Maximum Medical Improvement Following Baltimore Car Accidents

As a Chiropractor that has been treating injured patients for nearly 7 years, one of the most common questions I get asked by new patients is “how long do I need to come in for treatment?” I suspect that this stems from the misconception that Chiropractic care is ongoing and that “once you go to a chiropractor you have to keep going for the rest of your life.” While I would argue that there are health benefits to getting routine “maintenance” spinal manipulation/adjustments, generally speaking insurance companies do not want to pay for this care stating that there are no clearly defined health benefits to long term manipulation in asymptomatic patients. Nonetheless, since the question of duration of treatment comes up quite often I figured I would address it in this article.

When it comes to treatment length, I never discuss it in terms of time (i.e. 2 weeks, 4 weeks, etc). Rather, I tell patients that I will recommend treatment until a patient reaches MMI, or maximum medical improvement. This is a med-legal expression stating that a patient is not expected to improve or worsen with the addition of any additional therapy or time.

Keep in mind, this does not mean that all patients that treat in my office for Baltimore car accidents and that have suffered Baltimore auto accident injuries are pain-free at the time of their final evaluation. Rather, it just means that additional therapy will not improve their condition. That is, there condition is stable. Ideally, this will occur once a patient has reached pre-injury status, but that is not always the case.

Here are two examples to demonstrate maximum medical improvement following a Baltimore auto accident:

1). Jane Doe gets rear-ended and presents for care. She declares no prior symptoms before the auto accident, but on day 1 mentions that she is experiencing headaches, neck pain, mid back pain, and lower back pain as a result of the crash. We treat her for six weeks and at the end of the six weeks she is completely pain free and feels “back to where she was before the crash.” In this instance Jane will be released at MMI since she is back to pre-injury status and since she does not stand to benefit from any additional treatment in my office or with any other specialists.

2). John Doe (No relation to Jane) gets rear-ended and presents for care. He declares that prior to this Baltimore auto accident he had chronic lower back pain stemming from a separate crash six years ago. He reports to be seeing a pain specialist once a month and has been since his previous crash where he undergoes lower back cortisone injections as needed. He reported his pre-crash lower back pain levels as being present approximately 3-4 days per week, intermittent (25-50% of awake time), and a pain scale of 4/10. Now, as a result of the new crash, he is reporting headaches, neck pain, mid back pain (all new complaints) and worsened lower back pain (that is now daily, constant (75-100% of awake time) and a 9/10. The key thing to note with Mr. Doe’s treatment is that as much as he would like me to completely eliminate his lower back pain, it is not something that I can actually do, since he reports a pre-accident level of pain. That is, I can only treat him until he reaches pre-injury status.  So let’s say he treats for 8 weeks and that his headaches, neck pain, and mid back pain have resolved. And let’s also assume that his lower back pain levels are now back at pre-injury levels of 3-4x/week, intermittent, and 4/10. At this point Mr. Doe is exactly where he was prior to the new crash. Provided that an addition or absence of treatment both in my office or with other specialists is not expected to improve or worsen his condition, I would also be releasing Mr. Doe from treatment at MMI at that time.

The point of the above example illustrates that MMI is not the same as being released pain free. MMI just means that more care (whether by me, by a physical therapist, pain management doctor, orthopedic specialist, etc) will not benefit the patient’s condition.

The reason that determining MMI is important is because (and this is more so true in worker’s compensation claims) patients can have permanency ratings based on their residual injuries. These permanency ratings can be equated to a financial payout for the injured claimant (or worker). While it is true that auto accident patients/claimants can also be given permanency ratings, it does not occur that often. When permanency ratings are indicated, I typically refer my patients to noted orthopedists in the area who are more familiar with the AMA guidelines for permanent impairment and who can properly evaluate and assign a rating.

So to reiterate – Following a Baltimore auto accident, if you ask me how long you need to treat, the answer will be the same. I will treat you until you reach maximum medical improvement, nothing more and nothing less.

