Dr. David B. Starkey DC MS Dipl. Ac.

Correlating Crash Severity with Injury Risk, Injury Severity, and Long-term Symptoms in Low Velocity Motor Vehicle Collisions

Medical Science Monitor

October 2005; 11(10): RA316-321

Arthur C. Croft and Michael D. Freeman

These authors note: In the mid-1990s, a set of guidelines was published by a leading U.S. auto insurer instructing claims adjusters that injury claims resulting from motor vehicle crashes with less than $1,000 US in claimant's vehicle property are "unlikely to — or cannot cause significant or permanent injury" and should "be handled as a fraudulent claim," regardless of medical evidence of injury. The "claim goal was to close without payment."

The MIST (minor impact soft tissue) protocol uses vehicle property damage as a construct for injury, and all injury claims less than $1,000 US of vehicle property damage are considered to be false.

These authors "conducted a comprehensive best evidence synthesis of the existing medical and engineering literature to investigate the relationship between vehicular structural damage and occupant injury in motor vehicle crashes."

 The key points noted in this article include:

1. A substantial number of injuries are reported in crashes of little or no property damage.

2. Property damage is an unreliable predictor of injury risk or outcome in low velocity crashes!

3. 95% of rear impact injury crashes occur below 25 mph.

4. Rear-end collision injury severity and duration can be reduced with a head restraint closer to the occupant's head.

5. Well-done studies documented cases of injury with "almost no vehicle damage."

6. There is "no statistically significant associations between crash severity and the 6-month injury status."!

7. "Persons who were unaware of the impending crash were significantly more likely to have persistent symptoms."

8."No statistically significant relationships existed between measures of crash severity in terms of calculated velocity change or maximum deformation and long-term symptoms."

9. There are no significant correlations between crash severity and long-term symptoms.

10.There is a substantial injury risk in frontal and rear impact low speed crashes without sustaining appreciable vehicle damage.

11."It seems clear that property damage in low velocity motor vehicle crashes does not provide a reliable means of assessing the validity of injury claims and, provides no reliable means of prognosticating long term outcome."

12."A substantial number of injuries are reported in crashes of severities that are unlikely to result in significant property damage."

13."Property damage is neither a valid predictor of acute injury risk nor of symptom duration."

14."Based upon our best evidence synthesis, the level of vehicle property damage appears to be an invalid construct for injury presence, severity, or duration."

15. "The MIST protocol for prediction of injury does not appear to be valid."    

Similar reviews of articles pertaining to whiplash trauma, subluxation, neurology, neuroimmunology, nutrition, and health can be accessed on this webpage, www.danmurphydc.com.

Dr. David B. Starkey DC MS Dipl. Ac.

www.coveroffice.com

Whiplash

Whiplash is a generic term applied to injuries of the neck caused when the neck is suddenly and/or violently jolted in one direction and then another, creating a whip-like movement. Whiplash is most commonly seen in people involved in motor vehicle accidents, but it can also occur from falls, sports injuries, work injuries, and other incidents.

What structures are injured in a whiplash?

Whiplash injuries most often result in sprain-strain of the neck. The ligaments that help support, protect, and restrict excessive movement of the vertebrae are torn, which is called a sprain. The joints in the back of the spine, called the facet joints, are covered by ligaments called facet capsules, which seem to be particularly susceptible to whiplash injury.

In addition, the muscles and tendons are strained—stretched beyond their normal limits. The discs between the vertebrae, which are essentially ligaments, can be torn, potentially causing a disc herniation. The nerve roots between the vertebrae may also be stretched and become inflamed. Even though it is very rare, vertebrae can be fractured and/or dislocated in a whiplash injury.

What are the common signs and symptoms of whiplash?

The most common symptoms of whiplash are pain and stiffness in the neck. These symptoms are generally found in the areas that are “whiplashed.” For example, during a whiplash, first the head is lifted up from the upper-cervical spine. This creates a sprain/strain in the region just below the skull, where symptoms usually occur. Symptoms may also commonly be seen in the front and back of the neck. Turning the head often makes the pain and discomfort worse.

