Whiplash Injury - A Pain In The Neck

Whiplash is an injury to the neck caused by a sudden movement back, forward or sideways of the head and neck. Depending upon the severity, it is also called a neck sprain or strain, cervical sprain or strain. The injury often involves the muscles, discs, tendons, and nerves.

Causes

• Most whiplash injuries are caused by a car accident, often by being struck from behind.
• Shaken Baby Syndrome
• Falls from a horse or a bicycle
• Headbanging
• Trauma from being hit, kicked or shaken
• Accidents, such as from riding a snowboard or a skiing accident
• Injury from riding a roller coaster or an amusement park ride that hyper-extends the neck or causes it to be snapped suddenly
• Extreme, sudden straining to lift or pull a very heavy object
  

Muscle and Ligament Symptoms

• Tightness or spasms of the muscles of the neck or upper back
• Pain with movement of neck
• Decreased mobility and stiffness
• Burning and tingling in neck and shoulders, upper back
• Pain in shoulder
• Pain in upper back or between shoulder blades
• Pain in one arm
• Low back pain
• Pain in jaw or face
• Pain in the face, the entire head, or behind the eyes
• Difficulty swallowing and chewing plus hoarseness, which can be symptoms of injury to the esophagus or larynx

Neurological Symptoms

These symptoms may be the result of injury to the soft tissue in the neck or a mild brain injury or concussion.

• Vision problems, blurred vision
• Ringing in the ears (tinnitus)
• Poor concentration, forgetfulness
• Feeling of disorientation
• Sensitivity to sound and light
• Irritability
• Depression
• Sleeplessness
• Fatigue
• Headache
• Dizziness (vertigo)
• Feeling of pins and needles in arms, possibly legs

Diagnosing A Whiplash Injury

• History and Physical must be done
• X-rays to rule out fracture or dislocation
• CT Scan (Computerized Axial Tomography) shows detailed images of neck
• MRI ( Magnetic Resonance Imaging) produces detailed images

Treatment

Treatment depends upon the severity of symptoms.

• Ice may be applied to neck for 24 hours after injury.
• NSAID Non-steroidal Anti-Inflammatory Drugs) may reduce pain and muscle inflammation.
• Muscle Relaxants may be prescribed.
• Physical therapy may be recommended.
• Mild range of motion exercises may be prescribed with proper posture methods to relieve excessive strain on neck.
• Cold and heat treatments may bring some relief.
• Massage therapy promotes healing and relieves pain.
• Chiropractic therapy may be recommended. Spinal manipulation appears to be the most effective within the first 6 weeks following the injury.
• Soft collars are advised only for the first 2 or 3 days when pain and inflammation re the worst. Prolonged use has been shown to delay recovery from whiplash. In some cases, intermittent use is helpful.
• A fracture or dislocation requires the wearing of a collar.

Prognosis

• Mild whip lash injuries may heal within 2 to 3 weeks.
• Moderate injuries require 2 to 3 months.
• Severe whiplash may take months to heal and symptoms, such as headache and neck pain, may linger for 6 months or longer.
• Chronic symptoms may last for years and degenerative changes in the disc and vertebrae may develop.

A whiplash injury truly can become a ‘pain in the neck’ for sufferers of its long term effects.

Brought to you by Boca Raton Spinal Decompression.

Treatment Of Sacroiliitis

Sacroiliitis is a disorder that is far more complex than back pain and it is important to seek medical attention early if you develop the symptoms. The condition is complicated with a variety of causes; it may be secondary to an injury or pregnancy but this is not a disorder to gamble with.
Delay may lead to joint degeneration or the pain may be a symptom of a larger, inflammatory arthritic condition known as ankylosing spondylitis. This is one of the many forms of inflammatory arthritis, the most common of which is rheumatoid arthritis. Complications of ankylosing spondylitis can be quite serious and include:

• Spine Deformities
• Difficulty Breathing
• Lung Infections
• Heart Problems.

Symptoms OF Sacroiliitis

• Pain and stiffness in lower back, thighs, buttocks
• Pain becomes worse with walking, due to the motion of the hips.
• Psoriasis, an inflammatory skin condition, may occur with a type of arthritis and sacroiliitis.
• Pain radiating down leg, often mimicking sciatica
• Limp
• Decreased range of motion
• Elevated temperature
• Bloody diarrhea occurs with Reiter’s Syndrome, which causes painful urination, joint pain, sacroiliac joint pain, and eye inflammation, and accompanies sacroiliitis.
• Eye inflammation in one or both eyes, a symptom of Reiter’s Syndrome and evident with sacroiliitis.

