“Whiplash Injuries, The Cervical Acceleration/Deceleration Syndrome, third edition”

They say that the term whiplash has evolved now into a vague, non-descriptive diagnosis of the problem described by patients about their major symptoms of neck pain after motion trauma. 

Croft says that there have been calls for the diagnosis name to be updated to be more descriptive and injury relevant, such as acceleration/deceleration trauma or hyperextension/hyperflexion trauma.  However, the latter diagnosis would hint that the injury was caused by an initial hyperextension, followed by hyperflexion of the neck but, if the injuries occurred in reverse, the diagnosis may need to reflect the reverse and become hyperflexion/hyperextension.

Additionally, in high acceleration, the sudden head and neck rotation backwards may cause significant hard (bone and cartilidge) and soft (tendon, ligament and muscle) tissue damage, as seen in cervical ‘whiplash’, which is unique to this type of injury.  So, hyperextension and/or hyperflexion of the neck is not pre-requisite to such an injury and, as many patients cannot accurately remember the exact direction of force after an accident, this terminology would be obsolete.

Interestingly, there has been some research done that suggests, and I think with ‘authority’, that the main mechanism of injury is not the flexion and extension bit but the lateral translation.  Bearing in mind that 40 mph is the same as 58.6 feet per second and, if you are hit from behind, your body, pushed by your seat, will accelerate to over 50 feet per second in less than a second.  At the same time your head remains relatively stationary.  So, there is a huge difference in speed between these two parts of your body, the main body mass travelling at about 50 feet per second and the head at about 0 feet per second.  The damage this will cause is pretty significant and stretches and snaps ligaments and tendons, crushes soft tissue and can fracture bones. 

 The term has become most associated with rear-impact collision but it has also been used by various practitioners for any generally harmful motion or impact to the cervical spine, unrelated to the direction of force or size of force.

Croft calls for the use of the more descriptive diagnostic term “cervical acceleration/deceleration injury”. The term does not give an estimation of direction of the force and, if the accident was a frontal impact, the term could be reduced to cervical deceleration injury but a side on impact injury would be expanded to lateral cervical acceleration/deceleration or lateral CAD injury.

This is what their web site looks like:

We already offer a discount to service personnel but I think this has formalised the arrangement for us a bit further and we hope we can add something to support this lot who have given in many cases more than we can imagine.

We are looking forward to seeing how the campaign develops, I suspect it’ll be a popular one.

“Why You Should Never Get Fusion Surgery For Plain Back Pain
Jan. 10 2011
By ROBERT LANGRETH
A recent Bloomberg article should put the fear of God in anyone who wants to get a fusion operation for low back pain blamed on worn-out spinal discs…..This is one of the best indictments of this highly controversial and lucrative operation that has been growing like wildfire, despite multiple studies that say it is no better than a good physical therapy and exercise program (my underlining) –and a lot more dangerous.”

In the article he mentions that:

“..Another 125 patient study touted as having positive results for fusion is missing follow up data from a full 45 patients. In another study more than 5% of people who got complex fusion operations had life-threatening complications.”

And

“I’ll add another detail: the theory behind this operation is poor, as there is no surefire way to pinpoint the pain to the degenerated discs being operated on.”

He goes on to add:

“Another amazing fact: Even if the doctor performs the operation properly, you may still end up paralyzed from the waist down”

and then quotes a pretty horrible example of failed back surgery. The main point of this is that in most cases with bad results, proponents of the op can blame the doctors who performed it, saying they could have done it better. In his quoted case the surgeon was not to blame having carried out the op in a flawless manner – no, it was the op itself that was flawed.

His main thrust is that in the US the reason there is a huge surge in this operation is that both the surgeon and the implant manufacturer all gain from this op, and in the US, big time.
Studies that have looked at the expansion in these expensive back pain treatments have found no overall improvement in health. In 2009, two large studies found that another common back operation to treat pain from severe spinal osteoporosis was no better than a fake operation. Another op done for knee arthritis pain has been performed for years on thousands of patients before studies showed it did nothing more than a placebo operation.

And, so:

“In the absence of a rigorous placebo controlled trial there is simply no way to tell [if these are working]. Surgeons have all sorts of excuses for not doing these studies.”
Maybe they are afraid of what the results may reveal.

