Disc Herniations resulting from Baltimore Auto Accidents

Disc Herniations resulting from Baltimore Auto Accidents

Before we discuss different types of disc inflammatory processes in my next blog post, I’d like to discuss some popular myths regarding disc herniation in the “asymptomatic population.” The asymptomatic population refers to people like you who walk around without neck and back pain. When I treat patients involved in Baltimore auto accidents if they are not improving with therapy quickly I will usually refer them for an MRI of the neck and/or lower back to determine if there is any stenosis or disc herniation resulting from the Baltimore auto accident. Many times once I get the results the patients (and the insurance company responsible for paying for or denying care) want to know if the disc inflammation found on MRI predated the auto accident or if the cause of the disc herniation was the auto accident itself.

There is a popular misconception that as many as 50% of the asymptomatic population have at least one disc herniation in their neck or lower back. According to Dr. Arthur Croft in his book “Whiplash and Mild Traumatic Brain Injuries: A Guide for Patients and Practitioners” this myth began with an article published in the journal Spine in 1984. According to Dr. Croft, the original authors have since changed their opinion with the prevalence of asymptomatic disc herniations ranging from 4-28%, with the majority of experts today agreeing that 20% is probably the most appropriate number. Despite the latest research that puts the number closer to 20% the old 50% myth prevails.

The reason this is important is because the insurance company handling the claim (the company representing the driver who caused the Baltimore auto accident) will always attempt to marginalize, or downgrade the severity of the injury following a Baltimore auto accident. If they can effectively accomplish this they can discontinue paying for chiropractic therapy and rehabilitation and limit your recovery, thus improving their bottom line financially.

The bottom line according to Dr. Arthur Croft is that “…disc herniations are not common among asymptomatic persons.  They are generally the result of a gradual breakdown of the disc, usually initiated by a series of microtraumas, and can also result from overt traumatic events such as falls, motor vehicle collisions (auto accidents), etc.” (p.159).

In my next blog entry I will discuss the different types of names of disc herniations and what they mean clinically. I will also discuss certain types of therapy that we use to treat patients with acute disc herniations resulting from Baltimore auto accidents.

Until then, if you, or anyone you know has suffered from neck pain or back pain and suspect you may have a herniated disc as a result of a Baltimore auto accident and require Baltimore auto accident treatment, please call Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz

The Difference in Effectiveness of Medical vs. Chiropractic Care
In The Treatment of Acute and Chronic Back Pain

Have you ever considered what type of provider is the best suited to treat back pain?  Since there are so many treatment options available today, it is quite challenging to make this decision without a little help.

To facilitate, a study looking at this very question compared the effectiveness between medical and chiropractic intervention.  Over a 4-year time frame, 2780 patients were followed with questionnaires. Low Back Pain patients were treated using conventional approaches by both MDs (Medical Doctors) and DCs (Doctors of Chiropractic).

Chiropractic treatments included spinal manipulation, physical therapy, an exercise plan, and self-care education.  Medical therapies included prescription drugs, an exercise plan, self-care advice and about 25% of the patients received physical therapy.

The study focused on present pain severity and functional disability (activity interference) measured by questionnaires mailed to the patients. It was reported that chiropractic was favored over medical treatment in the following areas:

•    Pain relief in the first 12 months (more evident in the chronic patients)
•    When low back pain radiated below the knee (more evident in the chronic patients)
•    Chronic low back pain patients with no leg pain (during the first 3 months)

Similar trends favoring chiropractic were seen for disability but were of smaller magnitude.  All patient groups saw significant improvement in both pain and disability over the four year study period.

Acute patients saw the greatest degree of improvement with many achieving symptom relief after 3 months of care.

This study also found early intervention reduced chronic pain and, at year 3, those acute low back pain patients who received early intervention reported fewer days of low back pain than those who waited longer for treatment.

While both medical care and chiropractic treatment approaches helped, it’s quite clear from the information reported that chiropractic should be utilized first.

These findings support the importance of early intervention by chiropractic physicians and make the most sense for those of you struggling with the question of who to see for your lower back pain.

