Repeated Disc Injuries Causes Persistent Inflammation

Repeated Disc Injuries Causes Persistent Inflammation

As a Baltimore Chiropractor that spends much of my time treating patients that suffer from headaches, neck pain, back pain and other whiplash symptoms, I routinely see patients that have been involved in multiple crashes in short periods of time. It is not unusual for a patient to go 10 or more years between crashes and then undergo a series of two or even three crashes over the next several months while under my care.

When these instances occur patients seem to think “Ok, I guess we are starting over” in terms of their therapy in this office. In reality, the case is that we may be starting from less than square one. That is, a subsequent injury to intervertebral discs can cause persistent inflammation over time. There appears to be more than an additive effect of cumulative trauma on intervertebral discs with subsequent injuries.

I remind my patients that Baltimore auto accidents generally happen in an instant, but that healing is a process. Even in the absence of active and passive modalities in my office an injured patient will still be undergoing phases of healing for nearly a year following their dismissal from treatment. If they are subsequently injured during this time period it is not unusual for their injuries to be worse than the original injury. That is, these patients exist in a “pre-weakened” state following treatment and are more susceptible to worse injury following new trauma.

A recent study on rat tail discs (I didn’t know there were discs in there, either) found that repetitive stab injuries to the discs during active healing phase caused persistent inflammation and enhanced degeneration. While this was understood to be true up until now I am not sure if it had been found clinically. This supports the idea that a pre-weakened patient that is actively healing and suffers a new injury can cause much worse pathological disc injury than had the disc never been injured in the first place. You can check out the abstract of the article here.

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

Dr. Gulitz

Activities of Daily Living Impact Following Baltimore Auto Accidents

As a Baltimore Chiropractor that treats many patients who have been injured in Baltimore auto accidents, I see many patients with physical symptoms. As previously discussed these symptoms typically include headaches, neck pain, back pain, and occasionally radiating arm and leg pain. The majority of the treatments in this office are geared towards increased ranges of motion, decreasing pain, and restoring pre-injury levels of functioning.

Injured patients are more than just a list of injured body parts. They are our mothers and fathers, our auto mechanics, our bus drivers, and our friends. Each patient has a unique set of circumstances that lead to their injuries and each has a unique set of impacts that their injuries have on their lives. These life activities are grouped under the umbrella term of “activities of daily living” or “ADLs.”

The extent to which an injury can impact a patients ADLs are important for providers to note during care, as it can give insurance companies insight into the degree to which an injured claimant’s life has been impacted as a result of an injury. Impacts on ADLs are considered value drivers in most personal injury claims. Despite the fact that they are important to note, many chiropractors and physical therapists do not take the time to ask about these lifestyle impediments and they go mostly undocumented. It probably makes sense that a dominant right-handed female hair dresser’s wrist sprain would impact her life more than would a left knee sprain for a patient that sits at a desk all day. It is important for the treating provider to ask and record these ADL impacts both at the beginning of a therapeutic regimen and at the end of care as well.

There are three main categories of ADLs. The categories and activities are generally divided up as follows:

• General Activities
  • Sitting
  • Standing
  • Bending
  • Lifting
  • Walking
  • Lying Down
  • Sleeping
• Duties Under Duress
  • Driving
  • Working
  • Housework
  • Dressing
  • Personal Hygiene/Self Care
  • Caring for Children
• Enjoyment Activities
  • Using a computer
  • Exercising
  • Watching TV/Movies
  • Playing Video Games
  • Etc.

I have patients fill out these ADL checklists on their first and last visits in my office. This information is extremely useful when the injured patient or their legal representatives hope to make a claim to a third party for damages.

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

Dr. Gulitz

Ice or Heat Following Baltimore Car Accidents?

As a Baltimore Chiropractor that spends a lot of time treating injured patients following Baltimore car accidents I see many patients that suffer from headaches, neck pain, and back pain. I get asked frequently what is the best course of treatment to help with pain immediately following the Baltimore auto accident.

Generally speaking the more recent an injury is, the best modality of choice is ice. Ice helps to constrict blood vessels, decrease swelling and help numb the topical pain associated with an acute injury. Ice can be applied via topical ice packs or even a bag of peas from the freezer. Care should be used to not put ice directly on the skin because it can cause frostbite if left in place for too long. Most commercially available ice packs thaw out after about 20-30 minutes and help to avoid the possibility of frost bite. Here we offer all new patients ice packs for use at home to help soothe their aches and pains between visits.