If you, or someone you know, has been injured in a Baltimore auto accident, and you wonder whether or not you have reached maximum medical improvement, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz

How To Be A Good Patient Following A Baltimore Car Accident

As a Baltimore Chiropractor that spends the majority of my time treating patients injured in Baltimore auto accidents that have developed Baltimore whiplash, headaches, neck pain, mid back pain, and/or lower back pain, I have spent a lot of time in this blog discussing the appropriate management of patient’s condition. I have implored patients to ask good question and to hold their medical team or providers accountable for the very best care. Recently I had a patient ask me what THEY could/should be doing to help mitigate their pain and to be the best patient possible. I found this to be a refreshing idea. As a treating provider all I can do is give patients my best intention, care and treatment. It really is up to a patient to be the best patient possible. After all, a patient and a doctor form a team, and how good is a team without proper communication?

I have assembled a list of things that Baltimore auto accident patients as well as Baltimore chiropractic patients can do to help be good patients so that they can make a complete and speedy physical recovery.

1). Have a good attitude – Having neck and back pain is not a fun thing and very few patients “want” to have to come to treatment. It is a stressful time in your life, as it is in mine as your provider. Take a deep breath, answer my questions to the best of your ability and trust that my staff and I want to help you. In previous blog posts we discussed that having expectations of a quick and complete recovery can actually lead to positive outcomes. With this in mind, please be optimistic about your recovery.

2). Be disciplined – Following an initial evaluation and diagnosis a treatment plan will be given to you. It will detail how often you should be seen in the office, any other doctors that I want you to follow up with, and any home-based activities that I expect. Please keep in mind these recommendations are for your benefit. Patients that follow our recommendations to the “t” end up doing well. We do not make recommendations just to make them, but rather, they are based on sound science and my personal experience having treated thousands of patients in Baltimore with Chiropractic joint pain and/or whiplash injuries.

3). Be committed – Alert your employers and your family to your injury and your desire to recover. Having other people hold you accountable will help you stay committed during the dark times. Explain that you may need to spend time taking care of yourself and that it may temporarily alter your normal schedule. They will understand.

4). Be consistent – Even as you feel better with treatment (and you will!) don’t rush back into all of your pre-injury activities. I want you to resume your activities at 25%, then 50% then 75% then 100%. The key is slow and steady progress so that I can monitor your complaint and so that you don’t suffer from any setbacks while you heal.

5). Be flexible – At Mid-Atlantic Spinal Rehab & Chiropractic we offer some of the most flexible office hours in Baltimore for providers that treat Baltimore auto accident patients. We offer morning hours so patients can come in before work, we offer lunch time hours so patients can get treatment during their lunch breaks, and we offer evening hours so patients can receive treatment after work and before heading home for the evening.  Additionally, we offer some Saturday hours for those patients that just can not make it during the week. While these hours are long it is our commitment to help our patients reach maximum physical recovery that drives us to accommodate everyone’s complex schedule. Don’t be afraid to shake up your normal routine in order to help your body heal and feel better following your injury.

In general, just remember that we want to help you recover from your Baltimore auto accident injuries and/or your Baltimore neck pain and Baltimore back pain. We are committed to being here and being ready to serve you. In order to make a complete physical recovery from your injuries, patients need to commit to their treatment as well. It is unrealistic to expect to be “fixed” overnight or without committing to the treatment plan provided for you. Patients and healthcare providers must effectively work together as a team to reach the best clinical outcomes.

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

Dr. Gulitz

Vehicle Override/Underride During Baltimore Auto Accidents

The theme of the majority of my blog posts generally involves Baltimore auto accidents and Baltimore car accident injuries. I spend the majority of my time treating headaches, neck pain, back pain, and radicular complaints associated with auto accident injuries in Baltimore. One of the themes that keeps coming up is whether or not an insurance company wants to accept liability for injured claimants. Typically these adverse insurance companies state that their insured(s) could not have injured the claimants (my patients) due to how little property damage was sustained by the claimant’s vehicle. In past blog posts we discussed that there is no scientific link between property damage and occupant (claimant) injury. Rather, we determined that occupant kinematics and personal medical history (age, prior injuries, health status, seated position, preparedness for impact, etc.) are better predictive indicators for injury. With that said, I have treated several injured patients that have had severe injuries and some that even required surgical intervention where property damage to their vehicle was minimal.

