Low Back Pain with Radiation Following Baltimore Auto Accidents

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

Medical Co-Management in Baltimore Whiplash Treatment

As a Baltimore Chiropractor that routinely treats acutely injured patients with whiplash, headaches, neck pain, and back pain following Baltimore auto accidents, I have seen plenty of patients that have delayed beginning chiropractic care/rehabilitation because they wanted to get some medicine for their pain. Typically a patient would schedule an appointment with their primary care provider, go to an urgent care, or go to the Emergency Room. There are problems with these models, in that these providers are not specifically trained in musculoskeletal medicine and often miss subtle injuries that require attention. I have spoken about ERs that miss subtle skeletal fractures in past blog posts.

From a patient perspective I understand the desire and “need” for medications following acute injury. These patients are people like you and me- they want to return to work and provide for their families. While Chiropractic care combined with physical therapy and soft tissue treatment will help heal them and restore their tissues to their pre-injury state throughout a course of treatment, they can not make a patient feel better “overnight”. That’s the value of medication in the acute injury paradigm. Patients can feel better and resume normal life activities as they heal under my care.

In an effort to ever improve the quality of care available to my patients, I have teamed up with Dr. Kevin Carr M.D. of Carr Medical Specialties. He is the ex-medical director of Jai Medical Clinics in Baltimore. He recently started a private practice in Baltimore and will be moonlighting at Mid-Atlantic Spinal Rehab & Chiropractic to assist in the evaluation and treatment of auto accident patients with whiplash. He is able to provide medication and trigger point injections, as needed. Currently he is available on Tuesday mornings from 9:00a-1:00p and Thursday afternoons from 3:00p-7:00p.

If you, or someone you know has been injured in a Baltimore auto accident and have whiplash, headaches, neck pain, or back pain, please contact Mid-Atlantic Spinal Rehab & Chiropractic. With the offerings of Carr Medical Specialties we are quickly becoming the go-to location for acute whiplash rehabilitation in downtown Baltimore.

Dr. Gulitz

Effective Management of Baltimore Whiplash

As I write this blog post it occurs to me that it’s been nearly 2 years since I left Las Vegas to move to Baltimore to open my own Chiropractic practice that focuses on treating patients involved in auto accidents, whiplash, motor vehicle collisions, and other forms of personal injury. One of the most important things I learned while working in Las Vegas was the effective evidence-based management of whiplash patients. Chiropractors often see their care criticized by third party payers and other health professionals. Many people consider care rendered in a Chiropractic office as “MUSH”. MUSH is an acronym for: manipulation, ultrasound, stim (electric muscle stimulation), and heat. The implication is that all care rendered is passive (i.e. the patient lays there and the services are rendered TO the patient). Most research indicates that regardless of the type of therapy you choose to use to recover from a Baltimore auto accident, the early introduction of active care has been shown to have the best results for long term prognosis.

At a recent continuing education conference on the management of Whiplash injuries generally accepted treatment guidelines were reviewed. As I sat in my chair thinking “this is obvious, I do this everyday” it amazed me how many other providers were not doing for their patients what I’ve been doing since my first day. Apparently the other providers have been putting out “MUSH.”

For uncomplicated whiplash cases, many chiropractors utilize the “Croft Guidlines” for whiplash care. It details the maximum treatment length for uncomplicated cases (no neurological findings, no extremity weakness, etc.)

Utilizing the Croft Guidelines, we can break up rehabilitation therapy into three phases of care (lasting on average 4-16 weeks post Baltimore car accident:

1. Acute Care (first 1-5 weeks). 3-5 visits per week, focusing on pain management (often co-treating with medical providers), emphasis on early return to work and normal activities

2. Subacute care (next 2-6 weeks): Decreased frequency of visits to 1-2x/week, a de-emphasis on passive modalities with an emphasis on active care (rehabilitative exercises, stretching, strengthening)

3. Rehabilitative care (next 1-5 weeks): One visit every week to every other week, continued emphasis on self-care strategies, home exercises, return to normal activities of daily living.

Generally speaking, a re-evaluation of the patients condition is performed every 10-12 visits (or one month, whichever comes first). Provided that a patient is progressing, they move into the next stage of care. If they are getting worse or not improving with care patients are either referred for a specialist evaluation or referred for advanced imaging such as MRI or CT scan, depending on the condition and presentation.

One thing to consider is that these are merely GUIDELINES. They are not hard and fast rules. Patients who are older, who smoke, who are diabetic, or who are on blood thinners generally do not heal as fast as those that are younger and healthier. Some patients do better quickly and some do better slower than the guidelines.

If you, or anyone you know, has suffered whiplash as a result of a Baltimore car accident, and need the help of a Baltimore chiropractor that treats these conditions every day, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be glad to help!

Dr. Gulitz

Immobilization Following Whiplash in Baltimore

As a Chiropractor that treats patients with neck pain following Whiplash in Baltimore, I routinely see patients referred to me from medical doctors that come in wearing a cervical spine collar (soft neck collar). Many of these patients have already had radiographs taken (x-rays) which have been cleared and are negative for fracture or dislocation. Those patients sometimes continue to wear the soft collar due to medical advice and sometimes they continue to wear them out of fear of harming themselves.

Almost without exception soft collars are NOT NECESSARY following neck trauma due to Baltimore car accidents.

The Bone and Joint Decade review notes “there is consistent evidence from 2 RCTs (randomized control trials) and one nonrandomized study that soft or rigid collars alone or in combination with other treatments were not associated with greater pain or disability reduction in the short or long term (up to 1 year) in persons with acute WAD (whiplash) when compared with advice to rest, exercises, and mobilization, and usual or no care.”

A link to the Bone and Joint Decade article can be found here.

If you are injured in a Baltimore auto accident and develop whiplash with neck pain, by all means get the medical care you need. If an EMT puts a collar on you to stabilize your neck so that you can go to the emergency room for x-rays, you should comply. Once you are “cleared” and your neck is “stable” do yourself a favor and do not wear a soft collar. The prolonged immobilization can actually slow your ability to heal by limiting motion to the tissues of the neck.

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

Dr. Gulitz