Proper Positioning of Safety Belts in Baltimore Auto Accidents

Proper Positioning of Safety Belts in Baltimore Auto Accidents

According to the Centers for Disease Control and Prevention (CDC) there are approximately 6,400 adults injured in auto accidents daily in the United States. Probably the easiest thing we can do as passengers in vehicles in Baltimore or elsewhere is to wear our safety belts correctly. Safety belts are designed to keep occupants restrained during a collision. Without these safety measures many people would be ejected from a vehicle through the windshield following a rear-end auto accident. Despite the ubiquity of safety belts there is a growing concern that many adults either do not wear them at all or mistakenly do not use them properly. When used improperly safety belts can actually cause increased injury to occupants.

For a seat belt to function as it was designed, the seat and the occupant must be in the correct position. The seat back should be upright and the occupant should be sitting back into the seat, with their lower back, hips and shoulders all touching the seat. The headrest should be adjusted to its maximum allowable height in order to cut down on the likelihood of the head hyper-extending over the top of the headrest during a rear-end impact.

Before engaging a safety belt, make sure to check that the material is flat and not twisted like a rope. At high speeds the edges of a twisted safety belt can cut into the soft tissue of the skin and caused abrasions and lacerations superficially, or worse, caused damage to internal organs.

The lap portion of the safety belt should be placed across the pelvis. Many people make the mistake of wearing this portion too high across the abdomen. During an automobile accident this can cause injuries to the abdominal muscles as well as the visceral organs and intestines.

The shoulder belt portion of the safety belt should be placed across the rib cage, sternum (breast bone), and mid way across the clavicle (collar bone). This puts the most pressure on bony structures that can withstand impact and not on soft tissue structures that can easily be injured at high speeds. Never make the mistake of placing this shoulder portion under your shoulder or behind your back. When the shoulder belt portion is not enable properly your body will not be protected in cases of auto accidents.

Fortunately for the citizens of Baltimore and the rest of the United States every vehicle we enter has access to safety belts which do a wonderful job at protecting and saving our lives during the unfortunate periods of automobile accidents. Unfortunately, if ignored completely or if used improperly, safety belts can and will cause injury to their occupants.

The next time you step into an automobile take the extra few seconds and make sure that you and those you are traveling with are safe. You will be glad you did!

If you, or anyone know you know, has been injured in an automobile accident in Baltimore and require treatment please contact Dr. Marc Gulitz and his team at Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be glad to help!

Baltimore Auto Accidents and PIP coverage

As a Baltimore Chiropractor that spends a lot of my time treating patients involved in Baltimore auto accidents and provides treatment to patients with whiplash, headaches, neck pain and back pain I get asked about how patients can have their medical and chiropractic bills paid. Although this is not a clinical discussion, but rather a financial one, I think it comes up in conversation enough that it warrants a small discussion.

Personal Injury Protection (PIP)

In the State of Maryland it is mandatory that all drivers carry auto insurance. A component of the auto insurance that drivers carry is called PIP, or Personal Injury Protection. PIP is designed to pay for medical care (including x-rays, chiropractic care, and physical therapy) and up to 85% of lost wages for injured people in automobile accidents in Maryland. PIP is a no-fault benefit, meaning that it is available regardless of whether or not the driver caused the crash or was the victim of another driver’s negligence.

PIP is written in different amounts depending on the auto insurance policy. It is usually written in amounts of $2,500, $5,000 or $10,000 and can be waived in writing at the time of purchasing of auto insurance.

Maryland law dictates that medical bills and lost wages that are reasonable, customary, usual, and causally related to the automobile accident will be paid by PIP up to the policy limits.

In cases of non-faulted auto accidents, your auto insurer will not raise your auto insurance premiums even if you file a PIP claim with your own auto insurance company. That is, you can access PIP and use the benefits to pay for your treatment and lost wages without any negative financial consequences to yourself if you were the victim of an accident. If accessed during your treatment, PIP does not need to be repaid upon the conclusion of your treatment.

How do I apply for PIP ?

If you’ve been involved in an automobile accident contact your auto insurance company’s claims hotline to let them know you were injured.

Speak to your claims representative and confirm that you have PIP on your auto insurance policy.

