Neck Exercises following a Baltimore Auto Accident

Neck Exercises Following a Baltimore Auto Accident

As a chiropractor that routinely treats patients with neck pain following Baltimore auto accidents, it is not uncommon for me to treat patients with a combination of both joint and muscle pain and dysfunction. Traditionally Chiropractors have been thought of as providers that only engage in only passive therapies- that is treatment where a patient has the therapies done TO them, instead of by them. To some degree this is true. I offer patients electrical muscle stimulation, ultrasound, intersegmental traction, and even spinal manipulation which are all passive modalities. Research has shown that in addition to passive treatments, more active treatments such as muscle stretching and resistance exercises help patients to decrease pain, increase ranges of motion, and decrease healing time. More interestingly, the faster a patient resumes active therapies following their injury, the faster they heal.

At Mid-Atlantic Spinal Rehab & Chiropractic we offer both passive and active modalities to help our injured patients heal from whiplash following Baltimore Auto Accidents.

Assuming that a patient has an injury to the joints and muscles of their neck, lets take a look at a few exercises we would likely have them perform in the office. Keep in mind- no two patients are the same and some patients may require additional or different exercises depending on their specific condition and injury. These exercises are to be considered a guideline for neck stretching. Please contact me or another healthcare professional if you have questions before performing any of these stretches on your own.

1. Side Bending Stretch (Lateral Flexion). A link can be seen here. You lean your ear to your shoulder as far as you can. Make sure to repeat both sides and not push past perception of pain.

2. Turning Stretch (Rotational Stretch). A link can be seen here. You turn your chin towards your shoulders as far as you can. Make sure to repeat both sides and not push past perception of pain.

3. Chin out/Chin Back (Protraction/Retraction Stretch). A link can be seen here. You “jut” your chin forward and bring it back (think about making a “double chin”), paying particular attention to not extend your neck. Typically extension will bother your condition following whiplash, although this is not always the case.

4. Isometric Resistance Stretching. A link can be seen here. This is the addition of light resistance, either by utilizing a hand, a towel, or a small ball to engage muscles actively while restricting joint motion. These are considered a progression over the first three stretches we discussed and should be worked up to over time.

If you, or someone you know, has suffered whiplash and has neck pain as a result of a Baltimore Auto Accident, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be glad to help.

Dr. Gulitz

Measuring Activities of Daily Living following Baltimore Auto Accidents

As prolific readers of my blog, many of you know that I spend a fair amount of time discussing diagnosis and treatment of patients who have experienced headaches, neck pain, or back pain following Baltimore auto accidents. Appropriate diagnosis and treatment are paramount for the Baltimore auto accident patient since patients want to feel better as fast as possible following an injury.

One of the services I provide to my patients that many other local providers do not is an analysis of a patient’s activities of daily living. That is, I try and figure out what degree their pain and discomfort impacts their normal activities of daily living, or ADLs.

I understand that the patients I treat in this office are not just “my patients”- they are also bosses, employees, brothers, sisters, husbands and wives. They have responsibilities to themselves and their families outside of my office. Pain is more than a physical thing when it impacts other areas of life. While I understand that often times neck and back pain are not “life threatening” this pain is often “quality of life threatening” when a mother has too much back pain to lift up her child without back pain, or when a father has too much back pain which prevents him from going to work and earning money for his family.

In my office we discuss not only the pain a patient is feeling, but also the impact that that pain has on their activities of daily living. There are three main areas of ADLs that we discuss and one other area, that while important, most patients do not usually openly discuss with me:

1. General Activities– sitting, standing, bending, lifting, walking, lying down, sleeping, and driving.

2. Duties Under Duress– working, housework, dressing, personal hygiene, and child care

3. Enjoyment Activities– using the computer, watching television, reading, exercising, (other personal enjoyments).

*4. Loss of Consortium- If couples are unable to be intimate and engage in a sexual relationship due to pain.

