterior odontiod there is no way he would consider adjusting you). Let me just tell you what I would do clinically if a similar scenario had happened to one of my THREE DAUGHTERS.
The first thing to remember is that after an accident like this, you are working against a clock. What I mean by that is that numerous studies show that if you are not "well" or at least significantly improving at 30 days, 60 days, and 90 days, your odds of becoming chronic increase dramatically. Bottom line, THE MOST CURRENT RESEARCH on whiplash is saying that as many as 1 in 2 people injured in an MVA, progress to chronic. Do whatever it takes not to become a statistic.
Because the first few days of the process constitute the "INFLAMMATORY" portion of the healing process, this would be a good time to use cold therapy. And because addressing diminished RANGES OF MOTION is so critical to the long-term prognosis, as long as they can be tolerated, massage, GENTLE ADJUSTMENTS, and simple range of motion exercises need to be added as well. If you can tolerate these things, you can move on to the NORMAL PROTOCOL. If you cannot, there are a couple of things you must do.
Firstly, you need to treat your problem as though it were systemic because as I am going to show you, it likely is. Violent impacts and head injuries are big deals for many reasons. However, one of the biggest --- a reason that seems to not be talked about much in the mainstream medical community even though there are mountains of peer-review backing this assertion --- is that head injuries lead to autoimmunity. Let me take a moment to show you the mechanism as well as some of the other issues that can occur along the way.
- CAN WHIPLASH CAUSE TBI / MTBI PART I? An article in Harvard Magazine called The Traumatized Brain began by talking about an individual who had been in a rear-ender accident, going on to describe the millions of Americans with similar problems as having symptoms that, "extend well beyond the physical injury and can unfold over long periods of time. Unlike the damage resulting from a stroke, which is often localized to one part of the brain, traumatic injuries often affect many areas of the brain in sometimes unpredictable ways." Neurosurgeon dot com says in an article called Whiplash that, "Whiplash injury is the most common injury resulting from car accidents. Whiplash injury symptoms are often chronic problems that persist for years. Microscopic research has shown that irreversible nerve damage can occur even when the head does not strike an object, but instead is only shaken violently as in a whiplash incident. Even in a low speed rear impact collision of 8 mph, your head moves roughly 18 inches, at a force as great as 7 G’s in less than a quarter of a second. The Discovery space shuttle is only built to withstand a maximum of 3 G’s. The force that an accident victim is exposed to is generally two and a half times greater than that which the vehicle is struck. Rapid change in the spinal fluid result in pressure damage to nerve fibers because the forces that occur during a rear impact happen too fast to allow normal fluid exchange." And in case this was not clear enough.....
- CAN WHIPLASH CAUSE TBI / MTBI PART II? An incredible study from a 2012 issue of Rehabilitation Research and Practice (Postconcussion Symptoms in Patients with Injury-Related Chronic Pain) showed that the most common injury --- by at least two and a half times --- that resulted in MTBI was whiplash from a car crash. It's a great (free) study that has a bibliography with many similar studies, some from the early 1990's. Another interesting study, this one from the July 2002 copy of the British Columbia Medical Journal (Purports of Brain Damage Following Presumed Whiplash Injury) went on to say that, "Mild traumatic head injury, with or without direct impact to the head, is a possible consequence of an acceleration-deceleration mechanism of injury (whiplash). Patients may present without a history of significant loss of consciousness and may not demonstrate any short-duration superficial loss of consciousness. Although there may be numerous short-lasting (days) somatic, psychological, or cognitive symptoms following mild whiplash trauma, a tissue damage cause, and a basis on which these symptoms may be demonstrated over a prolonged period of time (months), is a matter of controversy. Patients making claims of brain damage but without the prerequisite unconsciousness and peritraumatic amnesia should not be considered bogus....." In other words, even though there are no great tests for showing soft tissue and related nurological damage, the damage is nonetheless there.
