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

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

More on Types of Intervertebral Disc Injuries Following Baltimore Car Accidents

In my last blog post I discussed disc protrusions as a form of disc injury following acute spinal trauma such as that which occurs in Baltimore auto accidents. In this blog post I would like to discuss another type of disc herniation called disc extrusions.

Disc extrusions are types of disc herniations in which disc material extends beyond the normal disc space, similar to disc bulges and disc protrusions. By definition the depth of the extruded disc material is longer than the width of the extruded disc segment. Whereas if you remember in disc protrusions the wideth of the protuded segment is wider than the depth of the lesion.

Generally speaking disc extrusions are usually more clinically significant than disc bulges and disc protrusions. That is because there is a longer piece of disc material extending outside of its normal boundaries. This can lead to compression within the neural canal (central canal stenosis) and/or compression in the neural foramen, leading to true nerve compression as the disc materials contacts the dorsal root ganglion or spinal nerve any level. Patients with disc extrusions sometimes respond well to chiropractic therapy in my office, but sometimes they do not.

It is important to note that due to the sensitive nature of disc extrusion type injuries, often traditional rotatory spinal manipulation is relatively contra-indicated. That is, there is a concern that manual manipulation of the spine can lead to a worsening of the condition. With these patients I generally take a “less is more approach” and begin with mobilization techniques to their spines rather than full on chiropractic spinal manipulation.

Again, the best way to characterize a disc injury with patients following Baltimore whiplash or Baltimore auto accident injuries is via MRI. The MRI will help the treating provider and patient understand which neurological structures may be compressed. In these instances it may be important to refer the patient to an orthopedist or to a pain management specialist to consider either surgical or non surgical approaches towards pain relief.

While patients with disc bulges and even some disc protrusion may or may not have symptoms, a patient with a disc extrusion is not that hard to spot clinically. They usually have intense lower back pain with concurrent radiating pain down their arm or leg, past their elbows or knees, that does not abate regardless of position. Sometimes there are lower motor neuron findings of numbness, tingling, or weakness also associated with these injuries. If left for too long of a period patients with these complaints run the risk of long term nerve damage and pain.

With any disease process or injury, the most important step is getting access to care quickly and making an appropriate diagnosis. All to often I have seen patients that have found me after treating with other physical therapists or chiropractors that have not improved after months of treatment. I typically recommend MRIs in these challenging cases and then refer the clients for pain management or surgical intervention if clinically indicated. While I am a chiropractor and spend the majority of my day utilizing chiropractic spinal manipulation it is important to recognize that a patient’s needs come before my own. I will always make an appropriate recommendation for care, especially if it is for a condition that I can not treat myself.

If you, or someone you know, has suffered from a disc extrusion 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

In my last blog post we discussed disc bulges and their clinical significance. As we discussed these are pretty common findings that often do not cause a patient’s presenting symptoms. The next classification of disc injuries that I would like to discuss is what is called a disc protrusion. Technically, a disc protrusion is a type of disc herniation. By specifying the difference between a disc protrusion and a disc extrusion (more on this to come in the next blog post) a provider and radiologist can better understand the type of injury and the treatment that might best suit that particular injury.

A disc protrusion is a type of herniated disc that involves tearing of the outer annular fibers of an intervertebral disc. This is important to note because even without disc protrusion, torn annular fibers are known to be pain-sensitive fibers that can be the source of a patient’s pain. Once the outer tissue of a disc is torn it allows for migration of disc nuclear material to migrate and extend beyond the limits of the normal disc space. Typically this migration is a backwards movement. By definition, a disc protrusion is a type of herniation where the protruded material is wider than it is long. That is, the base of the lesion is broader than the depth of the lesion. You can see a picture of a disc protrusion here.

Discs can protrude in many different directions, and as a result, they can cause various different symptoms. There can be central protrusions, where there is some spinal canal stenosis and inflammation. There can also be paracentral or paramedian protrusions where the swelling and protrusion occurrs off of the mid line, with a bias towards either the left or side side.

Clinically speaking paramedian disc protrusions can cause symptoms of back or neck pain with concurrent numbness, tingling, and/or weakness down the affected arm or leg. That is, they can present with these symptoms but that is not always the case.

