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,
| || |
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.
AMERICA'S NUMBER ONE SOURCE
FOR CHRONIC NECK PAIN?
For instance, Medline Plus (Neck Injuries and Disorders) says of neck pain, "Any part of your neck - muscles, bones, joints, tendons, ligaments, or nerves - can cause neck problems. Falls or accidents, including car accidents, are a common cause of neck pain." A 2009 position paper by the IASP (International Association for the Study of Pain) said, "Neck pain is a common global problem, at least in the industrialized world, and it constitutes an important source of disability. Neck pain affects 30–50% of the general population annually."
According to the American Academy of Pain Medicine, "severe headache or migraine pain (15%), neck pain (15%) and facial ache or pain (4%)" are some of the leading causes of pain in America (HERE). Furthermore, "Almost 59% reported an impact on their overall enjoyment of life, 77% reported feeling depressed, 70% said they have trouble concentrating, 74% said their energy level is impacted by their pain, and 86% reported an inability to sleep well." And as for how many MVA's there are here in America, USA Coverage (How Many Driving Accidents Occur Each Year?) says, "The most common question in issues involving vehicular fatalities is how many driving accident occur each year? If it’s all summed up in a yearly basis,there are 5.25 million driving accidents that take place per year. Statistics show that each year, 43,000 or more of the United States’ population die due to vehicular accidents and around 2.9 million people end up suffering injuries." But these statistics don't really tell the whole story.
Fetterman and Associates (How Many Car Accidents Occur Per Year?) reveal on their website that, "The most up-to-date information currently available only extends to 2012, and is provided by the Bureau of Transportation Statistics. In 2012, there were an estimated 5,615,000 highway accidents. But that number does not include accidents that occur in neighborhoods or parking lots. Highway accidents are easier to track. Some estimates of total accidents including the more minor ones are as high as 10 million per year." But even this is not presenting the entire picture. Less than two years ago, Consumer Reports (14 Million Americans Were Involved in Accidents with Senior Drivers this Past Year) said that, "Over the past year, 14 million Americans aged 18 to 64 were estimated to be involved in accidents caused by drivers aged 65 and over." It's almost like every study and statistic that comes out is worse than the one that came out before it.
WHAT CAN YOU DO TO MAKE SURE YOU DO NOT BECOME A WHIPLASH STATISTIC?
- HEAD RESTRAINT ADJUSTED PROPERLY: This is the inarguable #1, with tons of information found on this topic online, much of it in the form of peer-review. Without going in to great detail, make sure that the middle of your head restraint is even with your ear. Part of the problem is that many people keep their head restraints all the way down, allowing it to act as a fulcrum as the head is forced over it in the the event of a rear end collision. Be aware that studies have shown that most (over 85%) head restraints are positioned improperly.
- SEAT POSITIONED PROPERLY: Keep the seat in a relatively upright position. This has become a bigger deal in recent years, with younger people wanting to recline their seats.
- DRIVE A SAFER CAR: It seems like year in and year out, the safest cars are made by Volvo and Saab (not that I own or promote either brand). It is also important to remember that the smaller the vehicle you drive, the greater the chance of all injuries, including whiplash. Make sure to check out the various safety features and safety ratings before buying.
- PREPARE FOR THE REARENDER IN ADVANCE: I get it; you can never completely prepare to get rearended. However, if you hear brakes squalling, rather than first looking in the mirror or turning your head to look (whiplash is much worse in side impacts or if the head is turned at impact), plaster your back and head to your seat back and head restraint. If the head and neck don't move (whip) on impact, there is no tearing of soft tissues in the neck
- SEAT BELTS: While seat belts unarguably save lives, they do not prevent or even reduce whiplash. A similar thing can be said of airbags. While I am a fan of airbags (I will forever have the scars from the "rug" burns on the insides of my arms from THIS CRASH), airbags will not help you out in a rear-ender type accident. They will, however, help in front end collisions.
WHAT TO DO IF YOU ARE INJURED IN A WHIPLASH TYPE OF ACCIDENT
- HOW LONG DOES IT TAKE INJURED SOFT TISSUES TO HEAL? I answer this question in my COLLAGEN SUPER PAGE. The bottom line here is that current peer-review shows that although the first phases of healing only take about three weeks, the final phase --- the part where the Scar Tissue is strengthened and remodeled --- can take two years or more. If you don't know this, I promise that insurance companies will use it against you.
- WHAT IS PHASE I OF TREATING PEOPLE WITH WHIPLASH INJURIES? HERE is Phase I of treating Whiplash Injuries. Way too often people are bypassing Phase I and going straight to Phase II.
- WHAT IS PHASE II OF TREATING PEOPLE WITH WHIPLASH INJURIES? PHASE II of dealing with whiplash-induced soft tissue injuries is the focus of the majority of treatment plans. Unfortunately, the final aspect of Phase II --- dealing with FHP --- is rarely addressed (HERE).
The end result of either of the latter two bullets is people who frequently do great with adjustments. For a very short time. Often times just a day or two. Or maybe only an hour or two. If you want to see what makes a visit to my clinic different, take a look at THIS SHORT POST. As I have talked about at length in the past (HERE is one example), my goal is always to help you ASAP, as opposed to long and drawn out treatment schedules.
CHRONIC NECK PAIN
ONLY ONE OF THE MANY CONSEQUENCES OF WHIPLASH
THE INJURY THAT KEEPS ON GIVING.... WHIPLASH
The title of a 2012 study from Department of Physical Therapy at the University of Alberta sums the whole mess up nicely --- If They Can Put a Man on the Moon, They Should be Able to Fix a Neck Injury: Explaining Pain Beliefs About WAD. Unfortunately, research is say that this is far from the case, and as I showed you THE OTHER DAY, it's unfortunate that experts say we aren't much further along at solving this puzzle than were 30 years ago.
- AS MANY AS 50% OF THE PEOPLE INJURED IN A WHIPLASH-TYPE ACCIDENT PROGRESS TO CHRONIC: Earlier this year, BMJ Publishing wrote, "The pain and stiffness from whiplash usually go away in a few days or weeks." While they did admit that, "symptoms can sometimes last a lot longer," what does "longer" really mean? A 2013 PLoS One study on INFLAMMATION and the relationship to whiplash (The Course of Serum Inflammatory Biomarkers Following Whiplash Injury....) said, "Widespread hyperalgisa, morphological muscle changes and psychological distress are common features of WAD. Whiplash associated disorders (WAD) are a common and costly health problem for western society. Many (up to 50%) of those injured transition to chronicity and current management approaches for both acute and chronic WAD are only modestly effective." More recently, last October's issue of the Journal of Orthopedic and Sports Physical Therapy (JOSPT) revealed that, "It is generally accepted that up to 50% of those with a whiplash injury following a motor vehicle collision will fail to fully recover. Twenty-five percent of these patients will demonstrate a markedly complex clinical picture that includes severe pain-related disability, sensory and motor disturbances, and psychological distress. To date, no management approach (eg, physical therapies, education, psychological interventions, or interdisciplinary strategies) for acute whiplash has positively influenced recovery rates." This stat is repeated over and over again in the peer-reviewed scientific literature. And while it isn't totally true (our TESTIMONIAL PAGE would take issue), it's true in far more cases than it should be. And unfortunately......
- THE LONGER IT GOES ON, THE WORSE THE PROGNOSIS: In October of last year, JOSPT ran another study in a series on whiplash called Recovery Pathways and Prognosis After Whiplash Injury. The authors concluded that, "Recovery from a whiplash injury is varied and complex. Three distinct patterns of predicted recovery (trajectories) have been identified using disability and psychological outcome measures. These trajectories are not linear, and show that recovery, if it is going to occur, tends to happen within the first 3 months of the injury, with little improvement after this period." Not only is this scary, but helps prove the earlier point; that unfortunately......
- WE ARE NOT GETTING BETTER AT TREATING IT: A different study from still the same issue of JOSPT verified all of this when the author began his study (Whiplash Continues its Challenge) by saying, "There have been many advances in the management of neck pain disorders, but a personal frustration as a clinician and researcher in the field is that the incidence of full recovery following a whiplash injury as a result of a motor vehicle crash has not increased and, subsequently, the rate of transition to chronic neck pain has not lessened." Much of this has to do with the fact that.....
- STANDARD IMAGING IS RELATIVELY WORTHLESS FOR SHOWING THE REASON(S) BEHIND MANY OF THE COMMON SYMPTOMS OF WHIPLASH INJURIES --- BUT THERE IS A PROMISING NEW TECHNOLOGY OUT THERE: After talking about the same things we've already discussed thus far, Dr. James Elliot, a professor of Physical Therapy as Northwestern University's PT & Human Movement Sciences department said of a study he was working on a few years ago, "Very rarely, if ever, do we have any available imaging findings – with radiography, with CT, with MRI – to accurately identify the lesions that would potentially point to the injury responsible for a person’s ongoing symptoms." While this is certainly true, Diagnostic Ultrasound is increasingly being used (at least on THE RESEARCH SIDE OF MEDICINE) to image injured soft tissues (HERE is a cool example). Two recent studies --- one from last August's Science Reports that dealt with women and Whiplash, the other from the October 2015 issue of the same journal --- concluded that, "Tools to assist in the diagnosis of WAD and an increased understanding of neck muscle behaviour are needed. We examined the multilayer dorsal neck muscle behaviour in nine women with chronic WAD versus healthy controls during the entire sequence of a dynamic low-loaded neck extension exercise, which was recorded using real-time ultrasound movies with high frame rates. The WAD group showed more shortening during the neck extension phase in the trapezius muscle and during both the neck extension and the return to neutral phase in the multifidus muscle. For the first time, a novel non-invasive method is presented that is capable of detecting altered dorsal muscle strain in women with WAD during an entire exercise sequence... Skeletal muscles actively contract and produce force in response to control signals from the central nervous system, leading to mechanical changes in the muscles. Ultrasound enables quantitative descriptions of these mechanical changes and allows non-invasive investigation of different muscle layers in real time and in vivo. Ultrasound analysis measures deformation (mechanical muscle changes, such as elongations and shortenings of the muscle) and deformation rate (how fast the deformation occurs) simultaneously in the superficial and deep neck muscle layers." This radically improves our understanding of FASCIAL ADHESION as related to.....
- WHIPLASH AND INJURIES TO THE NECK MUSCLES: Sometimes I think the medical community can be too smart for their own good; to the point where they are missing the forest for the trees. Case in point, a scientific article published for lay people just last month (Whiplash Pathology: Does Knowledge Change Clinical Practice?) from Physical Therapist, Chris Worsfold's site, Pain in the Neck: Notes From a Neck Pain Clinic. Worsfold says (cherry picked, as are all quotes on this post), "muscle injury occurs in whiplash injury – but it’s rare..." After telling readers that muscle damage is seen in only about one percent of MRI'S, he goes on to say of specialized blood tests used to detect enzymes released as the result of muscle tearing; "Blood tests can reveal elevated creatine kinase levels after muscle trauma and this often correlates with the degree / severity of the muscle injury. The researchers could find no evidence of muscle damage following whiplash injury; further evidence that frank muscle injury is rare." Worsfold is correct here --- "frank" (gross) muscle injuries are rare in Whiplash Injuries. However, I am convinced that the vast majority of what we refer to as muscle strains, muscle pulls, or muscle tears, are anything but (HERE). In light of YESTERDAY'S POST, concerning Diagnostic Ultrasound and FASCIA, I think it safe to say that muscles are involved in these sorts of injuries. Proof of that are the numerous studies showing...
- THE MUSCLES OF PEOPLE INJURED IN WHIPLASH ACCIDENTS TURN TO FAT: I showed this in a very recent post, and because there are lots and lots of studies on this topic ("Fatty Infiltration"), I am not covering it in any more depth. Suffice it to say that it's bad, and will not only affect the ranges of motion of your neck (cervical spine) but will be adversely affected by these same ROM's, leading to rampant spinal decay. Which begs the question.......
- HOW IMPORTANT IS CERVICAL RANGE OF MOTION IN PEOPLE RECOVERING FROM WHIPLASH? On the surface, this question is a no-brainer. I've shown you repeatedly what abnormal ranges of motion (HERE) and subsequent DIMINISHED PROPRIOCEPTION lead to. No matter how you slice it, the end result is going to be some sort of PHYSICAL DEGENERATION. Let me show you another reason ROM of the Cervical Spine is such a big deal. Sixteen years ago, three Danish MD / Ph.D's (all of them neurologists associated with the Pain Research Centre at Aarhus University Hospital) published a study in the journal Neurology called Handicap After Acute Whiplash Injury, in which they looked back a year later at the factors that made Whiplash Injuries worse. "Exposure to a whiplash injury implies a risk for development of chronic disability and handicap. In a 1-year prospective study of persons with acute whiplash injury and control subjects who had acute ankle distortion, pain intensity, number of nonpainful neurologic complaints, cervical mobility, workload during extension and flexion of the neck, and results of psychometric assessment were recorded. After 1 year, 7.8% persons with whiplash injury had not returned to usual level of activity or work. The best single estimator of handicap was the cervical range-of-motion test, which had a sensitivity of 73% and a specificity of 91%. Accuracy and specificity increased to 94% and 99% when combined with pain intensity and other complaints." Think about this for a moment; of all the crazy neurological issues that neurologists deal with day in and day out, the number one predictor of crappy outcomes and poor recovery was poor ROM of the cervical spine --- something you can test on your own (HERE). Just remember that this issue of muscle injury helps explain why.......
- WOMEN ARE MORE LIKELY TO BE INJURED THAN MEN: Although many people (mostly insurance companies) have been saying for years that this is the result of female susceptibility to DEPRESSION and other psychological issues, a study from the November 2015 issue of Pain Practice (Sex Differences in Patients with Chronic Pain Following Whiplash Injury: The Role of Depression, Fear, Somatization, Social Support, and Personality Traits) failed to bear this out by concluding, "Except for emotional support in problem situations and social companionship, psychosocial factors do not differ between men and women with chronic WAD. These findings imply little to no risk for sex bias in studies investigating psychosocial issues in patients with chronic WAD". Studies from HERE and HERE respectively concluded that elderly females are the most common group with permanent injuries, and that all our mathematical Whiplash models so far have been based on males. As of late last summer there is now an advanced model based on females and the differences in their tissues and musculoskeletal structure. And while women are more commonly injured, both males and females injured injured in MVA find that.....
- TRIGGER POINTS ARE MORE COMMON IN WHIPLASH VICTIMS: After reading my numerous posts on TRIGGER POINTS, this bullet is not tough to grasp. A study from Pain Medicine (Myofascial Trigger Points in Patients with Whiplash-Associated Disorders and Mechanical Neck Pain) said that, "Manual examination of suboccipital, upper trapezius, levator scapula, temporalis, supraspinatus, infraspinatus, deltoid, and sternocleidomastoid muscles, was done to search for the presence of both active or latent muscle trigger points. The mean number of active muscle trigger points was significantly greater in the WAD group than in the mechanical neck pain group." This is because.....
- CHRONIC PAIN FROM WHIPLASH IS DIFFERENT THAN OTHER KINDS OF CHRONIC PAIN: There are so many studies on this topic; suffice it to say that they agree almost unanimously --- Whiplash is a different sort of animal than run-of-the-mill injuries, and leave behind a different footprint, with a different sort of pain. It's not just a "SPRAINED ANKLE" in the neck as some are fond of saying. One of the many reasons may be.....