- DO MEDICAL FACILITIES ADEQUATELY DIAGNOSE, DOCUMENT, AND ADDRESS THESE INJURIES? I think we just answered this (there are only about a million studies on this topic), but I found a study I thought was interesting and helpful. At least two weeks post-accident, the September 2012 issue of The Journal of Emergency Nursing (Mild Traumatic Brain Injury: Are ED Providers Identifying Which Patients are at Risk?) looked at over fifty individuals who were diagnosed with whiplash or some sort of MTBI. "Between 1 and 23 MTBI symptoms were reported by 84.6% of the participants. Headache and fatigue were the most common; female patients had almost twice as many symptoms on average as male patients. Of MVC (motor vehicle crash) patients, 83.3% reported moderate severity scores for all 4 Post Concussion Symptom Scale categories, and these represented the highest overall severity scores. Emergency nurses need to be aware patients may have an MTBI regardless of their presenting symptoms or injury severity." Bottom line, this is extremely common and is not being reported nearly as often as it should be. Many of the patients I see complain about essentially being "blown off" when the tests come back negative, which invariably they will.
- CAN WHIPLASH INJURIES CAUSE NEURO-INFLAMMATION? This is sort of a no-brainer because if there is an injury to the brain (MTBI) there will be some degree of INFLAMMATION. Four months ago, the journal Nature Reviews Neurology (The Far-Reaching Scope of Neuroinflammation After Traumatic Brain Injury) concluded that, "The 'silent epidemic' of traumatic brain injury (TBI) has been placed in the spotlight... Neuroinflammation can cause acute secondary injury after TBI, and has been linked to chronic neurodegenerative diseases; however, anti-inflammatory agents have failed to improve TBI outcomes in clinical trials." I've shown you numerous times that THE BIG FIVE (NSAIDS and Corticosteroids included) are not therapeutic but only palliative. In other words, they cover symptoms without addressing underlying pathologies. BTW, with nearly 250 citations, this study's bib is a goldmine.
- INFLAMMATION DISRUPTS THE BODY'S BARRIER SYSTEMS, AND MOST PARTICULARLY, NEURO-NFLAMMATION DISRUPTS THE BLOOD BRAIN BARRIER: There are over 10,000 studies showing that inflammation causes something called LEAKY GUT SYNDROME. But would you have guessed that neuro-inflammation can disrupt the barrier that keeps toxicity out of the brain --- the BBB or Blood Brain Barrier? How big a deal is this? Last April's issue of the FASEB Journal (Blood-Brain Barrier Dysfunction and Microvascular Hyperpermeability Following Mild Traumatic Brain Injury) concluded that, "Brain edema, elevated intracranial pressure and reduced cerebral perfusion pressure occurring in traumatic brain injury (TBI) are attributed heavily to the hyperpermeability of the blood-brain barrier (BBB)." This "hyperpermeability of the brain is widely known as "LEAKY BRAIN SYNDROME". Furthermore, just a few months ago on his blog, Ivy League Neurosurgeon and researcher, David Younger, wrote that, "Treatment options have generally been lacking for the early syndromes and late presentations of TBI and the associated neurobehavioral and neuropsychiatric symptoms. With increasing recognition of the contribution of neuro-inflammation as a major mediating factor in animal models and human translational studies, there is the prospect for improving the understanding of the mechanisms of TBI, and developing therapeutic strategies to improve the outcomes of the millions of people affected each year. Systemic and neuro-inflammatory mechanisms result from disruption of the blood-brain barrier (BBB) that normally delimits its immune privileged status, at the time of, or after the insult, are important mediators of neurological outcome of TBI. The motor, cognitive, emotional, and psychosocial consequences of TBI can be devastating and long-lasting leading to deterioration of one or more domains of adaptive functioning, with loss of independent function and safe performance of activities. The associated symptoms and neurobehavioral changes can mimic the psychiatric manifestation of an endogenous psychiatric disorder." Big words one and all, but just realize that the very symptoms we talked about earlier can be caused by inflammation / neuroinflammation.
- WHIPLASH-INDUCED NEURO-INFLAMMATION AND BBB DISRUPTION LEADS TO GLIAL CELL ACTIVATION: When we think of the brain, we think of nerve cells called neurons. The thing is, there are ten times more GLIAL CELLS in the brain than neurons. Activate large numbers of them and you have problems on your hands. Two years ago last month, the World Journal of Virology (New Advances on Glial Activation in Health and Disease) revealed that, "Astrocytes are the most numerous cells in the mammalian brain. In addition to being the support cells of the central nervous system (CNS), astrocytes are now recognized as active players in the regulation of synaptic function, neural repair, and CNS immunity. Astrocytes are among the most structurally complex cells in the brain, and activation of these cells has been shown in a wide spectrum of CNS injuries and diseases. Astrocytes respond to [are activated by] CNS trauma. After traumatic injury, stroke, infection, or other severe CNS insult, areas of focal tissue damage become filled with inflammatory, fibrotic, and other cells that derive from the perivascular cells, endothelia, bone marrow, and meninges. These tissue lesions become surrounded by reactive astrocytes forming glial scars that serve to separate necrotic from healthy tissue. Evidence has demonstrated that astrocytes contribute to sustained inflammation in the CNS after trauma or infection and growing research implicates sustained glial inflammation in neurodegenerative disorders. Chronically activated microglia and astrocytes can release reactive oxygen intermediates [free radicals], nitric oxide, and inflammatory cytokines, which are toxic to neurons. One mechanism by which astrocytes may contribute to sustained inflammation in the CNS is through upregulation of inflammatory pathways.... triggering a self-sustaining inflammatory loop and long-term glial activation." Glial cells should be activated after an injury, but too much activation creates a viscous cycle of inflammation / damage / glial activation / repeat.