Most times when a patient feels better with the Baltimore auto accident treatment provided in this office they are able to resume their ADLs and are able to be discharged from treatment without ADL impairment. Sometimes, however, that is not the case and a patient is released with residual pain and residual impact on ADLs. While unfortunate, the documentation allows me to effectively communicate this disruption in their lives to their personal injury attorney so that they can be compensated for these problems and the disruption that it has caused to them personally.

If you, or someone you know, has suffered from a Baltimore auto accident and require treatment, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be glad to help!

Dr. Gulitz

More On Disc Herniations Resulting from Baltimore Auto Accidents

In the last blog post I mentioned the prevalence of disc herniations in the asymptomatic population. We discussed that despite prevailing thought that approximately 50% of the population has an asymptomatic (painless) herniated discs, we discovered that the true number is probably closer to 20%. The other 80 percent of population that has herniated discs get to be this way due to the gradual breakdown of the discs, usually initiated by a series of micro traumas, and can also result from overt traumatic events such as falls, and motor vehicle collisions (Baltimore Auto Accidents).

So now that we know how prevalent these injuries are, what exactly IS a herniated disc? I am sure we have all heard about “slipped” “prolapsed” “blown out” “ruptured discs” and “shredded” discs, but what does it all mean?

Fortunately the American Society of Neuroradiology and the North American Spine Society have come together to release terms that all doctors and laypeople can use to discuss disc pathology in order to better understand what is going on.

1. Disc Bulges– A common term denoting less than 3 mm of extension beyond the normal disc margin. There can be symmetrical bulging or asymmetrical bulging (right sided vs. left). These are not considered herniated discs.

2. Disc Protrusions- A type of disc herniation where the distance of protrusion is less than the width of the base.

3. Disc Extrusions- A type of disc herniation where the distance of protrusion exceeds the width of the base.

3b. Sequestered Disc Fragments– These are a specific type of disc herniation where the extruded disc fragment has penetrated the outer annular fibers and has broken loose.

A visual of the different type of disc injuries can be seen here.

An important thing to consider as a Chiropractor that treats patients involved in Baltimore auto accidents resulting in disc bulges, disc protrusions and disc extrusions is that everyone is different. That is, just ordering an MRI and having an MRI report does not tell me how to best help a symptomatic patient. Typically, I concern myself with the degree, if any, there is neurological compression in the spine. That is, typically the bigger disc injuries (disc extrusions) cause more neurological findings such as numbness, tingling, or weakness, and need to be treated more cautiously. Provided that there are no signs of stenosis or lower motor neuron lesions, it is typically safe to perform Chiropractic spinal manipulation/mobilization to the affected spinal levels. As always, patient preference is taken into account and patients that are fearful of being adjusted will instead be focused on corrective therapeutic exercises and spinal mobilization, similar to what they would do if they were being treated by a physical therapist.

Most patients with disc bulges and protrusions respond favorably to chiropractic care. Those that do not respond to care are referred to an orthopedic spinal specialist for a second opinion and future treatment recommendations. Although every case is unique, as a general rule, most bulges and protrusions do well with chiropractic care, while most extruded discs with and without sequestered fragments are typically not as responsive to care and are referred out to a specialist quickly.

If you, or someone you know has suffered from a disc bulge, disc protrusion, and/or disc extrusion as a result of a Baltimore auto accident and are in need of treatment, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be glad to help!

Dr. Gulitz

Disc Herniations resulting from Baltimore Auto Accidents

Before we discuss different types of disc inflammatory processes in my next blog post, I’d like to discuss some popular myths regarding disc herniation in the “asymptomatic population.” The asymptomatic population refers to people like you who walk around without neck and back pain. When I treat patients involved in Baltimore auto accidents if they are not improving with therapy quickly I will usually refer them for an MRI of the neck and/or lower back to determine if there is any stenosis or disc herniation resulting from the Baltimore auto accident. Many times once I get the results the patients (and the insurance company responsible for paying for or denying care) want to know if the disc inflammation found on MRI predated the auto accident or if the cause of the disc herniation was the auto accident itself.

