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!

Head Restraint Height Can Impact Neck Injury Likelihood

When was the last time you checked that the height of your head restraint was appropriate to prevent whiplash? If you are like most people, the answer is probably never. Interestingly, it is this one step that, if performed by drivers even one time over the life of car ownership, would drastically reduce the incidence of whiplash in Baltimore and across the globe.

While change in velocities between two impacting vehicles play a part in relatively likelihood of injury following motor vehicle collision, as do human metrics (age, size, bracing for impact, previous injuries, etc), an often overlooked component about relatively likelihood of whiplash is something as simple as head restraint geometry.

The Insurance Institute for Highway Safety has created a static head restraint rating diagram. For proper safety, a head restraint should be positioned at least as high as the head’s center of gravity, which for most people is approximately 9 cm below the apex of the head. This vertical height is referred to as “topset” distance. The other component that they measure is called “backset.” Backset should be as little as possible, with a resting position of the back of the head no more than 8 cm from the head restraint.

For those who don’t want to measure their topset and backset- take one simple step. Move the headrest up as high and as far forward as possible (in vehicles that have adjustable head restraints). Doing so will decrease the likelihood of neck injury following a rear-end impact. This simple step may just save you months of therapy in my office!

If you, or anyone you know has suffered whiplash and is experiencing headaches, neck pain, or back pain associated with an auto accident in Baltimore or the surrounding areas, please contact Mid-Atlantic Spinal Rehab & Chiropractic or call us at (443) 842-5500. We would be happy to help!

Mild Traumatic Brain Injury in the News

Everywhere you look these days the top of concussions and/or mild traumatic brain injuries (MTBIs) is being discussed. The issue came to the national forefront over the summer when famed football player Junior Seau tragically took his own life. An autopsy revealed that Seau’s brain had signs of damage consistent with multiple concussions over his long playing career. Those who knew him well said that he was depressed, isolated, and generally just “not himself” prior to his death.

In addition to seeing signs of MTBI in football players and athletes, we are starting to see signs of MTBI and concussions in veterans. In yesterday’s 60 Minutes there was a news story entitled “Invisible Wounds of War” where the broadcasters looked into the “silent epidemic” of MTBI in our veterans. They determined that it was a severely underdiagnosed condition in our veterans. Just like how athletes are expected to rest and take time away following a concussion, so to are soldiers expected to take a break. Unfortunately they are not given the same opportunity to rest as professional athletes are often given. Concussions and PTSD are frequent conditions seen in our veterans returning from combat.

As a Baltimore Chiropractor that focuses on treating acutely injured clients with whiplash, concussions, mild traumatic brain injuries, along with headaches, neck pain, and back pain, I routinely see patients involved in auto accidents that results in concussions. In most cases the Emergency Room staff have not diagnosed these patients with these injuries. It is important to remember that ER staff are doing their job correctly in the majority of cases- they are ruling out life threatening conditions and releasing these patients when it is safe to do so. Chiropractors such as myself are some of the best resources to be able to diagnose and monitor concussions and MTBI since we see patients frequently following the onset of their symptoms. We are able to pick up on subtle differences day to day in behavior, emotion, cognition, and sleep differences that can be crucial in making an accurate diagnosis. Often the patients themselves do not realize that they are behaving differently and it is with the help of friends, family, and loved ones that help me make an accurate diagnosis.

The good news about concussions is that they are often self limiting and resolve in up to 12 weeks. Research has shown that repeat concussions, such as often seen in patients involved in multiple crashes in a short period of time, can lead to a worsening of symptoms, and in some cases, a problem that never completely resolves. At our office we routinely refer these patients to neurologists for appropriate diagnosis and testing. Don’t be afraid of your concussion- get the help you need!

Low Property Damage Crashes Can Cause Injury to Occupants 

One of my pet peeve’s in clinical practice is when claims adjustors arbitrarily decide not to pay the medical/chiropractic bills of their insureds involved in auto accidents in Baltimore. They like to make the claims that their bumpers “only had a scratch” and that as such, there is no way the occupants of the vehicle could be injured. I typically remark that I am not a mechanic- that is, I don’t care how much property damage a car has sustained…I don’t treat the car, I treat the occupants of the car. They sometimes go on to imply that any individual treating with less than $1,000 in property damage to their vehicle (so called M.I.S.T. “minor impact soft tissue” cases) must be committing fraud and/or embellishing on their complaints.