The most clinically significant types of disc protrusions are called lateral disc protrusions. These protrusions move disc material into that lateral recesses, or the lateral canals. The reason that these are so clinically significant is because they either directly touch or chemically alter the dorsal root ganglia at this level and as a result are more likely to cause the numbness, tingling, or weakness that we classically suspect when dealing with disc protrusions.

It is important to note that not all disc protrusions are the same. That is, some can cause pain in the absence of numbness, tingling, and weakness. And some can cause numbness, tingling, or weakness in the absence of pain. Additionally, some will respond well to chiropractic care, spinal manipulation, and soft tissue modalities, and some fill have no response at all.

This is why it is extremely important that when treating for injuries sustained in Baltimore car accidents that involve headaches, neck pain, and back pain with numbness, tingling or weakness, that you work with providers that understand the difference of these types of injuries. That is, classifying the morphology (shape) of an injured disc not only impacts care in the moment, but may well impact how much a patient can recover. The best way to image a disc protrusion is by way of an MRI of the neck or back. I routinely refer out for these tests on my injured clients.

In my next blog post I will write about another type of herniated disc, known as a disc extrusion.

For now, if you or someone you know is suffering from a disc protrusion that has resulted in back pain, neck pain, or numbness, tingling or weakness, please contact Mid-Atlantic Spinal Rehab & Chiropractic. We would be happy to help!

Dr. Gulitz

Types of Intervertebral Disc Injuries Following Baltimore Car Accidents

As a Baltimore chiropractor that spends a significant amount of my time treating patients in Baltimore auto accidents, it is very common for patients to present for care that have injuries to their intervertebral discs. The discs are the “shock absorbers” that exist between the bones of the spine that function to help in not only decreasing compressive forces of the spine but also in allowing for smooth segmental motion at every level of the spine. This enables the spine to rotate, bend and twist in complex manners which would not otherwise be possible in the absence of all the vertebral segments.

There are a myriad of terms to describe altered disc morphology (shape) that have made their way into our everyday lexicon. Some of these terms include “slipped disc”, “blown disc”, “shredded disc”, “inflamed disc”, “prolapsed disc”, “hot disc”, etc.

The problem with these terms is that they are not universal; that is, they might mean one thing to one person and another thing to another person. Following recommendations of the Combined Task Forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology the nomenclature of disc pathology has been simplifed as follows:

• Disc Bulge
• Disc Herniation (Protrusion, Extrusion)
• Sequestered Disc

In this and the next several blog posts I will discuss the different type of disc injuries and their clinical implications. For now, let’s start with “Disc Bulge.”

Out of all of the different types of disc pathology, the least clinically significant is the “Disc Bulge.” It refers to an extension of disc material beyond the edge of the vertebrae. In many people this is considered “normal” and it can exist with or without pain at a given spinal level. For a disc to be considered a disc bulge, more than 50 percent of disc material needs to extended over the vertebrae. While it is common for disc bulges to extend posteriorly (backwards) into the neural canal, there can also be anterior (ventral) disc bulges.

Most people with disc bulges usually are not even aware that they have them. That is, the disc inflammation or compression is usually a result of repetitive microtraumas over a lifetime rather than one acute injury. Additionally, since the compression and or inflammation is relatively small there is usually little or no neural compression in the spinal canal or the lateral canals. This means that most patients do not usually have associated numbness, tingling, or weaknesses associated with these findings.

While it is true that many patients live their lives with undiagnosed disc bulges in their neck, it is also important to note that these injuries, while not usually caused directly by traumas such as motor vehicle collisions, work-related injuries, or slips and falls, can actually predispose an injured patient to worse pain than had they never had a disc bulge to begin with. That is, the presence of disc bulges renders a patient “pre-weakened” and more likely to be seriously injured following resultant trauma to their spine.

The treatment for disc bulges is conservative management: A patient will undergo a series of treatments that include stretching, moist heat, electric muscle stimulation, and when appropriate, spinal manipulation and/or traction. Some patients with low pain tolerance levels may elect to take medications such as tylenol or advil in addition to muscle relaxers. A diagnosis of disc bulging does not contraindicate spinal manipulative therapy and in fact many patients with these injuries respond well to conservative chiropractic therapy.

In the next several blog posts I will discuss the other different types of disc injuries and their clinical presentations and treatment.

If you, or someone you know has been experiencing neck pain with or without disc bulges, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz