Predicting Chronic Pain In Whiplash Injuries

Predicting Chronic Pain In Whiplash Injuries

As many of my avid blog followers are already aware, I am a Baltimore Chiropractor and I spend the majority of my clinic time treating whiplash injuries resulting from Baltimore auto accidents. As I’ve mentioned previously these injuries typically present with acute post-traumatic headaches, neck pain and back pain. Of course, no two patients are the same, and these are not hard and fast rules.

I find this work very rewarding because there is usually a predictable outcome for the majority of our acutely injured Baltimore whiplash patients. That is, they present with intense symptoms quickly after whiplash injury, they respond favorably over the first 3-4 weeks of care, and they continue to improve as we ween them off care and progress them onto home care. For the majority of our Baltimore whiplash patients, there is a complete resolution of their symptoms and complete return to normal activities of daily living.

Unfortunately, not all Baltimore whiplash patients respond well to treatment. And this seems to be true regardless of age, gender, vehicular damage or prior injuries. I have been treating these types of patients for about eight years and I’ve often wondered why, despite my best effort, some patients make a complete recovery while others do not. And while I still don’t think we have a “perfect answer”, I think I have a bit more understanding of why that may be.

Research from the journal SPINE attempted to look at chronicity of pain in whiplash patients and they found that there was a link between early muscle fatty infiltrates (MFI) in the neck multifidi muscles and the chronicity of pain in whiplash patients.

They studied 36 whiplash subjects that were enrolled in the study less than a week after sustaining whiplash injuries. They studied these subjects at 1 week, 2 week, and three months post injury, measuring self-reported pain-related disability questionnaires, self-reported post-traumatic stress disorder questionnaires, and fat/water MRIs of their necks. They found that those subjects with higher levels of reported pain throughout the study had higher levels of MFIs in the cervical (neck) multifidus muscles.

The authors of the study suggest that we can use specialized MRIs to make predictive outcomes early on in care to determine who, despite rehab, chiropractic care, and physical therapy, are likely to have chronic pain following whiplash injuries. We can look at the MFIs in their neck muscles and based on that make predictions about who will be left suffering with chronic neck pain.

I find this result particularly fascinating for its implication in my practice. Often if patients are not having favorable outcomes to treatment and continue to report high levels of neck pain, we refer them for MRIs. The MRIs will typically focus on ligaments, intervertebral discs, and neurological tissues (nerve roots and the patency of neural foramina) while looking for evidence of pathophysiology. When these MRIs come back “negative” for disc injuries and nerve root compression, certain whiplash patients are considered to be “malingerers”, “liars”, or “crazy.” But maybe they aren’t. Maybe we need to run a different type of MRI and look for evidence of MFI as a cause of their reported chronic pain. Its something I will spend more time thinking about and discussing with radiologists who I refer MRI work to.

In the meantime, if you, or someone you know, has neck pain due to a Baltimore whiplash injury, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Thanksgiving – The Deadliest Day On The Road

As a Baltimore Chiropractor that spends the majority of my time in my clinic treating Baltimore auto accident patients with headaches, neck pain, and back pain, I spend more than a fair amount of time keeping up to date on all things Baltimore auto accidents. I am intrigued by what causes crashes, how people become injured in these crashes, and how to best help these injured individuals recover from their auto accident injuries.

If you are like me, you plan to hit the road Wednesday night to head home and stay with family before Thanksgiving on Thursday. While the holiday is one of my favorite, the grid lock and increased auto accidents that it causes are not my favorite. Did you know that Thanksgiving Day in the U.S. is the number one day for auto accidents and deaths from auto accidents each year?

As you might imagine there are a number of reasons why Thanksgiving is considered to be the deadliest day on the road. Here are some of the reasons:

1. A general increase in alcohol consumption on the evening before Thanksgiving. Since very few people have to work the next day, many people have “a few extra” adult beverages in an effort to socialize and relax. If they get behind the wheel they increase the odds of harming themselves or someone else.

2. The number of cars on the roads increases. I will personally be traveling about 250 miles to go to New York to see my family. There is about a 50 percent increase in the number of cars traveling more than 50 miles throughout Thanksgiving weekend compared to “normal” weekends. These long drives can be tiresome for drivers, so both a combination of increased cars on the roads and increased drowsiness is responsible for more crashes.

3. Increase darkness. As mentioned in a previous blog post, it is darker now when most people finish work and start driving home due to the end of daylight savings time. The decreased visibility makes it hard for us to see as we do in daylight, causing an increase in the likelihood of crashing.

Despite the numerous reasons why it is more likely that any of us will be injured or killed in a Baltimore auto accident on Thanksgiving and the days following, there are several straightforward and practical tips in order to have a safer ride and higher likelihood of surviving the weekend without being killed or injured in a Baltimore auto accident:

1. Check your tires – Even healthy tires lose air over time. Take 15 minutes to check tread and air pressure before departure. And remember to always check the air pressure of your tires when they are “cold”, generally before driving more than 2-3 miles on them.

