Brain Injuries (MTBIs)

Brain Injuries (MTBIs)

Brain injuries (some of which are mild traumatic brain injuries or MTBIs) are nothing new. There is reference to brain injury in the Edwin Smith Surgical Papyrus, the oldest known medical manuscript at approximately 5,000 years old. Ancient Egyptians noted that an injury to one side of the head can lead to “a spasm on the opposite side of the body”. Even Galen, considered to be the father of modern medicine notes that a brain injury may be followed by “a loss for words.”

According to the National Institutes of Health (NIH), “Mild TBI is significantly under-diagnosed and the likely societal burden is, therefore, even greater.” Some have even gone on to refer to MTBI as the “silent epidemic” since it is hard to “see” and is only something that can be determined by questioning and monitoring a patient over time.

It should be understood that Baltimore car accidents and Baltimore auto accidents are the main cause of traumatic brain injury seen in Baltimore. In addition to suffering from neck and back injuries associated with whiplash in Baltimore, many people involved in Baltimore auto accidents also suffer from mild traumatic brain injuries. In fact, a term for patients with both neck symptoms and cognitive symptoms following auto accidents has been coined and is referred to as “cervicoencephalic syndrome.”

It is beyond the scope of just one blog post, but it should be known that mild traumatic injuries, when present, will produce some combination of cognitive, behavioral, and emotional symptoms in the injured party. Often the injured party does not notice these subtle differences in themselves, but it is their family and friends and notice that “something isn’t quite right.”

Fortunately, most MTBIs are self-limiting and many people return to a normal baseline following several weeks of rest. Some other people are not so lucky and go on to live with some form of disrupted congition, behavior, or emotional disturbance for the rest of their lives.

At Mid-Atlantic Spinal Rehab & Chiropractic we routinely treat patients involved in Baltimore car accidents and auto accidents in Baltimore. Many of our clients end up experiencing whiplash and mild traumatic brain injuries associated with Baltimore car accidents. The key to a speedy recovery is prompt diagnosis and treatment. If you or someone you know would benefit from therapy for whiplash and MTBI do not hesitate to call us at (443) 842-5500. We would be happy to help!

Excerpts from this blog post were borrowed from Dr. Arthur Croft’s “Whiplash and Mild Traumatic Brain Injuries” on pages 179 and 180.

Car Accidents and Pre-Existing Conditions

A segment of my practice deals with treating acutely injury patients suffering from whiplash, concussions, headaches, neck pain and back pain. I often see these types of injuries resulting from auto accidents (properly referred to as motor vehicle collisions) in Baltimore.

Many people think that if they are injured in a non-fault car accident that the adverse (other person’s) insurance company will deal with them fairly and give them access to needed chiropractic and medical care. Often, it is a real fight for injured clients to get the care they need. One tactic that insurance companies and claims adjustors use is the “pre-existing condition” arugment. They state that the pain that a patient has is due to a condition that they already had before their car accident, and that as such, the insurance company should not have to pay for care.

A pre-existing condition can be “active” in that the patient was already having a complaint which was worsened as a result of the car accident (i.e. lower back pain that was present 2x/week at a 3/10 which is now daily at a 7/10) or it can be “inactive” such as a prior resolved lower back injury resulting from a car accident three years ago.

When taking a history of patients involved in a car accident in Baltimore I attempt to “tease out” old injuries from new and so that I can properly apportion any pre-existing complaints. Many doctors do not take the time to do this, as they rush to see patients. What patient’s often do not realize is that if a proper honest history isn’t in a doctor’s report that it WILL BE USED AGAINST YOU!

Most claims adjustors and insurance companies read through your medical records with a fine toothed comb looking for anything they can claim might be a reason why you were a) not injured in this car accident or b) if you were injured, you were already injured from a pre-existing condition or c) you were injured unrelated to this car accident.

Dr. Art Croft in his book “Whiplash and Mild Traumatic Brain Injuries: A Guide for Patients and Practitioners” sheds some light on the pre-existing condition tactics used by insurance companies (page 102):

“Disc disease and spondylosis (spinal degeneration) are part of the normal aging process, like wrinkles, sagging flesh, gray hair, and age lines. About 50% of all people will have radiologically demonstrable spondylosis by their mid-30s and about 85% will have them by the time they are in their 50s. This condition is quite common, being found at autopsy in more than 80% of persons by the age of 50 years. Since it can not be said that 80% of persons over the age of 50 have chronic spinal pain, it provides no valid probative evidence of pre-existing symptoms in a forensic setting. Most people with moderate degenerative disease, in fact, do not have spinal pain.”

What Dr. Croft is saying is that while it is true that spinal degeneration becomes more likely as we age, most people with this condition do not have pain. Therefore, it is safe to conclude that pre-existing spinal degeneration (spondylosis) is NOT the cause of spinal pain following a car accident. This is an extremely important statement and one that needs to be understood by treating Chiropractors and other professionals involved in the rehabilitation of spinal injuries following car accidents in Baltimore.

My best advice to patients involved in a car accident in Baltimore is be honest. If you are injured, say so. If you are not, say so. If you have prior injuries from other car accidents, say so. Insurance companies know more about you than you know about yourself. The more honest you are with your care providers the more likely you will be treated fairly by the adverse insurance company.

Low Back Pain: Why Is It So Common?

This question has plagued all of us, including researchers for a long time!  Could it be because we’re all inherently lazy and don’t exercise enough? Or maybe it’s because we have a job that’s too demanding on our back?  To properly address this question, here are some interesting facts:

1.    The prevalence of low back pain (LBP) is common, as 70-85% of ALL PEOPLE have back pain that requires treatment of some sort at some time in life.
2.    On a yearly basis, the annual prevalence of back pain averages 30% and once you have back pain, the likelihood of recurrence is high.
3.    Back pain is the most common cause of activity limitation in people less than 45 years of age.
4.    Back pain is the 2nd most frequent reason for physician visits, the 5th ranking reason for hospital admissions, and is the 3rd most common cause for surgical procedures.
5.    About 2% of the US workforce receives compensation for back injuries annually.
6.    Similar statistics exist for other countries, including the UK and Sweden.

So, what are the common links as to why back pain is so common?  One reason has to do with the biomechanics of the bipedal being – that is, the two legged animal. When compared to the 4-legged species, the vertically loaded spine carries more weight in the low back, shows disk and joint deterioration and/or arthritis much sooner, and we overload the back more frequently because, well, we can! We have 2 free arms to lift and carry items that often weigh way too much for our back to be able to safely handle. We also lift and carry using poor technique. Another reason is anatomical as the blood supply to our disks is poor at best, and becomes virtually non-existent after age 30.  That makes healing of disk tears or cracks nearly impossible. Risk factors for increased back injury include heavy manual lifting requirements, poor or low control of the work environment, and prior incidence of low back pain.

Other risk factors include psychosocial issues such as fear of injury, beliefs that pain means one should not work, beliefs that treatment or time will not help resolve a back episode, the inability to control the condition, high anxiety and/or depression levels, and more.  Because there are so many reasons back problems exist, since the early 1990’s, it has been strongly encouraged that we as health care providers utilize a “biopsychosocial model” of managing those suffering with low back pain, which requires not only treatment but proper patient education putting to rest unnecessary fears about back pain.

As a Baltimore Chiropractor I routinely treat patients with back pain, both acute and chronic. If you, or someone you know, is experiencing back pain as a result of an auto accident, slip and fall, worker’s compensation injury, or just “waking up stiff”, please do not hesitate to contact Mid-Atlantic Spinal Rehab & Chiropractic or call us at (443) 842-5500. We would be glad to help!

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

Bullet vs. Target Vehicles in Auto Accidents

I’ve spoken to many friends and family members who have been involved in auto accidents in Baltimore. Some have accidentally caused the collision (the bullet vehicle) while others have been on the receiving end (target vehicle).  Almost universally those causing the crash end up saying “there’s no way that person could be hurt! I barely hit them!” On one hand they are likely concerned about their auto insurance rates rising as a result of a faulted motor vehicle collision, but on the other hand, they really can’t imagine the passenger’s in the other car being injured given the fact that they feel ok after the crash.

Dr. Arthur Croft sheds some light on this phenomenon in his book “Whiplash and Mild Traumatic Brain Injuries: A Guide for Patients and Practitioners.” His institute, the Spine Research Institute of San Diego, was the first to conduct an experiment that examined the difference between the forces experienced in a frontal crash (the bullet vehicle) and a rear-end impact (the target vehicle).

In his research he determined that the forces on the human subject’s necks were up to 4 times higher in the rear-ended vehicle than in the front impact vehicle. He also noted that subjects felt more of an impact when they were in the rear-ended vehicle than if they were in the bullet vehicle.

One major explanation as to why this is the case deals with preparation. The front-end impacted vehicle (bullet vehicle) typically can see the accident unfolding in front of them, allowing for even minor “bracing” in preparation which leads to less injury as compared to the unaware target vehicle’s occupants.

More interestingly the spinal kinematics are different between the striking and struck vehicle. In the bullet vehicle the driver experiences a “monophasic” response, in which he experiences a single forward bending motion as he is restrained by the seat belt and shoulder harness.

The target (rear-ended) vehicle’s occupants actually undergo a “biphasic” response. First, the seat back strikes the occupant from the rear, causing the curves of the spine to flatten. Then the pelvis and torso are accelerated forward by the seat, leaving the head momentarily at rest, causing the head to lag behind slightly before striking the head restraint. Once it strikes the head restraint, the head actually accelerates quicker than the rest of the body forcing it to rebound faster, and accelerate at a greater magnitude than that of the car or the pelvis or the torso. Then in the second phase, the occupants must actively resist forward motion aided by the seat belt by decelerating their forward head and body movement.

Dr. Croft’s mathematical analysis in the rear-ended vehicle is quite striking. He notes that if the rear-ended (target) occupant’s head were to be extended over a table she would feel the acceleration of 1g (earth’s gravity). Given that the average human head weighs 8-10 lbs, with a peak acceleration noted to be around 13g during a rear-end impact, it is the equivalent of a human head effectively effectively weighing between 102-128 lbs in a matter of 2 tenths of a second! Even knowing that a rear-end impact was pending (which most real-life occupants do not know) they CAN NOT under any circumstances actively brace themselves to prevent this level of acceleration in their necks.

Hence, it is clear that rear-ended occupants can and do experience more force in their spines than do the individuals in the car causing the collision in a front-end collision.

If you or anyone you know has been involved in an auto accident in Baltimore or the surrounding areas please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. Dr. Gulitz is a Baltimore Chiropractor specifically trained in the rehabilitation of auto accidents including whiplash and mild traumatic brain injuries.

More on Car Seats and Head Restraints

In past blog posts I have discussed various topics about whiplash from auto accidents in Baltimore. The last blog post mentioned how head restraint positioning can minimize injury risk if positioned properly prior to a rear-end motor vehicle collision.

Besides just properly positioning head restraints, certain automobile manufacturers have taken additional steps to make their vehicles more “crashworthy” so that occupants can “ride down” the crash and minimize any likelihood of injury. Notably, Saab created the “Saab anti-whiplash head restraint” or “SAHR”. It is a pretty interesting mechanism. When a car gets rear-ended the occupants mid back (torso) flattens out against the car seat, causing a cam to push the head restraint up and forward to “catch” the occupants neck, thereby instantly reducing the occupants likelihood of injury. It is a smart system- the head restraint is out of the way during normal driving and engages suddenly during impact.

Volvo has taken some steps to improve upon the design of car seats and head restraints as well. They created the WHIPS system. It is a bit more complex than the SAHR system. When impacted from the rear the WHIPS system translates rearward horizontally and then rotates rearward simultaneously, allowing an occupant to ride down the crash, thereby reducing injury risk.

Interestingly though these ideas have been proven to reduce injury risk to occupants we do not yet see these safety features in all passenger vehicles. You may be asking “why?”. Its all about money. Each of these designs ads money to the manufacturing of these vehicles and adds weight to the vehicles, thereby reducing fuel efficiency. As such, they are not often seen in most vehicles.

If you are fortunate enough to be driving one of these safer vehicles, congratulations! If not, let me leave you with this safe piece of advice as mentioned in a past blog post. Always adjust your headrest height vertically and minimize the space between your head restraint and the back of your head. If your vehicle comes equipped with a “pinch lock” on the head restraint, make sure it is engaged so that your head will not smash the head restraint down during impact.

Good luck and safe driving out there!