The phenomenon that can help explain some of these cases where there are very serious injuries with very minimal property damage to a vehicle is called overriding and underriding.

Simply put, cars have front and rear-bumpers. These exist to help absorb an impact if two cars collide, and to help the occupant to “ride down” the crash. The bumpers absorb the tremendous forces that would otherwise be transferred to the vehicle’s occupants and cause serious injury. Generally speaking, bumpers work well. However, for them to work optimally, there needs to be a direct interaction between one vehicles bumper and the other bumper. If the bumpers are offset laterally, or if one bumper is higher than an another, then they will not function optimally to absorb forces.

I’ve treated patients who were in small sedans (for example, a honda civic). The civic might be stopped at a red light and rear-ended by a large Ford F350 truck. In the instance where the F350 truck’s bumper sits up off the road higher than the civic, it is entirely possible that the front bumper of the truck might override the civic’s bumper. (Please keep in mind I do not know the road clearance measurements of these vehicle’s bumpers, but instead, this is just a relative example). In this case, all of the force that would have been dissipated by the Civic’s bumper gets transferred into the vehicle’s frame, and carried through to the occupant. In this instance, the bumper damage to the civic may be minimal or non-existent, but the forces and injury to the occupant are real and severe. The trouble with this scenario is getting a claims adjustor, insurance company, or eventually a judge or jury to understand that due to the overriding of the bumpers, the occupant was injured.

It bears repeating that there is no clinical correlation between vehicular property damage and bodily injury. Sadly, most adverse insurance carriers are not concerned with an occupants injury, but rather, they are concerned with saving money and not paying out for legitimate injury claims. Unfortunately this often harms claimants whose vehicles were over or underridden, as their property damage may be lower than expected. As a result, their legitimate claims are often devalued or denied altogether.

Overriding and underriding of bumpers occurs very commonly in Baltimore auto accidents. It is imperative that the injured claimant should take their vehicle to a trusted body shop to search for other forms or property damage (frame damage, etc) that might otherwise have been missed. Only then, unfortunately, will an insurance company take their claim for injury seriously. It is also important that these injured claimants find a practice that understands these injuries and how to best treat them for maximal physical recovery.

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

Dr. Gulitz

How Do I Pay for My Medical and Chiropractic Care Following a Baltimore Auto Accident?

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. The three main ways to pay for care following a Baltimore auto accident include PIP, health insurance, and attorney/third party liens.

1. 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 Verification 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. Health insurance will pay your providers for their services rendered once PIP has been exhausted. The trouble with health insurance following a Baltimore auto accident is that the health insurance company will want to be paid back anything they pay out. That is, after you receive a settlement for your personal injury claim, the injured patient will have to repay any monies paid out by the health insurance company, effectively decreasing the amount of your settlement. To reiterate, PIP monies do not need to be repaid once they’ve been paid to your providers on your behalf.

Patients that do not have PIP or Health insurance (which sadly occurs more than you might think) are not necessarily out of options. That is, providers such as myself and Dr. Kevin Carr of Carr Medical Specialties will agree to treat you on a third party lien or on an attorney lien. This means that we agree to treat you with no cost out of your pocket and that we agree to wait to get paid until your case settles.  This type of arrangement is a delayed payment arrangement, sort of like a credit card for your care. In these instances if the responsible third party denies liability and does not pay your medical bills you will have to arrange a financial payment schedule with my office. Many patients do not want to deal with the hassles of the paperwork involved in third party liens and instead ask that we refer them directly to a qualified personal injury 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 recover from your Baltimore auto accident injuries.