The idea that a vehicle’s property damage necessarily correlates with a patient’s injury likelihood/severity has not ever been found to exist scientifically. Yet despite this, everyone from claims adjustors to lay people to patients always seem to “know” that there is a relationship. In my nearly 5 years as a Chiropractor I have seen several hundred patients that have sustained injuries in an auto accident. These run the gamut from no/low property damage to complex roll overs with brain trauma where occupants had to be extricated by the jaws of life. I use my experience clinically and my post graduate education to examine and grade an individual’s injury. I do not pay much attention to property damage of a vehicle when assessing an individual’s complaints.

Dr. Arthur Croft in this month’s “Dynamic Chiropractic” wrote an article where he succinctly describes the paradox between occupant injury and property damage in an article entitled “Reimbursement for Treating Crash Victims: Deconstructing the Objections”. If you have about 5-10 minutes give it a read, it is really interesting.  It explains why it is possible to sustain significant injury even in cases of no/low property damage to a bumper. In the article he explains the paradox:

“A general understanding of collision mechanics goes a long way to explain this seeming paradox involving speed and injury. Without delving into too much depth here, the vehicle is relatively stiff in lower-speed ranges: it does not undergo crush or mechanical deformation here. Much of the kinetic energy of the collision is used to accelerate the vehicle and its occupant.

When the speed of the crash is high enough that the bumper energy absorber, bumper reinforcing bar, struts, or even frame elements are damaged, two things happen: (1) the kinetic energy used to deform these structures is no longer available to accelerate the vehicle; and (2) the duration of the collision is increased. And, since acceleration is equal to the change in velocity (delta V) divided by the time of the change in velocity (delta T), a relatively long collision pulse translates into less acceleration.”

I’ve said it before and I’ll say it again. If you have been involved in an auto accident in Baltimore City or Baltimore County and you are injured- get the care you need. A delay in care will only potentially lead to a chronic condition that will lead to the need for more care in the future.  Don’t let an insurance company dictate your care. You know your body. You know when you don’t feel right, and only you know what “normal” is for you.

At Mid-Atlantic Spinal Rehab & Chiropractic Dr. Gulitz, a Baltimore Chiropractor, routinely treats individuals involved in auto accidents with little to no property damage. Many times these clients do not have huge injuries that require a lot of care and that is great. But when they do require a lot of care and coordination with other providers, Dr. Gulitz is happy to help as well.

Regardless of property damage to your vehicle, if you are in pain from an auto accident in Baltimore, call Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500 or email us. We would be glad to help!

Whiplash in Baltimore

 Here are some sobering words from Dr. Arthur Croft in his book “Whiplash and Mild Traumatic Brain Injuries: A guide for Patients and Practitioners” (page 28):

“Whiplash injuries are quite real and potentially disabling. In the U.S. there are approximately 3 million whiplash injuries each year, at a comprehensive cost of about $43 billion. They account for 25% of all claims paid by auto insurers. They can and often do occur in low velocity collisions-usually from the rear-in which little or no damage occurs to the car. About one third of those involved in low velocity rear impact collisions are injured to one degree or another. Nearly half of the people injured in this way will develop long-term pain varying from very minor to severe. About 10-12% will become disabled.”

It is interesting to point out that the amount of property damage to a vehicle is in NO WAY a predictive indicator of the forces that occupants are subjected to nor is it a predictive indicator of the injury that the occupants may or may not have sustained. All too often I hear insurance companies say “your client can’t be injured there’s only a scratch on the bumper.” They choose to ignore science in order to tow the company line and save money for their employers (insurance companies).

As the saying goes “accidents happen.” Statistically most of the time you will walk away without an injury. But for those of you who aren’t so lucky you owe it to yourself to get evaluated by a trained Chiropractor who sees these injuries every day. According to Dr. Croft nearly half the people that sustain injuries develop long term pain. It can be avoided with appropriate low-tech rehab and Chiropractic care.

If you, or anyone you know, is in need of a Baltimore Chiropractor for whiplash in Baltimore following an auto accident in Baltimore, contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500 or email us. We would be glad to help!

