North Dallas Chiropractic Blog – All Injury Rehab

I am often explaining to patients how they can injure their back by picking up a paper clip.  This article does a great job in explaining how it can happen.

High-Risk Moments for Your Low Back
How to Avoid Injury and Pain
By Marc Heller, DC

What are the high-risk times and events for your lower back? Why can you get into more trouble doing something as simple as picking up a loaf of bread from the trunk of the car, rather than doing something more challenging? What simple steps can you take to avoid injury and pain? Let’s get the answers to these questions and more.
Two Critical Moments

When it comes to your lower back and injury risk, there are two critical times when you need to be especially careful. One is first thing in the morning. Your back is actually swollen at that time. You are substantially taller, and the discs have extra fluid in them. A careless forward bend or twist first thing in the morning can do substantial damage to your discs or other back structures. It doesn’t seem fair that such a simple thing, bending and twisting, something you have done thousands of times before, can suddenly cause big problems.

The other critical time is after you have been sitting. Long car drives or airplane trips are especially challenging. In this case, the culprit is something called “creep.” This means that your ligaments and tendons lengthen into the position that you have been in. Think of sitting as a bent-forward position, as your legs are forward. The ligaments and tendons do not provide protection properly when they have been lengthened by creep. When you first get up from sitting, you are at risk. The longer you have been sitting, the higher the risk. If you sit more upright, with good lumbar support, you will have somewhat less risk.

Here are some common events that can contribute to lower back pain. Keep in mind that in all of these scenarios, your back was already vulnerable.

Scenario #1: You didn’t sleep well last night, perhaps from sleeping in an unfamiliar bed after travel, after sitting too long. You get up, feel stiff, but ignore it. You sit down in a soft chair to enjoy your morning hot drink. You get up and get a sudden sharp stab in the back.

Scenario #2: You get up from sleeping, and sit at your laptop, and get entranced by a video or article. You end up sitting far longer than you planned. You get up, and can’t completely straighten up.

Scenario #3: You get up from sleeping, drink your morning coffee, which wakes up your gut, and you go to bathroom to empty your bowel. You are a bit constipated, and have to strain. When you get up from the toilet, your back spasms.

Overnight sleeping, even a good sleep on your favorite bed, leaves your back somewhat swollen. Swollen may be an exaggeration, but the reality is that there is extra fluid in all of your joints.

If you have a good back, none of this matters. If you have a vulnerable back, it all matters. Ideally, when you get up, you should do some kind of activity that warms up and “wrings out” the excessive fluids. A short walk, some simple movements, can make a real difference. Sitting down at the computer, sitting on the toilet, etc., can get you in trouble.

So, who has a good back versus a bad back? Unfortunately, most of us have bad backs, at least in the sense that they can be subject to injury and pain at any time. In fact, studies suggest that as many as eight in 10 people experience low back pain during their lifetime. That’s a lot of back pain already happening or waiting to happen. And as you can tell from the above discussion, some of the scenarios whereby people experience back pain are all too common.

How to Avoid Injury and Pain

Don’t bend over immediately after sitting. Sitting, even in good posture, puts you at risk. The longer you sit and the worse the seat, the more at risk you are. Airlines are very risky; it’s hard to get up and move around because of the tight quarters, and the minute the plane stops, you bend over and get stuff from under the seat, or reach up, and twist and lift to get your bag from the overhead compartment. After a long sit, give yourself at least a few seconds of backward bending and/or moving around to reset your spine. Then you can carefully, using your hips rather than your back, bend over to pick up something.

When you sit, don’t slump. Slumping reinforces the risks, makes it more likely for something bad to happen to your discs or joints or muscles. So, sit up straight, and keep your back in neutral. Neutral means that you keep a bit of a lordosis in your lower back, keep the lumbar spine from slumping forward, stay more upright. This simple action can make a huge difference. Like any habit, this will require you to “Just Do It” for a few weeks.

Talk to your doctor about these and other high-risk moments for your lower back and what you can do to relieve low back pain or avoid the pain altogether. And make sure to review “Self-Care for Back Pain” in the May 2010 issue, which provides information on exercises your doctor may prescribe if you are experiencing back pain.

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Marc Heller, DC, maintains a chiropractic practice in Ashland, Ore. He is a nationally recognized expert in treating tailbone, sacroiliac and lower back pain.