He adds that:

“Another great article in the Wall Street Journal found that some doctors who are performing the controversial fusion surgery like crazy just happen to be getting huge fees from Medtronic, maker of gear that is used in the operation. The article proves what everyone had always suspected, there is a huge correlation who is getting industry payments and how often the operation gets done:
Norton Hospital in Louisville, Ky., may not be a household name nationally. But five senior spine surgeons have helped put it on the map in at least one category: From 2004 to 2008, Norton performed the third-most spinal fusions on Medicare patients in the country.
The five surgeons are also among the largest recipients nationwide of payments from medical-device giant Medtronic Inc. In the first nine months of this year alone, the surgeons—Steven Glassman, Mitchell Campbell, John Johnson, John Dimar and Rolando Puno—received more than $7 million from the Fridley, Minn., company.”

The risk doesn’t appear to be worth the it especially given that a good rehab program gets you the same results with less cost and much less risk of side effects. In many cases, there are simpler, less-controversial operations such as spinal decompression that may help without the hideous fusion of vertebrae.

Caveat: There are real reasons to do the fusion operation for certain spinal abnormalities and deformities. But these non-controversial uses and there has not been a sudden outbreak of significant scoliosis that is driving the explosion in use of this dubious procedure.

Carpal tunnel syndrome (CTS) is an injury caused by a compressed nerve in the wrist, resulting in pain and numbness in the index and middle fingers and weakness of the thumb. The carpal tunnel gets its name from the eight bones in the wrist, called the carpals, which also form part of the “tunnel” which the passes leading to nerve leading to the hand.

What you should expect to feel:
Some signs and symptoms of CTS include the following:

Night-time painful tingling in one or both hands that frequently cause sleep disturbance.
A sense that fingers are swollen, even though little or no swelling is apparent.
Daytime tingling in the hands, followed by a decreased ability to squeeze things.
Loss of strength in the muscle at the base of the thumb.
Pain shooting from the hand up the arm as far as the shoulder.

We commeonly treat CTS at the clinic – C1 Chiropractic Health Centre. The methods we, and most chiropractors, use to treat CTS include manipulation of the wrist, elbow and upper spine.

And there are some good studies that support the use of chiropractic treatment for CTS.

In the first study, 25 individuals diagnosed with CTS reported significant improvements in several measures of strength, range of motion and pain after receiving chiropractic treatment. Most of these improvements were maintained for at least 6 months.

A second study compared the effects of chiropractic care with conservative medical care (wrist supports and ibuprofen) among 91 people with CTS. Both groups experienced significant improvement in nerve function, finger sensation and comfort. The researchers concluded that chiropractic treatment and conservative medical care are equally effective for people with CTS. Now this one is the most significant bearing in mind the damage ibuprofen can do to you.

And the good news is that most people’s symptoms clear up within a few months with conventional treatment. If left untreated, CTS in advanced stages can become quite serious, involving a loss of sensation, muscle deterioration and permanent loss of function.

If you need to ask us more contact us at: info@c1healthcentre.co.uk

or have a look at: www.c1healthcentre.co.uk
And here’s the supporting research:

Banner R, Hudson EW. Case report: acupuncture for carpal tunnel syndrome. Can Fam Physician. 2001;47:547-549.

Bonebrake AR, Fernandez JE, Dahalan JB, Marley RJ. A treatment for carpal tunnel syndrome. J Manipulative Physiol Ther . 1993;16(3):125-139.

Bonebrake AR, Fernandez JE, Marley RJ, Dahalan JB, Kilmer KJ. A treatment for carpal tunnel syndrome: evaluation of objective and subjective measures. J Manipulative Physiol Ther . 1990;13(9):507-520.

Branco K, Naeser MA. Carpal tunnel syndrome: clinical outcome after low-level laser acupuncture, microamps transcutaneous electrical nerve stimulation, and other alternative therapies — an open protocol study. J Altern Complement Med. 1999;5(1):5-26.

Davis PT, Hulbert JR, Kassak KM, Meyer JJ. Comparative efficacy of conservative medical and chiropractic treatments for carpal tunnel syndrome: a randomized clinical trial. J Manipulative Physiol Ther . 1998;21(5):317-326.

Is there evidence for chiropractic treatment for sciatica?