- WHIPLASH AFFECTS MUSCLES THAT HAVE MYODURAL BRIDGES: Everyone has heard of an epidural. There are three layers of dura, which are the tough, fascia-like membranes that cover the spinal cord. Careful anatomy dissections have recently revealed that there are fascia-like "BRIDGES" of connective tissue between the muscles and the dura. In other words, the numerous tiny suboccipital muscles (the deep muscles that lay directly underneath the base of the skull) have what amounts to attachments to the cord itself. This is at least part of the reason that stress of various sorts leads to muscle tension, which leads to CERTAIN KINDS OF HEADACHES, ultimately affecting the brain itself (HERE). And when the brain ain't happy, ain't nobody happy! For a short video on MYO-DURAL BRIDGES, take a look at the provided link.
WHIPLASH AND NEUROLOGICAL DAMAGE
- GENERAL NEUROLOGICAL PROBLEMS: This, folks, is where things start getting interesting. Whiplash has the potential to foul your neurological systems up in ways that, as you've already seen, we are only beginning to scratch the surface of. Last October's issue of Frontiers in Neurology (An Attempt of Early Detection of Poor Outcome after Whiplash) by eleven French researchers did a good job of spelling this out. "The whiplash problem has generated no less than 566 review articles on whiplash since 1964, which summarize 3,266 papers since 1952. Although the majority of acute patients with whiplash-associated disorders (WAD) show no visible physical damage to the neck, up to 50% of them develop chronic pain. Whiplash injury would rather induce peripheral sensitization (hypersensitivity of the peripheral nociceptors) and central sensitization (hyper excitability of the central nervous system), which could persist for months and even years past the acute phase of the whiplash. Indeed, recent reviews pointed to clinical signs to evaluate WAD, which suggest a role of central sensitization in chronic whiplash associate disorders: persistent pain complaints, local and widespread hyperalgesia, referred pain, allodynia, decreased spinal reflex thresholds, inefficient diffuse noxious inhibitory control activation, and enhanced temporal summation of pain. 70% of chronic whiplash patients (CWP) complain of dizziness and unsteadiness within 1 week of their trauma, and 40% of acute whiplash patients (AWP) report dizziness and 10% of them develop later otological symptoms, such as tinnitus, deafness, and vertigo. Reduced cervical mobility, disturbed kinesthesia and altered neck muscles activity are often present at the acute stage and they persist over time in the moderate/severe whiplash groups of patients. Several reviews also point to dysfunctions of postural control in CWP. On the sensory side. Vestibular deficits may be at play because some AWP and CWP exhibit nystagmus, abnormal gain of the vestibulo-ocular, vestibulo-collic and cervico-ocular reflexes, and abnormal values of the vestibular evoked potentials. The clinical syndromes of whiplash patients can also result from abnormal neck somatosensory information. In particular, the sensitivity of the neck muscles spindle could be affected by ischemic or inflammatory events and degenerative changes. Furthermore, being at the convergence of the somatosensory, vestibular, and visual systems on several central nervous system (CNS) structures, abnormalities of one of more of these subsystems can lead to the oculomotor, cephalic, and postural syndrome." I completely realize you may not have gotten this whole thing, but suffice it to say that none of it is fun. It can all be summarized by the following points.
- WHIPLASH AND CONCUSSIONS / MTBI: Back in October, JOSPT published a paper (Whiplash Injury or Concussion? A Possible Biomechanical Explanation for Concussion Symptoms in Some Individuals Following a Rear-End Collision) where researchers reviewed data from football helmet impacts and the force generated on the head from MVA. The authors found, "a potential biomechanical link between whiplash injury and concussion, and advances our understanding of how head restraint interaction during a rear-end crash may cause an injury more typically associated with sports-related head impacts." Interesting, because numerous studies have shown that a properly adjusted head restraint (headrest) is the best method of preventing whiplash (middle of the restraint at the middle of the ear). The worst force in this study was when the head restraint was positioned too low, allowing the neck to be "fulcrumed" over it during rear end impacts. The Forensic Engineering Expert Witness Blog actually wrote a very interesting (short) post on this study just a couple of weeks ago called Concussion and Whiplash Injury. If you want to see why concussions have the potential to be a freaky problem, READ THIS CRAZY story about the downfall and demise of Elvis Presley.
- WHIPLASH IS RELATED TO BOTH PSYCHOLOGICAL / MENTAL STRESS: After initially looking at over 2,500 studies and settling on about 1% of that number that actually met their criteria, researchers writing in last September's issue of BMJ Open (Psychological Impact of Injuries Sustained in Motor Vehicle Crashes) tried to correlate things like PTSD, DEPRESSION, and psychological distress, to the Whiplash Injury. The authors concluded that, "Elevated psychological distress was associated with motor vehicle crash related injuries with a large summary effect size in WAD, medium to large effect size in spinal cord injury and small to medium effect size in mild traumatic brain injury. Increased psychological distress remains elevated in spinal cord injuries, mild traumatic brain injuries, and WAD for at least 3 years post-crash." And we've already seen where MTBI is related to WAD as well.
- WHIPLASH SUFFERERS TEND TOWARD SYMPATHETIC DOMINANCE: Seeing what we've seen so far, we can't be surprised that Whiplash sufferers frequently end up with SYMPATHETIC DOMINANCE, including it's number one diagnostic sign -- LOW HEART RATE VARIABILITY. This was confirmed by a study published in the November 2015 issue of Pain Practice (Lower Resting State Heart Rate Variability Relates to High Pain Catastrophizing in Patients with Chronic Whiplash-Associated Disorders). The study itself is not very exciting unless you understand the concept of Sympathetic Dominance --- living in a constant state of "fight or flight" adrenal arousal. It's no wonder this sort of stress burns out the adrenal glands, leading to "ADRENAL FATIGUE" that many refer to as FIBROMYALGIA.
- WHIPLASH CAN CAUSE PROBLEMS SWALLOWING AND BREATHING: Even though I am not going to go into the crazy complicated neurological pathways that explain it, a 2015 study published in Brain: Structure & Function (Neck Muscle Afferents Influence Oromotor and Cardiorespiratory Brainstem Neural Circuits) concluded that, "Whiplash associated disorders (WAD) and cervical dystonia, which involve disturbance to the neck region, can often present with abnormalities to the oromotor [chewing, swallowing, speaking, etc], respiratory and cardiovascular systems." And here's the rub; if you you don't have a someone examining you that understands functional problems and is aware of studies like this, you can forget about these problems being logically and systematically related back to your accident.
- IT CAUSES PROBLEMS WITH EYE MOVEMENTS, WHICH ARE INDICATIVE OF BIGGER PROBLEMS: Last October's issue of BMC Musculoskeletal Disorders published a study called Eye Movements in Patients with Whiplash Associated Disorders: A Systematic Review. Although there are some big words here, for anyone dealing with this junk, it's helpful to realize your problem is not only not in your head, it's relatively common. "Many people with Whiplash Associated Disorders (WAD) report problems with vision. Seventy percent of patients complain of pain, dizziness and unsteadiness, while 50% report problems with vision. These problems with vision comprise concentration problems during reading, sensitivity to light, visual fatigue, and eye strain. Such oculomotor problems in WAD patients could be related to cervical sensorimotor disorders. This may be because of the complexity of the cervico-oculomotor system, that includes not only the central nervous system but also the proprioceptive system of the cervical spine." I hope you grasped the importance of this last sentence in relationship to PROPRIOCEPTION of your neck. "Eye movement control depends on eye position in the head and on the position of the head in space. Head position is determined by integration of several sub-systems such as the vestibular system, visual information and proprioceptive system of the cervical spine. Disturbed afferent cervical information is related to nystagmus, dizziness and deficits in balance. The principal source of cervical afferent information is formed by mechanoreceptors in the upper cervical spine. Specifically in the deep upper cervical muscles (i.e. m. obliquus capitis superior and inferior, m. longus colli), the density of muscle spindles is extremely high compared to other muscles in the body. Muscle spindles are part of the sensorimotor system. In patients with WAD sensorimotor control is disturbed. The majority of studies in this review confirm the possibility of eye movement impairments in WAD patients" Sometimes these problems are intimately related to something called "Centralization" (HERE and HERE). Speaking of which......
- WHIPLASH CAN LEAD TO CENTRAL SENSITIZATION: CENTRAL SENSITIZATION is the granddaddy of CHRONIC (TYPE III) PAIN. This is the kind of pain that continues to play on a loop long after the injury itself has healed. The December issue of JOSPT said that, "Central Sensitization (CS) dominates the clinical picture in a subgroup of the musculoskeletal pain population," and that we need to be, "applying modern pain neuroscience to clinical practice implies, recognizing those patients having predominant CS pain, and accounting for CS when designing the treatment plan in those with predominant CS pain." This, however, is extremely tough to do as more or "better" drugs have not proven effective. It's also why (after discussing it with my patients) I sometimes take THIS APPROACH when I'm not sure whether or not their problem is Type III Pain. A study done at the University of Queensland said four years ago next month that, "There is compelling evidence for central hyperexcitability in chronic WAD. This should be considered in the management of chronic WAD." The Belgian authors of a study published in the May 2015 edition of Pain Physician (Cognitive Performance Is Related to Central Sensitization and Health-related Quality of Life in Patients with Chronic Whiplash-Associated Disorders and Fibromyalgia) concluded that, "A growing body of research has demonstrated that impaired central pain modulation or central sensitization (CS) is a crucial mechanism for the development of persistent pain in chronic whiplash-associated disorders (WAD) and fibromyalgia (FM) patients. Furthermore, there is increasing evidence for cognitive dysfunctions among these patients. In addition, chronic WAD and FM patients often report problems with health-related quality of life (QoL). In conclusion, this paper has demonstrated significant cognitive deficits, signs of CS, and reduced health-related QoL in chronic WAD and FM patients compared to healthy individuals. Significant relations between cognitive performance and CS as well as health-related QoL were demonstrated." Bad stuff, and in my estimation, the best way to avoid it (certainly not a foolproof) is to live an ANTI-INFLAMMATORY LIFESTYLE.
- GREATEST PREDICTORS OF LONG TERM PROBLEMS FROM WHIPLASH: Remember how just a bit ago I showed you that a group of neurologists determined diminished neck ranges of motion to be the best predictor of long-term WAD-related problems? A Japanese study from PLoS One that's not quite two years old said this. "Whiplash-associated disorders (WAD) are the most common injuries that are associated with car collisions in Japan and many Western countries. Based on the results of this analysis, we found that female sex, the severity of the collision, poor expectations of recovery, victim mentality, dizziness, numbness or pain in the arms, and lower back pain were significantly associated with a poor recovery from WAD."
- WE KNOW WHIPLASH LEADS TO DEPRESSION; WHAT ABOUT "BURNOUT"? Earlier this year, I wrote a post about burnout (HERE). Despite the fact that PubMed Health (Depression: What is Burnout?) says no one has "officially" defined it yet, it is loosely defined as, "exhaustion, alienation from work-related activities, and reduced performance". A five year old study from the International Journal of Rehabilitation Research (Burnout in Patients with Chronic Whiplash-Associated Disorders) concluded that, "A high proportion of burnout was found in the patient group (87%). The results indicate the possible clinical importance of burnout in relation to chronic WAD." It's not surprising when you realize how much pain has the ability to consume every waking thought --- you essentially become your pain (HERE).
- WHIPLASH, TEMPOROMANDIBULAR DISORDERS, AND FACE PAIN: The Swedish Dental Journal published a study called Frequent Jaw-Face Pain in Chronic Whiplash-Associated Disorders, in which they concluded, "Chronic Whiplash-Associated Disorders (WAD) presents with frequent pain in the neck, head and shoulder regions... In contrast to healthy subjects, a majority of the WAD patients (88%) reported frequent pain in the jaw-face, in addition to frequent pain in the neck (100%), shoulders (94%), head (90%) and back (72%). The WAD patients also reported stiffness and numbness in the jaw-face region, and frequent general symptoms such as balance problems, stress and sleep disturbances. The result suggests that frequent pain in the jaw-face can be part of the spectrum of symptoms in chronic WAD." The Journal of Orofascial Pain (Temporomandibular Disorder Pain after Whiplash Trauma: A Systematic Review) concluded similarly. After "A systematic literature search of the PubMed, Cochrane Library, and Bandolier databases was conducted from January 1966 through October 2012, the search identified 125 articles. The reported median prevalence of temporomandibular disorder (TMD) pain after whiplash trauma was 23%. For patients with a combination of TMD pain and WAD, treatment modalities conventionally used for TMD, such as jaw exercises and occlusal splints, had less of an effect compared to TMD patients without a whiplash injury. The poorer treatment outcome suggests that TMD pain after whiplash trauma has a different pathophysiology compared to TMD pain localized to the facial region." In other words, the issue could very well be neurological and not simply physical. For more on SKULL AND FACE PAIN, just click the link.
- WHIPLASH AFFECTS BALANCE: I'm not even going to go down this road because numerous studies have already mentioned it. Suffice it to say that balance issues, whether from CERVICAL VERTIGO or from other sources, are a significant problem in people suffering from WAD.
- WHIPLASH CAN LEAD TO OCCULT CORD DAMAGE: Engineers, physicians, and researchers from Chicago and Miami, teamed up to bring us this 2015 offering (Potential Associations Between Chronic Whiplash and Incomplete Spinal Cord Injury) in the journal Spinal Cord Series and Cases. After studying individuals who met criteria, the authors reported, "reduced spinal cord motor tract integrity, increased fatty infiltration of the neck and lower extremity muscles and significantly impaired voluntary plantarflexor muscle activation. The lower extremity structural changes and volitional weakness in chronic WAD were comparable to participants with incomplete spinal cord injury." The point of showing you this is not because it's common, but because it's yet another of the myriad of neurological symptoms of WAD that are routinely misunderstood, overlooked, or just plain ignored.
CURRENT STANDARDS OF CARE FOR TREATING PEOPLE WITH WHIPLASH
- According to the October issue of JMPT (The Treatment of Neck Pain-Associated Disorders and Whiplash-Associated Disorders: A Clinical Practice Guideline), treatment for chronic WAD should involve, "multimodal care or stress self-management; manipulation with soft tissue therapy; high-dose massage; supervised group exercise; supervised yoga; supervised strengthening exercises or home exercises (grades I-II NAD --- Neck Pain Associated Disorders); multimodal care or practitioner's advice (grades I-III NAD); and supervised exercise with advice or advice alone (grades I-II WAD). For workers with persistent neck and shoulder pain, evidence supports mixed supervised and unsupervised high-intensity strength training or advice alone (grades I-III NAD)." Notice here that all forms of treatment are active. While this is grand on many levels, it may be guilty of missing at lest part of the "PHASE I" boat.
- Two months later, the December issue of Canada's Spine Journal (Which Interventions are Cost-Effective for the Management of Whiplash-Associated and Neck Pain-Associated Disorders?) came up with this gem. "Structured education appears cost-effective for adults with WAD. For adults with NAD, acupuncture added to routine medical care; manual therapy; multimodal care that includes manual therapy; advice and exercise; and psychological care using cognitive-behavioral therapy appear cost-effective. In contrast, adding manual therapy or diathermy to advice and exercise; multimodal care by a physiotherapist or physician; and behavioral-graded activity do not appear cost-effective for adults with NAD." It would take me awhile to really unwind this enough to decipher it completely, but suffice it to say that it's another one of the studies touting "ADVICE" to be the equivalent of (or even superior to) action.
