Measuring Activities of Daily Living following Baltimore Auto Accidents

Measuring Activities of Daily Living following Baltimore Auto Accidents

As prolific readers of my blog, many of you know that I spend a fair amount of time discussing diagnosis and treatment of patients who have experienced headaches, neck pain, or back pain following Baltimore auto accidents. Appropriate diagnosis and treatment are paramount for the Baltimore auto accident patient since patients want to feel better as fast as possible following an injury.

One of the services I provide to my patients that many other local providers do not is an analysis of a patient’s activities of daily living. That is, I try and figure out what degree their pain and discomfort impacts their normal activities of daily living, or ADLs.

I understand that the patients I treat in this office are not just “my patients”- they are also bosses, employees, brothers, sisters, husbands and wives. They have responsibilities to themselves and their families outside of my office. Pain is more than a physical thing when it impacts other areas of life. While I understand that often times neck and back pain are not “life threatening” this pain is often “quality of life threatening” when a mother has too much back pain to lift up her child without back pain, or when a father has too much back pain which prevents him from going to work and earning money for his family.

In my office we discuss not only the pain a patient is feeling, but also the impact that that pain has on their activities of daily living. There are three main areas of ADLs that we discuss and one other area, that while important, most patients do not usually openly discuss with me:

1. General Activities– sitting, standing, bending, lifting, walking, lying down, sleeping, and driving.

2. Duties Under Duress– working, housework, dressing, personal hygiene, and child care

3. Enjoyment Activities– using the computer, watching television, reading, exercising, (other personal enjoyments).

*4. Loss of Consortium- If couples are unable to be intimate and engage in a sexual relationship due to pain.

Most times when a patient feels better with the Baltimore auto accident treatment provided in this office they are able to resume their ADLs and are able to be discharged from treatment without ADL impairment. Sometimes, however, that is not the case and a patient is released with residual pain and residual impact on ADLs. While unfortunate, the documentation allows me to effectively communicate this disruption in their lives to their personal injury attorney so that they can be compensated for these problems and the disruption that it has caused to them personally.

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

Dr. Gulitz

More On Disc Herniations Resulting from Baltimore Auto Accidents

In the last blog post I mentioned the prevalence of disc herniations in the asymptomatic population. We discussed that despite prevailing thought that approximately 50% of the population has an asymptomatic (painless) herniated discs, we discovered that the true number is probably closer to 20%. The other 80 percent of population that has herniated discs get to be this way due to the gradual breakdown of the discs, usually initiated by a series of micro traumas, and can also result from overt traumatic events such as falls, and motor vehicle collisions (Baltimore Auto Accidents).

So now that we know how prevalent these injuries are, what exactly IS a herniated disc? I am sure we have all heard about “slipped” “prolapsed” “blown out” “ruptured discs” and “shredded” discs, but what does it all mean?

Fortunately the American Society of Neuroradiology and the North American Spine Society have come together to release terms that all doctors and laypeople can use to discuss disc pathology in order to better understand what is going on.

1. Disc Bulges– A common term denoting less than 3 mm of extension beyond the normal disc margin. There can be symmetrical bulging or asymmetrical bulging (right sided vs. left). These are not considered herniated discs.

2. Disc Protrusions- A type of disc herniation where the distance of protrusion is less than the width of the base.

3. Disc Extrusions- A type of disc herniation where the distance of protrusion exceeds the width of the base.

3b. Sequestered Disc Fragments– These are a specific type of disc herniation where the extruded disc fragment has penetrated the outer annular fibers and has broken loose.

A visual of the different type of disc injuries can be seen here.

An important thing to consider as a Chiropractor that treats patients involved in Baltimore auto accidents resulting in disc bulges, disc protrusions and disc extrusions is that everyone is different. That is, just ordering an MRI and having an MRI report does not tell me how to best help a symptomatic patient. Typically, I concern myself with the degree, if any, there is neurological compression in the spine. That is, typically the bigger disc injuries (disc extrusions) cause more neurological findings such as numbness, tingling, or weakness, and need to be treated more cautiously. Provided that there are no signs of stenosis or lower motor neuron lesions, it is typically safe to perform Chiropractic spinal manipulation/mobilization to the affected spinal levels. As always, patient preference is taken into account and patients that are fearful of being adjusted will instead be focused on corrective therapeutic exercises and spinal mobilization, similar to what they would do if they were being treated by a physical therapist.

Most patients with disc bulges and protrusions respond favorably to chiropractic care. Those that do not respond to care are referred to an orthopedic spinal specialist for a second opinion and future treatment recommendations. Although every case is unique, as a general rule, most bulges and protrusions do well with chiropractic care, while most extruded discs with and without sequestered fragments are typically not as responsive to care and are referred out to a specialist quickly.

If you, or someone you know has suffered from a disc bulge, disc protrusion, and/or disc extrusion as a result of a Baltimore auto accident and are in need of treatment, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be glad to help!

Dr. Gulitz

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.”