Heat is useful for more chronic aches and pains. Typically those patients whose pain is ongoing who wake up stiff, sore, and achy do better with heat. It helps to loosen stiff muscles, increased blood flow and increase ranges of motion. This is why most people tend to feel more awake and ready to go following a warm shower in the morning. Some people with chronic pain tell me that they like to sleep on a hot pack. I warn against this since it is possible to suffer second and third degree burns as you sleep since the body’s ability to feel sensation changes as we sleep. If you must sleep with a hot pack there are commercially available hot packs with timers that turn off after 20-30 minutes.

Although there is no hard and fast rule, I tend to recommend ice to control soreness if an acute injury has been present for less than 72 hours. After 72 hours I prefer to use heat. These are just general guidelines and there are no hard and fast rules.

Self care with heat or ice is an excellent way to help soothe pain between visits. Each new patient at Mid-Atlantic Spinal Rehab & Chiropractic is given a mixed use heat or ice pack that can frozen or placed in a microwave to help with pain. This is beneficial for both acutely injured patients in Baltimore auto accidents as well as patients with chronic pain from everyday life.

If you, or someone you know requires treatment for neck and back pain please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500.

Dr. Gulitz

The Use of Neck Braces For Whiplash Patients Following Baltimore Auto Accidents

As a chiropractor that spends the majority of my time treating acutely injured patients that suffer from neck pain, back pain, and headaches, I spend a lot of my time treating patients in this area that have suffered whiplash injuries following Baltimore car accidents. These are injuries to the neck and upper back that present with pain and stiffness as well as occasionally numbness and tingling as well.

Many times these patients go to an urgent care or hospital emergency department prior to presenting for treatment. In some instances these clients come in wearing a neck brace or some form of other immobilizing structure on their neck. Traditionally patients have been taught that they should keep the neck brace on to prevent motion of the spine. Recent evidence suggests that immobilization with a neck brace actually prolongs symptoms and prevents a patient from recovering quickly.

In an article seen here, it suggests that the use of soft collars should be limited to no more than 10 days following the trauma. The article states:

“Based on these studies, Logan et al. concluded that the traditional use of soft collars for neck sprains and strains is no longer considered best practice. The temporary relief of pain and support given by a soft collar may prolong recovery of patients. They recommend the following protocol for management of whiplash injuries: No cervical collar, regular analgesia, early home exercise program, and physiotherapy if symptoms persist.”

While it may seem counterintuitive to take the neck brace off quickly following a motor vehicle collision, the research suggests that leaving the brace on can lead to worse long term outcomes. That is why in my office we co-treat all of our whiplash patients with a traditional medical provider who can prescribe short term medications to help relax muscles as healing occurs. That is, we want to help you feel better short term (medication) while we work to rebuild your tissues (time and chiropractic care).

If you, or someone you know has suffered from whiplash or neck pain following a Baltimore auto accident, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz

More on Types of Intervertebral Disc Injuries Following Baltimore Car Accidents

This is the final installment of my blog series on types of intervertebral disc injuries following Baltimore car accidents. We have already discussed disc bulges, disc protrusions, and disc extrusions to date.

The final type of disc injury that we see in Baltimore car accidents is a disc sequestration. It is also known as a “sequestered disc” or “free fragment.” This is a subtype of disc extrusions where the disc material has lost continuity with its disc of origin and has broken free entirely.

This free fragment or sequestered fragment can migrate, or travel, once it has broken free. The migration occurs in the neural canal and can lead to caudal or cephalic migration of the disc material. This can complicate matters clinically, as patient’s symptoms may wax and wane without a predictable pattern as the sequestered disc fragment moves and impacts different neural structures.

Out of all of the disc injuries we have discussed thus far, a sequestered disc fragment is usually the most clinically significant. Additionally, these types of injuries usually do not respond well to chiropractic care and/or physical therapy. Often times these injuries need to be referred to an orthopedic surgeon so that the free fragments can be removed surgically. On the bright side, once the sequestered fragment is removed a patient usually feels tremendous relief of their clinical condition.

As with the other types of disc injuries following Baltimore car accidents, the most important thing is an appropriate diagnosis. These diagnoses can only be made utilizing MRI. If you are treating for a Baltimore auto accident injury and you are not feeling any improvement after approximately four to six weeks, you should have your provider order an MRI. Often times an MRI can help determine the structure of spinal intervertebral discs and can help lead to a more appropriate course of treatment.

If you, or someone you know, is suffering from an intervertebral disc injury due to a Baltimore auto accident, contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500.

Dr. Gulitz