Dr. Gulitz

Baltimore Auto Accidents Due to Distracted Driving

As a Baltimore Chiropractor that spends the vast majority of my time caring for patients involved in auto accidents, it is becoming clear that auto accidents and whiplash injuries that result in headaches, neck pain, and back pain are becoming an epidemic. There are more cars on the road than ever before and there are more distractions behind the wheel than ever before. Years ago we only had to worry about DUI/DWI and perhaps some loud music behind the wheel.  With the addition of smart devices that buzz, tweet, and update in real time drivers are distracted at the greatest rate in recent history. Not surprisingly, this has lead to increased crashes, increased auto accident injuries, and in some cases, more deaths that could have otherwise been avoided had the driver focused on driving.

Distracted driving is defined as any activity that can distract a person’s attention away from driving a vehicle. Types of distractions that contribute to distracted driving include:

• Texting
• Speaking on a cell phone/smart phone
• Eating and drinking
• Grooming/applying make up
• Reading
• Using navigation systems
• Watching a video
• Adjusting radio/CD player/MP3 player
• Drinking or being under the influence of any substance that impacts reaction time (illicit drugs, prescription drugs)

Fortunately law makers in Maryland realize the importance of making sure that drivers are focused on the road. They have enacted laws that prohibit the use of a handheld phone for either texting or driving. Police are legally allowed to issue a ticket if they see a driver using their cell phone in the car. The fees are $83 for a first offense, $140 for a second offense, and $160 per offense thereafter.

Maryland lawmakers also enacted Jake’s Law. It states that a driver that causes serious injury or death while walking or texting on a cell phone may receive a prison sentence of up to 3 years and a fine of up to $5,000.

So it begs the question: what can we do to focus on driving rather than being distracted?

• Put your phone away- Out of sight is out of mind. Put it out of reach, in the glove box, or in the back seat.
• Have a designated communicator- Pass the phone to another occupant of the vehicle. Have them text or call on your behalf so that you can keep your eyes on the road.
• Hold each other accountable – If you are a passenger in a vehicle and you see a driver being distracted, volunteer to drive or to take over communications.
• Pull over- We all know emergencies happen and sometimes we just need to get to our phones. Where it is safe, pull over and put your car in park. And no, texting at a red light is not a good use of this.
• Don’t forget to fasten your safety belt. If you are involved in a crash, having your seat belt buckled is still single handedly the best choice for saving your life and preventing ejection and death if you are unfortunately involved in a Baltimore auto accident.

As they say, “accidents happen.” But that doesn’t mean that we have to accept them as inevitable. We all need to do our part to keep the roads safe and to focus on arriving safely. Once we arrive at our destination, we are free to call, text, and tweet until our heart’s content. For now, if you, or someone you know has been injured in a Baltimore auto accident as a result of distracted driving please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz

Beliefs Influence Outcomes in Baltimore Whiplash Treatment

As a Baltimore Chiropractor that spends the majority of my time treating patients with Baltimore whiplash injuries that require Baltimore whiplash treatment, I have seen a lot of fear and concerning injuries following Baltimore car accidents. Patient’s reactions to injuries vary greatly- some think that their injuries are not a big deal while others think that it is the most tragic thing to have ever happened in the history of the world. Interestingly enough, research has found that beliefs help by patients have been shown to influence outcomes in acute whiplash cases. That is, if a patient is conditioned to believe that they will make a speedy recovery they usually do and if they are condition to believe that their treatment will be protracted and painful, it can be.

Twenty participants were enrolled in a large pragmatic randomized control trial of physical therapy for acute whiplash injuries. They were interviewed at the beginning of their injury and following their treatment.

The authors concluded that people with whiplash injuries such as headaches, neck pain, mid back pain, and lower back pain following Baltimore auto accidents tend to have pre-existing beliefs regarding recovery from auto accidents. Interestingly, health professionals can have a major influence on these beliefs and can either help support patient’s expectations or can help to hold a patient’s recovery back.

Communication and setting expectations for patients involved in Baltimore auto accidents can influence the outcome for these patients. I tell all of my patients that the vast majority of patients will make complete recoveries. That is, they will reach maximum medical improvement by way of reaching pre-injury status. Interestingly, just telling patients that they will recover will help them recover. If you want to check out this article feel free to check out the link here.