There is a popular misconception that as many as 50% of the asymptomatic population have at least one disc herniation in their neck or lower back. According to Dr. Arthur Croft in his book “Whiplash and Mild Traumatic Brain Injuries: A Guide for Patients and Practitioners” this myth began with an article published in the journal Spine in 1984. According to Dr. Croft, the original authors have since changed their opinion with the prevalence of asymptomatic disc herniations ranging from 4-28%, with the majority of experts today agreeing that 20% is probably the most appropriate number. Despite the latest research that puts the number closer to 20% the old 50% myth prevails.

The reason this is important is because the insurance company handling the claim (the company representing the driver who caused the Baltimore auto accident) will always attempt to marginalize, or downgrade the severity of the injury following a Baltimore auto accident. If they can effectively accomplish this they can discontinue paying for chiropractic therapy and rehabilitation and limit your recovery, thus improving their bottom line financially.

The bottom line according to Dr. Arthur Croft is that “…disc herniations are not common among asymptomatic persons.  They are generally the result of a gradual breakdown of the disc, usually initiated by a series of microtraumas, and can also result from overt traumatic events such as falls, motor vehicle collisions (auto accidents), etc.” (p.159).

In my next blog entry I will discuss the different types of names of disc herniations and what they mean clinically. I will also discuss certain types of therapy that we use to treat patients with acute disc herniations resulting from Baltimore auto accidents.

Until then, if you, or anyone you know has suffered from neck pain or back pain and suspect you may have a herniated disc as a result of a Baltimore auto accident and require Baltimore auto accident treatment, please call Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz

The Difference in Effectiveness of Medical vs. Chiropractic Care
In The Treatment of Acute and Chronic Back Pain

Have you ever considered what type of provider is the best suited to treat back pain?  Since there are so many treatment options available today, it is quite challenging to make this decision without a little help.

To facilitate, a study looking at this very question compared the effectiveness between medical and chiropractic intervention.  Over a 4-year time frame, 2780 patients were followed with questionnaires. Low Back Pain patients were treated using conventional approaches by both MDs (Medical Doctors) and DCs (Doctors of Chiropractic).

Chiropractic treatments included spinal manipulation, physical therapy, an exercise plan, and self-care education.  Medical therapies included prescription drugs, an exercise plan, self-care advice and about 25% of the patients received physical therapy.

The study focused on present pain severity and functional disability (activity interference) measured by questionnaires mailed to the patients. It was reported that chiropractic was favored over medical treatment in the following areas:

•    Pain relief in the first 12 months (more evident in the chronic patients)
•    When low back pain radiated below the knee (more evident in the chronic patients)
•    Chronic low back pain patients with no leg pain (during the first 3 months)

Similar trends favoring chiropractic were seen for disability but were of smaller magnitude.  All patient groups saw significant improvement in both pain and disability over the four year study period.

Acute patients saw the greatest degree of improvement with many achieving symptom relief after 3 months of care.

This study also found early intervention reduced chronic pain and, at year 3, those acute low back pain patients who received early intervention reported fewer days of low back pain than those who waited longer for treatment.

While both medical care and chiropractic treatment approaches helped, it’s quite clear from the information reported that chiropractic should be utilized first.

These findings support the importance of early intervention by chiropractic physicians and make the most sense for those of you struggling with the question of who to see for your lower back pain.

My recommendation is to try chiropractic care first. If it is going to help you, it will do so quickly (2-6 weeks). If it fails to help, you can be referred for appropriate diagnostic imaging and/or referred for specialist evaluation.

If you, or someone you know, is experiencing acute or chronic back pain, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be glad to help!

Dr. Gulitz

The above was reproduced with permission of Dr. Ben Altadonna and “The Practice Building Alliance.”

Does Chiropractic Work? – What Do Insurance Companies Say?

If chiropractic care helps patients get better faster and costs the patient and/or insurance company less, shouldn’t EVERY low back pain patient FIRST see a chiropractor before any other type of doctor?  That is in fact, what should be done, based on a recent report!