- Same group, same month (Are Manual Therapies, Passive Physical Modalities, or Acupuncture Effective for the Management of Patients with Whiplash-Associated Disorders or Neck Pain and Associated Disorders?). "Our review adds new evidence to the Neck Pain Task Force and suggests that mobilization, manipulation, and clinical massage are effective interventions for the management of neck pain. It also suggests that electroacupuncture, strain-counterstrain, relaxation massage, and some passive physical modalities (heat, cold, diathermy, hydrotherapy, low-level laser therapy (LLLT) and ultrasound) are not effective and should not be used to manage neck pain." Got to say that I am a believer in LLLT for any number of things, and with the cost coming down all the time, these creatures have become affordable to the general public.
- Again, same group, same time (Are Psychological Interventions Effective for the Management of Neck Pain and Whiplash-Associated Disorders?) only this time they were looking at psychological interventions. "We did not find evidence for or against the use of psychological interventions in patients with recent onset NAD or WAD. We found evidence that a progressive goal attainment program may be helpful for the management of persistent WAD and that Jyoti meditation may benefit patients with persistent NAD."
- Two years ago, PLoS One published The Effectiveness of Conservative Management for Acute Whiplash Associated Disorder (WAD) II: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. In it they determined that, "Conservative intervention was more effective for pain reduction at 6 months and 1-3 years, and improvement in cervical mobility in the horizontal plane at <3 months compared with standard/control intervention. Active intervention was effective for pain alleviation at 6 months and 1-3 years compared with passive intervention. Behavioural intervention was more effective than standard/control intervention for pain reduction at 6 months, and improvement in cervical movement. This rigorous systematic review found that conservative and active interventions may be useful for pain reduction in acute WADII management in the medium-long term. Additionally, improvement of cervical movement in the horizontal plane short term could be promoted by the employment of a conservative intervention. The employment of a behavioural intervention (e.g. act-as-usual, education and self-care including regularly exercise) may be an effective treatment in reducing pain and improving cervical mobility in patients with acute WADII in the short-medium term." The problem with this study and others like it is that ultimately, "The level of evidence from this systematic review is evaluated as low/very low according to GRADE."
I love looking at STANDARDS OF CARE, but am not convinced they are always in the patients best interest. And as you see, they don't always agree with each other, with the evidence used to create them sometimes being poor or biased. To see how I go about dealing with individuals struggling with chronic WAD in my clinic, HERE is a quick overview. Although this is certainly not always the case with acute WAD, with chronic WAD, you will know in a single treatment whether my approach is going to help (HERE). My thought processes fall back on a few different things. Firstly, if you look at the material pertaining to healing times on my COLLAGEN SUPER-PAGE, you'll see that at three months there's still a long way to go as far as complete healing / remodeling is concerned.
Secondly, the common theme in these guidelines seems to be that things that increase ROM of the C-Spine (manipulation, mobilization, massage, exercises, stretches, etc, etc) were largely beneficial in every study that pertained to the physical body. This is nothing new and has been shown by the medical community for decades. The year I got married (1996), the most renowned whiplash researchers on the planet (Gargan & Bannister) published a study in the journal Injury called Chiropractic Treatment of Chronic Whiplash Injuries. When you read their conclusions, you need to note that the patients were "chronic" --- the group that the medical community essentially says nothing will help, so HERE'S YOUR DRUGS. Now run along and have a nice day.
"Forty-three percent of patients will suffer long-term symptoms following 'whiplash' injury, for which no conventional treatment has proven to be effective. A retrospective study was undertaken to determine the effects of chiropractic in a group of patients who had been referred with chronic 'whiplash' syndrome. The severity of patients' symptoms was assessed before and after treatment using the Gargan and Bannister classification. 93% improved following chiropractic treatment. The encouraging results from this retrospective study merit the instigation of a prospective randomized controlled trial to compare conventional with chiropractic treatment in chronic 'whiplash' injury."
DOES THE FACT YOU'VE HIRED A LAWYER HAVE ANY BEARING ON THE OUTCOME OF YOUR INJURY?
The medico-legal arena seen hovering behind the scenes of the "Whiplash Injury" has become an industry unto it's own, with no question more hotly debated than the one raised by the title of this section. After combing through lots of studies on the subject (there are dozens), I find it to be a wash --- as many yeses as nos. While it's true that the majority of studies used to show that pending litigation had no effect on outcomes, this is no longer the case.
My guess is that much of this is due to the idea promoted by a bumper sticker I saw recently; Hit Me: I Need The Money! --- an idea being driven home by the NUMEROUS ATTORNEY'S OFFICES springing up everywhere. I would also assume that some of this discrepancy could be ascertained by looking at who funded said studies. Was it funded by an association of treating practitioners (AMA, ACA, APTA, AOA, etc). Was it funded by an insurance company? Trust me when I tell you it makes a difference (HERE).
Without going into details or attempting to provide legal advice, when my family was in THIS ACCIDENT almost a dozen years ago, I settled the claim (it was actually multiple claims) myself using THIS DIY TOOL. Also, no matter what is wrong with you, you'll do better if you are not living in a state of perpetual SYSTEMIC INFLAMMATION. To see a template of what can be done to start breaking the chains of the pain, dysfunction, and distress you are in, take a look at THIS SHORT POST.
IS YOUR CHRONIC NECK PAIN AFFECTING YOUR BRAIN AND NERVOUS SYSTEM?
"Chronic musculoskeletal pain is one of the most intractable clinical problems faced by clinicians and can be devastating for patients. Perhaps no other symptom induces such fear and loathing as chronic pain. Most images of pain are focused on portraying negative emotions and the intrusive nature of the pain experience. Clinicians as people fear chronic pain, a symptom that demands attention and intrudes into every aspect of a person's life. Clinicians also loathe chronic pain, perhaps the symptom that brings more patients into our practices than any other but also the symptom most likely to make us feel helpless as healers" Dr. Leslie Crofford from a 2015 issue of the Transactions of the American Clinical And Climatological Association (Chronic Pain: Where the Body Meets the Brain)
"Some recent studies have also shown that chronic pain can actually affect a person’s brain chemistry and even change the wiring of the nervous system. Cells in the spinal cord and brain of a person with chronic pain, especially in the section of the brain that processes emotion, deteriorate more quickly than normal, exacerbating many of the depression-like symptoms. It becomes physically more difficult for people with chronic pain to process multiple things at once and react to ongoing changes in their environment, limiting their ability to focus even more. Sleep also becomes difficult, because the section of the brain that regulates sense-data also regulates the sleep cycle. Untreated pain creates a downward spiral of chronic pain symptoms, so it is always best to treat pain early and avoid chronic pain." Integrative Pain Center of Arizona (The Long-Term Effects of Untreated Chronic Pain)
"Chronic pain is certainly a difficult condition to live with, affecting everything from your activity levels and your ability to work to your personal relationships and emotional states. But did you know that it could also be affecting your brain and the way that it functions? Chronic pain doesn’t just affect a singular region of the brain, but in fact results in changes to multiple important regions, which are involved in many critical functions and processes. Various studies over the years have found changes to the hippocampus, in addition to reduction of gray matter in the dorsolateral prefrontal cortex, amygdala, brainstem and right insular cortex, to name a few. Pain’s effects on the brain may seem overwhelming, but there’s good research to suggest that the changes are not permanent; they can be reversed when patients receive treatment for their painful conditions. “Gray matter abnormalities found in chronic pain,” a 2009 study concluded, “do not reflect brain damage, but rather are a reversible consequence … which normalizes when the pain is adequately treated.” The 2011 study concurred, suggesting that “treating chronic pain can restore normal brain function in humans.”" From Brenda Poppy's post (How Pain Can Seriously Affect Your Brain) on the Pain Management Resource Blog
I showed you via the first link of the previous paragraph that those of you living with Chronic Pain are degenerating your brains at a rate 10 times higher than the general population. Unfortunately, that's just the tip of the iceberg. Thanks to Chronic Neck Pain, some people wind up living with things like FIBROMYALGIA and CENTRAL SENSITIZATION. Allow me to show you how crazy the newest studies on this topic really are specifically for those of you struggling with Chronic Neck Pain.
- ABNORMAL BRAIN ACTIVITY AND CHRONIC NECK PAIN: Sure, we've seen that generalized Chronic Pain leads to abnormalities in the brain, but what about Chronic Neck Pain specifically? A study from February's issue of the Journal of International Medical Research (Abnormality of Spontaneous Brain Activities in Patients with Chronic Neck and Shoulder Pain) answers this question by saying, "Most chronic pain diseases are accompanied by structural and functional changes in the brain. This initial structural and functional MRI study of CNSP (chronic neck and shoulder pain) revealed characteristic features of spontaneous brain activity of CNSP patients." Believe me when I tell you that spontaneous brain activity (activity that happens out of the blue for no good reason) is never a good thing.
- CONCUSSIONS, BRAIN ISSUES, AND CHRONIC NECK PAIN: Last month's issue of Medicine (Concussion / Mild Traumatic Brain Injury-Related Chronic Pain in Males and Females) concluded that, "Of the 94 participants diagnosed with mTBI, head/neck and bodily pain were reported by 93% and 64%, respectively...... a primary complaint of head and/or neck, or bodily pain that persists long after concussion – one of the most common types of mild traumatic brain injury (mTBI) – represents an activation of brainstem structures." Not only have I shown you that HEAD INJURIES are bad news in ways the general public CANNOT BEGIN TO COMPREHEND, but loss of consciousness (LOC) is a huge deal when it comes to Chronic Neck Pain. "Participants who experienced LOC during the concussive event and those who reported head and neck pain had significantly higher pain scores than those who did not experience LOC and those without head and neck pain."
- CHRONIC NECK PAIN, NECK DYSFUNCTION, AND MIGRAINE HEADACHES: In a study from January's issue of the European Journal of Physical and Rehabilitative Medicine (Musculoskeletal Disorders of the Upper Cervical Spine in Women with Episodic or Chronic Migraine), we see just how devastating this link between Chronic Neck Pain and MIGRAINE HEADACHES really is. The authors, a group of doctors and researchers from Spain and Brazil, concluded that, "Women with migraine showed reduced cervical rotation compared to healthy women. Significant differences for flexion- rotation test were also reported, suggesting that upper cervical spine mobility was restricted in both migraine groups. Referred pain elicited on manual examination of the upper cervical spine mimicking pain symptoms was present in 50% of migraineurs." For more on the Upper Cervical Subluxation and its ability to adversely affect the brain, I talked a bit about it the other day (HERE).
- CHRONIC NECK PAIN, CATASTROPHISING, AND DEPRESSION: When it comes pain, there are catastrophizers (it's the worst ever --- SOCCER FLOPPERS) and minimizers (it's no big deal, I'm fine --- MONTY PYTHON'S BLACK KNIGHT). Two studies from 2016, one from Medicine (Factors Associated with Increased Risk for Pain Catastrophizing in Patients with Chronic Neck Pain) and the other from the Pan African Medical Journal (Chronic Neck Pain and Anxiety-Depression: Prevalence and Associated Risk Factors) had some things to say about ANXIETY / DEPRESSION and their link to Chronic Neck Pain. Even though doctors want to way over-emphasize Depression's causal role in Chronic Pain, I've always argued that the opposite is a far more accurate description of what's really going on --- pain is causing the Depression. "Chronic neck pain is a frequent reason for consultation. It's a highly prevalent condition with about two thirds of the adult population affected at some time in their lives. 10% neck pain recurs or persists with consequences which are responsible for physical disability and high health care cost. In our study which concerned eighty patients with chronic neck pain, a state of anxiety was found in 68.4% cases, and 55.7% patients had depression. High pain intensity, clinical insomnia, and a high level of depression/anxiety were strongly associated with high pain catastrophizing in patients with chronic neck pain. Depression was the strongest predictor of high pain catastrophizing. In conclusion, poor psychological states should be addressed as an important part of pain management in chronic neck pain patients..." You'll see how this is done shortly.
- CHRONIC NECK PAIN, CHRONIC TRIGGER POINTS, AND ABNORMAL NERVOUS SYSTEM FUNCTION: There are two sides of the "Myofascial" coin; TRIGGER POINTS and FASCIAL ADHESIONS. Both can be brutal, and while in most cases intimately linked to each other, are not the same thing. A year ago in June, the journal Pain Medicine published a study called Prevalence of Myofascial Pain Syndrome in Chronic Non-Specific Neck Pain. "Chronic non-specific neck pain is a frequent complaint. In recent years, case reports about myofascial pain syndrome (MPS) are emerging among patients suffering from pain. MPS is a regional pain syndrome characterized by myofascial trigger points (MTrP) in palpable taut bands of skeletal muscle that refer pain to a distance, and that can cause distant motor and autonomic effects. All participants presented with MPS. MTrPs of the trapezius muscles were the most prevalent, in 93.75% of the participants. Furthermore, active MTrPs in the levator scapulae, multifidi, and splenius cervicis muscles reached a prevalence of 82.14%, 77.68%, and 62.5%, respectively. MPS is a common source of pain in subjects presenting chronic non-specific neck pain." Now check this out. A study from a 2011 issue of Chinese Medicine (Myofascial Trigger Points: Spontaneous Electrical Activity and its Consequences for Pain Induction and Propagation) stated, "Active MTPs contribute significantly to the regional acute and chronic myofascial pain syndrome apart from localized pain conditions, such as chronic tension type headache and migraine, myofascial low back pain, chronic prostatitis/chronic pelvic pain syndrome in men, lateral epicondylalgia [HERE], headache, mechanical neck pain, whiplash syndrome and fibromyalgia. Current evidence shows that spontaneous electrical activity at myofascial trigger point originates from the extrafusal motor endplate. The spontaneous electrical activity represents focal muscle fiber contraction and/or muscle cramp potentials depending on trigger point sensitivity. Active myofascial trigger points may play an important role in the transition from localized pain to generalized pain conditions via the enhanced central sensitization, decreased descending inhibition and dysfunctional motor control strategy." Although there is a lot here, suffice it to say that TP's usually indicate that something is fouled up in the nervous system. Read my link on Trigger Points above to see how to successfully address them.
- WHIPLASH WILL SCREW YOU UP IN WAYS YOU COULD NOT HAVE IMAGINED UNTIL YOU WERE REARENDED: After talking extensively about how medicine was on the cusp of solving the WHIPLASH PROBLEM, the authors of last October's issue of the Journal of Orthopedic and Sports Physical Therapy (Whiplash Continues it's Challenge) had to admit that, "management of whiplash, especially the challenge of lessening the rate of transition to chronicity, has yet to be achieved." A 2015 issue of BMC Public Health echoed that thought with a study (Five Years After the Accident, Whiplash Casualties Still Have Poorer Quality of Life in the Physical Domain than Other Mildly Injured Casualties) that let us know that, "Defined as an acceleration-deceleration mechanism in the neck, whiplash is the most common injury in road accidents, particularly for motorist. Considered a minor injury, whiplash is reported to generate both short and long-term consequences, such as neck pain, headache, dizziness, sensory disorder and reduced neck mobility. In most studies described in the international literature, more than half of whiplash casualties reported non-recovery one year after the accident. Five years after the accident, whiplash casualties were twice as likely to report pain as non-whiplash casualties (40.7 % vs. 22.2 %). Whiplash casualties suffered from neck pain." Furthermore, after looking at just under 400 studies on the topic, Belgian researchers writing in last April's Manual Therapy (Does Muscle Morphology Change in Chronic Neck Pain Patients?) revealed that muscles can be so screwed up by whiplash injury that they sometimes turn to fat. "Increasing evidence suggests that morphological muscle changes, including changes in cross-sectional area (CSA) or fatty infiltration, play a role in chronic neck pain. Fatty infiltration, which could be accountable for an increased CSA, of both cervical extensors and flexors seems to occur only in patients with WAD." By the way, WAD stands for Whiplash Associated Disorders (HERE).