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

Dr. Gulitz

Chiropractic Care Offers Faster Back Pain Recovery Than Medical Care

As a Baltimore Chiropractor that spends the majority of my clinical hours treating patient with back pain, it is not uncommon for patients to see me after they have seen their family medical provider. Typically these patients present for care to their PCPs office with a complaint of back pain. These patients are usually prescribed some combination of rest, activity modification (i.e. no lifting, bending, twisting), pain relievers such as ibuprofen, and maybe some muscle relaxers. When these remedies fail to bring about resolution of the lower back pain, these clients usually present to my office for evaluation and treatment recommendations. In some other instances patients with lower back pain in Baltimore either do not have a primary care doctor to see, or are in so much pain that they do not want to wait several weeks to get into their doctor to see them, so they just come to my office in pain.

Regardless of how a client gets to my office, the vast majority suffer from back pain. Regardless of how they go about feeling better, one thing is true: patients want to feel better quickly and they want to feel better now!

Recent research out of the journal Spine in December 2014 seems to indicate that patients that undergo spinal manipulation therapy had the best outcome compared to patients who either underwent “mechanical assisted manipulation” or “usual medical care.”

This study was a randomized control trial that set to compare to approach of manual-thrust manipulation vs. mechanical assisted manipulation vs. usual medical care to see what impact these approaches had on patient’s pain and disability levels.

Each of the first two groups underwent a series of 8 total treatments (2 visits per week for four weeks) and the medical care group saw their provider a series of 3 times. The study followed participants’ self reported levels of pain and disability at the beginning of the study, immediately after their fourth week of treatment, and then again at three and six months following the termination of their treatment.

While research was quick to point out that all three groups saw improvement in pain an disability levels, it was found that the first group, the manual-thrust manipulation group (aka the chiropractic manipulation group) saw the greatest reduction in pain and disability levels at the end of care.

This study is important to me for two main reasons. First, it backs up what I tell my patients, which is that for mechanical lower back pain chiropractic spinal manipulation is incredibly successful. Secondly, and most importantly, it confirms that healing is a process that takes time. Even though spinal manipulation beat the other methods of back pain relief, notice that it still took 4 weeks of treatment to reach the outcome. Often I see patients who discontinue treatment after 2 or 3 treatments because “it isn’t working” and I assure them that healing is a process that takes time. This study also seems to suggest that patients should expect to see results within about 3-4 weeks. After that period any patient that is not improving may want to consider referrals to other specialists for second opinions and future treatment recommendations.

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

Dr. Gulitz

What Position is the Best for Sleeping?

As a Baltimore Chiropractor that spends much of my time treating patients with neck and back pain, I commonly get asked questions regarding sleeping posture. Patients want to know which positions they should be sleeping in for optimal spinal health. This makes sense since we spend nearly one-third of our lives in bed.

Best Position: On Your Back

Research seems to suggest that the best position for your spine is sleeping on your back. This preserves the curves of the neck, mid back, and lower back and does not put extra pressure on your spine. For patients that have acute lower back pain that can not lay on their back comfortably, it has been suggested that using one pillow below the knees can help to lessen back tension, allowing for a smoother transition to sleep. Additionally, only one small pillow should be used to not elevate or stress the neck while in this position. While this is the “ideal” sleeping position, it is not the only one.

Second Best Position: Starfish

This position is similar to the first position, with the addition of your arms being placed above your head. This position can cause snoring so if your sleeping partner notices that you snore in this position, take note and be prepared to transition to the best position, on your back.

Third Best Position: Laying On Your Side

Sleeping on the side is considered to be beneficial as it helps to open up the spine during sleep, by elongating the spine. This position helps to open up the spine and to reduce the probability of snoring. Pregnant women are especially encouraged to sleep on their sides (left side, specifically) to optimize uterine blood flow.  There is a difference in health effects depending on which side you lay on. Research has shown that asymmetrical sleeping can lead to facial wrinkles or sagging breast tissues. So, if you choose to sleep on your side, make sure to alternate each side whenever possible.