On October 20, 2009, a report was delivered on the impact on population, health and total health care spending.  It was found the addition of chiropractic care for the treatment of neck and low back pain “…will likely increase value-for-dollar in US employer-sponsored health benefit plans.”  Authored by an MD and an MD/PhD, and commissioned by the Foundation for Chiropractic Progress, the findings are clear; chiropractic care achieves higher satisfaction and superior outcomes for both neck and low back pain in a manner more cost effective than other commonly utilized approaches.

The study reviews the fact that low back and neck pain are extremely common conditions consuming large amounts of health care dollars. In 2002, 26% of surveyed US adults reported having back pain in the prior 3 months, 14% had neck pain and the lifetime prevalence of back pain was estimated at 85%.  LBP accounts for 2% of all physician office visits where only routine examinations, hypertension, and diabetes result in more.  Annual national spending is estimated at $85 billion in the US with an inflation-adjusted increase of 65% compared to 1997. Treatment options are diverse ranging from rest to surgery, including many various types of medications.  Chiropractic care, including spinal manipulation and mobilization, is reportedly also widely utilized with almost half of all patients with persisting back pain seeking chiropractic treatment.

In review of the scientific literature, it is noted that 1) chiropractic care is at least as effective as other widely used therapies for low back pain; 2) Chiropractic care, when combined with other modalities such as exercise, appears to be more effective than other treatments for patients with neck pain.  Other studies reviewed reported patients who had chiropractic coverage included in their insurance benefits found lower costs, reduced imaging studies, less hospitalizations, and surgical procedures compared to those with no chiropractic coverage.  They then utilized a method to compare medical physician care, chiropractic physician care, physiotherapy-led exercise and, manipulation plus physiotherapy-led exercise for low back pain care.  They found adding chiropractic physician care is associated with better outcomes at “…equivalent to an incremental cost-effectiveness ratio of $1837 per QALY (Quality-adjusted Life Year).”

When combined with exercise, chiropractic physician care was also found to be very cost-effective when compared to exercise alone.  This combined approach would achieve improved health outcomes at a cost of $152 per patient, equivalent to an “incremental cost-effectiveness ratio of $4591 per QALY.”  When comparing the cost effectiveness of chiropractic care with or without exercise even at 5 times the cost of the care they utilized in their analysis, it was still found to be “substantially more cost-effective” compared to the other approaches.  It will be interesting given these findings if insurance companies and future treatment guidelines start to MANDATE the use of chiropractic FIRST – it would be in everyone’s best interest!

If you, or anyone you know has acute or chronic neck pain or back pain, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be glad to help!

Dr. Gulitz

The above was reproduced with the permission of Dr. Ben Altadonna and “The Practice Building Alliance.”

Low Back Pain with Radiation Following Baltimore Auto Accidents

As many of you who follow my blog realize, I enjoy writing about the area of whiplash injuries associated with Baltimore auto accidents. Although on the surface you may think that if you’ve seen one auto accident you’ve seen them all, each case and its individual differences are really interesting to me.

One area that I have not spent much time on is the idea of lumbar radiculopathy which usually results in low back pain with radiation of pain symptoms. The radiation of pain can be down the front of the leg, down the back of the leg, across the flank, or even into the groin region. Many people refer to all radiation of pain down a leg to be “sciatica” but that is not the case. I will talk about that more in another blog post. For those who pay close attention to detail you may remember a blog post I made several months back about cervical radiculopathy- a similar occurrence in the neck. It’s nice to know people are reading :).

In simple terms, radiculopathy is inflammation of a nerve root. Anytime the spine is stressed or compressed, such as in a Baltimore auto accident, there can be irritation to nerve roots. This is the case for the entire spine, but for the sake of this discussion, we will only be considering the lower back, or lumbar radiculopathy.

The nerve roots in the lower back comprise all of the motor and sensory fibers that innervate the lower extremities (legs). The motor fibers control motion in the lower extremity while the sensory fibers convey sensation from the environment (such as heat, cold, pain, light tough vibration, pressure) to the brain.