- WHIPLASH, NECK PAIN, AND BLOOD FLOW TO THE BRAIN: Last August's issue of EBioMedicine (Altered Regional Cerebral Blood Flow in Chronic Whiplash Associated Disorders) said that, "There is increasing evidence of central hyperexcitability in chronic whiplash-associated disorders (cWAD). WAD includes neck pain and headache as the most frequent symptoms. Although WAD includes regional neck symptoms, the common presence of psychological manifestations suggests the involvement of central nervous system processes in WAD symptom presentation." What could possibly be causing some of this mess? Among other things, researchers have discovered that, "The present study shows that, compared with healthy volunteers, chronic WAD patients have increased perfusion of the right posterior cingulate gyrus and right precuneus, and decreased perfusion of the right superior temporal gyrus, right parahippocampal gyrus, left inferior frontal gyrus, right dorsomedial thalamus, and in the bilateral insular cortex." In other words, with WAD, the blood flow to the brain is all kinds of screwed up. The real problem is that this is known to lead to "LEAKY BRAIN / NERVE / CORD SYNDROME".
- YOU CAN'T FIX WHIPLASH ASSOCIATED DISORDERS (INCLUDING CHRONIC NECK PAIN) WITH DRUGS: Get in a whiplash accident and I promise you will be prescribed drugs --- probably lots of drugs (PAIN MEDS, NSAIDS, MUSCLE RELAXERS, and if chronic, CORTICOSTEROIDS and ANTI-DEPRESSANTS. The thing is, I've shown you over and over again via peer-review that this approach does not only not work, it's DOWNRIGHT DANGEROUS. "Whiplash-associated disorder (WAD) is a group of symptoms and clinical manifestations resulting from rear-end or side impact. Despite the wide use of medications in WAD, the published research does not allow recommendations based on high evidence level. In chronic WAD, the use of nonsteroidal anti-inflammatory drugs is more concerning due to potential gastrointestinal and renal complications with prolonged use and lack of evidence for long-term benefits. Antidepressants can be used in patients with clinically relevant hyperalgesia, sleep disorder associated with pain, or depression. Anticonvulsants are unlikely first-choice medications, but can be considered if other treatments fail. The use of opioids in patients with chronic pain has become the object of severe concern, due to the lack of evidence for long-term benefits and the associated risks. Extreme caution in prescribing and monitoring opioid treatment is mandatory. As for any chronic pain condition, concomitant consideration of rehabilitation and psychosocial interventions is mandatory." In other words, since all the medical community has to offer you is THE BIG FIVE, you might want to take a rain check and look into something that actually addresses the underlying problem instead of merely covering the symptoms.
- CHRONIC NECK PAIN AND ABILITY TO BREATHE: Remember that the level of C1 (Atlas) has the potential to affect breathing via the part of the brainstem known as the Medulla Oblongota. A brand new review of almost 80 studies from this month's American Journal of Physical Medicine and Rehabilitation (The Association Between Neck Pain and Pulmonary Function) concluded that, "Significant difference in maximum inspiratory and expiratory pressures were reported in patients with chronic neck pain compared to asymptomatic subjects. Some of the respiratory volumes were found to be lower in patients with chronic neck pain. Muscle strength and endurance, cervical range of motion, and psychological states were found to be significantly correlated with respiratory parameters. Lower Pco2 in patients and significant relationship between chest expansion and neck pain were also shown. Respiratory retraining was found to be effective in improving some cervical musculoskeletal and respiratory impairment. Functional pulmonary impairments accompany chronic neck pain." The truth is, breathing is one of the most-affected (in a good way) arenas when it comes to chiropractic adjustments (HERE).
- VISUAL EFFECTS AND VERTIGO: A study from January's issue of Frontiers in Neurology (Inaccurate Saccades and Enhanced Vestibulo-Ocular Reflex Suppression during Combined Eye–Head Movements in Patients with Chronic Neck Pain: Possible Implications for Cervical Vertigo) determined about Chronic Neck Pain and VERTIGO that, "In patients with chronic neck pain, the internal commands issued for combined eye–head movements have large enough amplitudes to create accurate gaze saccades; however, because of increased neck stiffness and viscosity, the head movements produced are smaller, slower, longer, and more delayed than they should be. VOR suppression is disproportionate to the size of the actual gaze saccades because sensory feedback signals from neck proprioceptors are non-veridical, likely due to prolonged coactivation of cervical muscles. The outcome of these changes in eye–head kinematics is head-on-trunk stability at the expense of gaze accuracy. In the absence of vestibular loss, the practical consequences may be dizziness (cervical vertigo) in the short term and imbalance and falls in the long term." By the way, saccades (a normal eye movement) are defined as quick (ballistic) movement of both eyes simultaneously between two or more points in the same direction.
- CHRONIC NECK PAIN AND DHEA: You may have heard of DHEA before as a nutritional supplement. The reason is that (according to a well known online encyclopedia), DEHA is "also known as androstenolone and is an endogenous steroid hormone. It is the most abundant circulating steroid hormone in humans, in whom it is produced in the adrenal glands, the gonads, and the brain, where it functions predominantly as a metabolic intermediate in the biosynthesis of the androgen and estrogen sex steroids." In other words, no DHEA, and you can count on FEMALE PROBLEMS, INFERTILITY, LOW T, and SEXUAL DYSFUNCTION. Another study ---- this one from the August issue of Pain Medicine (Different DHEA-S Levels and Response Patterns in Individuals with Chronic Neck Pain, Compared with a Pain Free Group) compared groups of "persons with chronic neck pain and controls without present pain." The authors, all Swedish doctors and researchers, concluded that, "the plasma DHEA-S levels appeared to be lower among the persons with chronic neck pain, compared with the control group."
- CHRONIC NECK PAIN AND INSOMNIA: INSOMNIA sucks (as does SLEEP APNEA) and is frequently a function of something called SYMPATHETIC DOMINANCE. The November 2015 issue of Pain Physician (Factors Associated with Increased Risk for Clinical Insomnia in Patients with Chronic Neck Pain) concluded that, "Insomnia is highly prevalent among people with chronic pain conditions. Because insomnia has been shown to worsen pain, mood, and physical functioning, it could negatively impact the clinical outcomes of patients with chronic pain. Neck pain development; 22.9% of patients met the criteria for clinically significant insomnia. In analysis, high pain intensity, the presence of musculoskeletal pain, and a high level of depression were strongly associated with clinical insomnia in patients with CNP. Among these factors, a greater level of depression was the strongest predictor of clinical insomnia. This study was conducted in a single clinical setting including a selected study population with a homogeneous racial background. Insomnia should be addressed as an indispensable part of pain management in CNP patients with these risk factors, especially depression." The problem is, the medical community is going to address it with one of the most dangerous drugs on the market --- SLEEPING PILLS.
- BRAIN, MEMORY, AND CHRONIC NECK PAIN: I've shown you how in people with TYPE III PAIN, their pain plays on a loop --- sort of like the cassette tape of a bad memory going around and around and around on auto-reverse (anyone older than 35 will understand). A study from January's edition of Pain Physician (Neural Correlates of Maladaptive Pain Behavior in Chronic Neck Pain - A Single Case Control MRI Study). "Functional magnetic resonance imaging (fMRI) showed distinct brain activation patterns that depended on the side of rotation (pain-free versus painful side) and the kind of movement (distracted versus non-distracted head rotation). Interestingly, brain areas related to the processing of pain such as primary somatosensory cortex, thalamus, insula, anterior cingulate cortex, primary motor cortex, supplementary motor area, prefrontal cortex, and posterior cingulate cortex were always more strongly activated in the non-distracted condition and when turning to the left. In the patient, maladaptive pain behavior and the activity of pain-related brain areas during imagined head rotations were task-specific, indicating that the activation and/or recall of pain memories were context-dependent."
- CORRECTING FORWARD HEAD POSTURE AFFECTS BRAIN: I've shown you a bunch of studies revealing how bad FHP (Forward Head Posture) really is --- not to mention the fact that it's intimately associated with Chronic Neck Pain (HERE). Not surprisingly, a study from last October's issue of Physical Therapy Science (Effects of Neurofeedback Training on the Brain Wave of Adults with Forward Head Posture) showed that it affects the brain as well. "Owing to the prevalence and popularity of computers, students and workers are increasingly experiencing musculoskeletal abnormalities in their neck and shoulders. Using computers and smart phones for many hours, coupled with lack of exercise, may cause stiffness of the muscles in the neck and shoulders, inducing weakness in the soft tissues. Such postural and lifestyle habits lead to forward head posture (FHP), which can cause relative compensation such as increased lordosis in the junction of the skull and neck [a hump] consistent muscular contraction inducing changes in the craniocervical junction. Posture affects people in terms of psychological, physical, structural, and functional changes. Specifically, bad posture is thought to increase the possibility of a decline in learning efficiency, attention, and memory. The column and the brain, in particular, are closely situated in terms of anatomical structures. According to previous research, FHP may induce a reduction in proprioceptive sensibility, in addition to interference between the nerves and the muscles. These problems may, in turn, affect an individual’s mind and emotions. It is thought that neurofeedback training, a training approach to self-regulate brain waves, enhances concentration and relaxation without stress, as well as an increase in attention, memory, and verbal cognitive performance. Therefore an effective intervention method to improve neck pain and daily activities." While this is well and good, there are ways to deal with FHP that actually help correct it --- not just manage it. But.........
- FHP CANNOT BE CORRECTED WITH ADJUSTMENTS ALONE: The December 2015 issue of the journal, Chiropractic and Manual Therapies published a study called Does Cervical Lordosis Change After Spinal Manipulation for Non-Specific Neck Pain? In this study, the authors (a group of European chiros and research scientists) looked at sixty volunteers who underwent several weeks of chiropractic adjustments. Not surprisingly, and as I have told you time and time again, adjustments alone never solve the reverse cervical curve (FHP). "This study found no difference in cervical lordosis (sagittal alignment) between patients with mild non-specific neck pain and matched healthy volunteers. Furthermore, there was no significant change in cervical lordosis in patients after 4 weeks of cervical spinal manipulation." The good news is, there are things you can do to help reverse the reversed cervical curve, and most of them can be done at home under the supervision of a competent chiropractor (HERE).
- NECK ADJUSTMENTS AFFECT BRAIN AND METABOLIC PATHWAYS: Knowing the numerous ways that CHIROPRACTIC ADJUSTMENTS AFFECT THE NERVOUS SYSTEM, we should not be surprised to find a study showing us that adjustments affect metabolic pathways as well. The January 2017 issue of Evidence-Based Complementary and Alternative Medicine (Glucose Metabolic Changes in the Brain and Muscles of Patients with Nonspecific Neck Pain Treated by Spinal Manipulation Therapy) looked at PET Scans --- remember that PET Scans are used to find cancer by finding areas of increased sugar uptake (HERE) --- of people with Chronic Neck Pain, determining that, "Glucose uptake in skeletal muscles showed a trend toward decreased metabolism after SMT (spinal manipulative therapy)... Other measurements indicated relaxation of cervical muscle tension, suppression of sympathetic nerve activity, and pain relief after SMT. Brain processing after SMT may lead to physiological relaxation via a decrease in sympathetic nerve activity." Again, why is this a big deal? Can anyone say "SYMPATHETIC DOMINANCE"? Chiropractic adjustments have been shown time and time again to help down-regulate the Sympathetic Nervous System (the "fight or flight" response) that so frequently ruins people's lives when it is flipped to the "on" position.
- STRESS MANAGEMENT AND COGNITIVE BEHAVIORAL THERAPY FOR THOSE WITH CHRONIC NECK PAIN DRAMATICALLY IMPROVES OUTCOMES: Last May's respective issues of the Journal of Back and Musculoskeletal Rehabilitation (Effect of a Stress Management Program on Subjects with Neck Pain) and Clinical Rehabilitation (Group-Based Multimodal Exercises Integrated with Cognitive-Behavioral Therapy Improve Disability, Pain and Quality of Life of Subjects with Chronic Neck Pain) concluded that, "A group-based multidisciplinary rehabilitation program including cognitive-behavioral therapy was superior to group-based general physiotherapy in improving disability, pain and quality of life of subjects with chronic neck pain. The effects lasted for at least one year. Stress management has positive effects on neck pain patients." This is not really anything new as the venerable Hans Seleye (AN ENDOCRINOLOGIST) was discovering the General Adaptation Syndrome and HPA-Axis back in the 1930's and 40's.
Knowing this information is great. After all, knowledge really is power (HERE). However, the real rubber-meets-the-road question is what are you who are struggling going to do with it? In other words, how can you, the Chronic Neck Pain sufferer, use this information to help your cause, decrease your pain, and increase your ability to function on a day to day basis? Glad you asked.
- FIRSTLY: You must understand the difference between acute inflammation and chronic inflammation, and control the latter (HERE). Diet plays a huge roll in this, and the diet I recommend to my patients helps control CHRONIC INFLAMMATION like nothing you've ever seen before (HERE).
- SECONDLY: You will need to read a bit about PHASE I and PHASE II of solving the underlying physical / mechanical basis of your neck pain. If you fail to address these, or address them out of order, I promise that your results will be compromised --- especially in people with the more severe problems. For those of you who are really struggling, this can be difficult (HERE).
- THIRDLY: You are going to have to learn how to control your thoughts and fears, get active, and develop strategies to cope with the situation. While formal group CBT (Cognitive Behavioral Therapy) mentioned earlier can be fantastic, many of you will find the same level of therapeutic benefit by becoming part of a community on an internet message board. I don't really care how you go about it, but you are going to need some sort of sounding board and support group, possibly someone with letters behind their name.
- FOURTHLY: Purchase your own pain aids and modalities. There are any number of great "gizmos" that have amazing potential modulate / down-regulate Chronic Neck Pain. COLD LASER is amazing as is WHOLE BODY VIBRATION. Electric massagers, Theracanes or similar, FOAM ROLLERS, EXTENSION AIDS and EXERCISE BALLS, cervical pillows, home traction devices (over-the-door, DAKOTA, or any number of others), heat lamps, and even ULTRASOUND as long as you use it correctly / safely...... And that's just for starters. There are almost an infinite number of things out there that can help you help yourself. The tough part is trying to wade through the sales pitches by those individuals and companies PREYING ON PEOPLE WITH CHRONIC PAIN.
- FIFTHLY: Educate yourself. As I said earlier, knowledge is power. Find people or sites and study. What makes my site different than most others is that I'm not trying to sell you anything. My goal is to weed through the sales pitches and BS so that you can have the facts, the whole facts and nothing but the facts. Just realize that when it comes to science, the facts are (FOR ANY NUMBER OF REASONS) constantly changing.
Don't kid yourself. This list could be infinite if I had the time to sit down and write a book. HERE is a bit more in-depth information on how you might accomplish some of these things. And as I always suggest to people, after studying the situation, sit down and create a personalized EXIT STRATEGY for yourself --- a way to take your life back and start living again. If you want to see some examples of this in action, take a look at some of our CASE HISTORIES.
SEVERE MOTOR VEHICLE ACCIDENT LEAVES PATIENT IN CHRONIC PAIN
OPTIONS & POTENTIAL SOLUTIONS
"I was in a car accident just short of 2 years ago and I'm still getting treated. I was hit by someone who ran a red light traveling at least 55mph while I was stationary. I was hit on the front passenger side of my vehicle. The whiplash I incurred went sideways. My accident happened on a Sunday, I was sore afterwards, but on the following Wednesday I woke up in pain from head to toe."