The Worst Position: Stomach Sleeping

Sleeping on your stomach is considered to be the worst of all of the sleeping positions. The spinal curves are not naturally supported. This can lead to neck pain, mid back pain, and lower back pain. It is the equivalent of standing for 8 hours in a night- given enough time a joint will be painful since the joints will have been “loaded” throughout a night of sleep. Nor surprisingly, the vast majority of my patients that come in with neck and back pain seeking chiropractic care are usually stomach sleepers. Some common symptoms of stomach sleeping include numbness into the hands or legs when they wake up in the morning. A subset of stomach sleeping (of which I am guilty) is known as the “fetal position.” This is someone sleeping on their stomach with one leg flexed up towards their chest to varying degrees of hip flexion. This position should be avoided at all costs, as it can cause hip or knee pain as well.

Sleeping is probably the best way to heal our wounds yet many of us do not get enough sleep, or sleep poorly when we do sleep. Sleeping patterns can be changed over time, but they take time. We should all aim for the optimal sleeping position.

For now, if you develop neck or back pain related to sleeping poorly please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz

What Is My Baltimore Car Accident Case Worth?

As I’ve mentioned in many past blog posts, I treat many patients involved in Baltimore car accidents. After taking a thorough past medical history, evaluating chief complaints, and beginning treatment, one of the questions I am most frequently asked is “what is my Baltimore car accident case worth?” When I first started in practice I had no idea how to answer the question. As a medical provider I did not want to give an opinion on the value of a case. That is, I only treat patients and their symptoms. How could I possibly know?

If you look up case values on the internet, attorneys and insurance companies often list a formula to determine the value of a personal injury case. The formula is something like this:

Past Medical Expenses + Future Medical Expenses + Past Lost Wages + Future Lost Wages + Pain and Suffering = Total case value

Although I’ve been in clinical practice for approximately six years I can say that my answer to this question has not changed much at all. I still tell patients that I do not know the value of their case (in dollars) because it does not concern me. I encourage them to not worry too much about the monetary value of their claim either. The only thing that I can control when a patient is under my care is the treatment that I render on any given visit and in some capacity, how a patient heals.

When the question comes up about case value I like to re-direct the conversation back to the topic of activities of daily living. If you remember, these are activities that we either must do, or enjoy doing that can be made more difficult or impossible as a result of musculoskeletal pain. The question should not be what is the case of my value (in dollars) but rather, what is the value of my life and my daily routine? How valuable is it that I can be the person I was before the car accident and that I can “move on” and not be reminded for the rest of my life of this motor vehicle collision?

How much would you enjoy waking up each day if you woke up with searing back pain? How much would you enjoy going to work if bending to get into your car and sitting caused you numbness down a leg? How much would you miss carrying your newborn child if neck pain and looking down caused you hand numbness? How much would you enjoy reading a book to your child if sitting a chair caused back spasms?

Obviously the “quality of life” questions are endless, but it stands to reason that regardless of the monetary value of your personal injury claim, the quality of life interruption that you may be experiencing is way more important.

To be clear, I understand that money “makes the world go ’round” but it is not the most important thing following a Baltimore auto accident. Without a physical and emotional recovery, all the money in the world can not make you “whole” again.

If you really must know the value of your Baltimore auto accident claim, I would recommend contacting one of the many Baltimore auto accident attorneys that can better answer that question. If, on the other hand, you are concerned about making a complete recovery and resuming your life as quickly as possible with as few complications as possible, please contact Mid-Atlantic Spinal Rehab & Chiropractic. We would be happy to help you feel better and go back to living your life, which is the true “value” of a Baltimore auto accident claim.

Dr. Gulitz

Length of Treatment Following a Baltimore Car Accident

As a Baltimore Chiropractor that spends a considerable amount of time treating patients injured in Baltimore car accidents I often get asked by patients how long they should expect to be treating for their injuries. It is a complex question that is often hard, if not impossible, to answer on the first visit. That is, when patients first come into the office for an evaluation it is usually several hours to several days following their injury. Often their conditions will get slightly worse before they get better as their body begins to heal.  Additionally, these patients may be severely medicated if they went to a hospital following their injury, so it is difficult to accurately assess their “true” levels of pain and discomfort. Research suggests that human metrics are way more important in determining injury severity than are vehicle metrics. That is, it stands to reason that all things being equal, a previously healthy 16 year old male may not be injured as much as a 75 year old male with diabetes and heart disease.