Well, we’ve blogged about sciatica before. Sciatica is a loose, nearly slang term for leg pain originating in the back or buttock.

In the past we have talked about the symptoms, causes, and treatment of this problem; but does chiropractic treatment work? In practice many chiropractors report success treating this symptom, but there is little research that has been done. This makes it hard to know an actual predicted success rate, or compare the success of this to other treatment such as surgery.

Recently there has been more research done into this area, for example in October there was a study published which compared the clinical effect of chiropractic spinal manipulation against microdiskectomy (a type of surgery to remove a disk bulge). This was done in patients with sciatica secondary to lumbar disk herniation – which is when the intervertebral disk herniates, like this:

This causes entrapment and irritation of a nerve leaving the back, which causes leg pain.

They looked at patients who had failed to respond to at least 3 months of other nonoperative management (including treatment with painkillers, massage, and physiotherapy) and found that there was a significant improvement in both those treated with chiropractic and surgery. Sixty percent of the patients with sciatica benefited from spinal manipulation to the same degree as if they underwent surgical intervention (I had to do that in red as it’s a vital piece of information). This is very interesting as most people would like to avoid surgery when possible.

They also found that at 1 year follow up there was no difference in outcome based on the patients original treatment group (chiropractic or surgery), but they allowed patients to swap treatments after 3 months if they wanted to. Of the 40% left unsatisfied after their chiropractic treatment, subsequent surgical intervention had an excellent outcome (it worked as well for them as those who went for surgery straight away).

This study only compared treatment for one cause of sciatica, but this is an important cause, and the findings suggest that patients with this kind of sciatica (due to lumbar disk herniation) should definitely consider spinal manipulation. This may be followed by surgery if there is still no response.

Hopefully there will be more research into this and other causes of sciatica, as these findings are promising, and it is nice for patients to have another option than surgery.

Reference:
McMorland, Suter, Casha et al. (2010). Manipulation or Microdiskectomy for Sciatica? A Prospective Randomized Clinical Study. Journal of Manipulative and Physiological Theraputics, Volume 33, Issue 8, Pages 576-584.

We regularly treat ‘sciatica’. Though as a diagnosis it really irritates me, it is nearly as bad as ‘lumbago’ and as misused as ‘special needs’. Sciatica is not a diagnosis or a disorder, it is a symptom of a disorder.

Sciatica is a description of pain that originates in the low back or buttock that travels into one or both legs.

It is a radiating or referred pain, so a neuropathy or neuralgia. The pain generating structure itself is the sciatic nerve, hence the name, which is a relatively massive thing, about the diameter of your thumb, and, as a result, more vulnerable to injury. The nerve pain varies in intensity and frequency and is described by our patients as:

Intermittent, frequent or constant
Dull, achy, sharp, toothache-like, pins and needles or similar to electric shocks
Burning, numbness and tingling sensations.

What causes sciatic pain?

Full on, no messing sciatica is generally caused by sciatic nerve compression. This can be caused by:

1. Lumbar spine dysfunction (misaligned vertebra)

2. Lumbar herniated or prolapsed discs (aka “slipped discs” gaaaahhhh, there’s another cod-diagnosis for you)

3. Changes inpPregnancy and childbirth

4. Tumors pressing on the nerve root

5. Non-spinal disorders such as diabetes, constipation or even sitting on your wallet in your back pocket of your 501s

6. Piriformis Syndrome. This is named after the piriformis muscle. This muscle is in the lower part of the bottom and connects from the pelvis to the thigh and assists in hip rotation. The sciatic nerve runs beneath or, in a percentage of the population, through ithe piriformis muscle. This muscle is susceptible to injury from a slip and fall, hip arthritis or a difference in leg length. Such situations can cause cramping and spasm to develop in the piriformis muscle, thereby, pinching the sciatic nerve and causing inflammation and pain.

In extremis the compression of the sciatic nerve may result in the loss of feeling, paralysis of a single limb or group of muscles (monoplegia).

How’s it treated?