- CHANGES IN PERSONALITY ASSOCIATED WITH MTBI FROM WHIPLASH: I have included this bullet because it seems like L is already here or is headed here fast. A study from a 1996 issue of Brain Injury (The Spectrum of Emotional Distress and Personality Changes After Minor Head Injury Incurred in a Motor Vehicle Accident) started things off by letting readers know that, "This is a systematic presentation of the emotional and personality disorders of 33 patients who incurred minor traumatic brain injury (MTBI) in a vehicular accident." What were some of these changes? I won't go into it here, but suffice to say that almost anything you could possibly think of was on the list. Another study, this one from last September's issue of BMJ Open (Psychological Impact of Injuries Sustained in Motor Vehicle Crashes) searched over 2,500 studies and concluded that, "Elevated psychological distress was associated with MVC-related injuries with a large summary effect size in whiplash associated disorders (WAD)... the negative psychological impact of a WAD injury is substantial."
- WHIPLASH INJURIES LEAD TO NEURO-INFLAMMATION THAT CAN CAUSE AUTOIMMUNITY: Remember the neurosurgeon I spoke of earlier, Dr. David Younger? He said that, "the switch to a second wave of autoimmunity inherent in the adaptive immune response culminates in the infiltration by immune T-cells and B-cells across the disrupted BBB, with the production of antigen-specific antibodies. The importance of heightened cell-mediated immunity is in the possibility of immune reactivation by a subsequent injury such as another neuro-inflammatory stimulus or infectious process that subsequently reopens the BBB, exposing memory immune cells to self-antigens leading to a variety of post-traumatic syndromes." The inflammation causes the gaps that make up the BBB to get bigger so that they let things through that should never get through (Leaky Brain). When the immune system sees various sorts of brain cells in the blood stream due to the injury, because they are not where they should be, the body recognizes these as foreign (antigens) and makes antibodies against and starts attacking. As you might imagine, this is not a good thing. By the way, Dr. Y concluded that, "Early and mild psychiatric symptoms following a TBI may be the best indicator of underlying neurophysiological, neurocognitive, and neuropsychiatric changes of altered brain pathology." In other words, since standard medical tests don't cut it, changes in behavior (psychiatric symptoms) offer as good a diagnostic tool as any. A great overview of this process can be found HERE or HERE.
- THE LIST OF AUTOIMMUNE DISEASES RELATED TO TBI / MTBI IS ALMOST ENDLESS: All one has to do is plug in the name of any AUTOIMMUNE DISEASE (HERE is a short list) alongside MTBI / TBI, and see what comes up. For instance, when I did that with MS, the first thing I got was a study from a 2012 issue of the Journal of Neurotrauma (Increased Risk of Multiple Sclerosis After Traumatic Brain Injury) that concluded that six years post-trauma, "patients with TBI are at higher risk for subsequent MS." Why? Probably because studies like THIS ONE have conclusively shown that, "Impact-acceleration forces to the head cause traumatic brain injury (TBI) with damage in white matter tracts comprised of long axons traversing the brain. White matter injury after TBI involves both traumatic axonal injury and myelin pathology that evolves throughout the post-injury time course." The axon is the long finger carrying impulses away from nerve cells and covered in myelin (an insulating material made by glial cells and known as "White Matter") is the fatty covering of the brain and nerves.