Clinically mild traumatic brain injuries (MTBIs) and concussions are not the same thing- that is concussions are a type of mild traumatic brain injury. For the sake of this post they will be considered the same thing. MTBIs and whiplash can often co-exist. Interestingly, they are often under reported and under diagnosed by physicians and providers (Chiropractors included) that are likely to treat patients involved in auto accidents in Baltimore and the rest of the country.

According to Dr. Arthur Croft in his book “Whiplash and Mild Traumatic Brain Injuries: A Guide for Patients and Practitioners” he states (p.28-29) “…the mortality from head injury in the last 12 years has exceed the cumulative number of Americans killed in all wars since the founding of this country. The number of non-fatal injuries is conservatively estimated to be more than 2 million each year (potentially up to 7 million each year) with an overall economic cost to society of about $25 billion per year.” This equates to an incidence of approximately one mild traumatic brain injury for every 40 citizens per year.  This is why mild traumatic brain injuries and concussions are considered the “silent epidemic.”

The clinical signs and symptoms of mild traumatic brain injuries vary.  Not every patient with an MTBI or concussion will display all of these complaints. Symptoms include: nausea, vomiting, confusion, memory loss, dizziness, tinnitus (ringing in ears), blurred vision, problems focusing, changes in sleep patterns, etc. In some more serious cases other patterns of behavior, emotion, or cognition can be impaired. It is often difficult for the injured patient to notice these changes in their own lives. Instead it is not uncommon for their friends, coworkers, or loved ones to notice these changes and report them to their providers.

Dr. Croft goes on to report that “As for outcome, 25-35% of persons suffering an acute MTBI will report unrelenting complaints 3-6 months later. In many cases, these complaints will persist indefinitely. Many have reported, and it is also my clinical experience, that 6 months is an important watershed point. If symptoms are persistent at that point, they are likely to be permanent. From a medical perspective this one of the most under-diagnosed problems of all time.”

These assertions by Dr. Croft can not be understated. As a Baltimore Chiropractor that treats patients with whiplash and mild traumatic injuries/concussions in Baltimore I routinely see patients with these complaints. They are promptly referred for co-treatment with Baltimore Neurologists who can monitor their conditions, order appropriate diagnostic tests, and medicate patients as necessary.

If you or anyone you know is suffering from a concussion or mild traumatic brain injury as a result of a Baltimore auto accident please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500 or email us. We would be glad to help!

Whiplash in Baltimore, MD

Whiplash is a term for a condition that occurs when the neck and head move rapidly forwards and backwards or, sideways, at a speed so fast our neck muscles are unable to stop the movement from happening. This sudden force results in the normal range of motion being exceeded and causes injury to the soft tissues (muscles, tendons and ligaments) of the neck. Classically, whiplash is associated with car accidents or, motor vehicle collisions (MVCs) but can also be caused by other injuries such as a fall on the ice and banging the head, sports injuries, as well as being assaulted, including “shaken baby syndrome.”

The History Of Whiplash. The term “Whiplash” was first coined in 1928 when pilots were injured by landing airplanes on air craft carriers in the ocean. Their heads were snapped forwards and back as they came to a sudden stop. There are many synonyms for the term “whiplash” including, but not limited to, cervical hyperextension injury, acceleration-deceleration syndrome, cervical sprain (meaning ligament injury) and cervical strain (meaning muscle / tendon injury). In spite of this, the term “whiplash” has continued to be used usually in reference to MVCs.
Why Whiplash Occurs. As noted previously, we cannot voluntarily stop our head from moving beyond the normal range of motion as it takes only about 500 milliseconds for whiplash to occur during a MVC, and we cannot voluntarily contract our neck muscles in less than 800-1000 msec. The confusing part about whiplash is that it can occur in low speed collisions such as 5-10 mph, sometimes more often than at speeds of 20 mph or more. The reason for this has to do with the vehicle absorbing the energy of the collision. At lower speeds, there is less crushing of the metal (less damage to the vehicle) and therefore, less of the energy from the collision is absorbed. The energy from the impact is then transferred to the contents inside the vehicle (that is, you)! This is technically called elastic deformity – when there is less damage to the car, more energy is transferred to the contents inside the car. When metal crushes, energy is absorbed and less energy affects the vehicle’s contents (technically called plastic deformity). This is exemplified by race cars. When they crash, they are made to break apart so the contents (the driver) is less jostled by the force of the collision. Sometimes, all that is left after the collision is the cage surrounding the driver.

