Apportionment of Baltimore Auto Accident Injuries

Apportionment of Baltimore Auto Accident Injuries

As many of my avid blog followers already know, I spend a good amount of my time treating and therefore blogging about injuries associated with Baltimore auto accidents. Typically the mechanisms of these injuries are fairly straight forward (front end impact, rear-end impact, side swipe, T-bone, etc) and the resultant injuries are fairly straight forward (neck pain, back pain, headaches, whiplash, etc.). However, as I eluded to in my previous blog post about injuries to rat intervertebral discs, injured patients do not live in a bubble or vacuum. That is, they are healing from the moments immediately following their injuries up until around a year after their initial injury, whether or not they are still undergoing care. That is, they can be thought of as “pre-weakened” following their initial injuries. In the vast majority of situations the injured patients are able to make complete recoveries given enough time and therapy. However, some of my patients are not so fortunate. I would estimate that approximately 3-5% of my patients that are treating for motor vehicle collision injuries will be injured in a subsequent crash within six months.

For reasons discussed in the previous blog post, this is a bad thing. Patient’s injuries do not “reset to 0”. Instead, the secondary set of traumatic forces will usually injure the patient to a level that was worse than before their first crash. So while I am willing to treat them for their second injury, they are often disheartened to realize that they usually feel worse after their second crash and that their response to therapy after the second injury is usually slower and more painful than after the first crash.

A reality that all treating providers must face especially while treating personal injury patients (auto accidents, slips and falls, worker’s compensation patients) is dealing with apportionment of injuries. That is, the insurance company or responsible third party who is paying for care for the injured claimant wants to know what injuries they are legally responsible for paying for and which injuries pre-dated their legal involvement in the claim.

For instance: Let’s say I have a patient that had a non-faulted crash on January 1, 2015. Their complaints were: headaches, neck pain, mid back pain, and lower back pain (all non-complicated). Presuming this patient had no prior injuries to these body parts, I will draw a conclusion that the crash on January 1 caused their injuries and I will treat them until they resolve or get as well as possible (Maximum medical improvement).  However, lets fast forward two months. Lets assume that their headaches, neck pain, and mid back pain have resolved and they are having lower back pain about 2-3 days per week. Now, they get in ANOTHER non-faulted crash. The insurance company or the responsible third party will want to know the EXACT level of pain that the patient was having prior to the second crash. And rightfully so. Why would they want to pay for care that is not their responsibility?

Most providers need to ask a specific series of questions on EVERY visit to best characterize their patient’s injuries. I want to know all of the subjective levels of pain frequency and severity for each injured area. So for each of the above patient’s complaints: I would want to know the frequency and severity of the patient’s headaches, neck pain, mid back pain, and lower back. I want to know three basic subjective characteristics of each complaints:

• Days per week/month: How many days per week are you experiencing this pain?
• Daily Frequency: On days with pain, what percentage of awake time are you experiencing pain?
  • Constant (76-100% of awake time)
  • Frequent (51-75% of awake time)
  • Intermittent (26-50% of awake time)
  • Occasional (1-25% of awake time)
• Pain Scale: 0-10 level of pain when experienced

By asking these specific questions for each injured body part on each visit, it makes it very easy to apportion injuries in light of new injuries. This has allowed me and my staff to successfully separate and allow for injury claims to settle because our notes are clear and succinct. While I can not speak for other offices that treat the same types of injuries that we do, I suspect that they do not spend the time and attention to their paperwork and their clients that we do.

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

Dr. Gulitz

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