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For years we have been battled by our foes. Those that feel their pocket books getting lighter because of the results we get with our patients. More and more, people come to us for the successful results that we get, patient by patient, yet we are attacked, not because of our results with patients, but because they are feeling the pinch financially in their practice, with lackluster results. People want an answer when they have a problem, and they want to get it fixed with the least invasive, cost effective procedure, with no side effects. Yes, we get results, with all of the previously mentioned included. All of this has been so true that we caught the eye of the US National Government, and as a result, they have been passing sweeping legislation to include it in the healthcare of all of those who have risked their lives, and for some, given portions of it, for us American Citizens. We know what we do, our patients know what we do, and the Federal Government now knows through numerous trails. Here is the latest thumbs up for Doctors of Chiropractic:

Texas Journal of Chiropractic
Texas Chiropractic Association
US House Passes Expanding Chiropractic to ALL Major VA Medical Centers
Published 05/25/2010 – 11:34 a.m. CDT

The American Chiropractic Association reports on May 25, 2010, and FOUND HERE at Chiroeco.com that “the U.S. House of Representatives passed H.R. 1017, the “Chiropractic Care Available to All Veterans Act,” putting America’s veterans one step closer to gaining access to chiropractic care at all major Department of Veterans Affairs (VA) medical centers. The bill was approved 365:6.”

“H.R. 1017 requires the VA to have doctors of chiropractic on staff at no fewer than 75 major VA medical centers before the end of 2011 and for all major VA medical centers to have a doctor of chiropractic on staff before the end of 2013. There are nearly 160 VA treatment facilities nationwide. Currently, the VA provides chiropractic care at 32 treatment facilities across the country.”

“The bill comes after a recent VA report, “Analysis of VA Health Care Utilization Among Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) Veterans,” from February 2010, which cites “diseases of Musculoskeletal System/Connective System,” such as back pain, as the number one ailment of Iraq and Afghanistan veterans accessing VA treatment.”

“The American Chiropractic Association (ACA) believes inclusion of chiropractic care in the VA healthcare system would speed the recovery of many of the veterans returning from current operations in Iraq and Afghanistan. Chiropractic care has been proven to be a cost-effective and beneficial treatment option. In fact, a 2010 study published in Clinical Rehabilitation found that spinal manipulation provided better short and long-term functional improvement and more pain relief in follow-up assessments than other physiotherapy interventions. Furthermore, a 2003 study published in the medical journal Spine found that manual manipulation provides better short-term relief of chronic spinal pain than a variety of medications.”

“House VA Committee Chairman Bob Filner (D-CA), a strong supporter of extending chiropractic care benefits to military retirees and active-duty personnel, introduced the legislation. Over the years, Rep. Filner has worked closely with ACA in securing support for a number of pro-chiropractic measures. Rep. Michael Michaud (D-ME), Ranking Member Steve Buyer (R-IN) and Rep. Jerry Moran (R-KS) also deserve recognition for their support of this legislation.”

“Prior to congressional intervention over the past decade, no doctors of chiropractic served on the staff of any VA treatment facility. The availability of chiropractic care for eligible veterans was limited to VA “referrals” to doctors of chiropractic serving in private practice outside of the VA system. Such referrals were so rare that chiropractic care was essentially non-existent within the VA system.”

“I am especially proud that the member institutions that comprise the Association of Chiropractic Colleges will play a pivotal role in preparing the next generation of doctors of chiropractic to serve our military veterans throughout the United States and overseas,” said Frank J. Nicchi, DC, MS, President of the Association of Chiropractic Colleges. “This legislation will assist in making that possible.”

“In the U.S. Senate, a companion bill (S1204) has been introduced by Sen. Patty Murray (D-WA), who is a member of the Senate VA Committee. This legislation would also expand access to chiropractic care within the VA system.”

AirForceTimes.com REPORTS HERE that “the Senate passed a bill earlier this year to require chiropractic treatment at a minimum of 42 locations, an increase from the current 36, but legislation passed by the House on Monday by voice vote requires every Veterans Affairs Department medical center to provide the care. This big difference between the two bills will have to be worked out later this year, probably as part of a package of veterans health care legislation.”

“Rep. Bob Filner, D-Calif., the House Veterans’ Affairs Committee chairman and chief sponsor of the House bill, said chiropractic care could be important to today’s service members, who may carry up to 55 pounds of combat equipment and armor. ‘Consistently supporting such a heavy load places a serious strain on the backs and joints of our service members, causing musculoskeletal injuries,’ Filner said.”