Following trauma to the spine, such as that often experienced in Baltimore auto accidents, the nerve roots may become injured, manifesting in a myriad of symptoms. Most commonly patients present with low back pain along with numbness and/or tingling and/or weakness into the lower extremity on the affected side. There may or may not be associated hyporeflexia (decreased reflexes) as well. Often times radiculopathy can be confirmed on physical examination and if need be, advanced imaging studies such as MRIs are used to better understand the degree of impingement of any other soft tissue structures such as intervertebral discs.

As part of the therapy for Baltimore auto accidents that I provide in my office, therapy usually involves heat, electric muscle stimulation, traction therapy, and if appropriate, chiropractic spinal manipulation. Most patients respond favorably within 6-12 weeks to conservative chiropractic therapy. Those that don’t are referred to specialists for additional intervention. The key to recovery is quick intervention. That is, the longer a patient experiences radiculopathy the longer it takes for the symptoms to resolve. In many cases patients make a complete recovery.

If you, or anyone you know, has suffered a lumbar radiculopathy as a result of a Baltimore auto accident and require Baltimore auto accident treatment, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be glad to help!

Dr. Gulitz

Phases of Healing Following Baltimore Auto Accidents

As a Baltimore Chiropractor that routinely provides Baltimore auto accident treatment for patients injured in Baltimore auto accidents, I am often asked how long I will treat any given patient for. That is, from day 1 being “the accident” and day “x” being release from therapy, how long will it take?

It’s a complicated question and one that really does depend on the specifics of the injury. What types of vehicles were involved in the crash? What was the mechanism of injury? What about patient factors (age, weight, pre-injury health status, previous injures, etc.)? Are the patients smokers? Drinkers? Diabetics?

The answer that I generally give is: I don’t know how long it will take. I inform patients that healing occurs both inside and outside of my office and will CONTINUE even after I dismiss the patient from care. That is, I don’t need to be actively treating an injured individual for them to continue to heal. More importantly, most patients don’t realize that just because they feel better and I release them they are not yet “back to normal.” They are still healing and their tissues will be healing for up 24 months.

So how do I know this? Its all in the research…

In 1988 the American Academy of Orthopedic Surgeons publish a paper that researched how long it takes soft tissues such as ligaments to fully heal. Hereis a link to their research paper for those who care to read it.

They determined that there are three phases of healing:

1. Phase 1: Acute inflammation: First 0-72 hours. Microscopic swelling, blood pools to injured areas, focal inflammation and immobilization. (Think about how stiff your neck is immediately following a Baltimore auto accident)

2. Phase 2: Repair Phase (6-8 weeks). Inflammation decreases and new repair tissue is deposited. New collagen is deposited on top of injured tissue and begins to integrate itself into the tissue matrix, albeit haphazardly.

3. Phase 3: Remodeling Phase (from 8 weeks to 2 years!). This is the phase that most people are unaware of or choose to ignore. The newly deposited collagen tissue is stressed and put under tension so as to properly align with old collagen tissue. This is why chiropractors and physical therapists perform active exercises for injured areas that are painless. It allows the muscles and tendons to heal in the proper orientation. This is also the reason why patients that are released pain free in this phase and get involved in a second Baltimore auto accident shortly thereafter usually feel like they are “back to square one” after a second crash.

Many insurance companies that pay for Baltimore auto accident therapy following a Baltimore auto accident injury would have you believe that you should be “healed” following 8 weeks of therapy. This misinformation is not supported by scientific research or my clinic experience.

If you, or someone you know, has been involved in a Baltimore auto accident and require Baltimore auto accident therapy, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz

Medical Co-Management in Baltimore Whiplash Treatment

As a Baltimore Chiropractor that routinely treats acutely injured patients with whiplash, headaches, neck pain, and back pain following Baltimore auto accidents, I have seen plenty of patients that have delayed beginning chiropractic care/rehabilitation because they wanted to get some medicine for their pain. Typically a patient would schedule an appointment with their primary care provider, go to an urgent care, or go to the Emergency Room. There are problems with these models, in that these providers are not specifically trained in musculoskeletal medicine and often miss subtle injuries that require attention. I have spoken about ERs that miss subtle skeletal fractures in past blog posts.