I don’t like to set hard and fast parameters for my patients in terms of how much care they need. I let their treatment “do the talking.” If they are making their appointments, if their subjective pain levels are improving within the first 3-4 weeks of care by at least 50 percent, and if they are able to resume their activities of daily living without much interruption, then chances are they will not require much treatment and will be released to home care shortly. Typically for these patients care lasts anywhere from 4-8 weeks, on a declining frequency basis. They may start at 3 visits per week but by the time they are close to being released, they may only be treated in the office about once per week or once every other week as they continue to resume their activities outside of the office.

If, on the other hand, a patient is not making their treatment visits, is not performing the stretches that we have assigned for them to perform at home, and has other comorbidities that delay wound healing (smoking, diabetes, heart disease, etc.) then it stands to reason that the length of care that the injured patient requires would be longer.

The purpose of this blog post is to alert you to the fact that it is impossible to predict, particularly early on following an injury, the exact amount of time that it takes for a patient to be dismissed from therapy. Keep in mind, even once dismissed from treatment in my office, a patient will continue to go on and heal, as healing is a long process.

There are some chiropractic clinics that treat all patients the same. They treat all motor vehicle collision patients with the same therapy, for the same number of visits, without regard to their age, pre-existing health conditions, or restrictions. These clinics will routinely tell their patients that they need 16 visits. How they can predict such a specific number is beyond me. This type of blanket treatment often leads to misdiagnosis, suboptimal care, and disgruntled clients who are left “holding the bag” by remaining in pain and having had their time wasted.

Mid-Atlantic Spinal Rehab & Chiropractic combines both chiropractic care and rehabilitation activities to help facilitate healing in our injured clients. We also work closely alongside Dr. Kevin Carr M.D. of Carr Medical Specialties to co-treat our patients to make sure that they get the best care medically and physically.

If you, or someone you know, has suffered injuries as a result of a Baltimore car accident, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz

Top 5 Chiropractic Myths

As a Baltimore Chiropractor that has spent my entire professional life treating patients with chiropractic care and physical therapy modalities it recently dawned on me that although I know and understand what chiropractic care is all about, many of my current and perspective patients may not. There are a lot of mistruths and misunderstandings about Chiropractic care. Typically this is why my office offers a free consultation, to let potential patients ask any questions that they would like in order to determine if they are in the right place. As a result of the success of my last blog post about the Top 5 Whiplash myths, I’ve decided to put together (in no particularly order) what I view to be my Top 5 Chiropractic myths. So here they are.

1) Once you go to the Chiropractor you will “always have to go.” Admittedly many patients feel relief of their neck and back pain symptoms with a short course of therapy and choose to return for additional treatment on a recurring basis, but you do not have. I see many patients who are experiencing an acute bout of neck or back discomfort that is able to become eliminated after only a few visits and then they stop presenting for care until, or unless, they need me again. There are no contracts to sign, no long term treatment plans, and no “guilt” associated with discontinuing treatment. Like a fisherman, we “catch and release” and a patient’s desire to come back after their initial treatment is completely up to them.

2) Chiropractic care is unsafe. There have been many research articles demonstrating both the safety and efficacy of chiropractic care for acute and chronic neck and back pain. And while there are the occasional sensationalistic stories about patients having negative outcomes under chiropractic care, the incidence of cataclysmic injury while under the care of a licensed and trained Chiropractor is so small as to be nearly negligible.

3). Chiropractic care is expensive. Like most health care providers we accept many means of payment for our treatment. These include fee-for-service (cash), health insurance, worker’s compensation payments, and auto insurance for personal injury cases. Typically the costs for services rendered are presented to an insurance company who will pay our bill. The out of pocket cost to a patient is determined by an insurance company’s plan, just like it would be at a family physician’s office. Many of the common insurance plans have chiropractic benefits that you are already paying for when you pay your monthly premiums. Care is not expensive, at least not more than a copay would cost you at your family physician’s office. Additionally, research has shown that for patients experiencing lower back pain care is about 20 percent less expensive than for those initiating care in a traditional medical setting.