Diagnosis

• History and Physical
• When examined, pain localized around sacroiliac joints, can be detected.
• Laboratory studies, including blood cultures
• X-rays of sacroiliac joints
• MRI (Magnetic Resonance Imaging) scan of sacroiliac joints
• Culture of fluid from affected sacroiliac joint

It is important that the doctor be informed if there is a history of IV Drug use and whether any antibiotics have been taken recently. Recent antibiotic use can delay the proper diagnosis and identification of the infectious organism if a blood culture is done.

Treatment

The underlying cause and symptoms are considered when implementing a treatment plan.
• NSAIDs (Non-Steroidal Anti-inflammatory Drugs) such as naproxyn and ibuprophen reduce inflammation and pain.
• Cortiosteroid Drugs, such as prednisone and medrol, reduce inflammation and slow down joint deterioration.
• DMARDs (Disease Modifying Anti-rheumatic Drugs), such as Azulfidine and methotrexate, help limit joint damage.
• Antibiotics, if an underlying infection is determined by a blood culture or culture of fluid from infected sacroiliac joints. Drug must be specific for that infectious organism.
• Rest to relieve strain on sacroiliac joints.
• Tumor necrosis factor inhibitor medications, such as Enbrel, Humira, Remicade, can block a cell protein that acts as an inflammatory agent. This helps reduce pain and stiffness. These medications are quite expensive and may not be prescribed unless other medications are not effective.
• Physical therapy will be started after the painful, acute phase is under control.
o Range of motion exercises and stretching exercises to improve muscle strength and joint flexibility.
• Decrease or eliminate smoking because nicotine decreases the blood flow to the affected areas and makes it more difficult for the body to fight the disease.

These medications can effectively relieve the painful symptoms of sacroiliitis but they have many side-effects. They may interact with medications you are already taking so it is important that you understand all their side-effects and how to use them appropriately. Some of these drugs increase the risk of bleeding, the risk of a cardio-vascular event or damage to your kidneys, liver or gastrointestinal tract. Complete patient education is vital to the management of sacroiliitis and the effective relief of its symptoms.

Brought to you by Deerfield Beach Spinal Decompression

The Car Accident And Whip Lash Injury

Whiplash, a painful neck injury, is usually the result of a car accident but, at one time, it was known as ‘railway spine’, because of injuries received in train accidents. Around 1928, the term, ‘whiplash injury’, was first used. It is a general term for damage to both the bone structure as well as the muscle and soft tissue of the neck. Whiplash associated disorder is a broader term used to describe a more severe, chronic condition.

Anyone who has ever had a whiplash knows the pain that comes with it. For a while, if a person was involved in a car accident and then claimed symptoms of a whiplash injury, he was often regarded with suspicion. Some even went so far as to suggest that complainers were seeking generous insurance settlements. There were sneers that complainants were not suffering from a real injury but were just complaining for monetary gain.

In the past, if there were no broken bones, an actual injury was hard to document as soft tissue injuries did not show up on an x-ray. As a result, insurance companies would deny all coverage. When a patient was really suffering, this just added insult to injury. It didn’t help that their misery was often scoffed at. It was fakery and the patient was a liar, a fraud, or, at the very least, a raving hypochondriac. Some people, who had genuine whiplash injuries and obvious symptoms from car accidents, actually refused to seek medical treatment. They dreaded the raised eyebrows and skepticism that often greeted the symptoms of whiplash. Some said they would rather deal with their pain than the suspicious attitude that was encountered in hospital emergency rooms.

Clinical studies were eventually undertaken to investigate the whiplash issue. The conclusions were, that while there would always be the unscrupulous few who were trying to exploit an insurance company, most claims were legitimate and a whiplash caused pain and some long term damage. It was vindication for the injured; a whiplash was a real injury with real symptoms.

Consider How It Happens

Most whiplash injuries occur as a result of a riding in a car which collides with another vehicle or is hit from behind. The head is suddenly jerked forward and then back, stretching the ligaments and muscles, which can be torn. In a rear end collision, the victim’s car is pushed forward and then, if he has his foot on the brake or his car slams into the one in front of him, there’s another sudden jolt, snapping his body forward while his head snaps back, stretching and damaging the muscles and cervical spine a second time. If the victim is not wearing a seatbelt, he may hit the steering wheel with force or strike the windshield. The neck is most vulnerable to injury in this type of accident but the muscles of the upper back may also be damaged. Studies show that a whiplash injury can be the result of an accident, even at a speed of 15 mph.