The first thing I want you to understand is that every study that comes out, shows that healing takes longer than the study that came out before it. Although insurance companies love to tell their insured that "research says" healing of soft tissues takes no more than 4-6 weeks, this is patently untrue as seen in the latter part of THIS LINK. Although the FIBROSIS (the medical word for SCAR TISSUE) is laid down in that amount of time, your body must remodel said tissue into something functional, which takes much longer --- current research says as long as two years or more. Furthermore, Brenda has at least two of the biggest factors that potentially make WHIPLASH INJURIES worse working against her --- she's female and her impact was from the side as opposed to coming from either the front or the back (both found HERE). On top of everything else, having pain show up days or even weeks after the accident is not at all an uncommon phenomenon (HERE).
"I suffered from daily migraines, blurred vision, sensitivity to light, could not sit, stand or lay comfortably. My whole body felt like I was plugged into an electrical outlet. The immediate care doctor I saw the day after my accident prescribed muscle relaxants and ibuprofen. By Friday I was at my doctors office. He is an integrative medicine doctor, therefore no more muscle relaxants, no pain meds prescribed. As much as I laid wishing I had them, I'm grateful I did not. The amount of pain I was in I'm sure I would have become addicted. I saw a chiropractor 3 times a week for 3.5 months with a 1/2 hour massage once a week. My eyebrows were so tight on my face you couldn't pull them away. I was told the muscles in my back were like ropes with knots underneath. I have bulging discs from T4-5 to T10 and broad base to moderate disc bulges in my lumbar/sac."
The first sentence tells me that you had a MTBI / TBI, as all symptoms you list --- including MIGRAINES --- are well known sequelae of such. It is extremely common for people who are in these sorts of accidents become heat-intolerant as well. Typical pharmacological fare for these sorts of injuries includes THE BIG FIVE (with the ANTI-DEPRESSANTS usually coming a bit later). In the acute part of the injury, you'll need lots of care, including massage. As for your "tight eyebrows," make sure you look at my articles on FACIAL FASCIA. As for the discs, some of these may or may not be a source of your pain. And as to the argument that they were pre-existing (invariably this is what the insurance company will say), how can this be proven one way or another without a previous MRI? Even if these disc injuries were pre-existing, the accident took a stable situation (HERE) and destabilized it (HERE).
"Still to this day my legs still buzz. I can feel it in the back of my upper legs and then it encompasses both lower legs from the knee to my toes with my left side worse. Sometimes I also have tingling on the back of my left arm and into my last 2 fingers. I also have issues with my left knee that comes from my tight hip flexors. After seeing the chiropractor for so long and eventually being told, "I can't fix you (and it's not because he didn't give it 125%) I saw a myofascial release therapist. I finally starting getting some relief. The treatments were painful; I screamed at times, had tears from the pain but the next day I felt relief."
Let me take this time to address your low back pain. Many insurance companies will tell you that low back pain after motor vehicle accidents is rare. Hogwash! According to any number of studies (not to mention notes from Dr. Dan Murphy's 24 hr Whiplash Seminar), it's the third leading symptom of these sorts of accidents, just behind NECK PAIN and HEADACHES. Also, RADICULAR PAIN and SCIATICA can take on many forms, often leading to paresthesias ("abnormal nerve sensations"). As for the tight HIP FLEXORS, adjustments, while extremely important, don't, in and of themselves, have the ability to solve this or any of the other major "SOFT TISSUE" components of the injury. The soft tissue parts of the injury will almost always require some sort of bodywork.
When it comes to bodywork, there are two different kinds. There is what I call rub-a-dub, which is the feel-good stuff you can get at the spa to help you relax. This is great for people not experiencing any majorly painful problems. However, as I have talked about previously (HERE, HERE, HERE, and HERE), bodywork often needs to be harsh, because if it's not, the threshold for breaking the adhesed fascia is not being met. Thus, sub-threshold treatment is not breaking down the Fibrosis / Scar Tissue, which is why I sometimes say of this sort of treatment, 'a whole lot of nothing is still nothing' (see links).
"I tried working for the 1st three months after my accident, but sitting all day (and trying to learn a new job), I eventually had to go on Medical Leave for six months, or risk losing my job due to call offs. Since I had no pain meds prescribed, I would take 3 ibuprofen upon waking, then 2 extra strength Tylenol at noon, followed by 3 more ibuprofen early evening and then 2 Tylenol pm's to fall asleep. I did this for 9 months, before I said enough."
In many cases, especially cases where you are able to constantly move around without having to do heavy or repetitive jobs (especially on CONCRETE), the best thing you can do is go back to work. However, so many jobs require people to spend their days hunched over a desk or computer screen (or an assembly line) that it creates it's own set of problems (CHRONIC TRUNK FLEXION and FORWARD HEAD POSTURE). And as for the TYLENOL and NSAIDS (Ibuprofen), clicking on the links reveals their own unique sets of associated problems, many of which can be deadly or at least debilitating.
"The myofascial release was helping until insurance said no more visits. What do they know? And how could they judge me and my condition sitting at desk wherever they are? I eventually ended up back with my myofascial therapist a few months later for another 12 visits they OK'd. Once again, I was getting better, then insurance stopped it. I tried going back to the activities I enjoyed prior to my accident. Aquatic exercises. Tried riding my bike, and would have mid back spasms later in the day. I have a horse and have enjoyed riding for 45 years. I got back to the barn again to enjoy everything that comes with caring for a horse, mucking stall, brushing, riding and once again back spasms and soreness. I love hiking/walking. I'm a photographer."
What do they know? Insurance is evil. In our society it's a necessary evil, but an evil nonetheless, whether run by private enterprise or our government (a government that has proved time and time again that they are incapable of most of what they are charged with --- HERE for instance). Sounds like there was a huge amount of ADHESED FASCIA created by this accident. This is a good time to mention that as unfortunate as it is, a significant number of those injured in MVA's (some studies actually say as great as 25%) never fully recover, being left to deal with varying degrees of CHRONIC (TYPE III) PAIN. My goal is always to keep my patients from falling over that precipice into the pit of despair.
"I now felt as if my ovaries hurt, my left knee was bothering me, I would get up all stiff and sore and limp for several steps. I saw my PCP and asked him should my ovaries hurt if I'm in menopause? My left knee is bothering me too and I still have the buzz in my legs. He has me get up on the table and raises my legs up and down. The left leg was turned "on" I experienced a large electrical current throughout my whole leg with buzzing, pins & needles and tingling all the way to my big toe. He said you might have piriformis syndrome. That leg raise must of woke up a nerve somewhere. Within a couple of days I experienced daily headaches again, culminating into a migraine, my knee hurt worse and the buzzing was worse. I ended up seeing a different chiropractor that specializes in Active Release Technique (ART). It's working and I'm getting a full body deep tissue massage weekly. I'm feeling better but still have the same issues."
Depending on how much nerve irritation you have (PIRIFORMIS SYNDROME can certainly be a factor), this could not only cause the radicular symptoms, but the abdominal pain as well since nerves from your LOW BACK control your sex organs (HERE). Also be aware that right along with the hip flexor issue, it's not uncommon to end up with FASCIAL ADHESIONS of the lower abdomen (HERE). By the way, ART is fantastic stuff for lots and lots of people.
"The buzzing in the legs to my toes is still here but my knee does feel better most of the time. Forgot to mention along with the knee pain I was also experiencing plantar fasciatis too. My chiro thinks I should get an EMG. I go to a 3rd neurologist and he tells me he thinks my issues go deeper than any of the medical equipment locally could read and suggests I try a university setting. Do I need a referral? No; well yes I do, or insurance will not pay. Three weeks later I'm still waiting on the referral."
Your neurologist is probably a fantastic individual. He / she is also likely leading you on about your local university having "special" equipment that is going to show this problem. Unfortunately, the most abundant, pain-sensitive, and commonly injured tissue in the body does not show up with standard imaging, including MRI (HERE). And as for an EMG providing an "ah ha" moment.... Not to be a party-pooper, but after 25 years of practice, I would go "all in" betting against it. As far as a neurologist is concerned, because you are so close to Chicago, you should have no problem finding a Functional Neurologist trained by DR. TED CARRICK to at least evaluate you. DR. JAY ROHLEDER is in your state and I would consider him to be tops in his field. I've sent patients to him with great results, and know him personally as he was the Valedictorian of our chiropractic class of 1991. Great guy; great doctor.
"The last couple of my massage visits she could feel my knots or lumps whatever you call them. She tried working them out, and it was painful. My right side of my back still has the stringy rope going down it and I could feel it all the way into my elbow. The lump of tissue on the left side of thoracic is still here 2 years later and is very stubborn. I would really like to get to the root of these problems, I don't want a doctor to tell me 10 years from now, that you should have done this or that. Is there any hope for me? By chance do you have any insight on what I should do next? I'm going to be 57 in a couple of months, prior to my MVA I was very active, limber, felt as if I could do anything I wanted. I wanted to go into my senior life with a younger body. You know the saying "move it or lose it"."
The knots you are referring to Brenda are called TRIGGER POINTS and are miserable by anyone's definition. I commend you for wanting to get to the root of the situation. However, it can be tough to do --- even if you know exactly what's wrong. Which brings me to the next part of this post; what would I do if I were in your shoes?
Firstly, because head injuries are associated with crazy things like LEAKY BRAIN SYNDROME, INFLAMMATION, and autoimmunity (HERE), I would take a long hard look at doing an ELIMINATION DIET, which I think is far more accurate than any sort of sensitivity testing. Secondly, a middle-of-the-road WBV MACHINE might prove invaluable as far as a way to both exercise and stretch (it actually provides exercise to your brain). Thirdly, because the cost of virtually all technology continues to plummet, a LASER for home use might prove invaluable for you. Otherwise, I would read THIS POST (as well as looking at the links I provided for you today). Certainly, not everything I've included is going to pertain to you, but some of it will. If you can possibly find a hidden source of inflammation, it could prove highly beneficial as far as getting to that "root cause" of your problem.
THE NIGHTMARE KNOWN AS WHIPLASH
Back in the winter of 2013, "Roger" was REAR-ENDED by a full-sized pickup truck, while sitting with his wife at a stoplight. A carphile, he was driving a much smaller and lighter Renault Clio (IV), which was totaled. Although Roger had dealt with periodic episodes of LOW BACK PAIN for the previous decade and had suffered through a number of SPORTS INJURIES from his days as an athlete (he also had MIGRAINE HEADACHES about three or four times a year from the time he was in grade school), these episodes had always been short-lived. They rarely caused him to miss work, bouncing back and returning to "normal" within a day or two.
The 2013 injuries were different, and rapidly became a big deal. Roger found himself missing more and more work. He could feel himself being dragged into the world of Chronic Pain via a WHIPLASH INJURY. Unfortunately, it's a story I have seen over and over and over again in my 25 years of practice.
After the accident, Roger was the model patient. He did exactly what his doctors told him to do --- namely take CERTAIN MEDICATIONS and go to the PHYSIOTHERAPIST, whose directions he followed religiously as well. Instead of getting better, he found himself getting worse. He went to several specialists who told him things like, "just lose some weight," "it's just one of those things that happens to people at 40," and my all-time favorite, "I can't really find anything wrong with you that explains why you're having this much pain".
And of course there was the imaging --- X-RAYS, CT, MRI, with all of them showing essentially the same thing --- that there was nothing really wrong (a low back MRI done a few years prior to the accident was not substantially different than a low back MRI done post-accident --- even though his pain is worse by several orders of magnitude). By Memorial Day, Roger --- a successful physician with a thriving 15 year practice --- could no longer work. Let me take you back to the time before the accident.
Because Roger is a doctor, he was prone to go to his doctor if he had problems or questions pertaining to his health. Thus the reason he had received imaging on his lumbar spine pre-accident. And because of the work he did (surgery), he was required to sit in a very specific position and bend forward for much of the day. Certainly not anything out of the ordinary for any number of professions, but something that can certainly aggravate a low back.
Due to the FORWARD POSTURE, his neck would also get stiff and sore, which he mentioned to his doctor on a couple of occasions. Not that it was a primary concern --- the main reason for the visit --- or that he was asking to have anything really done about it, but was instead asking if there was anything he could be doing on his own (i.e EXERCISES / STRETCHES) to prevent future problems. Unfortunately, this made it into his doctor's notes as 'neck pain', which became part of his permanent record and is now being used against him as a pre-existing condition.
After finding our site on one of his many sleepless nights, Roger began to realize there was more going on than what his doctors were telling him and decided to contact me. Having told him that his low back problem sounded like a CLASSIC CASE OF HERNIATED DISC and that it was unlikely I could help him with his problem, he decided to come anyway. Other than the fact that he was dealing with lots of pain and his spinal RANGES OF MOTION were all in the toilet, his examination findings were fairly unremarkable for what he was going through.
His main question to me was "How can my two low back MRI's appear almost the same even though I have vastly greater amounts of pain now?" Most of it has to do with the difference between Functional Problems -vs- Pathology. Although I have covered this topic before (HERE and HERE), it is important to grasp the difference. One of the 'dirty little secrets' in medicine is that a top reason people visit doctors is for something called MUPS (Medically Unexplained Physical Symptoms). Throw in the fact that the "Disc Theory" of back pain has been increasingly falling out of favor for years; probably more like decades ---- at least in the SCIENTIFIC COMMUNITY --- and you begin to get a sense of Roger's frustration.
Using TISSUE REMODELING to break down the SCAR TISSUE / DENSIFICATION that was occurring in numerous places (as well as to STIMULATE FIBROBLASTIC ACTIVITY), I treated the FASCIAL ADHESIONS that were restricting normal motion of his NECK and BACK, as well as his SHOULDER. For the record, it is my opinion that Roger probably has TYPE II PAIN, without CENTRALIZATION. How much was I able to help him? Some, but certainly not completely.
I cannot leave this post without at least mentioning the neurological or "BRAIN" aspect of these sorts of injuries. Intense whiplash --- NO MATTER THE CAUSE --- can result in BRAIN INJURIES (MTBI). Unfortunately, every study that comes out on this subject is scarier than the one before it. Stop and think for a moment about what's going on in the NFL right now. I would also like to mention that whether your particular problem is Functional or Pathological, one of the single most important things you can do to help your cause is to control INFLAMMATION (no, not THAT WAY). In case you are not versed as to the best way(s) to accomplish this, I created SEVERAL POSTS that will at least point you in the right direction.
WHIPLASH & CHRONIC NECK PAIN
FACTORS THAT MAKE THE ACCIDENT OR INJURY WORSE
- BEING FEMALE: Not only are women more prone than men to virtually all ENDOCRINE PROBLEMS, AUTOIMMUNE DISEASES, and even some of the CHRONIC INFLAMMATORY DEGENERATIVE DISEASES, they get the short end of the stick as far as Whiplash is concerned as well. Women are far more likely than men to have Chronic Pain and Disability (WAD --- Whiplash Associated Disorders) as the result of these sorts of injuries. This is believed to be due mostly to the fact that women have less muscle mass in their necks and upper backs.
- BEING UNAWARE OF THE IMPENDING CRASH: Not sure if this is still the number one factor, but it used to be. Contrary to popular belief, not realizing you were about to be rearended was something like 15 times worse than your being aware.
- PROPERLY ADJUSTED HEAD-RESTRAINT: They are officially called head "restraints" --- not head "rests" --- for a reason. By restraining the head during impact, it cannot fly backwards during a rearender. Tearing tissue requires some degree of movement. Prevent the ability of the head to move during impact, and you prevent at least a certain degree of tearing. The middle of the head restraint should line up with the middle part of your ear. If you know (or think) you are going to get hit, plaster your body and head against your seat and head restraint.