Since there are many disorders that cause sciatica, our first step is to determine what of the above is causing your sciatica. Forming a diagnosis is the most important thing we do as, without this, what are we treating. This is why if you hear sciatica given as a diagnosis you should ‘consider your options’ and seek a second opinion. The examination involves a thoughtful review your medical history and a physical and neurological examination. Diagnostic testing can be done and includes:

X-rays, MRI, CT scan or clectrodiagnostic tests (nerve conduction velocity, electromyography).
The type of chiropractic manipulation provided depends on the cause of the patient’s sciatica
A sciatica treatment plan may include several different treatments such as ice/cold therapies, ultrasound, TENS, and spinal adjustments – sometimes called manipulation.

1. Ice/cold therapy reduces inflammation and helps to control sciatic pain

2. Ultrasound is gentle heat created by sound waves that penetrates deep into tissues. Ultrasound increases circulation and helps to reduce muscle spasms, cramping, swelling, stiffness, and pain. We rarely use US as I suspect it is less effective than we’d like to think.

3. TENS (transcutaneous electrical nerve stimulation), which is a small box-like, battery-powered, portable muscle stimulating machine. Variable intensities of electrical current control acute pain and reduce muscle spasms and it is widely used to help during labour. Larger versions of the home-use TENS units are used by chiropractors, physical therapists and other rehab professionals.

4. And the most important – spinal manipulative therapy to address the underlying causes. Adjustments (Spinal Manipulation) are the core of our chiropractic care. This frees restricted movement of the spine and helps to restore misaligned vertebral bodies to their proper position in your spinal column. Spinal adjustment help to reduce nerve irritability responsible for causing inflammation, muscle spasm, pain and other symptoms related to sciatica. Adjustments should not be painful. Spinal manipulation is proven to be safe and effective.

At University and during our training, students of chiropractic learn many different adjustment techniques enabling us to tackle several types of disorders. Techniques vary from a swift high velocity thrust to those that combine minimal force and gentle pressure. Mastery of each technique is an art that requires great skill and precision and spinal manipulation is the treatment that differentiates chiropractic care from other medical disciplines.

To prepare a patient for adjustment, we usually get you to sit up or lie down. It is not uncommon that we use totally different adjustment techniques during your subsequent visit. Treatment tables differ too. Some are stationary, flat padded tables and others are elaborate with electrically or manually operated head and foot rests.

Limitations

Sciatica can be caused by other disorders beyond the scope of chiropractic practice. If we decide that you need treatment by another type of doctor, then you may be referred to another specialty.

We have patients coming in every working day with episodes of neck pain. These are either acute ones, the ones who can’t move, or chronic ones, whose who can move but are limited in some way.

Neck pan can be split into 3 broad categories:

1. Acute pain – uncomplicated

2. Acute neck pain – complicated. This involved compression of the spinal cord in the cervical spine. Patients reported an improvement of up to 70% for pain and disability following chiropractic care in a trial carried out by Donald Murphy of Rhode Island.

3. Sub-acute and chronic neck pain.

And these patients, coming into C1 Chiropractic Health Centre, with any one of these levels of neck pain are not alone:

Hill and co-workers report that in the UK many as 31% of adults have had neck pain in the last month and 48% of neck pain patients report persistent pain a year later. (Hill J, Lewis M et al. (2004) Predicting Persistent Neck Pain. Spine 29:1648-1654).

But what causes it:
Liebenson, Skaggs et al. say that it is
‘difficult to pinpoint the specific pain-generating tissue’ of neck pain and even if you can the reasons why ‘are often elusive’. Additionally, up to

71% of patients who have chronic pain following whiplash have undetected vertebral end plate fractures at the spinal levels associated with the pain that were overlooked on standard medical imaging. (Michael Freedman Dec 2001).

So how is it best treated:

Cleland et al. have shown that manipulation of the thoracic spine produces immediate analgesic effects in patients with mechanical neck pain. (Cleland JA, Childs JD et al. (2005) Immediate Effects of Thoracic Manipulation in Patients with Neck Pain: A Randomized Clinical Trail, Manipulative Therapy 10:127-135).

Liebenson recommends manual therapy and rehabilitation exercises supported by one of the strongest research trials in this field carried out by Bronfort, Evans et al. In this trial 191 patients were split into three groups:
• Spinal manipulation and low-tech exercise,
• MedX exercise – receiving dynamic progressive resistance exercises on MedX machines,
• Spinal manipulation.
Outcomes were measured at 5 and 11 weeks and 3,6 and 12 months after the trial. At the one year follow up the group that were receiving exercises and manipulation did significantly better than the group doing manipulation alone. This study suggests that patients with chronic neck pain often have weak neck muscles and that the best practice for these patients should combine manipulation with exercise.