Injuries

• The cervical discs, the soft cushion between each vertebrae can bulge, tear or rupture.
• The cervical vertebrae can be popped and forced out of position
• The spinal cord and nerve roots can be stretched and irritated.
• The muscles and ligaments that support the neck can be stretched or torn.
• Inflammation of soft tissues develops as a result of nerve root compression
• Muscles of the upper back can be over-stretched.

Car accidents are the most common cause of whip lash injuries but a sports injury, such as a skiing accident, can also cause these painful symptoms.

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Study Shows Back Injury Secondary To Muscle Fatigue

A recent study funded by the National Institute for Occupational Safety and Health shows the relationship between muscle fatigue from repetitive lifting and back injury. It was conducted by an Ohio State industrial systems engineer and an MD who is studying biomechanics. The study which recently appeared in Clinical Biomechanics is the first to examine muscle oxygenation throughout the workday.

The Study
Ten people participated in the study; six had at least one year’s experience in a job that requires lifting, such as in stocking shelves. Four were considered novice lifters. Each person wore a Lumbar Motion Detector, a device that was designed to measure the spine’s movement. They wore oximeters, a gauge that measures the oxygen level of the muscles – just like the pulse oximeter, a device that clips onto a finger, measures oxygen level of the blood.

Activity
Study participants lifted a box from a waist high stand and set it on a chest-high conveyor belt. The box traveled on a conveyor belt to the next participant, who would lift the box and set on another conveyor belt. The boxes weighed 2 pounds, 11 pounds, and 26 pounds. Participants worked 8 hours with a half-hour lunch break and two 15 minute breaks.

Researchers said that the 26 pound box weighed less than half as much as loads that some workers are routinely required to lift in industry. The researchers studied the oxygen levels in the muscles. After 2 hours of lifting, the oxygen level gradually increased until it reached 11% above the resting level. During hours 2 to 4, it rose to 13%. During the lunch break, the oxygen level returned to the resting level but immediately rose to 11 % with lifting during hours 4 to 6. During the last 2 hours of the work day, the oxygenation level rose to 16%, the highest level of the day. This oxygen level indicates how hard the muscles were working and whether they were becoming fatigued. Citing his study, Professor Marras of Ohio State, says, “ Because the oxygen demand at the end of the day was so much higher, that’s when we’d expect people to get hurt on the job.” As muscles fatigue and begin to hurt, workers tense up and try to lift with other muscles that are not as painful.

Conclusion
Tense muscles constrict blood vessels, preventing the flow of oxygen and nutrients to the tissues and the removal of waste produced by muscle activity. While using different muscles may bring relief at first, it increases stress on the joints and the spine, increasing the chance of injury. The muscles of inexperienced lifters tensed up more quickly as they needed more oxygen. Injuries were most likely to happen during the last 2 hours of a shift when muscles were the most fatigued.

Professor Marras showed in the study that half-hour breaks were more effective in reducing muscle fatigue but agreed that this might not be practical in the industry. The study also concluded that people who are new to lifting need to take breaks more often than experienced workers.
• According to the US Bureau of Labor Statistics, in 2002, there were more than 345,000 on the job back injuries which required time off from work.

• In 2004, a Harvard Medical School Study showed that back pain was the reason for over 100 million lost work days per year.

Perhaps this latest study on muscle fatigue could be helpful in implementing some changes in the workplace where back injury is a constant factor.

Brought to you by Jupiter Spinal Decompression

Studies of Stress Related Back Pain

Life is full of stress and its physical effects can be felt throughout the body. Too much stress can lead to heart and blood pressure problems, ulcers and strokes, and the list goes on. You can hurt your back by lifting something but accumulated emotional stress and mental strain can also create pain and damage.

Sometimes back or neck pain is the body’s way of protecting itself and literally forcing a general slowdown. Stress creates tension in the muscles which leads to spasms that squeeze the blood vessels and reduce the flow of oxygen and nutrients to the tissues. Just as it brings nourishment to the tissues, the circulatory system also carries away the waste byproducts of muscle activity.

With increasingly tense muscles, there is a buildup of carbon dioxide and waste chemicals, such as lactic acid, in the tissues, leading to increased fatigue and pain. Stress also increases nerve activity in the muscles which increases tension and decreases flexibility. As the muscles lose their fuel supply, they weaken and are more susceptible to strain and injury.