- NEUROLOGICAL SIGNS AND SYMPTOMS: NECK PAIN is one thing, but when you start having neurological problems post-accident, this is not a good sign. A study from last week's issue of the medical journal PLoS One (Risk Factors for Prolonged Treatment of Whiplash-Associated Disorders) stated that, "the baseline symptoms (dizziness, numbness or pain in the arms, and lower back pain) had the strongest associations with prolonged treatment for WAD (Whiplash Associated Disorders)". I have seen any number of other studies dealing with numerous other neurological symptoms (HEADACHES or VERTIGO for instance), many of which could be categorized as a form of SYMPATHETIC DOMINANCE.
- MENTAL ISSUES GOING IN: The March, 2015 issue of the journal Physiotherapy (Risk Factors for Chronic Disability in a Cohort of Patients with Acute Whiplash Associated Disorders Seeking Physiotherapy Treatment for Persisting Symptoms) said that, "psychological and behavioral factors were important" as far as, "the strongest association with chronic disability" was concerned. What are these factors? PTSD was mentioned, but the authors were chiefly talking about something called "Catastrophizing". Catastophizing is characterized as having a "victim mentality" and assuming / expecting that you will not get better with treatment. The study used the term, "self-assessed predicted time to recovery." I have seen numerous other studies that say things like ANXIETY or DEPRESSION are also big factors in poor outcomes concerning WAD, although this study says, "Previous findings are mixed regarding the role of anxiety and depression in the development of chronic disability in acute WAD".
- BECAUSE THE BRAIN IS AFFECTED, THE WHOLE BODY IS AFFECTED: One of the clearest examples of this phenomenon is seen in people who have crazy, long-term symptoms after Head Injuries or Concussions (HERE and HERE). A study from the August 2013 issue of BMC Psychiatry (Somatic Symptoms Beyond Those Generally Associated with a Whiplash Injury are Increased in Self-Reported Chronic Whiplash) looked at 17 health issues that would not be thought of by most people as typical of WAD (these are collectively known as somatiziation). They learned that, "Chronic whiplash was associated with an increased level of all 17 somatic symptoms investigated." Gulp!
- GET BACK TO WORK AND DAILY LIFE ASAP: The April, 2014 issue of BMC Musculoskeletal Disorders (Multidimensional Associative Factors for Improvement in Pain, Function, and Working Capacity after Rehabilitation of Whiplash Associated Disorder) revealed that, "Pain relief, improved physical function and working capacity were associated with each other. Improved coping (catastrophizing and ability to decrease pain) and reduced depression may act as important predictors for pain relief and improved function." The problem is that so often in the medical field, because most Whiplash sequelae cannot be seen on standard tests, the pain is blamed on Depression instead of the more likely fact that the pain and subsequent inability to function normally, causes one to be depressed. The subsequent ANTIDEPRESSANT MEDICATIONS are rarely beneficial over the long haul.
- BEING YOUNGER AND HEALTHY GOING IN: The study in the quote from the top of the page had this to say. "They found that patients who were younger than 35 years old and had a low level of disability soon after the injury.... had a better chance of achieving a full recovery." This is old information, as it has been known for decades that older people with DEGENERATIVE ARTHRITIS in their necks were much more likely to have poor outcomes. There are also a number of studies, including Factors Related to Non-Recovery from Whiplash, from last June's issue of the International Journal of Behavioral Medicine that reveals, "Poor self-rated health seems to be a strong risk factor for whiplash injuries becoming chronic". The problem with we Americans is that we don't always have a firm grip on reality. Numerous studies have revealed that we dramatically overestimate our health, while dramatically underestimating our weight (HERE).
- BEING HEALTHY GOING IN, PART II: Last month's issue of PLoS One (Sick Leave Within 5 Years of Whiplash Trauma Predicts Recovery: A Prospective Cohort and Register-Based Study) took this concept a bit farther, showing that a high level of, "sick leave before the collision strongly predicted prolonged recovery following whiplash trauma. Neck pain at inclusion predicted future neck pain. Acute whiplash trauma may trigger pre-existing vulnerabilities increasing risk of developing whiplash-associated disorders."
- OTHERS: The truth is, there are any number of others. Having the accident on wet or icy pavement means less friction and more impact (more potential tearing of tissue). Side impacts or having your head turned at impact can be a huge factor in worsening Whiplash Injuries. Also; still having pain and dysfunction 90 days after the accident does not bode well for a full recovery. And if you are driving one of those tiny econo-cars, be warned.
Before we move on, I want to leave you with one more interesting tidbit I found that is related to studies I saw while taking a SPINAL DECOMPRESSION seminar in Chicago several years ago. It turns out that it does not take much time for a person dealing with serious lower back pain for the one of the chief muscles under the THORACOLUMBAR FASCIA (the Multifidus) to turn to fat.
A brand new study from the journal Spine (The Rapid and Progressive Degeneration of the Cervical Multifidus in Whiplash: An MRI Study of Fatty Infiltration) reveals that essentially the same thing is going on in the neck (the Cervical Multifidus muscle) after a Whiplash Accident / Injury. "The development of MFI (Multifidus Fatty Infiltration on conventional magnetic resonance image has been shown to be associated with specific aspects of pain and psychological factors. Consistent with previous evidence, muscle degeneration occurs soon after injury in those patients with poor functional recovery. This study provides further evidence that multifidi MFI occur in tandem with known predictive risk factors (older age, pain-related disability, and post-traumatic stress disorder)."
YOU'VE BEEN INJURED
WHAT DO YOU DO NEXT?
- UNDERSTAND THE INJURY: If you don't have a grasp of WHAT'S GOING ON as far as the healing process of the injured tissue is concerned, you are much more likely to blow it off because the pain's 'not that bad'. The problem is, there is a window of opportunity for healing to occur that begins closing immediately after the WHIPLASH INJURY. A failure to reach "Functional Recovery" means a tougher row to hoe in the future. Not that you can't be helped (many examples on my TESTIMONIAL PAGE of people being helped with decades-long Chronic Neck Pain), it's just harder.
- DEAL WITH INFLAMMATION: You have to deal with both Chronic Systemic Inflammation as well as Local Inflammation. This is because Inflammation always leads to Fibrosis (microscopic Scar Tissue --- HERE, HERE, HERE, and HERE). Doctors are aware of this and prescribe NSAIDS and CORTICOSTEROIDS --- both of which are crappy options for healing soft tissues such as LIGAMENTS, TENDONS, MUSCLES, and particularly FASCIA. A failure to effectively deal with Inflammation means that on some level, you'll be working against yourself.
- RESTORE MOTION: This must be done segmentelly as well as sectionally. In other words, it's not enough to simply use stretches in an attempt to restore gross RANGE OF MOTION of the neck. The motion must be normalized at each individual joint. This is one of the many things that CHIROPRACTIC ADJUSTMENTS work well for, and why STRETCHING ALONE is typically not enough (see next bullet) --- particularly in severe injuries.
- BREAK THE ADHESIONS: Microscopic adhesions of the Fascia (SCAR TISSUE) are a huge problem, not only because of the fact that Scar Tissue is so incredibly PAIN SENSITIVE, but because it cannot usually be imaged with standard tests such as MRI (HERE). Fail to deal with it and it not only has the potential to create pain, but tethers your ability to move normally, which sooner or later always leads to problems.
- RESTORE THE NECK'S PROPER CURVE: This is of critical importance, and as amazing as it may sound, even the medical research community is starting to talk about the numerous problems associated with not having this proper curve of the neck. If you want to understand this point better, I created several articles on the topic, all of which can be found under THIS ARTICLE.
- USE A COLD LASER: There are any number of modalities out there (Ultrasound, Electric Stimulation, etc, etc), but I believe that Low Level Laser Therapy stands head and shoulders above all of them. Rather than me spending time talking about it, just take a moment to look at THIS LINK.
WHIPLASH AND THE ELDERLY NECK
This month's issue of Annals of Emergency Medicine (Persistent Pain Among Older Adults Discharged Home From the Emergency Department After Motor Vehicle Crash: A Prospective Cohort Study) shows us why this is a big deal --- mostly because these sorts of injuries are so common. "Motor vehicle crashes are the second most common form of traumatic injury among individuals aged 65 years and older and result in an estimated 250,000 US emergency department (ED) visits by older adults each year." The study then reveals an important truth about these "older adults". "Because safe and effective pharmacologic management of their acute pain is challenging, and once pain becomes persistent in older adults, it has profound negative consequences for function and quality of life."
The problem is, drugs don't work for these sorts of mechanical injuries. Never have, never will. You can't fix a mechanical problem in your car by adding chemicals or simply changing the oil; and you certainly can't do it in your body. While things like PAIN PILLS, MUSCLE RELAXERS, ANTI-INFLAMMATORY MEDS, and CORTICOSTEROID INJECTIONS have the potential to cover symptoms on a temporary basis, they are never a long-term solution. Nor are the ANTIDEPRESSANTS that will be prescribed on their heels when they don't work.
Furthermore, the results of this study were, at least to a degree, skewed. Here's why. Approximately 8% of those eligible for the study, "did not want to participate because they were in too much pain." When those who are a great deal of post-accident pain are excluded from the study, the results are not as accurate as they otherwise would be, possibly telling you this problem is less serious than it really is.
"Follow-up assessments were completed at 6 weeks, at 6 months, and at 1 year. At 6 months, 26% of patients had moderate to severe pain that they attributed to the motor vehicle crash, and at least 1 in 4 participants had overall pain symptoms and moderate to severe pain interference with general activities, walking, sleep, and enjoyment of life, attributed to the motor vehicle crash. More than half of participants continued to receive an analgesic (ie, an opioid, acetaminophen, or a non-steroidal anti-inflammatory drug) at 6 months, and 18% were receiving a daily opioid..... 10% of the sample had become long-term opioid users. The frequencies of moderate to severe motor vehicle crash–related pain and pain interference at 1 year were similar to those at 6 months."
Although we are dealing with CHRONIC NECK PAIN in this post, following close on its heels in this study were Head Pain (not sure if this was HEADACHES OR SKULL PAIN), Chest Pain, Upper Back Pain, and Lower Back Pain. Furthermore, they talk about this sort of pain as having the ability to activate the the Adrenal - Hypothalamus - Pituitary - Adrenal (HPA) Axis, which is the known cause of FIBROMYALGIA, which used to go by the name "ADRENAL FATIGUE".
"Among older adults discharged home from the ED post-evaluation after a motor vehicle crash, persistent pain is common and frequently associated with functional decline and disability. The observed association between persistent pain and functional decline in our sample suggests that persistent pain is an important determinant of functional decline among older adults experiencing a motor vehicle crash. In contrast, pain was less prevalent and not significantly associated with functional decline among older adults presenting to the ED after falls. This difference suggests that the mechanisms leading to functional decline among older adults presenting to the ED after injury differ,depending on the injury mechanism...... in particular,activation of the hypothalamic - pituitary - adrenal system, may contribute to the transition from acute to persistent pain."
Here's the rub. This study goes on to admit that, "Evidence about the ability of established interventions to reduce persistent pain for individuals experiencing motor vehicle crash is conflicting." They talk about studies showing that neither acupuncture nor active [physical] therapy are very effective. What are the things these authors mention as being a possibility for relieving geriatric pain in older accident victims? Honestly, it sounds like a list born out of sheer desperation.
- PAIN COPING SKILLS: This is simply telling people that it's going to be alright. They do stop short of recommending playing Bob Marley's classic reggae hit Everything's Gonna Be Alright on a continual loop.
- NOVEL THERAPEUTIC AGENTS: Believe me when I tell you that this could be almost any sort of funky drug out there. I would assume that weed might fall under this category as well.
- COGNITIVE BEHAVIORAL THERAPY: Web MD's Elizabeth Shimer Bowers reveals that, "CBT is a form of talk therapy that helps people identify and develop skills to change negative thoughts and behaviors. CBT says that individuals -- not outside situations and events -- create their own experiences, pain included. And by changing their negative thoughts and behaviors, people can change their awareness of pain and develop better coping skills, even if the actual level of pain stays the same." The study we are reviewing today tells us that CBT, "reduces depressive or pain catastrophizing symptoms." The group they are specifically targeting here are those falling into the category labeled CENTRAL SENSITIZATION.
What would I recommend? Before starting the bullet points above to help with MVA-INDUCED Chronic Neck Pain, I would seriously think about trying these next three bullet points first.
- WORK TOWARD FUNCTIONAL RECOVERY: This should include not only CHIROPRACTIC ADJUSTMENTS (these can be done with an instrument for the elderly) and any number of exercises (keep it all simple), I would strongly recommend dealing with the underlying soft tissue injury by using FASCIAL REMODELING TECHNIQUES as well as some sort of CURVE RESTORATION PROTOCOL.
- COLD LASER THERAPY: Once you understand HOW THIS MODALITY WORKS, it's a no-brainer. WHOLE BODY VIBRATIONAL THERAPY could provide some tremendous benefits as well.
- DEAL WITH INFLAMMATION: This probably should have been the first bullet point, as there is ample evidence that INFLAMMATION ALWAYS LEADS TO FIBROSIS (Fibrosis is the medical name for "Scar Tissue"). I have tons of information on how to go about accomplishing this point, but before starting, you can take THIS SIMPLE TEST to see if your body is inflamed to begin with.
A UNIQUE WHIPLASH TESTIMONIAL
Here's an interesting WHIPLASH case for you. Not quite four years ago Amber was REAR-ENDED while leaving work. Although she had some initial pain, she didn't think much of it at the time (she went to her chiro) and went on with her life. That us, until she started living a nightmare.
Although Amber never really had bunches of NECK PAIN with her injury, she had a nagging restriction that prevented her from looking over her shoulders while driving or backing up. But the real problem was her shoulders themselves. For three years Amber struggles with a case of RADICULAR PARESTHESIA (abnormal sensations in her upper extremities) that manifested itself as severe / chronic itching of her shoulders and upper arms. How bad was this itching? If you get a chance, ask her husband.
The problem got so bad that she could barely leave the house --- she could not go anywhere because of the constant "itch attacks". She would sometimes scratch herself until she bled, and has the scars to prove it. Dermatologists and Neurologists proved ineffective for treating her problem; or for that matter, even diagnosing it.
In fact, as those of you who have been through similar scenarios might imagine, she was told her health issue was due to DEPRESSION and then put on the "proper" DRUGS --- a scenario here in America which is, unfortunately, more common than it's not. She would leave these doctor visits feeling both marginalized and ridiculed. The problem was, due to the fact that every single aspect of her life was being controlled by her itching and pain, she was developing Anxiety and Depression. Listen to what the same journal I quoted from at the top of the page has to say about this phenomenon.
"The increased load of symptoms of anxiety and depression found among individuals reporting a whiplash injury, is in line with previous studies. Two explanations have been given for the increased level of anxiety and depression seen in chronic whiplash: It has been considered a psychological response to the injury, like in post-traumatic stress disorder, or as a response to physical pain resulting from the injury. Recent findings do, however, suggest reverse causality, namely that: anxiety and depression at baseline increases the risk of reporting whiplash at follow-up. This debate of cause or effect in the association between whiplash and anxiety/depression does have consequences for whether anxiety/depression is to be regarded a mediating, confounding or even moderating factor in this association."
In other words, there are two explanations for the Anxiety and Depression seen after a Whiplash accident. I have written about this phenomenon extensively on this site because it is absurdly common. Either the pain and dysfunction of the Whiplash causes the Depression, or the Depression causes the pain seen after a Whiplash. Not only is the first scenario the logical one, it is by far the most common. However, because there no tests that image FASCIA --- the most COMMONLY INJURED TISSUE in a Whiplash Accident --- patients are blown off as hypochondriacs or malingerers (or looking for a pot of gold at the end of an attorney's rainbow). At first it's angering --- insulting --- to be told that your problem is essentially in your head. But as symptoms worsen for no perceptible reason, patients begin to wonder.