Whiplash Symptoms. Symptoms can occur immediately or within minutes to hours after the initial injury. Also, less injured areas may be overshadowed initially by more seriously injured areas and may only “surface” after the more serious injured areas improve. The most common symptoms include neck pain, headaches, and limited neck movement (stiffness). Neck pain may radiate into the middle back area and/or down an arm. If arm pain is present, a pinched nerve is a distinct possibility. Also, mild traumatic brain injury can occur even when the head is not bumped or hit. These symptoms include difficulty staying on task, losing your place in the middle of thought or sentences and tiredness/fatigue. These symptoms often resolve within 8-12 weeks with a 40% chance of still hurting after 3 months, and 18% chance after 2 years. There is no reliable method to predict the outcome. Studies have shown that early spinal mobilization and manipulation results in a better outcome than waiting for weeks or months to seek chiropractic treatment. The best results are found by obtaining prompt chiropractic care.

Whiplash injuries are common for those injured in auto accidents in Baltimore. If you or anyone you know may need the help of a local Baltimore Chiropractor for whiplash with or without associated concussion/mild traumatic brain injuries, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500 or email us. We would be happy to help!

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

Baltimore Car Accidents and Mild Traumatic Brain Injury

When you woke up today, you thought this was like any other Friday. You’re on your way to work, and traffic is flowing smoother than normal. Suddenly, someone crashes into the back end of your car and you feel your head extend back over the headrest and then rebound forwards, almost hitting the steering with your forehead. It all happened so fast. After a few minutes, you notice your neck and head starting to hurt in a way you’ve not previously felt.When the police arrive and start asking questions about what had happened, you try to piece together what happened but you’re not quite sure of the sequence of events. Your memory just isn’t that clear. Within the first few days, in addition to significant neck and headache pain, you notice your memory seems fuzzy, and you easily lose your train of thought. Everything seems like an effort and you notice you’re quite irritable. When your chiropractor asks you if you’ve felt any of these symptoms, you look at them and say, “…how did you know? I just thought I was having a bad day – I didn’t know whiplash could cause these symptoms!”

Because these symptoms are often subtle and non-specific, it’s quite normal for patients not to complain about them. In fact, we almost always have to describe the symptoms and ask if any of these symptoms “sound familiar” to the patient.

As pointed out above, patients with Mild Traumatic Brain Injury (MTBI) don’t mention any of the previously described symptoms and in fact, may be embarrassed to discuss these symptoms with their chiropractor or physician when they first present after a car crash. This is because the symptoms are vague and hard to describe and, many feel the symptoms are caused by simply being tired or perhaps upset about the accident. When directly asked if any of these symptoms exist, the patient is often surprised there is an actual reason for feeling this way.

The cause of MTBI is due to the brain actually bouncing or rebounding off the inner walls of the bony skull during the “whiplash” process, when the head is forced back and forth after the impact. During that process, the brain which is suspended inside our skull, is forced forwards and literally ricochets off the skull and damages some of the nerve cells most commonly of either the brain stem (the part connected to the spinal cord), the frontal lobe (the part behind the forehead) and/or the temporal lobe (the part of the brain located on the side of the head). Depending on the direction and degree of force generated by the collision (front end, side impact or rear end collision), the area of the brain that may be damaged varies as it could be the area closest to initial impact or, the area on the opposite side, due to the rebound effect. Depending on which part of the brain is injured, the physical findings may include problems with walking, balance, coordination, strength/endurance, as well as difficulties with communicating (“cognitive deficits”), processing information, memory, and altered psychological functions. The good news is that most of these injuries will recover within 3-12 months but unfortunately, not all do and in these cases, the term, “post-concussive syndrome” is sometimes used.

Concussions and mild traumatic brain injuries are common findings for people injured in auto accidents in Baltimore. Dr. Gulitz routinely co-treats his concussion patients with local neurologists for patients that require additional treatment.  If you or anyone you know may need the help of a local Baltimore Chiropractor for whiplash with or without associated concussion/mild traumatic brain injuries, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500 or email us. We would be happy to help!The preceding was reproduced with permission from Dr. Ben Altadonna and “The Practice Building Alliance.”