“‘Musculoskeletal disorders “are the single most common ailment facing returning veterans,’ he said. ‘Among veterans of Operation Enduring Freedom and Operation Iraqi Freedom who have received treatment from VA, over 52 percent have been diagnosed with such a disorder; however, VA is not presently equipped to serve this clear need.’”

“Rep. Steve Buyer of Indiana, ranking Republican on the veterans committee, said he is a big supporter of the proposal and wants to ensure that care is available through contracts for veterans who do not live near VA medical centers.”

“The Congressional Budget Office estimates each additional chiropractor would cost an average of $115,000 a year.”

Visit us at All Injury Rehab for more information and to set up an appointment.

It is primetime for allergies right now. Through the sniffling, sneezing, and watering eyes, I’m reminded of the old adage “death, taxes, and allergies.” OK, maybe I have my adages a bit wrong, but nonetheless, allergies are a problem for almost all of us, if you say you’ve never had them, then don’t brag, I don’t need it. Here is a helpful article on curbing your dubious friend, the allergy:

To Your Health
April, 2010 (Vol. 04, Issue 04)

Sneeze No More
Get Rid of Allergy Symptoms Without Drugs
By Clair Whiteman

If you are one of the 26 million Americans who suffer from upper respiratory allergies, you may already be stocking up on tissues as we enter spring. Allergic rhinitis or hay fever is associated with a wide range of uncomfortable symptoms including excess mucous production, nasal blockage, sore throat, stuffy head, puffy eyes, and fatigue. Although none of these symptoms can be classified as life-threatening, anyone with allergies will tell you they can be a nuisance and interfere with daily activities. There are numerous medications that can be effective at masking allergy symptoms, but each comes with its inherent risks and may only treat the symptoms. Fortunately, there are also natural therapies available that can help your body manage the many underlying causes of allergies.
Breaking Down Allergies: The When, Why and How

There are three main forms of upper respiratory allergies. The most common form, seasonal allergic rhinitis, occurs only at specific times of the year in response to high circulating levels of pollen or other allergens in the air. Alternatively, perennial allergic rhinitis occurs year round and is often due to an allergy to pet dander or dust mite droppings. Finally asthma can also be classified as an allergic disorder when it is stimulated by exposure to an external irritant. This form of asthma is classified as extrinsic or atopic and is characterized by excessive mucous production, shortness of breath and cough.

Allergies differ from other forms of illness as they are the result of overactivity of the immune system. When we think of being sick, we typically think of the immune system being unable to fight off an offending agent, such as a bacteria or virus. Allergies, on the other hand, occur when the body initiates an immune response to a non-offending substance, such as pollen or a type of food. In the case of upper respiratory allergies, the body initiates an immune response to an inhaled particle. When the particle comes in contact with the nasal surface, it links with specific antibodies known as IgE, which can be found on the surface of immune cells within the nasal mucosa.

Once this binding takes place, the body stimulates secretion of numerous inflammatory mediators including histamine, heparin, and kinins. These complexes take immediate action by causing nasal vascular dilation, which results in excess mucous production. Meanwhile, immune cells continue to produce other inflammatory messengers known as leukotrienes, which stimulate constriction of bronchial cells to further enhance allergic effects.

Potential Causes to Consider

Allergies and asthma are both increasing in prevalence within the developed world, leading researchers to look into environmental (non-genetic) factors as a possible causative factor. For example, children who are fed solid foods too early or receive antibiotic therapy within the first two years of life are more likely to develop both respiratory and food allergies. This indicates that there may be a protective mechanism in the immunoglobulins in mother’s milk as well as the natural microflora of the nasal and oral passages.

Recently, researchers have begun to look at the overuse of antiseptics and antibiotics as another influential factor in the development of allergic rhinitis. This concept, known as the “hygiene hypothesis,” proposes that lack of childhood exposure to microorganisms, both symbiotic (i.e., health-promoting probiotics) and pathogens, leads to modulation of the immune system to favor the development of unnecessary antibodies. Epidemiological support for this theory points to the lower incidence of allergies and autoimmunity in the developing world when compared to the increased incidence within industrialized societies.