Ask your claim’s representative to mail you an application for PIP benefits.  Typically these forms are about a page long and take less than ten minutes to complete.

Ask the claims adjuster to mail you an Attending Physician’s Report and Salary Verification Form. Hand these to your treating chiropractor and your supervisor at work to be completed.

Upon receipt, complete the applications and mail the PIP application, Attending Physician’s Report and Salary Vertification Form back to your claims adjustor.

Provide your claim number, adjuster name, claim office address, and phone number to all of your health care providers. This will allow your providers to be paid for your care while you are still in treatment. This also lowers, or in some cases, eliminates any money owed to your providers for treatment rendered upon conclusion of your care.

What If I don’t have PIP?

Injured patients that do not have access to PIP do have other means to get their bills paid.

If there is no PIP coverage available on your auto insurance you can use your health insurance to pay for your medical care.

If you do not have health insurance you can speak to a qualified personal injury attorney to see what other options may be available to you. Please let us know if you are interested in speaking to an attorney.

Automobile accidents are stressful but recovery from your injury does not need to be.

If you have questions please speak to the office manager La Keesha Arrington-Vega by phone at (443) 842-5500 or by email at [email protected]. The team at Mid-Atlantic Spinal Rehab & Chiropractic would be happy to help you.

Dr. Gulitz

More on Spondylolisthesis in Baltimore, MD

In my last blog post I discussed a lower back condition called spondylolytic spondylolisthesis. If you recall, it was a condition that resulted from an bilateral acute bony fracture and a resultant slippage of one vertebral body on another.

As a Chiropractor that uses X-rays to help me determine the structure of a patient’s lower back prior to spinal manipulation I see these pretty regularly. One of the questions that I get a lot is how I know whether to have a patient see an orthopedist/consider bracing or to undergo spinal manipulative therapy in my office and return to activities.

The first thing I consider is the mechanism of injury. If a patient comes in with an acute injury (they were weightlifting, playing sports, etc) I am more inclined to consider the injury (if present on standard x-ray) to be acute, or “hot.” In cases like these I tend to air on the cautious side and refer patients out for STIR MRIs to look for acute spondylolytic spondylolisthesis. If positive, these patients are referred for orthopedic evaluation and bracing. Bracing typically includes the fitting of a boston brace which allows for patients to spend over 23 hours a day not loading the posterior elements of the spine, and giving their bones time to heal. Research has shown that appropriately used bracing in these instances can “cure” the spondylolisthesis.

If, on the other hand, a patient presents with a spondylolisthesis and their physical examination does not seem to indicate that it is the cause of their pain I will begin treatment to include spinal manipulation of the joints above and below the effected segment. Much of the time spondylolistheses are “red herring” diagnoses- in that they are present but are not the cause of a patient’s lower back pain.

As a provider I have two concerns with these patients. The first is the pain that they are experiencing. As mentioned, most people present due to pain and want to be out of pain as quickly as possible. I will generally perform lesser invasive techniques and then progress to more aggressive techniques as tolerated. The second concern I have is the stability of the segment. If the patient has had a STIR MRI and there is evidence of an acute spondylolisthesis, I will refer the patient for orthopedic evaluation and have them discontinue provocative activity. Generally speaking, non-acute spondylolistheses are stable structures and will not continue to slip, whereas acute spondylolistheses that are active on STIR imaging are considered unstable and should be referred out to orthopedists and braced.

In summary, spondylolisthesis are one cause of lower back pain seen in my chiropractic office. X-rays are a good starting point to determine what MAY be the cause of lower back pain. In some cases it is safe to proceed with spinal manipulation of the lower back and in some cases it is not. I am trained to know when it can be handled in my office and when I should refer it out and I work with several orthopedists who are equipped to handle these conditions if they are outside of the scope of my practice.

If you, or someone you know, thinks they may have a spondylolisthesis please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz

Spondylolisthesis in Baltimore, MD

As I have spoken about in several other blog posts, there are many causes of lower back pain. Part of the challenge (but fun!) of being a chiropractor is trying to determine which structure or structures in any given patient are responsible for their presenting lower back pain.

