Cervicogenic Headaches and Neck Pain

Patients with headaches also commonly complain of neck pain.  This relationship is the rule, not the exception. Therefore, treatment for headaches must include treatment of the neck to achieve optimum results.  The term, “cervicogenic headaches” has been an accepted term because of the intimate connection between the neck and head for many years.  There are many anatomical reasons why neck problems result in headaches.  Some of these include:

•    The first 3 nerves exiting the spine in the upper neck go directly into the head.  They penetrate the muscles at the top of the neck near the attachments to the skull and therefore, any excess pressure on these nerves by the muscles or spinal joints will result in irritation and subsequent pain.
•    The origin or nucleus of the 5th cranial nerve called the Trigeminal, innervates the sensation to the face and is located in the upper cervical region near the origin of the 2nd cervical spinal nerve, which innervates sensation to the back of the head up to the top.  Therefore, problems located in the upper neck will often result in pain radiating up from the base of the skull/upper neck over the top of the skull to the eyes and /or face.
•    The 11th cranial nerve that innervates the upper shoulders and muscles in the front of the neck arises from the top 5 to 7 spinal cord levels in the neck.  Injury anywhere in the neck can result in spasm and pain in these large muscle groups.
•    Other interconnections between the 2nd cervical nerve and trigeminal/5th cranial nerve include communication with the 7th cranial / facial nerve, the 9th cranial / glossopharyngeal nerve, and the 10th cranial / vagus nerve.  These connections can affect facial muscle strength/movements, taste, tongue and throat movements, and stomach complaints such as nausea from these three cranial nerve interconnections, respectively.

When patients seek treatment for their headaches, a thorough examination of the neck, upper back, and cranial nerves is routinely performed for the above reasons.  It is common to find upper cervical movement and vertebral alignment problems present in patients complaining of headaches. Tender points located between the shoulder blades, along the upper shoulders, on the sides of the neck and particularly, at the base of the skull are commonly found.  Pain often radiates from the tender point over the top of the skull when pressure is applied in the upper neck/base of the skull area. Tenderness on the sides of the head, in the temples, over the eyes, and near the jaw joint are also common. Traction or pulling the head to stretch the neck is often quite pain relieving and this is often performed as part of the chiropractic visit and can also be applied at home with the use of a home cervical traction unit. Chiropractic adjustments applied to the fixated vertebra in the upper neck often brings very satisfying relief to the headache sufferer.  Exercises that promote movement in the neck, as well as strengthening exercises are also helpful in both reducing headache pain and in preventing occurrences, especially with stress or tension headaches.

As a Chiropractor that routinely treats patients with headaches and neck pain as a result of auto accidents in Baltimore, I see patients with headaches and neck pain every day. If you, or someone you know, can use the help of a Baltimore Chiropractor for headaches and neck pain, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

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

How Important is a Good History and Physical Examination?

If you are reading the title of the blog post you probably already know where I am going with this. A good history and physical examination is the cornerstone to an accurate diagnosis and an appropriate treatment plan. Without a problem-focused examination and history a patient’s complaints will be missed and the healing process will be protracted.

Sure, this seems obvious enough. When you get injured in a Baltimore auto accident and present to your doctor, ER, or urgent care facility, you expect that the doctor examining you is giving you an appropriate evaluation with appropriate radiographs (x-rays). Believe it or not, this may not always be the case. In this day in age with longer wait times and more patients being seen per day, most providers (whether they be doctors, PAs, nurse practitioners, chiropractors etc) are under more pressure than ever to “treat and street” patients to make room for more patients. In doing so they often go through a history and physical examination in a cursory manner, sometimes missing key injuries sustained by patients. You would be surprised how often the time of day or day of the week dictates how thorough a history and examination is given to any given patient. As you might expect, it has been my experience that more diagnoses are missed on Friday nights when the ERs are busy than are on Monday nights. In my nearly 5 years as a Chiropractor treating acutely injured patients involved in Baltimore auto accidents and baltimore worker’s compensation injuries, I am shocked at how often diagnoses are missed by portal of entry providers.

Dr. Arthur Croft in his book “Whiplash and Mild Traumatic Brain Injuries: A Guide for Patients and Practitioners” (page 211) notes that “…medical school training is woefully inadequate to prepare doctors to examine and understand musculoskeletal disorders, despite the fact that this very class of disorder constitutes the leading causes of disability in the U.S. In a recent study published in the Journal of Bone and Joint Surgery, a validated musculoskeletal cognitive examination was given to medical students, residents, and staff physicians in multiple disciplines of medicine to assess the adequacy of their musculoskeletal medicine training. Only 21% received a passing score.”

In news closer to my area of practice treating patients involved in Baltimore auto accidents, “…fourth year medical students from the University of Chicago were presented with a fictitious whiplash patient to evaluate how they would assess him if he were a real patient. He was a 21-year-old male who gave a history of being a passenger in a car that was struck from the rear…Shortly after the crash, he began to experience neck pain and was transported by ambulance to the ER…Only 21% palpated (touched) the neck, and only 17% asked the patient to turn his head from side to side.”