Low intake of dietary antioxidants and exposure to cigarette smoke and other environmental pollutants are also strong indicators of increased allergy risk. Other potential factors which may increase allergy risk include low gastric acid secretion (known as hypochlorhydria) and intestinal overgrowth of yeast (Candida albicans).

Why Drugs Aren’t the Answer

Pharmaceutical management of allergies focuses on stopping the allergenic response, primarily via the inhibition of histamine. Antihistamines are a mainstay in the management of allergies, and although they have been improved upon in recent years, many antihistamine medications may cause significant brain fog and fatigue, among other potential side effects. Other commonly used medications for reducing allergens include steroids, which can be given via a spray directly to the nasal membranes or as an oral medication. These medications take action by modulating the underlying inflammatory pathways which contribute to allergies and asthma. Unfortunately, use of steroidal anti-inflammatory medications can impair overall immune function, and therefore increase the risk of other infections. Other commonly used medications include expectorants, decongestants, and immunotherapy drugs, all of which provide varying levels of relief.

How to Fight Allergy Symptoms Naturally

When looking to control allergy symptoms naturally, the first step is to limit your exposure. Using an air filter, preferably one that ties into a central heating and air conditioning system, can drastically reduce the build-up of allergens in your home. It is also important to focus on areas where allergens can collect. Pet areas, carpets, rugs, and upholstered furniture should be cleansed regularly, and bedding should be washed at least once a week.

In addition to these simple steps, you may want to look to your diet as a means for controlling your allergy symptoms. A study of 35 patients conducted in the Journal of Asthma found a positive correlation between allergy relief and vegetarian or vegan diets. In a clinical observation, 92 percent of patients who followed a vegan diet for one year reported reduction in asthma symptoms. Improvement was seen in a number of clinical variables, including lung vital capacity and forced expiratory volume.

Relief from allergic rhinitis may also be achieved via elimination of allergenic foods in the diet. Foods that have been closely linked to respiratory allergies include dairy products, chocolate, sugar, and gluten. There is also strong evidence indicating a connection between allergic rhinitis and intake of certain food additives, including artificial dyes and colorants, sulfites, and benzoates. According to the Encyclopedia of Natural Medicine, evidence linking these compounds to asthma attacks may be so strong that avoidance of these synthetic additives could be vital to controlling allergy symptoms.

Intake of omega-3 fatty acids has also been shown to support healthy airways and additionally favor the production of anti-inflammatory mediators. In a 2009 study reported in the International Archives of Allergy and Immunology, atopic asthma patients supplemented daily with omega-3 fatty acids improved airway responsiveness even when subjects were exposed to a known allergen. Dietary sources of omega-3 fatty acids include cold water fish, flax seeds, chia seeds, and walnuts. Other powerful anti-inflammatory agents which may be beneficial include members of the allicin family, such as onions and garlic, ginger, rosemary, curcumin (turmeric), and the herb Boswellia.

Increasing intake of antioxidants is also essential to prevent the free radicals which are often elevated in allergies and asthma. Vitamin C is considered as one of the most important dietary antioxidants for the protection of the lungs, and low levels of blood vitamin C are considered an independent risk factor for allergic rhinitis. Other beneficial antioxidants may include vitamin E, selenium, the carotenoids, and the flavonoids, which all posses powerful free radical quenching capabilities. Of the flavonoid complexes, quercetin appears to be of extreme benefit as it has been shown to limit the production of both histamine and the leukotrienes.

Another nutritional substance that may be of benefit is bromelain, a proteolytic enzyme derived from the juices and stems of pineapples. Bromelain supports anti- inflammatory activity and supports the thinning of mucous to function as a natural decongestant.

Why go through life suffering from allergies if you don’t have to? With a few dietary and lifestyle changes, you can face allergy season without stockpiling allergy medications and Kleenex. The big point is that these natural solutions not only fight allergy symptoms, but also help combat the underlying mechanisms which cause allergies while also supporting a healthy immune system. Talk to your doctor for more information about allergies and natural solutions.

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Interesting Allergy Risk Factors

Children who are fed solid foods too early or receive antibiotic therapy within the first two years of life are more likely to develop both respiratory and food allergies.

Exposure to cigarette smoke and other environmental pollutants is another strong indicator of increased allergy risk.

Low intake of antioxidants (found in various foods, particularly certain fruits and vegetables) may also increase allergy risk.