4). I can crack my own back, I don’t need to see a chiropractor. Many patients ask me some variety of this statement each day. I remind them that the joints that they are able to cavitate or “crack” on their own are typically joints that are already hypermobile- that its, they are moving too much. Chiropractors are trained to palpate and adjust hypomobile fixated joint segments. So while it may be true that you hear joints cracking on your own, typically these are joints that are already moving appropriately and should not be adjusted. Chiropractors are trained to seek out and manipulate joints that are truly fixated.

5). Chiropractors break bones when they adjust you. Patients are often confused about what the “cracking” sound is. Research tells us that is is the sound of dissolved carbon dioxide and nitrogen gases in synovial joints that rush out of solution with an appropriate joint adjustment. This is similar to the popping sound that a bottle of champagne makes once the cork is popped, or to a can of soda once the top is opened. It is not the sound of bones being broken. While it is theoretically possible to apply enough force to break a bone, instances of broken bones within chiropractic offices are extremely rare and special efforts are made to prevent such outcomes.

I am sure that there are many more chiropractic myths out there. If you would like more information on any of these myths or if you would like me to “debunk” some more, feel free to comment and I would be happy to address any Chiropractic myths that you may have.

In the meantime, if you, or anyone you know requires Chiropractic care for neck pain and back pain please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz

Top 5 Whiplash Myths

As a Baltimore chiropractor that spends the majority of my time rendering Baltimore whiplash treatment to those injured in Baltimore auto accidents, there is a lot of misinformation regarding whiplash injuries. In no particular order here are my top 5 whiplash myths that I intend to dispel.

#1) Patients who “tense up” are more likely to be injured than those who are loose (i.e. drunk drivers).

This is not true. The majority of cervical spine (neck) pain following acute whiplash comes from the pain fibers in the facet joint capsules. Tensing up and clenching muscles actually prevent facet joint jamming in some instances, thereby causing decreased injury when a patient clenches up. While there will still likely be muscle straining or tearing, the pain is often less severe than a series of sprained facet joint capsules.

#2) The faster one of the two vehicles is going (in a 2 car crash) the more severe the injuries for the occupants must be.

This one is not true. The so called “delta V” or change in velocity between both the target and bullet vehicles has no scientific correlation to occupant injury. Better predictive factors for injury are the change in acceleration rate of the occupants, also known as “jerk.” High rates of jerk can cause very severe injuries even in relatively low speed crashes.

#3) Men and women are equally likely to be injured in a crash.

Most crash test studies are performed on so called “50th percentile” men and women dummies. For men, this is roughly a 5’8” 175 pound man. How many men do you know that fit this exact criteria? Any deviation from this height and weight make it hard, if not impossible, to accurately predict relative injury risk following a crash. I do not know the qualifications for a 50th percentile woman, but the same logic holds. In any event, human metrics (age, sex, height, weight, and any pre-existing health conditions are more predictive indicators than are sex alone).

#4) You can not have been injured if your car is not damaged.

This one is fairly pervasive in the industry. Defense attorneys like to pretend that non-damaged target vehicles indicate that it is impossible for claimants to have been injured. Scientific research has demonstrated that there is no correlation between property damage of a vehicle and injury risk. In fact, many bumpers are built to not deform at low speeds, thereby paradoxically transferring energy that should be used to crush the bumper onto the vehicle’s occupants, and causing MORE injury!

#5) Whiplash patients/claimants are only in it “for the money.” If there is no money on the line, no one reports whiplash injuries.

Every country in the world handles the legal side of whiplash claims differently. Even in some countries that do not allow for financial renumeration following non-faulted whiplash injuries there are still injuries reported with similar frequencies as there are in the United States.

Whiplash is a real problem especially in Baltimore. If you, or someone you know has suffered from a whiplash injury and requires treatment please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to dispel any myths and get you on the road to recovery!

Dr. Gulitz