I am in no way trying to be negative towards portal-of-entry providers who must handle tons of new injured patients every day. All I am trying to do is point out that doctors are busy and sometimes rush through the history and physical examination. By doing so, they put a patient’s health at risk by missing diagnoses and not ordering appropriate diagnostic tests. It is important that you, as the patient, speak up and direct a doctor to your chief complaints to ensure that no appropriate diagnoses are missed.

As a Baltimore Chiropractor who routinely treats patients involved in Baltimore auto accidents, I have been trained to ask the right questions and take an appropriate history so that nothing is missed. I routinely work with other specialists such as orthopedists, pain management physicians, and neurologists who can perform special diagnostic testing if necessary. Rest assured that no matter how complex the motor vehicle collision I will take as much time as necessary to diagnose your condition and to establish an appropriate patient-focused treatment plan.

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

Dr. Gulitz

Cervical Radiculopathy following Baltimore Auto Accidents

In many of my past blog posts I have touched on topics of injuries associated with Baltimore Auto Accidents. One area that I have not spent much time on is the idea of cervical radiculopathy. 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 cervical, or neck, radiculopathy.

The nerve roots in the neck comprise all of the motor and sensory fibers that innervate the upper extremity. Incidentally, they also innervate some muscles in the neck and upper back. The motor fibers control motion in the upper extremity (which I activate as I type this blog post) 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 as a myriad of symptoms. Most commonly patients present with neck pain along with numbness and/or tingling and/or weakness into the upper extremity on the affected side. Often times radiculopathy can be confirmed on physical examination and if need be, advanced imaging studies such as MRIs.

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.

If you, or anyone you know, has suffered a cervical 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!

 

Viscoelasticity- A Special Property of Human Tissues

Human soft tissue, whether it be muscle, skin, ligament, tendon, nerve, intervertebral disc, or bone all contain a special property known as viscoelasticity. This is a property that allows these tissues to deform depending on the type and direction of force applied. It allows for these structures to start in one place/shape, change as a result of forces applied, and then to “bounce back” to their original size and shape. It is really a remarkable characteristic.

You can liken viscoelasticity to a rubber band. You can stretch them and they bounce right back. However, if the force used to deform them is too strong or occurs to quickly, the tissues are irreparably torn and broken.

If you sit in your chair reading this, you can bend your chin to your chest, and then you can extend it backwards. Provided that you don’t have any underlying problems with your neck, by the time you are done you will have your neck and its tissues in the same shape and condition as it was before you stretched it. Now imagine you are sitting at a stop light and you get rear-ended suddenly. In a matter of milliseconds your neck undergoes the same motion pattern. However, since the impulse occurrs so quickly the viscoelasticity of the neck soft tissue does not allow the tissue to return to its pre-accident shape. This results in torn soft tissues, and a trip to your local Baltimore Chiropractor for whiplash treatment.

While the motion of the neck is within anatomical limits (that is, we can bring our neck to our chest and bring it all the way back) the speed at which this motion occurs in an auto accident is so great as to not allow the viscoelastic structures of the neck to “bounce back” resulting in injury.

As a Baltimore Chiropractor that routinely treats patients with neck pain following a Baltimore auto accident, I routinely treat patients who have torn viscoelastic structures in their neck. If you, or anyone you know, as suffered from a Baltimore Auto Accident and can use the help of a Baltimore Chiropractor, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be glad to help!

Dr. Gulitz

*This information was taken from “Whiplash and Mild Traumatic Brain Injuries” by Dr. Arthur Croft, page 134.

No Correlation Between Property Damage and Bodily Injury

As a Baltimore Chiropractor that routinely treats clients injured in Baltimore auto accidents (Baltimore car accidents) I routinely see patients whose accidents run the gamut from a simple bumper tap collision to a total loss. Most insurance companies (largely responsible for paying out claims for accidents) would have you believe that there is a direct correlation between property damage to a vehicle and the likelihood of injury to an occupant.

The thought process goes like this: If two cars are involved in a crash with a small crash velocity, particularly a crash where there is no damage to either vehicle, no occupants can be injured. Any claim made for bodily injury must therefore be fraudulent.

I’ll admit. Before I became a Chiropractor I sort of believed this to be true myself. But how did I know it to be the case? I had never done any research, I had just “believed it” inherently.

When I started treating patients as a Chiropractor in Las Vegas I came across a lot of “low property damage” or “low PD” crashes where occupants were claiming injuries to their necks and backs. X-rays, physical examination and orthopedic examination confirmed injury. Professional interest lead me to the literature and research of Dr. Arthur Croft of the Spine Research Institute of San Diego and his post graduate series on Whiplash and Mild Traumatic Brain Injury.