Low gastric acid secretion (hypochlorhydria) and intestinal overgrowth of yeast (Candida albicans) may contribute to allergy onset as well.

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Natural Solutions for Allergies and Their Symptoms

Limit Allergen Exposure: Using an air filter, preferably one that ties into a central heating and air conditioning system, can drastically reduce the build-up of allergens in your home. Pet areas, carpets, rugs, and upholstered furniture should be cleansed regularly, and bedding should be washed at least once a week.

Avoid These Foods: Foods that have been closely linked to respiratory allergies include dairy products, chocolate, sugar, and gluten. There is also strong evidence suggesting that certain food additives, including artificial dyes and colorants, sulfites, and benzoates, are culprits.

Eat These Foods: Intake of omega-3 fatty acids has also been shown to support healthy airways and encourage the production of anti-inflammatory mediators. Also consider onions and garlic, ginger, rosemary, curcumin (turmeric), and the herb Boswellia.

Get Your Antioxidants: Increasing intake of antioxidants is also essential to prevent the free radicals which are often elevated in allergies and asthma. This includes vitamins C and E, selenium, carotenoids, and flavonoids. Bromelain, an enzyme, can also help.

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Clair Whiteman, BSc, received her degree in nutrition and dietetics from Bastyr University in Washington state. She is currently the on-staff nutritionist for BioGenesis Nutraceuticals, a professional-grade supplement line.

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Dynamic Chiropractic – January 15, 2010, Vol. 28, Issue 02

Study Confirms Flaws in Standard MVC Defense Strategy
By Arthur Croft, DC, MS, MPH, FACO

The seemingly complex, or perhaps even inscrutable, calculus of what practitioners term personal injury is, in truth, deceptively simple. However, while it keeps getting simpler, many practitioners and lawyers feel hopelessly wrapped around the axle of this puzzling system. The net result is abandonment of needful patients and clients, with a corresponding loss of revenue stream. Consider just a few facts. Motor vehicle collisions are a leading cause of injury in the U.S. and constitute one of our most burdensome public health dilemmas. With 3 million such injuries each year, a total recovery proportion of only about 50 percent, a permanent disability proportion of 10-12 percent, coupled with the fact that many of the injured are young and have many quality life years to lose, the $43 billion annual price tag is hardly surprising.1

Auto insurers make every reasonable effort to insulate themselves from their liability. Some would argue that they engage in efforts most of us would consider unreasonable, if not downright unsavory or unethical. Regardless of your personal judgment, most would agree that over the past two decades, the insurers’ concerted and very expensive campaign to limit claims has been fairly successful.

With Allstate taking the vanguard position with their now-famous three Ds – delay, deny, and defend – most major auto insurers have since instituted similar policies, and the plaintiff persona-injury bar has more often withered than weathered. With a loss of potential legal representation, plaintiffs have had fewer alternatives for compensation. This often has meant that needed health care resources are simply not available to them, which contributes further to the doleful outcome statistics mentioned above. Since inaugurating its get-tough policy in the mid-1990s, which was described by its consulting firm as a transition “from good hands to boxing gloves,” Allstate has reportedly posted surprising high profits.2 Other insurers have not failed to notice.

The Standard Defense and the Importance of Delta V

How could any of this possibly be simple? One need look no further than the essential game plan of most defense lawyers: deception, dissimilation and obfuscation. It requires a team of experts from the fields of medicine (including chiropractic), accident reconstruction and biomechanics who have collectively developed what I consider to be the standard defense strategy. It continues to be the most successful and widely used strategy today, having become the world standard.

This has fostered a small research industry dedicated to the production of pro-defense literature to aid in the cause. Most is junk science. Make no mistake, insurers have the best researchers money can buy and they know how to get published. As a result, even many clinicians remain split on critical issues depending on which brand of literature they rely upon. I note, with all due respect to the Insurance Institute for Highways Safety (IIHS) and members of the International Insurance Whiplash Protection Group (IIWPG), that their research activities are quite laudatory and most welcome. However, there is just a bit of schizophrenia in this industry when it comes to research. While the valid research of the IIHS and the IIWPG is squarely aimed at reducing the industry payout problem by reducing the number of actual injuries, the “other” research seems to be aimed at providing verisimilitude for company experts to wield in courtrooms to sway jurors toward defense theories.