In a literature review published by Hurwitz, Aker et al. in Spine and Aker, Gross et al. in the British Medical Journal the authors reported that manipulation and mobilization were both more effective than muscle relaxants and usual medical care in providing pain relief for patients with sub-acute or chronic neck pain.

In a new study (2003) in Spine, Giles and Muller compared acupuncture, joint manipulation and standard medication (NSAIDs). Patients in the acupuncture and medications groups had no significant improvement during the trial on any of the outcome measures and the manipulation group showed significant improvement on all measures with no patient made worse or experiencing side effects. Giles and Muller then followed up their patients a year later and reported that the manipulation group gained ‘significant broad-based beneficial…long-term outcomes’.

In a great study by Haneline at Palmer College of Chiropractic, 79% of the patients improved to the point they had only minimal or minor restriction of movement and their satisfaction rates were an astounding 94% – and I suspect few trials can report the same, with 70% indicating they were very satisfied.

When asked which provider helped the most 83% replied the chiropractor.

Couldn’t agree more

and so I then searched for the ‘incredibly brilliant’ DXR9000 and found this:

Hmm, what are we to conclude?

Axiom are lieing? NASA never happened? No, really tell me this isn’t true.

“The main things we see associated with using a laptop are headaches, neck pain and back pain” said Rupert Clements one of the chiropractors at C1 “and it’s starting to become an epidemic.”

Rupert adds: “most people have vague notion that that their computer is the cause of their ailments – but once diagnosed and fully explained they really get the problem. Unfortunately they are often unable to do much about it – if you have to use a laptop for work, you have to use a laptop.”

There are some troubling trends with school kids and students using them to do online home work often sitting in bed, way before they hit the workplace so many of our patients have years of postural abuse to deal with and no wonder its hurting.

“At the conventional computer, you sit at a desk and everything is as good, ergonomically as possible” said Leni Rautenbach who works at C1 “But with a laptop it’s all in one.” Because of their combined structure, Leni said that the problem with laptops comes from people’s extended use with their bodies in a scrunched position. Prolonged use of a laptop with bad posture can lead to issues such as headaches, neckaches, carpal tunnel, tendonitis and back pain.

Some tips to prevent “laptopitis,” or neck and back pain from working on a laptop:
1. Take a break about every 20 minutes, stand up, walk around, maybe even stretch a little.

2. If you’re going to use a laptop, try to sit at a desk or table.

3. If you can, use a desktop computer for those long, gruelling assignments or papers.

4. Switch out your laptop for a desktop. This may seem crazy, but it may prevent long-term damage.

5. If you have pain, see your chiropractor and get some help.

“Paracetamol leads way in back pain relief: study

Pharmacists are ideally placed to provide advice to people with lower back pain, researchers at The George Institute of Global Health in Sydney believe.

Following a study showing less than half of people suffering with the condition were taking paracetamol, as recommended in evidence-based guidelines, researchers have commenced recruiting patients through pharmacy for a three month study.”

Now, if you have an inflammatory issue going on in your low-back then paracetamol will help to reduce that and the pain but you’d struggle to argue that it is doing anything to address the cause. You are in effect removing the warning bulb form the dash board.

They go on to say:

“If you look at the current evidence that’s available, the first option of care for non-specific lower back pain [which encompasses 95 per cent of back pain] is to advise the patient to remain active, reassure them that they’ve got a favourable outcome, advise them against bed-rest and advise them about simple pain relief medication.”

Which is reasonable but missing one key recommendation, the spinal manipulation bit.

“The first line of care should be paracetamol, so pharmacists, we think, are ideally placed to do that,” oh, come on what tosh, a pharmacist would never suggest you go and see your osteopath or suggest you consider Pilates.

The Paracetamol for Lower Back Pain (PACE) study (sounds biased to me but…) has already started recruiting subjects. The research outline has said the study will be a double blind placebo controlled trial with patients split into three groups to compare regular paracetamol use to paracetamol as required, and a placebo.

The bottom line is that you do not have back pain because you have a lack of paracetamol in your blood stream – it’ll be for another reason and that’s what you should be looking to treat.