My recommendation is to try chiropractic care first. If it is going to help you, it will do so quickly (2-6 weeks). If it fails to help, you can be referred for appropriate diagnostic imaging and/or referred for specialist evaluation.

If you, or someone you know, is experiencing acute or chronic back pain, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be glad to help!

Dr. Gulitz

The above was reproduced with permission of Dr. Ben Altadonna and “The Practice Building Alliance.”

Does Chiropractic Work? – What Do Insurance Companies Say?

If chiropractic care helps patients get better faster and costs the patient and/or insurance company less, shouldn’t EVERY low back pain patient FIRST see a chiropractor before any other type of doctor?  That is in fact, what should be done, based on a recent report!

On October 20, 2009, a report was delivered on the impact on population, health and total health care spending.  It was found the addition of chiropractic care for the treatment of neck and low back pain “…will likely increase value-for-dollar in US employer-sponsored health benefit plans.”  Authored by an MD and an MD/PhD, and commissioned by the Foundation for Chiropractic Progress, the findings are clear; chiropractic care achieves higher satisfaction and superior outcomes for both neck and low back pain in a manner more cost effective than other commonly utilized approaches.

The study reviews the fact that low back and neck pain are extremely common conditions consuming large amounts of health care dollars. In 2002, 26% of surveyed US adults reported having back pain in the prior 3 months, 14% had neck pain and the lifetime prevalence of back pain was estimated at 85%.  LBP accounts for 2% of all physician office visits where only routine examinations, hypertension, and diabetes result in more.  Annual national spending is estimated at $85 billion in the US with an inflation-adjusted increase of 65% compared to 1997. Treatment options are diverse ranging from rest to surgery, including many various types of medications.  Chiropractic care, including spinal manipulation and mobilization, is reportedly also widely utilized with almost half of all patients with persisting back pain seeking chiropractic treatment.

In review of the scientific literature, it is noted that 1) chiropractic care is at least as effective as other widely used therapies for low back pain; 2) Chiropractic care, when combined with other modalities such as exercise, appears to be more effective than other treatments for patients with neck pain.  Other studies reviewed reported patients who had chiropractic coverage included in their insurance benefits found lower costs, reduced imaging studies, less hospitalizations, and surgical procedures compared to those with no chiropractic coverage.  They then utilized a method to compare medical physician care, chiropractic physician care, physiotherapy-led exercise and, manipulation plus physiotherapy-led exercise for low back pain care.  They found adding chiropractic physician care is associated with better outcomes at “…equivalent to an incremental cost-effectiveness ratio of $1837 per QALY (Quality-adjusted Life Year).”

When combined with exercise, chiropractic physician care was also found to be very cost-effective when compared to exercise alone.  This combined approach would achieve improved health outcomes at a cost of $152 per patient, equivalent to an “incremental cost-effectiveness ratio of $4591 per QALY.”  When comparing the cost effectiveness of chiropractic care with or without exercise even at 5 times the cost of the care they utilized in their analysis, it was still found to be “substantially more cost-effective” compared to the other approaches.  It will be interesting given these findings if insurance companies and future treatment guidelines start to MANDATE the use of chiropractic FIRST – it would be in everyone’s best interest!

If you, or anyone you know has acute or chronic neck pain or back pain, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be glad to help!

Dr. Gulitz

The above was reproduced with the permission of Dr. Ben Altadonna and “The Practice Building Alliance.”

Low Back Pain with Radiation Following Baltimore Auto Accidents

As many of you who follow my blog realize, I enjoy writing about the area of whiplash injuries associated with Baltimore auto accidents. Although on the surface you may think that if you’ve seen one auto accident you’ve seen them all, each case and its individual differences are really interesting to me.

One area that I have not spent much time on is the idea of lumbar radiculopathy which usually results in low back pain with radiation of pain symptoms. The radiation of pain can be down the front of the leg, down the back of the leg, across the flank, or even into the groin region. Many people refer to all radiation of pain down a leg to be “sciatica” but that is not the case. I will talk about that more in another blog post. For those who pay close attention to detail you may remember a blog post I made several months back about cervical radiculopathy- a similar occurrence in the neck. It’s nice to know people are reading :).