There were nights that Amber did not sleep --- at all. And there were only certain kinds of clothes she could wear, because most shirts or blouses made her itch continually. This "somatic" problem was consuming her. It was wearing her down physically, mentally, and emotionally. Because her itching and pain continued to progress, Amber was worried sick about what the future would bring. Shortly after Labor Day 2015, her husband convinced her that she needed to come and see if my unique approach could help her. That was 4 months ago. The video was shot yesterday. It's the only two days I've ever seen Amber. 90% better in a single treatment --- not bad considering what she had already been through.
For those of you who are interested in the mechanics of this process, just remember that it's all about the NERVE SYSTEM. Irritate a nerve and you can wreak havoc on whatever that nerve controls. Oh, and lest you forget, the Fascia acts as a SECOND NERVOUS SYSTEM. Thankfully Amber does not have to deal with the confusion, criticism and condescension of the medical community any more.
The problem is, Amber is not alone. Change the names, dates, times, places, and modes of injury, and I see these sorts of problems all day long, every day (HERE). How big a deal are these "Myofascial Injuries"? Listen to what Claire Davies, author of the Trigger Point Therapy Workbook has to say in her piece called Whiplash Injury (for the record, Amber's issue was more on the Scar Tissue side of things as opposed to TRIGGER POINTS).
"All of these seemingly unrelated symptoms can actually have a very simple, though often quite unsuspected, connection. They can be caused by myofascial trigger points (tiny contraction knots) in strained, overworked, or traumatized muscles of the head, face, jaws, and neck. This comes from decades of clinical research by Medical Doctors Janet Travell and David Simons, authors of the widely acclaimed medical textbook, Myofascial Pain and Dysfunction: The Trigger Point Manual. Whiplash Injury Any of these diverse symptoms can begin after a whiplash accident, a fall, or an athletic injury that violently overstretches or over contracts the scalene and sternocleidomastoid (SCM) muscles of the front and sides of the neck. Trigger points that are created by these incidents can exist undetected for years, the unknown and unaddressed source of disheartening chronic pain and disability."
What do we learn from this? We learn that SCAR TISSUE and Trigger Points can be a nightmare. We see that this sort of injury can also cause FACE OR SKULL PAIN. We find out that THE SCM MUSCLE is the muscle chiefly affected in Whiplash (HERE). And we see that Scar Tissue can cause symptoms which are "seemingly unrelated" to the original injury ("Organic" Injury).
"Formerly known as a somatoform disorder, a somatic symptom disorder is a mental disorder characterized by physical symptoms that suggest physical illness or injury – symptoms that cannot be explained fully by a general medical condition... In people who have a somatic symptom disorder, medical test results are either normal or do not explain the person's symptoms, and history and physical examination do not indicate the presence of a medical condition that could cause them. Patients with this disorder often become worried about their health because doctors are unable to find a cause for their symptoms. This may cause severe distress." Wikipedia's definition of a Somatic Symptom Disorder
THE LINK BETWEEN CHRONIC NECK PAIN, LOSS OF
THE CERVICAL CURVE, AND SPINAL DEGENERATION
"The lordotic curve of cervical spine radiographs was measured by analyzing the Cobb angle in 138 consecutive patients in a rheumatology office practice. All patients met the ACR criteria for fibromyalgia and complained of moderate to severe neck pain. 88% of fibromyalgia patients in this study had a straight neck based on measuring the Cobb angle, and 90% had a straight neck (loss of the lordotic curve) by visualizing the lateral view of cervical spine radiographs. The cause of the straight cervical spine in fibromyalgia is unknown. Speculation of the pathophysiology [cause of fibromyalgia] includes chronic muscle contraction and tightness of other soft tissues." From a paper (The Straight Neck in Fibromyalgia) presented by Dr. Robert Katz at last year's Annual Meeting of the American College of Rheumatology
"Degenerative changes of the cervical spine are commonly accompanied by a reduction or loss of the segmental or global lordosis, and are often considered to be a cause of neck pain. Nonetheless, such changes may also remain clinically silent." The opening sentences of a study called The Association Between Cervical Spine Curvature and Neck Pain from the May 2007 issue of The European Spine Journal
"In a healthy spine, the cervical lordosis looks like a very wide C, with the C pointing toward the back of the neck. This can begin to straighten in a condition called cervical kyphosis, in which the curve straightens up or even bows in the other direction. Sometimes this is referred to as “reverse lordosis,” referencing the fact that the spine is still curved, but the curve is now running in the wrong direction." From What is Cervical Lordosis? on the website WiseGeek.
Dr. Payne is a retired Alabama Chiropractor, who, back in 1988, started a company dedicated to the manufacturing of quality equipment to restore abnormal cervical curves (Matlin Manufacturing, Inc). Dr. Payne follows Don Harrison's Chiropractic Bio-Physics (CBP) Technique, and in 2008 wrote a 60 page booklet called The Best Corrections of Your Career: An Introduction to Postural Chiropractic. Dr. Mark sets out the premise of the book by revealing to chiropractors that, "Failing to deliver real and meaningful corrective care to our patients is a real tragedy in terms of their long term health.... The laws of physics dictate that abnormal posture will harm your patients in any number of very real ways. When you relieve the pain but fail to to correct the underlying structural deficits you are shortchanging your patients and the consequences are very real and predictable." He then gives the book's "Five Principles".
- NORMAL IS NECESSARY
- POOR POSTURE IS SUBLUXATION
- ADJUSTMENTS ALONE CAN'T FIX IT
- YOU MUST HAVE ACCURATE AND REPEATABLE METHODS OF ANALYSIS
- YOU MUST HAVE THE RIGHT TOOLS FOR THE JOB
-NORMAL IS NECESSARY
The whole reason your body requires a "normal" lordotic cervical curve is to allow for normal joint motion --- joints can only move correctly when normal structure is present. In an age of relativism, this can be a bitter pill to swallow --- particularly if you do not have any overt symptoms or pain. In other words, many would have you believe that your "normal" is different than my "normal". Not true. Back in a 1959 study done by Borden, Hechtman, and Gershon-Cohen --- all M.D.'s (The Normal Cervical Lordosis), began to answer this question of what makes up a normal cervical curve. And although the measuring method was dramatically different than today's methods, their picture of what constitutes "normal" was just about identical to what would pass for normal today. Although there have been numerous studies on this topic since, a 2005 study in the medical journal JMPT summed it up nicely in a study called Determining the Relationship Between Cervical Lordosis and Neck Complaints. Listen to what the authors wrote after sorting patients into two main groups --- those with neck problems and those without.
"We found a statistically significant association between cervical pain and lordosis less than 20 degrees and a "clinically normal" range for cervical lordosis of 31 degrees to 40 degrees. Patients with lordosis of 20 degrees or less were more likely to have cervicogenic symptoms [symptoms arising from the neck]. The odds that a patient with cervical pain had a lordosis of 0 degrees or less was 18 times greater than for a patient with a noncervical complaint."
In the years since Payne completed his short book, there have been great numbers of studies on this topic, many of which I covered HERE. Although many in the medical profession say it doesn't matter, the range I seen bantered around as "normal" is 30 to 40 degrees (I believe it was Dr. Shealy who said that normal lordosis of the cervical spine was 43 degrees). If you wish to see what that this normal curvature looks like, just take another glance at the picture at the top of the page. You will begin to understand more about normal once you begin to learn more about abnormal.
POOR POSTURE IS SUBLUXATION
SUBLUXATION is defined simply as bones (usually vertebrate) that lose their normal alignment or motion in relationship to each other. Study after study after study is verifying the devastating effects of poor posture / postural deformities on human health. I Googled "effects of poor posture research studies" and found studies linking postural abnormalities to diseases you would not suspect such as Type II Diabetes and High BP. Some of the others specifically mentioned in the peer-reviewed research included things as diverse as fear, sadness, emotional instability, mental acuity, mood, energy levels, back pain, coordination, constipation, and even certain types of cancer. There is even research linking poor posture to shorter life span. What I really want you to notice here is how few of these problems that were mentioned have anything whatsoever to do with pain. Suffice it to say that FHP (Forward Head Posture) along with trunk flexion (THE POSTURE OF AGE) have tons of peer-review showing how detrimental they are to human health.
ADJUSTMENTS ALONE CAN'T FIX IT
Chiropractors cringe at old standbys such as "How many chiropractors does it take to change a light bulb? Just one, but it will take him one year and 150 visits to do it." We deserve to cringe. For decades, the profession has been telling patients that all they need to solve their problem is more adjustments (HERE). Don't get me wrong; adjustments are extremely powerful (HERE). The problem is, simply adjusting patients over and over and over again without any sort of tangible goal in mind other than short-term pain relief is playing the same game that the medical doctors play, only without the nutty side effects of DANGEROUS & DEADLY DRUGS OR PROCEDURES. Listen carefully as Dr. Payne rares back and punches the chiropractic profession squarely in the mouth.
"The ugly truth about chiropractic adjusting is that there is almost no evidence at all to suggest that adjustments alone do very much to actually correct spinal structure." For those of you who didn't get this the first time, a few sentences later he repeats himself. "There's absolutely nothing in the scientific literature to indicate that you can actually change spines effectively with adjustments alone." He then says why. "The answer is painfully obvious to professionals in other fields like university biophyisics and biomedical engineering who are engaged in studying the more technical aspect of the human machine." In other words, chiropractors have failed to comprehend the importance of certain physical properties that all living tissues possess, "elasticity, viscosity, plasticity, and strength". We have collectively failed to grasp just how big a role that physics (BIOMECHANICS) plays in solving the problem of abnormal spinal curves.
When I graduated from Chiropractic College back in 1991, the big emphasis was on restoring joint motion. Not that this is a bad thing but me learning that restoration of joint motion (primary) takes care of joint misalignment (secondary) was about 180 degrees opposite of the truth. Don't get me wrong; restoration of motion (BOTH SECTIONAL AND SEGMENTAL) is critically important and can bring about rapid pain relief (HERE, HERE, and HERE are great examples of this). One of the chief things I like about our unique brand of Tissue Remodeling is the fact that it rapidly changes the VERY PHYSICS OF SCAR TISSUE so that long-term structural correction is easier to make --- much easier to make. However, it's important to understand that pain relief is not where the process ends for people wanting to live a long, fruitful, productive, and pain-free life.
YOU MUST HAVE ACCURATE AND REPEATABLE METHODS OF ANALYSIS
This isn't exactly rocket science. There are essentially two different aspects to this bullet point. Visual Postural Analysis and / or X-rays. The more accurate of the two will almost always be X-ray. I also love to use RANGES OF MOTION. This is simple to check, takes all of about 10 seconds to do, and in most cases, will tell me exactly where I need to focus my attention --- particularly with Tissue Remodeling.
YOU MUST HAVE THE RIGHT TOOLS FOR THE JOB
Thus far we have learned that there is a "normal" amount of cervical curve that you should have in order to up your odds of avoiding a myriad of health-related problems as well as chronic pain. Furthermore, we know that simply getting adjusted over and over and over again is never the solution. In order to restore an abnormal curve, you are going to have to engage in activities / forms of treatment that actually change the physical properties of the tissue mentioned a few paragraphs earlier --- things that actually cause TISSUE DEFORMATION. This takes time. Not time as in month after month of adjustment after adjustment --- adjustments that each last no more than a fraction of a second. But time as in changing tissues by stretching them into a normal position. Dr Payne puts it like this. "What we really need are ways to apply sustained corrective forces for a sufficient time to change the soft tissues."
This can be largely accomplished at home using the DAKOTA HOME TRACTION or COMPRESSION-COUNTER STRESSING TRACTION aka "The Stynchula Method" (Payne wants you to slowly work your way up to as much as a half hour a day). I think he's spot on. It was Dr. Rene Calliet's 1987 book Rejuvenation Strategy that stated, "Most attempts to correct posture are directed toward the spine, shoulders and pelvis. All are important, but, head position takes precedence over all others. The body follows the head. Therefore, the entire body is best aligned by first restoring proper functional alignment to the head". Dr. Calliet was the Director of Physical Medicine and Rehabilitation at USC's School of Medicine at the time he wrote this.
CONSEQUENCES OF SUBLUXATION / ABNORMAL CERVICAL CURVE
This, folks, is where the rubber meets the road. As the study at the top of the page said, some cases of subluxation / abnormal cervical curve are "clinically silent". In other words, because they might not be producing any overt symptoms, most people (physicians included) would not consider them as important or harmful. However, there are four symptoms that come up time and time again not only in the scientific literature, but in the clinical setting as well, that are associated with abnormal curvature of the cervical spine. These four are....
- ABNORMAL RANGE OF MOTION
- NEUROLOGICAL ISSUES
-ABNORMAL RANGE OF MOTION
I have written about what constitutes normal ranges of motion in the cervical spine (HERE), and the consequences of not having this curve. The biggest thing I want you to understand in this bullet point is that the proper lordotic curve allows "coupled motion" in the vertebra of the neck. Clear back in 1993, the brilliant spinal biomechanist Dr. Manohar Panjabi published a study in The Journal of Orthopedic Research called Posture Affects Motion Coupling Patterns of the Upper Cervical Spine. Very technical information, if you care to read it.
More recently in 2004, Physical therapist Gary Gray wrote that, "Functionally understanding that movement in any one plane of the vertebral column is accompanied by movement in the other two planes. With the three dimensional capacity of the cervical spine, the three dimensional spinal coupling concept is significant. Even when we load a bobble-headed doll in one plane of motion, it reveals that plane of motion plus the other two as it “bobbles its head”." How complex are these coupled motions in the cervical spine? A Chinese study last year (Three-Dimensional Analysis of Cervical Spine Segmental Motion in Rotation) was published in Archives of Medical Science stating that, "The movements of the cervical spine during head rotation are too complicated to measure using conventional radiography or computed tomography (CT) techniques".
Pain sucks --- especially if it is chronic (long term, relentless) pain. And unfortunately, the medical community's approach to dealing with CHRONIC PAIN is not known for having a fantastic success rate. I mean, let's be brutally honest with ourselves for a moment. Are PRESCRIPTION PAIN MEDS, NSAIDS, MUSCLE RELAXERS, CORTICOSTEROIDS, and ANTIDEPRESSANTS going to help a patient over the long haul who is struggling on a day-to-day basis with neck pain? How could they when they are not even attempting to address underlying cause(s)? Bear in mind that while it's usually pain that motivates people to come see me, it's often the easiest of the four bullet points to deal with. By the way, I am not minimizing your pain. It's just that there may be more to solving your problem than simply relieving your pain. After all, if pain relievers truly worked, you wouldn't be reading this post at 3 am with tears in your eyes.
This one covers a lot of ground. Technically, pain could have also been lumped into this class, as could things like RADICULOPATHY, most HEADACHES, and a large percentage of MIGRAINES. The bottom line is that a "Head Forward Posture" puts large amounts of excess mechanical stress on the cervical spine --- particularly the front (anterior) portion of the cervical spine. Clear back in 1974, Dr. Adalbert I. Kapandji, an orthopedic surgeon, wrote in his famous textbook, The Physiology of Joints, that, "for every inch of Forward Head Posture, it can increase the weight of the head on the spine by an additional 10 pounds." A few years later in 1978, Nobel Prize winner and Swedish neurosugeon, Dr. Alf Brieg, published a study in JAMA (the Journal of the American Medical Association) called Adverse Mechanical Tension in the Central Nervous System: An Analysis of Cause and Effect; Relief by Functional Neurosurgery.