The standard defense has three parts and is based on the ultimate playing field: a court of law, and, in particular, the biases and naivete (i.e., the normal lack of specific factual information in the field of crash traumatology) of jurors. Polls suggest that Americans are also divided on the question of whiplash injuries. As many as 60-70 percent consider it either definitively or very likely a non-injury, but merely an opportunity to bilk insurers at the expense of the rest of us policy-holders who subsidize the system through the increasing premiums we must pay. Thus, jurors are easily misled by the standard defense strategy because it merely reinforces that which they already believe.

The first and most fundamental part of this strategy is to demonstrate that the forces of the collision would not have been of a sufficient magnitude to cause injury. The common currency for this discussion is the plaintiff vehicle’s delta V or change in velocity. For this, an accident reconstructionist is usually employed. Because reconstructionists are rarely allowed to provide opinions as to injury risk, they are often followed by a biomechanist, who is granted more latitude to venture into the discussion of injury risk. In some cases, they are allowed to consider medical records, MRIs, etc., in forming their opinions. Finally, the defense physician (DC, DO or MD) adds the icing to the cake, testifying that either there was no injury or that there was a minor straining-type injury that has long since resolved.

When pre-existing conditions are present, the plaintiff’s complaints are often attributed to them rather than the injury. Company doctors will typically also be of the opinion that a large portion of the medical expenses claimed by the plaintiff are unnecessary, unreasonable,and represent unwarranted treatment and diagnostics. Note that low back injuries are virtually never admitted to be causally related to low-velocity collisions. I have written a paper on this subject which is available upon e-mail request at drcroft@san.rr.com .3

As I have so many times implored readers – and this fact is never contested even by my small army of industry-affiliated detractors – the entire defense mechanism just described is nothing more than a series of interlocking nonsequiturs. The accident reconstructions and biomechanists provide a very polished and seemingly airtight argument based on what appear to be sound mathematical principles and classical Newtonian physics. This is all very interesting, and would be even more so if it had the additional virtue of being true.

Delta V Not a Valid Gauge of Injury Risk?

But figures don’t always add up, which brings me back to the headline of this article. A new study that provides further compelling evidence that delta V, the keystone in the standard defense strategy, is not a valid gauge of injury risk.4 The authors recruited a total of 57 people within 48 hours of their MVCs. The subjects were recruited either from an engineer’s office for vehicle damage assessment or an ER. The whiplash grades ranged from 0-4 (0 indicating no claimed injury and 4 indicating fracture). The collision types included 13 frontal, 21 rear, 19 side, three multiple crashes and one rollover. There were 25 males and 32 females with a median age of 33.

In all cases a trained engineer determined the delta V by examining both crash vehicles. The VAS and Neck Disability Indexes (NDI) scores were tabulated. The authors found no significant correlation between NDI and delta V, no correlation between whiplash grade and delta V, and only a moderate correlation between VAS reported pain and delta V. However, the R2 value (coefficient of determination) for that correlation was only 0.30, which means that 70 percent of the proportion of the variability of pain severity was not explained by differences in delta V.

There was no lower threshold below which a large proportion would predictably not be injured, nor was there an upper threshold above which most would predictably be injured. This was because some people were injured in very low velocity crashes while others were not injured despite fairly high velocity crashes. The authors commented, “It can be concluded that delta V is an irrelevant predictive value for cervical spine injury after MVA [motor vehicle accident].”

Some specific findings include the following: Cervical spine fractures in frontal crashes occurred in delta Vs of 9.3, 19.9 and 31.1 mph. Fractures in side impacts occurred in delta Vs of 6.2 (z-joint fracture of C4), 9.9 (C7 with dislocation of C6-7), 19.9 (z-joint fracture of C2), 31.1 (C5 fracture with C5-6 dislocation and paraplegia), 32.3 (rupture of alar ligaments), 36.0 (atlantoaxial dislocation) and 36.6 mph (rupture of alar ligaments). There was a dens fracture in the one rollover with the delta V reported as 9.3 mph. This article is available for free download at www.ncbi.nlm.nih.gov/pmc/articles/PMC2657117.