Headache, especially at the base of the skull, is also a common symptom, seen in more than two thirds of patients. These headaches may be one-sided (unilateral) or experienced on both sides (bilateral). In addition, the pain and stiffness may extend down into the shoulders and arms, upper back, and even the upper chest.

In addition to the musculoskeletal symptoms, some patients also experience dizziness, difficulty swallowing, nausea, and even blurred vision after a whiplash injury. While these symptoms are disconcerting, in most cases, they disappear within a relatively short time. If they persist, it is very important to inform your doctor that they are not resolving. Vertigo (the sensation of the room spinning) and ringing in the ears may also be seen. In addition, some patients may feel pain in the jaw. Others will even complain of irritability, fatigue, and difficulty concentrating. These symptoms also resolve quickly in most cases. In rare cases, symptoms can persist for weeks, months, or even years.

Another important and interesting aspect of whiplash is that the signs and symptoms often do not develop until 2 to 48 hours after the injury. This scenario is relatively common but not completely understood. Some speculate that it may be due to delayed muscle soreness, a condition seen in other circumstances.

How is whiplash treated?

Staying active

One of the most important aspects of whiplash management is for the patient to stay active, unless there is some serious injury that requires immobilization. Patients should not be afraid to move and be active, within reason. In addition, your doctor will often prescribe an exercise or stretching program. It is particularly important to follow this program as prescribed, so that you can achieve the best long-term benefits.

Chiropractic manipulation and physical therapy

Ice and/or heat are often used to help control pain and reduce the muscle spasm that results from whiplash injuries. Other physical therapy modalities, such as electrical stimulation and/or ultrasound, may provide some short-term relief. They should not, however, replace an active-care program of exercise and stretching. Spinal manipulation and/or mobilization provided by a chiropractor can also give relief in many cases of neck pain.

Can whiplash be prevented?

Generally speaking, whiplash cannot be “prevented,” but there are some things that you can do while in a motor vehicle that may reduce the chances of a more severe injury. Always wear restraints (lap or shoulder belt), and ensure that the headrest in your vehicle is adjusted to the appropriate height.

DR. DAVID B. STARKEY DC MS DIPL. AC.

The most important piece of

golf equipment is your spine!

Professional golf instructors estimate that 80-100% of golfers' swing problems begin from faulty posture. Therefore, having a Chiropractor evaluate your posture should be the first and most important step toward building an optimal golf swing. Most postural faults are caused by muscle and connective tissue imbalances that pull a golfers body out of alignment, or a misalignment in spinal bones. The result of an unbalanced or asymmetrical standing posture will always be unbalanced and decreased performance. If the golf instructors are correct, a poor posture, when addressing the ball, will result in a poor and/or inconsistent golf swing. Moreover, sooner or later, golfing with a poor posture and swing motion will cause injuries. Research states that 80% of the population has lower back pain.

An onlooker may assume that the never-ending quest to put the little white ball into the cup calls upon little of the athleticism required by other warm-weather sports such as tennis or cycling. Not true. Many avid golfers contort their bodies into oddly twisted postures, generating a great deal of torque-the twisting force that opens a bottle cap-on the back. Couple this motion with a bent-over stance, repeat 90 to 120 times over three or four hours, add the fatigue that comes with several miles of walking, and you've got a good workout-and a recipe for potential lower back trouble.

As America's love affair with the game continues to grow and are playing in a big tournament, chiropractors advocate taking a proactive approach that will prepare your body for many years of pain-free play. "Most golfers go until they are in pain, then look for immediate relief. "Dr. David B. Starkey advocates a different approach-by helping patients look at what they can do right now to reduce the likelihood of future injury.” We want people to be able to play without pain and have the greatest potential for a lifetime.

If you take this approach, you're in good company. As a chiropractor I have found the direct connection between the spine and performance. Nerves control every muscle in your spine. A pinched nerve will decrease performance. “The difference between winning and losing could be just one stroke.” Many professional golfers such as Tiger Woods, Jack Nicklaus, and Tom Watson rely on chiropractors to increase their performance. To find out if chiropractic could increase your performance in golf please call me to schedule an appointment.