The paper's abstract (he also published a book by the same name) started out by saying that, "Hidden behind this forbidding title is a text that is radical, revolutionary, and incredible. It gets at the roots of things, should overturn cherished concepts, and parts of it are difficult to believe. Using cadaver, animal, and clinical material, Breig shows how tension in the brain, brain stem, spinal cord, and nerve roots can give rise to local and distant signs and symptoms. There are ample illustrations of the mechanical analyses and principles that are used to support his therapeutic suggestions and practice." The study went on to say that some of these signs and symptoms are specifically caused by "abnormal tensile forces" in the cervical spine. Breig's list includes things as diverse as, "facial neuralgias, spasticity [TRIGGER POINTS], bladder dysfunction, as well as cervical and lumbar spondylosis, disk hernias, trauma to the spinal cord, confusional states, and multiple sclerosis." This is yet another example of "Subluxation" and / or postural deformities leading to a wide variety of symptoms that are seemingly unrelated to the spine. If you want to see a radical example of Subluxation's effect on neurology, take just a second and READ THIS.
Degeneration is the visible finale of abnormal biomechanical stresses over time that can be seen on imaging tests such as X-ray or MRI --- even though IT MIGHT NOT MEAN WHAT YOU THINK IT DOES. If you were to go back and look at the picture of the normal cervical curve at the top of the page, the first thing you would see is the "forward curve". This forward curve is critical because it is not only the very thing that allows coupled motions of the neck to occur, but it acts as a shock absorber as well. Springs are curves that bounce back, and the normal curve in the neck acts as a spring. Furthermore, the neck is created and designed so that the mass of the head is carried on the Facet Joints that glide on each other and are found at the back (posterior) portion of the spinal column. As the neck loses its normal curve (or especially if the curve actually reverses), the head's mass will be carried on the fronts of the vertebral column instead of the rear. To help you understand this, take a look at the pictures of the Reverse Cervical Curves below). These abnormal curvatures will virtually always lead to degenerative changes such as bone spurs, calcium deposits, and thinning discs. Despite what doctors want you to believe, this is not so much a "DISEASE," but the result of something called "Wolff's Law".
Wolff's Law says that bone grows / remodels in response to mechanical stresses put on it, whether said stresses are normal or abnormal. This is why doctors put people with broken legs in "walking casts" as soon as possible in order to facilitate bone growth and healing. It is also why some areas of a skeletal system are much thicker or knobbier than others. Where muscles attach to bone and pull at them constantly --- especially powerful muscles --- the attachment points will be enlarged / thickened. Dr. Payne does not mince any words when talking about Wolff's Law.
"Want to know why your patients absolutely, positively, must regain structural balance in order to have good health? It's because gravity is a complete bitch. Like Schwarzenegger's Terminator character, it can't be reasoned with, it has no pity, and it won't ever, ever stop. If you don't do something to restore the normal structure of your patient, the end game has already been decided."
X-RAYS OF THE REVERSE CERVICAL CURVE
CAR WRECKS AND LOSS OF THE
NORMAL THE CERVICAL CURVE
The films below are both of middle aged women who each presented with CHRONIC NECK PAIN, and a history of being rear-ended years previously. Notice the beak-like bone spurs and thinning taking place at the C5-C6 disc space. Again, inordinate amounts of decay at C5-C6 indicates that a whiplash-like injury took place there at some point in time --- quite possibly decades previously.
DEGENERATION OF THE CERVICAL SPINE
One more quick note here. Degeneration is not the end of the world. It would shock many people (therapists and chiros included) just how much range of motion can actually be restored by breaking up Scar Tissue and Fibrosis --- sometimes even in people you would swear already had "normal" ranges (HERE). All of this is why you cannot skip PHASE I and go straight to PHASE II --- something numerous practitioners do. Neither can you live in Phase I like many chiros tend to do. It's all about doing the right things in the right order (HERE).
These are some pics of x-rays (all are lateral pictures of the neck, and all are facing to your right). Notice the bone spurs, calcium deposits, and thinning discs (some areas are literally fused together because the discs are gone). Also notice the funky curves. These were a few that were randomly pulled from my files when I was getting rid of x-rays that were over a decade old.
PRESCRIPTION DRUGS AND CAR CRASHES
WHAT IS THE LINK?
- More than 2.5 million Americans went to the emergency department — and nearly 200,000 were then hospitalized.
- Americans annually spend over a million days hospitalized as the result of MVA.
- The lifetime medical costs of each year's MVA's is currently estimated at 18 billion dollars, over 75% of which is spent in the first 18 months. Hospitalized individuals paid an average of $57,000 over their lifetimes, while Emergency Room visits averaged out to $3,300.
- The lifetime cost of loss-of-work due to each year's MVA's is currently estimated at 33 billion dollars.
More light was recently shed on this relationship between MVA and Prescription Drugs in a recent study published in the July-August issue of Public Health Reports (Fatal Crashes from Drivers Testing Positive for Drugs in the U.S., 1993-2010). In this study, the authors stated that, "Drugged drivers who were tested for drug use accounted for 11.4% of all drivers involved in fatal motor vehicle crashes in 2010. Drugged drivers are increasingly likely to be older drivers, and the percentage using multiple drugs increased from 32.6% in 1993 to 45.8% in 2010. Prescription drugs accounted for the highest fraction of drugs used by drugged drivers in fatal crashes in 2010 (46.5%), with much of the increase in prevalence occurring since the mid-2000s." Stop for a moment. Re-read this paragraph until the magnitude of what they are saying sinks in.
Once you begin to understand the sheer volume of Prescription Drugs (and for that matter, OTC drugs) that Americans are consuming (HERE, HERE, and HERE are a few examples), some of my ranting on this topic begins to make sense. When you look at studies like THIS ONE, you begin to see a pattern of Prescription Drug Abuse. What are some of the most commonly abused Prescription Drugs, whether we are talking seniors or adolescents? Actually, they are largely the same. They are NARCOTICS, ANTI-DEPRESSANTS, STIMULANTS (think drugs for ADHD here), and SLEEPING PILLS.
The bottom line is that drugs --- whether pushed or prescribed --- mess you up in numerous ways. Dr. Art Ayers talks extensively on his site about the fact that most prescription drugs have antibiotic effects that destroy GUT HEALTH. Many of the commonly used drugs are both addictive and DANGEROUS. But to answer the question posed in today's post; yes, there is a link between prescription drugs and MVA. My best advice is to find a follow a good protocol (HERE are a few), and get off as many drugs as you possibly can. Your life will be better for it in so many different ways.
CHRONIC NECK PAIN
BEFORE TREATMENT / AFTER TREATMENT
The thing is, he has tried Chiropractic Adjustments in the past. No real benefit. He simply learned how to put up with the pain. Like his dad, he is as tough as rawhide. But there comes a point where you come to the realization that if things are this bad at 28, what is it going to be like at 38? Or 48? Or 58? I don't care how tough you are, CHRONIC PAIN will eventually wreak havoc with your life. Take just a few minutes to watch these two videos. The second one was shot Friday; exactly two weeks (and one single treatment) after the first.
By the way, I am kicking myself. I did not get out of the office Friday evening until almost 7:00. This was due to treating a gal who has been struggling with severe, Chronic Neck Pain since a 7 end-over-end car wreck that happened over 20 years ago, which left her with a horrendous amount of Neck Pain. Despite having tried virtually everything under the sun, during the course of treatment, her range of motion in her neck went from crappy to essentially normal in about 15 minutes. The video will be up when I see her again.
CHRONIC NECK PAIN: BEFORE
CHRONIC NECK PAIN: AFTER
CHRONIC LOW BACK PAIN
CHRONIC NECK PAIN
HOW LONG DOES IT TAKE TO MAKE PERMANENT CHANGES?
After talking to him about it almost a year ago, Dave finally took me up on the invitation to see if I could solve his neck problem. Because his range of motion was so restricted (and had been for over 20 years), I did a "Before and After" video, thinking that I could change both his range of motion and his pain levels quickly. One of his chief complaints was that while CHIROPRACTIC ADJUSTMENTS were one of the only things that really helped him, the results would never last more than a few hours --- maybe a day if he was lucky. This is a classic sign of of FASCIAL ADHESIONS, and almost always indicates that Scar Tissue Remodeling would be appropriate. Bear in mind that these two videos were shot yesterday afternoon, about 15 or 20 minutes apart. Also remember that Dave had been a chiropractic patient for years.
DAVE "BEFORE" VIDEO
DAVE "AFTER" VIDEO
THREE YEARS OF CHRONIC BACK PAIN IN A YOUNG MAN
We took a few minutes and checked him for FASCIAL ADHESIONS of his THORACO-LUMBAR FASCIA. He was loaded with them. Before yesterday, I had not seen Stephen since I treated him eight months ago. Watch his testimonial! By the way, if you enjoy our VIDEO TESTIMONIALS, just click on the link to see dozens more.
CHRONIC LOW BACK PAIN VIDEO TESTIMONIAL
CHRONIC NECK PAIN AND THE STERNOCLEIDOMASTOID MUSCLE (SCM): IMPROVEMENT'S FIRST STEP IS INCREASING RANGE OF MOTIONRead Now
CHRONIC NECK PAIN & THE SCM
THE FIRST STEP TOWARD GETTING BETTER
IS INCREASING THE NECK'S ABILITY TO MOVE
Head in forward posture can add up to thirty pounds of abnormal leverage on the cervical spine. This can pull the entire spine out of alignment. Forward head posture (FHP) may result in the loss of 30% of vital lung capacity. Would you be surprised that your neck and shoulders hurt if you had a 20-pound watermelon hanging around your neck? Rene Cailliet M.D., famous medical author and former director of the department of physical medicine and rehabilitation at the University of Southern California
There are several things that happen when the SCM (as well as the PLATYSMA that covers it) has ADHESIONS OF THE FASCIA. One of the first is that it goes in to hyper-contraction or spasm. As you can gather from looking at the pictures above, this will draw the head downward (HEAD FORWARD POSTURE) or at the very least, prevent it from going backwards or side-to-side as much as it should. Not only is the FORWARD HEAD POSTURE associated with many bad outcomes (pain, ARTHRITIS, OSTEOPOROSIS, and even TYPE II DIABETES), so is the restricted motion that is almost always associated with it. It is critical to understand that DEGENERATIVE ARTHRITIS has a known cause --- loss of normal joint motion.
Joints that do not move properly wear out prematurely, and as joints wear out, they move worse. As you can see, it is a vicious cycle that actually feeds itself. Listen to what Allen Woodruff said about Whiplash in an article he wrote for last year's April 15 edition of Dynamic Chiropractic (The Illusive Root of Whiplash Associated Disorder).
"Unanswered questions surround whiplash, especially when no bones are broken. There is lack of evidence correlating speed, impact, size of vehicle, and severity of injury to chronic pain that shows up much later. A patient having fresh tissue injuries directly from whiplash unfortunately is a candidate for developing into a chronic sufferer, which can devastate their life. Most whiplash injuries begin with mild symptoms, but still pose an 18 percent chance of developing into chronic problems down the road, as much as two years following the initial injury."
"When the SCM is strained or shortened the muscle itself rarely hurts, no matter how stiff or tight it may be. Problems are referred elsewhere, to head and neck, ears, eyes, nose and throat. The astonishing laundry-list of pain and dysfunction includes severe dizziness and other neurological symptoms. These may be mistakenly diagnosed as migraine, sinus headache, atypical facial neuralgia, trigeminal neuralgia, arthritis of the sternoclavicular joint, ataxia, multiple sclerosis (MS), brain lesions, tumors, and other frightening conditions. As always, these possibilities should be eliminated through differential diagnosis. However, because of its intimate relationship with the brain stem and several nerves including the vagus nerve, the SCM can produce many neurological disturbances all on its own. One is a condition known as “postural dizziness” — just walking around feeling dizzy and disoriented — perhaps with a frontal headache commonly interpreted as “sinus” pain."
"quite common, especially in the cervical musculature, and most often found in patients 31 years to 50 years of age, with a greater incidence in women than men. Several studies have reported that up to 85% of back pain and 54.6% of neck pain and headaches are caused by myofascial pain."
Some of the things I use in my clinic include SCAR TISSUE REMODELING, CHIROPRACTIC ADJUSTMENTS, COLD LASER THERAPY, restoration of the normal cervical curve and stretching the SCM with the DAKOTA TRACTION DEVICE, STRETCHES, and strengthening exercises (the last three all done at home), among others. Just remember that whether or not you have pain today; if your neck does not move as well as it should, you will end up with pain at some point in the future (HERE). Prevent DEGENERATIVE ARTHRITIS, Chronic Pain, and other problems by dealing with the dysfunction in your neck today.
CAR CRASHES AND CHRONIC PAIN
"The great majority of these individuals are discharged to home after emergency department evaluation, but a subset of these individuals develop motor vehicle collision-related widespread pain which is characterized by substantial suffering and functional loss. We believe that our research indicates that doctors have to start treating these individuals with persistent widespread pain very early, and not wait for the pain to resolve in itself." - June Hu as told to MedPage Today
Interestingly enough, this is not the first time I have heard similar information. Back in the mid-1990's while attending a seminar on WHIPLASH by the venerable Dan Murphy, he was presenting studies (possibly by Gargan & Bannister) who were saying essentially the same thing. In fact, the research from two decades ago revealed that people who were not improving at 30 days and 60 days post-accident, were not very likely to get better --- ever. These were the people who entered the world of CHRONIC PAIN that Hu is speaking about.
If you are interested in learning more about how to deal with "Functional Loss", our site is a great place to start. We have lots of information on WHIPLASH and MVA, INFLAMMATION, and Chronic Pain due to FASCIAL ADHESIONS, as well as hundreds of VIDEO TESTIMONIALS from those who know what we do works! If you are struggling with Chronic Pain, click the links and educate yourself. Knowledge is power, and if you are not serious about learning how to avoid living a life of Chronic Pain, you will be taken advantage of, ignored, or both, by the medical community.
WHIPLASH AND CAR WRECKS
COMMON, BUT NOT THE ONLY WAY
When the head is 'whipped' violently back and forth, not only is there the propensity for injury to the FASCIA, there is significant chance of ending up with MTBI (Mild Traumatic Brain Injury). The problem with MTBI is that it opens the gates to all sorts of other health-related problems because it actually helps create AUTOIMMUNE REACTIONS within the body. This leads to the wild array of "bizarre and seemingly unrelated symptoms" that famous whiplash researchers Gargan & Bannister discussed in the conclusions of some of their ongoing studies. This means that not only might you be dealing with LOCAL FASCIAL ADHESIONS, but SYSTEMIC FASCIAL ADHESIONS (or SYSTEMIC TENDINOSIS or some other SYSTEMIC PAIN SYNDROME) as well.
If you are interested in delving deeper into this issue and figuring out a starting point for getting your life back, HERE are several posts which are related.
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).
Brain Based Therapy
Can You Help
Cardio Or Strength
Cold Laser Therapy
Death By Medicine
Degenerative Joint Disease
D's Of Chronic Pain
Evidence Based Medicine
Gluten Cross Reactivity
Ice Or Heat
Jacks Fork River
Leaky Gut Syndrome
Number One Health Problem
Platelet Rich Therapy
Post Surgical Scarring
Re Invent Yourself
Rib And Chest Pain
Scar Tissue Removal
Sleeping Pills Kill
Stay Or Go
Stretching Post Treatment
Tensegrity And Fascia
The Big Four
Thoracic Outlet Syndrome
Whole Body Vibration