A related component of the standard defense strategy is the property damage issue. Specifically, the argument goes, when the property damage is minor, an injury is very unlikely. We addressed this issue earlier in a meta-analysis of medical and engineering literature dating back as far as 1970 that failed to provide a clear link between property damage and any of three outcomes: risk for acute injury, degree of injury severity and risk for long-term symptoms.5 As I always caution readers, this lack of correlation considers the genre of collisions producing property damage that would be described as minor or non-severe. Clearly, when crash severity increases beyond this, there is an increased risk for injury or death.

A related interesting paper by Viano and Parenteau demonstrated that more than 60 percent of the National Automotive Sampling System case database for rear impacts are for crashes with delta Vs of under 15 mph. They noted, “In very low speed crashes, advanced age, stenosis and degeneration of the cervical spinal canal can lead to spinal cord injury and paralysis in crashes otherwise not causing injury in normal adults.”6 I would also note that it has been demonstrated rather conclusively that human variables (i.e., risk factors) are more determinative vis-a-vis injury risk than crash metrics in the lower crash-severity range.

In the end, when essential parts of the foundation of the defense strategy are tested, they repeatedly fail to hold up to the scrutiny of hard science. In a court of law, however, if the plaintiff and their experts cannot effectively present the real facts and rebut the junk science, 12 impressionable jurors will decide the outcome of the case based on their perception of the soundness of the arguments they heard. The simple fact is that more often than not, the plaintiff and their witnesses are simply not adequately prepared. Knowledge is power and information is the currency of success.

References

Zaloshnja E, Miller T, Council F, Persaud B. Comprehensive and human capital crash costs by maximum police-reported injury severity within selected crash types. Annu Proc Assoc Adv Automot Med, 2004;48:251-63.
Berardinelli DJ. From Good Hands to Boxing Gloves: The Dark Side of Insurance. Portland: Trial Guides, LLC, 2008.
Croft AC. Low back injuries in low velocity rear impact collisions. Forum, 2009;39(4):33-7.
Elbel M, Kramer M, Huber-Lang M, et al. Deceleration during “real life” motor vehicle collisions: a sensitive predictor for the risk of sustaining a cervical spine injury? Patient Saf Surg, 2009;3(1):5.
Croft AC, Freeman MD. Correlating crash severity with injury risk, injury severity, and long-term symptoms in low velocity motor vehicle collisions. Medical Science Monitor, 2005;11(10):RA316-21.
Viano DC, Parenteau CS. Serious injury in very low and very high speed rear impacts. SAE, 2008;2008-01-1485.

Visit us at All Injury Rehab for more information and to set up an appointment.

Dynamic Chiropractic – March 26, 2010, Vol. 28, Issue 07

Medicare Patients Give Chiropractic High Marks
Results from demonstration project suggest feasibility of expanding chiropractic services in the Medicare program.
By Peter W. Crownfield, Executive Editor

The long-awaited final report on the Centers for Medicare & Medicaid Services (CMS) chiropractic demonstration project, conducted from April 2005 through March 2007, is good news for chiropractic, with 87 percent of patients surveyed giving their doctor of chiropractic a score of 8 or higher when asked to rate their satisfaction with care (1-10 scale), and 56 percent rating their chiropractor a perfect 10. Moreover, in all but one of the demonstration sites (metropolitan Chicago), health care costs did not increase significantly with the addition of chiropractic services.

The demonstration project, “Demonstration of Coverage for Chiropractic Services Under Medicare,” was mandated under section 651 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003. The project evaluated the effects of expanding coverage of chiropractic services in four different regions of the country: Maine, New Mexico, 26 counties in northern Illinois and one county (Scott) in Iowa, and 17 counties in rural Virginia. Approximately 40 percent of eligible DCs in the four regions participated in the project at some point or another.

Key findings from the summary report, relative to patient experiences with chiropractic care and analysis of chiropractic-specific Medicare costs during the project, include the following. To review the report in its entirety, visit www.acatoday.org/pdf/demo_report.pdf.

“Medicare beneficiaries reported good relief of symptoms and high degrees of satisfaction with the chiropractic care they received.”

“The most frequent reasons given for seeking care from chiropractors were favorable earlier experiences (59 percent) and insufficient relief of symptoms by prior treatments of other health professionals (39 percent).”

“Clinical problems involved the back in 78 percent, neck in 50 percent, hip in 38 percent, and shoulder in 32 percent. Pain was the most frequent symptom, followed by difficulty walking. … Sixty percent of [survey] respondents indicated that they received ‘complete’ or ‘a lot of’ relief of symptoms from their chiropractic treatments.”