From a patient perspective I understand the desire and “need” for medications following acute injury. These patients are people like you and me- they want to return to work and provide for their families. While Chiropractic care combined with physical therapy and soft tissue treatment will help heal them and restore their tissues to their pre-injury state throughout a course of treatment, they can not make a patient feel better “overnight”. That’s the value of medication in the acute injury paradigm. Patients can feel better and resume normal life activities as they heal under my care.

In an effort to ever improve the quality of care available to my patients, I have teamed up with Dr. Kevin Carr M.D. of Carr Medical Specialties. He is the ex-medical director of Jai Medical Clinics in Baltimore. He recently started a private practice in Baltimore and will be moonlighting at Mid-Atlantic Spinal Rehab & Chiropractic to assist in the evaluation and treatment of auto accident patients with whiplash. He is able to provide medication and trigger point injections, as needed. Currently he is available on Tuesday mornings from 9:00a-1:00p and Thursday afternoons from 3:00p-7:00p.

If you, or someone you know has been injured in a Baltimore auto accident and have whiplash, headaches, neck pain, or back pain, please contact Mid-Atlantic Spinal Rehab & Chiropractic. With the offerings of Carr Medical Specialties we are quickly becoming the go-to location for acute whiplash rehabilitation in downtown Baltimore.

Dr. Gulitz

Effective Management of Baltimore Whiplash

As I write this blog post it occurs to me that it’s been nearly 2 years since I left Las Vegas to move to Baltimore to open my own Chiropractic practice that focuses on treating patients involved in auto accidents, whiplash, motor vehicle collisions, and other forms of personal injury. One of the most important things I learned while working in Las Vegas was the effective evidence-based management of whiplash patients. Chiropractors often see their care criticized by third party payers and other health professionals. Many people consider care rendered in a Chiropractic office as “MUSH”. MUSH is an acronym for: manipulation, ultrasound, stim (electric muscle stimulation), and heat. The implication is that all care rendered is passive (i.e. the patient lays there and the services are rendered TO the patient). Most research indicates that regardless of the type of therapy you choose to use to recover from a Baltimore auto accident, the early introduction of active care has been shown to have the best results for long term prognosis.

At a recent continuing education conference on the management of Whiplash injuries generally accepted treatment guidelines were reviewed. As I sat in my chair thinking “this is obvious, I do this everyday” it amazed me how many other providers were not doing for their patients what I’ve been doing since my first day. Apparently the other providers have been putting out “MUSH.”

For uncomplicated whiplash cases, many chiropractors utilize the “Croft Guidlines” for whiplash care. It details the maximum treatment length for uncomplicated cases (no neurological findings, no extremity weakness, etc.)

Utilizing the Croft Guidelines, we can break up rehabilitation therapy into three phases of care (lasting on average 4-16 weeks post Baltimore car accident:

1. Acute Care (first 1-5 weeks). 3-5 visits per week, focusing on pain management (often co-treating with medical providers), emphasis on early return to work and normal activities

2. Subacute care (next 2-6 weeks): Decreased frequency of visits to 1-2x/week, a de-emphasis on passive modalities with an emphasis on active care (rehabilitative exercises, stretching, strengthening)

3. Rehabilitative care (next 1-5 weeks): One visit every week to every other week, continued emphasis on self-care strategies, home exercises, return to normal activities of daily living.

Generally speaking, a re-evaluation of the patients condition is performed every 10-12 visits (or one month, whichever comes first). Provided that a patient is progressing, they move into the next stage of care. If they are getting worse or not improving with care patients are either referred for a specialist evaluation or referred for advanced imaging such as MRI or CT scan, depending on the condition and presentation.

One thing to consider is that these are merely GUIDELINES. They are not hard and fast rules. Patients who are older, who smoke, who are diabetic, or who are on blood thinners generally do not heal as fast as those that are younger and healthier. Some patients do better quickly and some do better slower than the guidelines.

If you, or anyone you know, has suffered whiplash as a result of a Baltimore car accident, and need the help of a Baltimore chiropractor that treats these conditions every day, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be glad to help!

Dr. Gulitz