- AUTOIMMUNE PITUITARY, HYPOTHALAMUS, AND OTHER ENDOCRINE ISSUES POST-TBI: A 2008 study from the European Journal of Endocrinology (Antipituitary Antibodies After Traumatic Brain Injury) stated plainly that, "This study shows for the first time the presence of the APA (anti-pituitary antibodies) in TBI patients 3 years after head trauma. Moreover, present investigation indicates preliminary evidence that APA may be associated with the development of TBI-induced pituitary dysfunction." Another study, this one from the May 2015 issue of the Journal of Clinical Medicine (Hypothalamic-Pituitary Autoimmunity and Traumatic Brain Injury) essentially said the same thing about the hypothalamus (a very important part of the brain as well). "Alterations of pituitary function can occur at any time after the traumatic event, presenting in various ways and evolving during time, so they require appropriate screening for early detection and treatment. Anti-pituitary and anti-hypothalamic antibodies were detected using indirect immunofluorescence in a significant number of patients with acute and chronic TBI." This is a huge deal because these two parts of your brain release the hormones that regulate the rest of the endocrine system (HERE). An article from the Feb 2016 issue of Medscape (Post Head Injury Endocrine Complications Clinical Presentation) stated, "Approximately 30-50% of patients who survive post–traumatic brain injury (post-TBI) demonstrate endocrine complications."
- IMMUNE SYSTEM SUPPRESSION FOLLOWING HEAD INJURY: Part of the reason that people develop autoimmunity for any reason is because their TREGS (T-Regulatory Cells --- the cells that keep the immune system in check and help prevent it from attacking itself) are themselves being suppressed. Thus suppressing TREGS causes autoimmunity. However, when the other part of the immune system is suppressed, you are likely to get sick as well; just in a different manner. Two years ago, Frontiers in Neurology (Traumatic Brain Injury and Peripheral Immune Suppression: Primer and Prospectus) said, "infections are a common occurrence in patients following traumatic brain injury (TBI) and are associated with an increased risk of mortality, longer length of hospital stay, and poor neurological outcome. Systemic immune suppression arising as a direct result of injury to the central nervous system (CNS) is considered to be primarily responsible for this increased incidence of infection, a view strengthened by recent studies that have reported novel changes in the composition and function of the innate and adaptive arms of the immune system post-TBI." As an interesting side note to this point, be aware that IMMUNE SYSTEM SUPPRESSION is America's number one form of medical treatment.
- CAN WHIPLASH LEAD TO SEIZURES? Because L was diagnosed with "Pseudo Seizures" it behooves us to answer this question. Although it is doubtful that L has developed epilepsy, the title of this study in a 2011 issue of Cardiovascular Psychiatry and Neurology (Blood-Brain Barrier Breakdown Following Traumatic Brain Injury: A Possible Role in Posttraumatic Epilepsy) makes us at least pause and think. Two months ago the journal Brain Disorders and Therapy published an abstract presented at the 3rd International Conference on Neurological Disorders and Brain Injury held in London saying that, "Abnormal EEG is 37% correlated with seizures and 20% related with memory loss. The patients who experienced seizures after the mTBI were six times more likely to have an abnormal EEG than those who did not experience any seizures." Not sure that this proves anything, but is interesting nonetheless.
- MTBI AND ALZHEIMERS / DEMENTIA: A study from the Journal of Neuropathology and Experimental Neurology (Repetitive Mild Traumatic Brain Injury Augments Tau Pathology and Glial Activation.....) tells the story via its title. Just remember that Tau plaques are the junk that foul up the brain in ALZHEIMER'S DISEASE. Another study, this one from a 1999 issue of the American Journal of Epidemiology (Traumatic Brain Injury and Time to Onset of Alzheimer's Disease) showed that the age that people developed Alzheimer's Disease dropped if they had been exposed to an MTBI. In other words, they developed that disease at an earlier age.
Many of you reading this are no longer dealing with a simple whiplash injury (as if there really is such a thing). You are dealing with a TBI / MTBI that unfortunately, few people in the medical field really understand. This means that it must be dealt with as the systemic problem that it is (HERE). Which brings me to my second point. Because time is of the essence, once you see that things are not coming around but are headed south, it's time to find a FUNCTIONAL NEUROLOGIST trained by Ted Carrick, and well-versed in the work of Dr. Datis Kharazzian.
Dr. Schierling completed four years of Kansas State University's five-year Nutrition / Exercise Physiology Program before deciding on a career in Chiropractic. He graduated from Logan Chiropractic College in 1991, and has run a busy clinic in Mountain View, Missouri ever since. He and his wife Amy have four children (three daughters and a son).
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