Treating Traumatic Injuries with Precision and Caution
TECHNIQUE
Anthony J. DeLuca
Despite all of the warnings, regulations, and safety precautions, traffic collisions are still a leading cause of pain, injury, and suffering across the country. In fact, The National Safety Council estimates that, in 2013, motor vehicle accidents resulted in the deaths of more than 32,000 Americans and another 3.8 million injuries.
As anyone who has either suffered from the results of an automotive collision or treated accident victims knows, the destructive power of a car, truck, or bus striking a vehicle even at reduced speeds can never be underestimated. The trauma can be instantaneous and catastrophic as a result of the impact of flying debris, or far more subtle with the painful effects not arising for days after the crash and lingering for months and sometimes years without the proper care and therapy.
That occurs because there are so many variables that play into the aftereffects. The size and speed of the vehicles are just the starting point. The point of impact and positon of the individuals are another. Was the vehicle struck from behind, on the side, or straight on? Was the injured person driving or in the front or rear passenger seat? How was he or she seated, and in what direction was the person looking?
These aie all key factors since many injuries occur when the individual either hits or is hit by something within the car, such as a knee against the dashboard, a head against a seat rest, or a shoulder against the chest of another passenger not wearing a seatbelt. The reality is that nearly two-thirds of all accident victims suffer some form of whiplash after a crash.
The treatment of cervical spine injuries resulting from such incidents commonly begins in the offices of chiropractors specializing in personal injury. The doctor should have an
* ^Managing cervical spine complaints with a range of therapies focused on reducing patient pain, improving motion, and restoring function to the head and neck region.??
understanding of the patient’s comprehensive history as well as observe the patient’s gait, standing posture, and sitting posture to identify deviations, such as a protracted cervical spine or shoulder girdle. Neurological and orthopedic testing procedures and indications also are used to assess the patient’s motor skills, cranial nerve functionality, coordination, and balance. This can include any number of diagnostic techniques, such as Bakody’s sign, Bikele’s sign, foraminal compression test, Jackson cervical compression test, maximal cervical compression test, distraction test, and Spurling test, to determine nerve root involvement. Before moving forward with osseous adjustments, it is also often prudent to use X-rays, MRIs, CT scans, and other diagnostic tests to help pinpoint the cause of symptoms and locate subluxations. Such diagnostic tests also help determine the possibility of severe spinal cord compression conditions, which are especially common among older patients
even if they haven’t been involved in traumatic collisions.
The next step includes treating and managing cervical spine complaints with a range of therapies focused on reducing patient pain, improving motion, and restoring function to the head and neck region. Common modalities used for accomplishing these goals include:
• Diversified Technique, which is the classic chiropractic deep thrust method for restoring normal biomechanical function and correcting subluxations.
• Trigger Point Therapy method combined with the use of a therapeutic massager to apply direct pressure or ischemic compression to restore normal muscle tone and flexibility.
• Active Release Technique8 (ART 8), which can be used to prevent acute injuries from becoming chronic problems and alleviate the complications associated with the buildup of scar tissue in areas such as the anterior scalene and posterior cervical musculature.
• Acupressure, which includes the application of pressure typically through the use of the doctor's thumb to acupoints on the body’s meridians to stimulate or reduce the flow around obstructions.
• Physiotherapy, in the form of muscle stimulation and ultrasound, which is ideal for reducing swelling and restoring musculoskeetal movement and function
• Proprioceptive Neuromuscular Facilitation, for enchancing both active and passive range of motion
In addition to these techniques, many chiropractors also favor the use of handheld instruments to gently apply force, restore joint movement, and treat muscle tension without thrusting into the spine or extremely sensitive cervical areas. While numerous instrument-assisted manipulative devices are available, the Activator is among the most prominent, with more
than half of all American chiropractors using the tool according to the National Board of Chiropractic Examiners. Ideal for assisting in the treatment of back and neck pain, the Activator provides quick, low-force impulses for
treating cervical spine misalignments resulting from whiplash injuries with pinpoint accuracy and minimal discomfort—a common requirement for often treating geriatrics and children.
Another extremely important ingredient in the rehabilitation of whiplash and related cervical spine injuries are the activities prescribed for home on a daily basis. With the proper treatment and care, the symptoms can be eased within a few months. It is also extremely important for patients to maintain a relatively active lifestyle within reason to avoid the atrophy of muscles located in other parts of the body. In fact, here are some relatively simple exercises patients can perform two to three times daily, provided they can be completed comfortably without increasing pain or the severity of other symptoms. Furthermore, most patients will attest that the effectiveness of these range-of-motion activities is heightened greatly if performed in a hot shower as often as possible.
■ "Another extremely important ingredient in the rehabilitation of whiplash and related cervical spine injuries are the activities prescribed for home on a daily basis. 5 J
• Chin tucks hold back and neck straight with shoulders slightly back. Face eyes and nose forward while tucking chin in for mild to moderate stretch. Hold for two sec-
onds and repeat 10 times.
Shoulder blade squeezes stand tall with back straight while squeezing shoulder blades together. Hold for five seconds and repeat 10 times.
Rotations hold back and neck straight with shoulders back slightly. Turn head over one shoulder without poking forward. Repeat 10 times on each side.
Chin tilt tilt chin forward to chest. Raise slowly and then tilt backward to look at ceiling. Hold for several seconds in each direction and then repeat 10 times.
Supraspinatus stretch stand straight and place the backs of hands in the middle of the back. Roll shoulders up and down.
Anterior shoulder stretch hold back straight and feet at shoulder width apart. Reach arms behind back with hands clasped together. Pull arms upward while keeping back straight.
• Sternocleidomastoid stretch face forward with hand on one shoulder. Tilt head back and away from the hand/shoulder. Hold for 10 seconds and repeat on opposite side.
For the best long-lasting results for cervical injuries such as whiplash, patients also should be reminded constantly that prolonged relief comes with moderation. One of the most common questions asked is, “When can I resume my normal activities?” Athletes are the hardest to convince, but the answer should always be, “Start slow and let comfort be your guide. Pain-free results should be the key for any activity.”
Anthony J. DeLuca, DC, is director of DeLuca Family Chiropractic in Old Bridge, New Jersey, which specializes in the treatment of personal injuries, such as whiplash suffered through traumatic automobile accidents. For more information, please visit www.dfccares.com or call 732-679-2414.