2. Tune up – If you have been putting off that oil change, or topping off your fluids, now is the time to do it. There’s no worse time to be pulled over on a highway with a broken down vehicle then on a major holiday when support will become more sparse.

3. Follow the speed limit – Since there will be more cars on the road, it is imperative to travel at the speed limit.

4. Wear your seat belts – Don’t forget to buckle up. Engaging the proper restraints in your vehicle will make the ride safer for you and all of your occupants. Plus, its the law.

5. Minimize distracted driving – Make sure your cell phone is connected by blue tooth (if your car has it enabled) If not, designate a passenger to be a caller/texter/snapchatter on your behalf. The only job the driver should have is keeping their hands and 10 and 2 and obeying the rules of the road.

6. Get a good night’s sleep the night before. We all get anxious before the holidays given the long drives and the hustle and bustle of the holiday season. If you can get a nap in before you drive to help you stay more alert, or if you can get more sleep the night before, or better yet, if you can leave really early the day of Thanksgiving just after waking up you will be more able to focus on the ever changing road conditions and thus decrease your likelihood of a crash.

We all have to do our part to make the roads safe on Thanksgiving so that we can enjoy our time with our family without injuring ourselves and each other. If you, or someone you know, is unfortunately injured in a Baltimore auto accident on Thanksgiving, please contact Mid-Atlantic Spinal Rehab & Chiropractic. We would be happy to help you recover from your injuries!

Happy Thanksgiving from Dr. Gulitz and the entire team at Mid-Atlantic Spinal Rehab & Chiropractic!

Dr. Gulitz

MVA Attempts to Save Lives with “5 to Drive” Rules

As my avid blog followers are already aware I am a Baltimore Chiropractor that spends the majority of my clinic time treating patients in Baltimore with headaches, neck pain, and back pain. We have been seeing an increase in the number of injured teen drivers as of late. I just figured that the end of daylight savings time which results in more dark driving hours was to blame. As it turns out, that’s only part of the reason for an increase in teen crashes and injuries as a result of Baltimore auto accidents.

As we all know young drivers are inexperienced. The inexperience they bring to driving, combined with distractions, can lead to a deadly combination for many Maryland teenagers. In 2015 Maryland saw 21 deaths in teenagers between ages 16-20, which was up from 12 in 2014.

The MVA is hoping to curb teen death by releasing what it calls the “5 to drive” rules. It is hoping that parents of teenagers go over these safety recommendations with their teenagers before they get behind the wheel.

1. No cell phones (no texting). It is said that glancing away from the road for even 5 seconds at 55 mph can have a car travel the entire length of a football field. With all of the social media apps out there, it can be hard not to glance at every beep on the phone or every snapchat message. The MVA wants teenagers to turn their phones off while they are driving.

2. No extra passengers. Driving alone allows a teen driver to focus on the road and not to be distracted by music or conversation. It has been determined that driving with even one extra friend in the car doubles the risk of a fatal crash for a teenager.

3. No speeding. Not surprisingly, it was found that the majority of teen deaths behind the wheel were directly attributed to speeding. It is important that young drivers learn how to follow posted speed limits.

4. No alcohol or drugs. Alcohol and drugs impair brain function and reaction time. This is a good recommendation for adults as well as teenagers. But as the saying goes, good habits start early.

5. Always buckle up. It has been determined that nearly 1 in 4 Maryland teenagers killed by a driving accident did not have their seat belts on. It is important to buckle your seat belt from the moment you get behind the wheel until you car is safely parked.

Obviously these “5 to drive” rules are pretty basic. It is important that parents discuss these rules with their teenagers and hold them accountable to these actions so that we can cut down the risk for teenage death and injury due to motor vehicle collision in Baltimore and Maryland.

If you, or someone you know, has been injured as a results of a Baltimore auto accident injury, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz

Increased Baltimore Auto Accidents Due To Daylight Savings Time Ending

As a Baltimore Chiropractor, the majority of my clinic time is spent treating patients in Baltimore that have been injured in auto accidents. Typically these patients suffer from post-traumatic headaches, neck pain, and back pain after having been involved in Baltimore auto accidents. Occasionally we see patients with shoulder, hip, and knee pain as well. In addition to auto accident injuries I spend time treating patients with non-traumatic headaches, neck pain, and back pain as well. We even see some patients who are not injured at all but just enjoy the process of having their spine adjusted in order to continue to live a pain free lifestyle.

Now that I’ve been practicing in Baltimore for over four years I am starting to see a trend of increased Baltimore auto accident injuries around the end of Daylight savings time. I wanted to look and see if there was a plausible explanation as to why we saw more of these injuries this time of year, and particularly, why we see so many immediately following the end of Daylight Savings Time. As it turns out, there are several explanations for this phenomenon. That is, it is true that there are statistically more automobile crashes this time of year.