In simple terms, radiculopathy is inflammation of a nerve root. Anytime the spine is stressed or compressed, such as in a Baltimore auto accident, there can be irritation to nerve roots. This is the case for the entire spine, but for the sake of this discussion, we will only be considering the lower back, or lumbar radiculopathy.

The nerve roots in the lower back comprise all of the motor and sensory fibers that innervate the lower extremities (legs). The motor fibers control motion in the lower extremity while the sensory fibers convey sensation from the environment (such as heat, cold, pain, light tough vibration, pressure) to the brain.

Following trauma to the spine, such as that often experienced in Baltimore auto accidents, the nerve roots may become injured, manifesting in a myriad of symptoms. Most commonly patients present with low back pain along with numbness and/or tingling and/or weakness into the lower extremity on the affected side. There may or may not be associated hyporeflexia (decreased reflexes) as well. Often times radiculopathy can be confirmed on physical examination and if need be, advanced imaging studies such as MRIs are used to better understand the degree of impingement of any other soft tissue structures such as intervertebral discs.

As part of the therapy for Baltimore auto accidents that I provide in my office, therapy usually involves heat, electric muscle stimulation, traction therapy, and if appropriate, chiropractic spinal manipulation. Most patients respond favorably within 6-12 weeks to conservative chiropractic therapy. Those that don’t are referred to specialists for additional intervention. The key to recovery is quick intervention. That is, the longer a patient experiences radiculopathy the longer it takes for the symptoms to resolve. In many cases patients make a complete recovery.

If you, or anyone you know, has suffered a lumbar radiculopathy as a result of a Baltimore auto accident and require Baltimore auto accident treatment, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be glad to help!

Dr. Gulitz

Phases of Healing Following Baltimore Auto Accidents

As a Baltimore Chiropractor that routinely provides Baltimore auto accident treatment for patients injured in Baltimore auto accidents, I am often asked how long I will treat any given patient for. That is, from day 1 being “the accident” and day “x” being release from therapy, how long will it take?

It’s a complicated question and one that really does depend on the specifics of the injury. What types of vehicles were involved in the crash? What was the mechanism of injury? What about patient factors (age, weight, pre-injury health status, previous injures, etc.)? Are the patients smokers? Drinkers? Diabetics?

The answer that I generally give is: I don’t know how long it will take. I inform patients that healing occurs both inside and outside of my office and will CONTINUE even after I dismiss the patient from care. That is, I don’t need to be actively treating an injured individual for them to continue to heal. More importantly, most patients don’t realize that just because they feel better and I release them they are not yet “back to normal.” They are still healing and their tissues will be healing for up 24 months.

So how do I know this? Its all in the research…

In 1988 the American Academy of Orthopedic Surgeons publish a paper that researched how long it takes soft tissues such as ligaments to fully heal. Hereis a link to their research paper for those who care to read it.

They determined that there are three phases of healing:

1. Phase 1: Acute inflammation: First 0-72 hours. Microscopic swelling, blood pools to injured areas, focal inflammation and immobilization. (Think about how stiff your neck is immediately following a Baltimore auto accident)

2. Phase 2: Repair Phase (6-8 weeks). Inflammation decreases and new repair tissue is deposited. New collagen is deposited on top of injured tissue and begins to integrate itself into the tissue matrix, albeit haphazardly.

3. Phase 3: Remodeling Phase (from 8 weeks to 2 years!). This is the phase that most people are unaware of or choose to ignore. The newly deposited collagen tissue is stressed and put under tension so as to properly align with old collagen tissue. This is why chiropractors and physical therapists perform active exercises for injured areas that are painless. It allows the muscles and tendons to heal in the proper orientation. This is also the reason why patients that are released pain free in this phase and get involved in a second Baltimore auto accident shortly thereafter usually feel like they are “back to square one” after a second crash.

Many insurance companies that pay for Baltimore auto accident therapy following a Baltimore auto accident injury would have you believe that you should be “healed” following 8 weeks of therapy. This misinformation is not supported by scientific research or my clinic experience.

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

Dr. Gulitz