“Chiropractic care was felt to be easily accessible, and nearly 95 percent of respondents indicated that they had to wait no more than one week for appointments. Similarly high proportions reported that chiropractors listened carefully and spent sufficient time with them.”

“Among users of expanded chiropractic services, visits increased by 60 percent overall and related Medicare expenditures increased by $34.8 million. … Essentially, all of the increased costs occurred in urban non-HPSA [Health Professional Shortage Areas] and in Illinois, and especially in Chicago and its suburbs.”

“Illinois accounted for 80 percent of the total increase in costs and also had the highest per-person increases in costs of $485 per person compared with increases of $136 per person in Virginia and $35 per person in Maine, and decreases in the other two states.” [Per-person costs decreased by $178 in Iowa and $59 in New Mexico.]

“The types of prior treatments received from other health care professionals differed strikingly from those received by chiropractors, including pain pills in 58 percent, pain injections in 30 percent, both pain pills and injections in 22 percent, and surgery in 12 percent. … The high reported use of pain medications and surgery in treatments received from other types of health care professionals suggests the potential for achieving cost offsets [by using chiropractic care].”
The stated purpose of the demonstration project was “for evaluating the feasibility and advisability of covering chiropractic services under the Medicare program (in addition to the coverage provided for services consisting of treatment by means of manual manipulation to the spine to correct a subluxation described in section 1861(r)(5) of the Social Security Act.” Chiropractic was defined as “care for neuromusculoskeletal conditions typical among eligible beneficiaries and diagnostic and other services that a chiropractor is legally authorized to perform by the State or jurisdiction in which such treatment is provided.” Chiropractic care needed to conform with CMS’s policy for reimbursement of chiropractic services, meaning treatment was for active conditions with reasonable expectation of improvement or resolution. Maintenance and prevention services were excluded per the CMS policy.

For additional background information on the Demonstration of Coverage for Chiropractic Services Under Medicare project, read “Details of CMS Demonstration Project Revealed” in the April 9, 2005 issue.

Visit us at All Injury Rehab for more information and to set up an appointment.

These days we have a lot of choices when choosing a Chiropractor. Just type in Chiropractor on your favorite search engine, and you are inundated with a bevy of Doctors waiting to serve you, but how do you choose which one you’ll entrust your health and well being to? With any profession, there are those which give the reputable a bad name. Here are a few things to look for when searching for a Doctor:

Experience
How long as the doctor been in practice?
Does the doctor have a specialty that is related to your health care needs?
Is the doctor experienced in performing procedures you are interested in?
How many procedures of this kind does the doctor perform each year?

Credentials
Did the doctor attend and graduate from an accredited chiropractic school?
Does the doctor keep up with post-graduate studies?
Is the doctor licensed to practice chiropractic in your state?

The Doctor
Do you feel comfortable with the chiropractor?
Do you like his or her personality?
Are your concerns or questions answered completely and understandably?
Are you comfortable with all phases of the process including consultation, examination, treatment, and follow-up?
Does the doctor offer informed consent for treatments?

The Staff
Are the office staff pleasant and helpful if you have a question?
Do you feel you are being treated with respect and courtesy by the staff?
Are you able to reach the doctor if you have questions?

The Office
Are the office hours convenient for you?
Is the office located near your home or work?
Is the office clean, well kept, with adequate space for a waiting room and examination rooms?

Referral
Does the Doctor have a relationship with specialists that you can be referred to if it is found that more than conservative treatment is needed?

Here is a helpful video: Finding the right Chiropractor

To make the decision easy for you, we hope that you choose one of our five clinics at All Injury Rehab.

A new study just revealed that stimulant medications, specifically methylphenidate, are associated with a 6- to 7-times increased risk for sudden death in children and adolescents. UGH!

What does the FDA say about that? “Given the limitation of this study’s methodology, the FDA is unable to conclude that these data affect the overall risk and benefit profile of stimulant medications used to treat attention-deficit/hyperactivity.”

The ADD/ADHD Page is devoted to the holistic approach…chiropractic care, dietary modification (no more food colorings and preservatives!), and no more dangerous drugs!

By Frank in Education on June 22nd, 2009 at 9:19 pm

This is just one of many pages in the Pediatrics Section .

Be sure to visit North Texas Chiropractic Services for more information about Chiropractic.