The back is much less able to tolerate any abuse when under stress. Lifting a box incorrectly, making a sudden twist, poor posture, sitting too long in one position, can lead to back pain. Literally, your back can’t bear it, and that ‘pain in the neck’ or pain in the back’ becomes a protest against the stress.

A person who has a ‘bad back’ due to a degenerative disease or secondary to an old injury often notices the effects of stress more quickly than someone with a healthy back. If spinal nerves are all ready being compressed by the calcium deposits of arthritis or spinal stenosis, it may take just a small amount of stress with minimal muscle tension to further compress nerves, triggering pain.

Sciatica from a disc’s compression of the spinal cord or nerve roots may flare up when a person is feeling stressed and tense. The slightest muscle tension may become ‘the straw that broke the camel’s back’.

Studies Of The Relationship Between Stress And Back Pain

Swedish Army Recruits

Recently, a study of more than 48,000 men in the Swedish Army showed the link between back problems and the ability to cope with stress. A battery of medical examinations, intelligence tests, and assessment of their ability to cope with stress were carried out on these Swedish recruits. Researchers found that in this group:

• Over 5000 men had back problems severe enough to interfere with their military service. The vast majority of their disorders were ‘nonspecific back pain and disease’.
• The recruits who had poor coping skills were also most likely to have back pain.
• Those with good coping skills also had higher intelligence scores, which may indicate that the smarter you are, the better you have learned how to handle stress.

US Army Soldiers

In another study, 368 US Army soldiers who came to a clinic complaining of low back pain, completed a questionnaire about their work habits and their health.

• The study linked job stress to emotional stress and this was directly related to their clinic visit complaining of back pain. The greater the emotional distress felt by the soldier, the more visits that were required to relieve his back pain.
• This study confirmed research that linked psychological distress and the physiological demands of work to the increased risk of back pain symptoms.
• The Army researchers believe that job stress plays an important role in persistent low back pain and that reducing the stress can also reduce the pain.
  

Great Britain Study

A study in Great Britain of nearly 6000 people showed:

• If you are under psychological stress when in your 20s, you are more than twice as likely to suffer low back pain when you reach your thirties.
• Researchers believe that early stress may have an adverse effect upon muscle tone which will eventually lead to pain and injury in a vulnerable area.

Stress expert, Venetta Campbell, Ph.D. at Mount St. Mary’s College in Los Angeles, says, “”People who don’t learn how to cope effectively get sick”. She offers some basic stress fighting suggestions:

• Get regular exercise
• Eat a balanced diet
• Keep your finances in order
• Follow your own dreams and let go of external expectations
• Set goals – having a vision for your future helps reduce the stress of uncertainty. (Brought to you by Fort Lauderdale Chiropractor)
  

Stress And Back Pain

Is stress contributing to your back pain? It’s becoming recognized that your state of mind has an effect upon your level of back pain and whether it eventually becomes chronic.. People who are unhappy, worried depressed, or miserable at work are more likely to develop chronic back pain, according to the latest findings. Several recent studies have shown that psychological distress has increased the risk of developing back pain and of experiencing a slow recovery. A study in Sweden found that anxiety and the practice of ‘catastrophizing’ – assuming that the worst will happen- increased the risk of back pain. In another study in the US, people who reported higher levels of anger and distress also reported higher levels of chronic back pain. These studies show that we must review the complete picture with back pain and recognize that it involves much more than just muscles and bones.

In citing the major causes of back pain, in addition to physiological and skeletal problems, the Mayo Clinic cites three Risk Factors:
• Stressful Job
• Depression
• Anxiety

The stresses that are experienced everyday by people are usually easily identified and can be dealt with. Some examples of stress causing situations are:
• Worry about being on time
• Missing a train or plane
• Worry about a job interview
These situations, while upsetting and tension causing, can be handled and, once dealt with, usually do not result in long-lasting problems.

Repressed Emotional Stress
The type of stress that can lead to troublesome back pain is called repressed emotional stress. The process is not logical but, then, many subconscious emotions are not logical or rational. Repressed emotional stress might be caused by:
• An unhappy relationship
• Hidden anger and resentment towards a spouse, children or parents
• Dissatisfaction with a job or career choice, or disillusionment and a poor self image.
• A rift in family relations
• Loss of a loved one
• Financial problems or disaster such as an impending foreclosure
• Physical abuse or threats

Repressed emotional stress may not be easily recognized as the subconscious mind may hide it, creating a smokescreen of back pain symptoms to keep your mind focused on the pain instead of looking for the underlying causes. Repressing (hiding) the real causes blocks any true healing and an effort must be made to recognize and deal with the factors behind the symptoms.