As everyone knows, this weekend we “fall back” an hour. This means that we gain an extra hour of sleep. Essentially we trade that extra hour of sleep for an extra hour of evening darkness. Some researchers suggest that the increase in the number of auto accidents (both in terms of fatalities and injuries) is due to the fact that we have more people awake at 7 pm than we do at 7 am. By this argument we have more people on the road running errands and coming home from work when it is already dark out. This is a “volume” argument and suggests that due to the increased volume of people on the road, we see an increase in the number of auto accidents as a result. Additionally, researchers suggest that although it is darker out earlier in the day, people continue to drive as if its light out. That is, some forget to put on their headlights, and some continue to drive at higher rates of speed, as they would if it was still light out.

But lets not forget the impact on circadian rhythms. These “biological clocks” tell us when we should wake up and when we should go to bed. Although you seem to “gain” an hour in the morning your body is still used to being awake approximately 16 hours for the average person on the average day. When evening comes, now we have millions of people on the road who are tired and who have less visible driving conditions which can lead to more auto accidents.

Still, researchers suggest that the increase in auto accident injuries that we see are part behavioral as well. That is, in anticipation of “gaining” an extra hour of sleep, some people stay out later on the Saturday night preceding the end of daylight savings time. Not only are the more groggy and tired as a result which can impair their driving abilities, but in many cases, there can be excess alcohol consumption as a means of a “celebration” of the extra hour of sleep, which in and of itself, can lead to more crashes.

I find it very interesting that there is scientific proof of increased auto accident injuries and fatalities immediately following the end of daylight savings time. If you are interested in reading the abstract of the journal article that found these conclusions you can click here.

If you, or someone you know, has been injured as a result of a daylight savings time Baltimore auto accident injury, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz

Meet Otto: The First Self Driving Truck

As many of my avid blog readers are already aware, I am a Baltimore chiropractor that spends the majority of my time treating patients in Baltimore with headaches, neck pain, and back pain. Sometimes these patients present following Baltimore auto accident injuries and Baltimore truck accident injuries, and sometimes they are “desk jockeys” or “weekend warriors.” The thread that unites them is the presence of spinal pain and discomfort that prevents them from actively participating in their activities of daily living. They always want to get out of pain and back into their normal routines.

One of the things that I like to spend my time blogging about on this website is technology. Several posts ago I discussed that new autonomous Uber cabs were on the road in Pittsburgh. As we discussed in that blog post, only time will tell how able Uber will be to get these cars on the roads in all major cities.

Uber is not stopping its quest for global transportation domination only with passenger vehicles. Uber recently aquired a company called Otto for $680 million just a few months ago and it has already managed to make its first semi-autnomous delivery of cargo in Colorado just this past week. What was the precious cargo that traveled from Fort Collins to Colorado Springs? 50,000 beers!

Unlike traditional cross-state and cross-country trucking outfits that require a large labor force of drivers to operate these big rigs, Otto sets out to help the bottom line of big businesses by decreasing their dependence on human control (which is the number one cause of accidents, injuries, and deaths on highways) all while decreasing fuel costs.

I’ll admit. As I was reading some articles about Otto on the web, I got nervous thinking about what it would feel like to see an 18 wheeler driving without a truck driver. But Otto doesn’t like to think of itself that way. It likes to think of the human truck driver on board as a “co-pilot” that can engage control of the truck with the push of a button.

Highways seem like a natural fit for semi-autonomous trucking operations. The roads are generally straighter. There are few if no pedestrians. There are no stop signs. And the already stretched thin work force of drivers can focus on the “tricky” driving that still requires human interaction. The driving that takes the truck the first few miles to the highway and the last few miles to its delivery zone. That is, it does not appear to be looking to eliminate human employees as drivers.

The first autonomous co-pilot on Otto was Walt Martin. He joked that he would be busy taking naps and practicing his yoga in the back of the truck while it drove over 120 miles to its destination.

Otto trucks only require about $30,000 worth of equipment to retrofit a traditional big rig into a high tech automated vehicle. It requires 3 LIDAR laer detection units, radar on the bumpers, and a high precision camera sitting above the windshield – thats basically it.

The makers of Otto foresee a future where trucks are “just trains on software rails”. They foresee their driving copilots as “harbor pilots” who just do the tricky navigation required before and after the highway driving on any given trip.

As with regular Uber cabs, it is still to be seen if semi autonomous of autonomous driving trucks will actually make the roads safer (as is being claimed) or if it will lead to more injuries and death due to some combination of computer and human error.

I am curious to see how long the next autonomous Otto ride will be and which additional obstacles (wind, rain, bumpy roads, etc) it will need to overcome. I, for one, welcome our new computer overlords.

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

Dr. Gulitz