Dr. Croft is one of the leading researchers on whiplash biomechanics/kinematics. As an epidemiologist he has studied all published research on the topic and determined that there is no correlation between crash velocity and injury risk. He states “Using paired comparison methods, the authors were able to demonstrate that when correlating crash delta V and comparing subjects within the same vehicle on the basis of injury risk, it appeared that human factors were more deterministic…than crash metrics.” (p. 98 “Whiplash and Mild Traumatic Brain Injuries”).

This makes some sense. I have seen plenty of older patients who suffer severe injuries that are involved in the same crash as young children/younger adults that walk away unscathed.

At the end of the day, as a Baltimore chiropractor that is involved in whiplash treatment in Baltimore, I do not necessarily concern myself with property damage. I treat injured clients- not injured cars. Often insurance companies will look to deny claims that involve low property damage to vehicles, claiming that they must be fraudulent. Fortunately, my patients know that I have research on my side to fight the insurance companies that look to deny their claims.

If you, or anyone you know, is in need of a Baltimore Chiropractor to treat you for injuries sustained in a Baltimore auto accident, please call Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz

Baltimore Whiplash and S-Shaped Cervical Curves

The normal anatomy of the neck (cervical spine) is a C-shaped curve. In rear-end auto accidents that result in whiplash prevailing thought was that getting struck from behind would result in a hyperextension/hyperflexion injury of the neck. That is, first the neck would extend all the way backwards and then it would rebound and hyperflex all the way until the chin touches the chest.

Research has shown that in the milliseconds during a rear-end auto accident the cervical spine actually forms an S-Shaped curve. This is important because it explains why patients with neck pain following an auto accident typically present with pain at the base and the apex of their necks.

During the 150 milliseconds of the rear-end impact the lower part of the neck hyperextends and simultaneously the upper part of the neck hyperflexes, creating an S-Shaped curve. This places extra stress and strain on sensitive tendons, ligaments, discs, and other connective tissue that normal exist in a C-shaped curve formation. The result is inflammation that leads to pain.

Baltimore Chiropractors, such as myself, routinely treat patients with whiplash in Baltimore resulting from auto accidents in Baltimore. If you, or anyone you know needs treatment for a Baltimore auto accident please do not hesitate to contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be glad to help!

Adverse Drug Reactions

As a Baltimore Chiropractor that often treats patients involved in Baltimore auto accidents and Baltimore slip and fall injuries, I spend a fair amount of time co-treating my patients with local medical doctors, neurologists, orthopedists, etc. Typically I will assist with the rehabilitation for the patients and the other providers will medicate them. If a patient has muscle spasms, they will be given a muscle relaxer. If they have inflammation, they will be given an anti inflammatory. If they are having difficulty sleeping following their Baltimore auto accident, they are prescribed sleeping pills.

On the surface, these are sound approaches to symptomatic management of painful conditions. However, not is all as it seems. There is a disturbing trend seen between the use of prescription drugs and adverse drug reactions (ADRs). According to a landmark study in the Journal of the American Medical Association (JAMA) in 1994, it was estimated that 106,000 people died as a consequence of ADRs.  By some measurements that would rank ADRs as anywhere from the 4th-6th leading cause of death in America! There is a possibility that these numbers are actually under-reported since there are on average 7,000 motor vehicle collision (auto accidents) that lead to death that are caused by ADRs that are not officially attributed to deaths by adverse drug reaction.

By all means if you are involved in a Baltimore auto accident or Baltimore slip and fall injury and you need medicine, go see a medical doctor. They will use their medical expertise to prescribe you appropriate medication for your condition. All I am suggesting is that you think before you blindly take medications without considering the risk involved. It is ok to experience some discomfort- it lets you know your limitations and gives our bodies time to heal while you undergo therapy. Unlike cars which can be replaced if they break down, we are only given one body. Do the best you can to take care of it.

Dr. Gulitz

The preceding statistics were provided by Dr. Arthur Croft in his book “Whiplash and Mild Traumatic Brain Injuries: A Guide for Patients and Practitioners” on page 45.

Whiplash and Chiari Malformations (Brain Injury)

A study in the July 2010 Issue of “Brain Injury” reveals that up to 20 percent of whiplash victims undergo a form of brain injury referred to as a Chiari malformation. The study examined neck MRIs in 1200 whiplash patients and determined that those with neck trauma following a whiplash injury had an increased likelihood of chiari malformation.

So what is a chiari malformation? It is an injury that occurs when part of the brainstem (the cerebellar tonsils) herniate through the hole at the base of the skull (the foramen magnum) thereby exposing the brain stem to potential trauma. Patients with chiari malformations can experience headaches, neck pain, upper extremity numbness/tingling, and balance problems. Many times these chiari malformations require surgical intervention to prevent further injury.

While it is true that whiplash is fairly common and chiari malformations are exceedingly rare, it is a good idea to present for evaluation if you suspect you might have this condition. If you or a friend has recently suffered whiplash from a Baltimore auto accident and are in need of Baltimore auto accident treatment, contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be glad to help.

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.