No one should ever discount the powerful effect of stress on the body and the mind.
Stress puts the body into a sustained ‘fight or flight’ mode. When confronted by a threat, whether physical or emotional, real or imagined, a gland in the brain, called the hypothalamus, releases noradrenaline and adrenaline. These hormones trigger a complex set of actions which lead to a physiological and psychological state of hyper-alertness. Problems arise when this hyper-alert state becomes the norm.

The fight or flight mechanism causes muscles to tense in preparation for action, and if this response is not deactivated, the muscles can go into painful spasms, causing severe back pain. As the muscles of the neck and back tighten and squeeze the blood vessels, just like a kink in a garden hose, the supply of nutrients and oxygen are decreased. This leads to pain and eventual weakening of the muscles, making them more susceptible to strain and injury.

Stress is a part of every day life but studies have shown that if we exist in a daily state of hyperawareness, due to all the stresses that confront us, that we are predisposed to develop a number of disorders including heart disease, hypertension, and depression.

Experts at Johns Hopkins Hospital say that a growing number of studies confirm that the mind-body connection plays a role in back pain, both in setting off an initial attack and in contributing to ongoing chronic back pain. These studies have also led to the development of stress-relaxation techniques that can be learned to help break this vicious cycle.

(Brought to you by Jupiter Chiropractor)

Sciatica During Pregnancy

Imagine the surprise a woman must feel while dealing with the physical symptoms and discomforts of pregnancy, to suddenly develop severe back pain. This is not the usual low back pain that is often experienced during pregnancy; it is sciatica. This sharp, shooting pain usually starts in the buttocks and radiates down the back or side of the thigh to the calf and possibly the heel. There may be paralyzing numbness, in addition to the pain, which can be severe enough to limit mobility.

Sciatica can occur at any time in a normal pregnancy but it is most common during the second and third trimester, when the baby is larger and carried lower in the abdomen. Known as Pregnancy-Related Sciatica, it is caused by the pressure of the baby on the sciatic nerve. This is the largest nerve in the body, about the diameter of a finger. Its fibers branch off the spinal cord at the 4^th and 5^th lumbar vertebra (L4, L5) and the first few segments of the sacrum.

As the pregnancy develops, the abdominal tendons and ligaments become looser to prepare for childbirth. The backs of some women become quite unstable and prone to injury. Medical evaluation should always be sought. In some cases, sciatic pain is due to pressure on the nerve that is caused by damage to the disc between the vertebrae of the spine. This creates inflammation and pain and requires specific treatment.

Most physicians avoid prescribing medications for pregnant patients suffering from sciatica but there are several steps that can be taken to relieve or decrease the discomfort. This includes:

• Massage to reduce muscle tension. Some experts believe that tightness in the gluteus and psosas muscles contribute to sciatic pain. Treatment once or twice a week can help relieve stress on weight-bearing joints.
• Moist heat alternated with ice packs
• Chiropractic treatments may be helpful. Be sure to select a practitioner experienced in treating prenatal patients.

In addition, these helpful habits may decrease the chances of developing sciatica:

• Avoid hours of sitting slumped at a computer or standing with a baby on one hip. Both can contribute to lower back pain.
• Maintain proper posture and try to stand straight.
• Wear flat shoes or ones with a very low heel. Avoid shoes that throw your weight backwards.
• Williams Exercises have been developed specifically for use during pregnancy. They may temporarily relieve sciatica pain as they help strengthen the muscles of the pelvic floor, the back and abdomen.
• Swimming and walking are excellent exercises if not contra-indicated by the physician.
• Avoid walking on an incline as this can cause joint irritation and lead to problems.
• Try to avoid significant weight gain.
• Try sleeping on a firm mattress, lying on one side. A pillow rolled up under the knees may be helpful.
• When getting out of bed, try rolling onto your side first, letting the weight of your feet and legs dangling over the edge of the bed, pull your body into a sitting position. This puts less stress on the lower back, helping you to avoid triggering a painful muscle spasm.
• Bedrest may be necessary at times.
• See your physician if the pain becomes unmanageable.

Sciatica is unique to a pregnancy and may gradually disappear on its own. Just because you had sciatica in one pregnancy does not mean it will appear in a subsequent one.

(Brought to you by Deerfield Beach Spinal Decompression)