One form of lower back pain that is not given much attention but is never the less important is spondylolisthesis. Though it is hard to pronounce, it is easy to describe. It is a condition where one bone slides forward on another bone. There are several types of spondylolisthesis, but the type that I come across most clinically and are the most challenging to treat clinically are spondylolytic spondylolistheses.  These are mainly seen in the lower back (lumbar spine) at the L5/S1 level, although not exclusively.

In spondylolytic spondylolisthesis the posterior aspect of a bone undergoes a systematic overload of force that leads to an eventual acute bony fracture. If this occurs on both sides of the posterior aspect of a bone the vertebral body can actually slide forward on the bone below it, causing not only back spasms and pain, but in some cases, instability. These are generally developed in youth with hyperextension loading mechanisms such as those seen in baseball pitches, wrestlers, and young dancers.

While high velocity low amplitude chiropractic spinal manipulation (what patients refer to as “back cracking”) is used on many patients with acute and chronic lower back pain in my office, it is not the only tool that I use to treat lower back pain. Though not an absolute contraindication to spinal manipulation, chiropractors and PTs need to exercise caution when handling spondylolisthesis patients.

The question that comes to mind is how to best help with the symptoms of pain and whether or not the spondylolisthesis is stable (not going to slide) or unstable (active and able to keep sliding).

Traditionally, SPECT bone scans have been used to determine clinically active sites of nuclear uptake which correlate with active acute spondylolistheses. While this has helped to determine the cause of active and unstable spondylolisthesis, it has recently come to light that the degree of exposure to patients to radioactive material has made these tests less desirable.

Fortunately a more readily available less deleterious test exists that is highly specific in detecting active spondylolisthesis in Baltimore, MD. The test is referred to as a STIR imaged MRI. STIR stands for short tau inversion recovery. It is a “fat suppression technique” that looks for signs of edema and fluid changes in and around the pars interarticularis- the location of spondylolytic spondylolistheses.

As a Baltimore Chiropractor that treats patients with acute and chronic lower back pain including active and inactive spondylolytic spondylolisthesis it is important to understand the use of STIR MRI imaging and what it means for patient outcome and treatment recommendations. I will discuss management of these conditions in a future blog post and how to determine whether it is appropriate to avoid activity, continue activity, undergo chiropractic care, or undergo bracing and/or surgical fusion.

For now, if you, or someone you know is suffering from lower back pain including spondylolisthesis please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be glad to help!

Dr. Gulitz

Digital vs. Analog X-rays

In previous blog posts I wrote about the importance of obtaining x-rays following Baltimore auto accidents. I wrote about how often clinically important diagnoses went unnoticed either because a hospital did not think a patient’s symptoms were severe enough to warrant x-rays or because a given Chiropractor treating the patient for whiplash, headaches, neck pain or back pain did not have x-rays on site for their patients.

Technology is ever changing and the technology of x-rays is no different. The machinery and chemicals that used to require dark rooms and expensive, smelly chemicals is long since behind us. Today’s x-rays look the same once developed but they are digital (on a CD) rather than analog (think the old big floppy x-rays).

There are several advantages to using new digital x-ray technology in a chiropractic office:

1. Radiation exposure to patients is decreased. This makes x-rays safer for patients.

2. Diagnostic imaging quality is improved. The radiologist or chiropractor can read the films with more clarity, make appropriate diagnoses, and direct care with more confidence than ever before.

3. Decreased development and storage/copy costs. There are no more smelly chemicals to process the films and no more necessity for dark rooms in small offices. A modern digital x-ray can be stored on a flash drive, hard drive, or CD in a matter of seconds and can be archived in a matter of seconds for little cost.

4. Faster interpretation: In a matter of 15 seconds digital x-rays can be transmitted securely to a teleradiology group that can read, interpret, and report their findings. It is not unusual for me to get x-ray interpretations back within 15 minutes of taking x-rays in my office.

The x-ray technology used at Mid-Atlantic Spinal Rehab & Chiropractic is state of the art. Patients involved in Baltimore auto accidents that have neck pain or back pain that require x-rays can have them taken quickly in the office. They can be viewed nearly instantly and interpreted in minutes. This allows patients to get on the road to recovery on the first visit rather then being sent down the street to wait in another office.

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

Dr. Gulitz