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Friday, July 29, 2011

The Truth About Low Speed Auto Accidents

Low Speed Auto Accidents

Thousands of car accidents occur everyday. And every day thousands are injured. Researchers note that the majority of auto accident injury claims occur at relatively low speeds of about 12 mph or less.
Car Accident Disputes
This causes tremendous disputes between injured parties and the insurance companies that are responsible for compensating them for their car accident claim. To insurers, there really is no speed at which they want to admit an injury could occur. For economic reasons they try to dismiss whiplash or car accident injuries entirely, as if they don’t exist.
Thanks to recent irrefutable research studies proving the existence and exact mechanism of whiplash car injuries, insurers are hard pressed to try the “whiplash is a hoax” defense nearly as much as in the past.
A more recent tactic is to claim the speed of the collision is too low to cause injury. Enter the “low speed collision” or “slow speed collision” defense. The defense often relies on their insured’s reports of how fast they were going when they ran into the back of the other party-obviously biased data.
Other times photographs of the vehicle damage is used to show a low speed car accident. Often, the photographs are shown to an Accident Reconstructionist who by merely looking at photographic damage of a car crash then renders an opinion on how fast the vehicles were traveling. They will even go so far to make statements such as “the evidence suggests there was insufficient force to cause human bodily injury…” This would be laughable if it didn’t cause so many problems for injured car accident victims. By the way, in most states Auto Crash Reconstructionists are only allowed to testify or ender an expert opinion as to vehicle damage. They are not trained to determine bodily injury.
The Truth
Here are but a few facts concerning motor vehicle injuries and their relationship to speed with supporting scientific evidence.
Three different studies (Panjabi, Panjabi and Cholewicki and Kaneoka) proved the mechanism by which the neck is injured by a rear impact force simulating a car accident. [1], [2], [3] The studies involved simulating a rear impact collision on live human test subjects and recording the results with cineradiography (high speed motion x-rays). The researchers found that the neck was injured by deforming into an “S- shaped” configuration within fractions of a second of the impact before the occupant is aware of the impact and before reflexes can protect them. All three of these studies found that this physical event occurred at speeds as low as 2.5 mph. In other words, when they simulated car crashes sufficient to cause the head to move in relationship to the body at a rate of 2.5 mph, injuries were recorded.
The radiographically proven human threshold for injury in a rear impact auto accident therefore is 2.5 mph. Other authors have disputed these figures and some insurance company sponsored studies have found the threshold to be closer to 5 mph.
For the sake of argument, let’s stipulate that the 5 mph threshold is correct. It still means that a collision of only 5 mph can cause damage to the neck.
Freeman et. al. in Spine, Vol. 23, Number 9, 1998, p. 1046 shows the damage thresholds for many cars. This is the minimum speed required to cause the car to show visible signs of damage. The smallest, lightest vehicle listed was the 1980 Toyota Tercel, which required a collision of 8.1 mph to become damaged. On the other end of the spectrum was the 1989 Chevrolet Citation, which required 12.7 mph. A Ford F-250 pick up required 11.7 mph.
Cars built today are equipped with rear bumpers designed not to show any damage below 5 mph. In an attempt to reduce repair costs shouldered by insurance companies, crash standards were adopted to mandate rear bumpers must withstand a 5 mph collision into a fixed barrier (wall, pole, etc) without any visible evidence of damage. It should be noted that this standard involves testing of “vehicle to barrier” crashes not “vehicle to vehicle” testing.
Hitting a pole as in “vehicle to barrier” testing yields more damage at lower speeds. The barrier does not move or absorb any energy.
In “vehicle to vehicle” crashes where the bumpers line up well, it takes considerably more force to cause visible bumper damage than a 5 mph collision. Some tests have shown that cars could be crashed repeatedly at 20 mph and not show outer damage. In a “vehicle to vehicle” crash it is estimated that the minimum speed to cause visible damage is approximately 15 mph.
What happens to the occupant in these collisions is what matters. If you are backing up in a parking lot and run into a pole at 6 mph. You will feel a crunch and a bump. You’ll be startled and upset about your bumper, but it is unlikley you’ll be injured.
On the other hand, if you are stopped in a parking lot waiting for a space and another vehicle strikes you at 12 mph (the average speed of a car in a parking lot) you will likely feel a tremendous jolt, hear a loud bang and your car will be pushed forward a few feet. It is probable that your neck will be injured, although it may not show up for hours or days, but your bumper may not even show a dent.
In the first scenario all the energy of the crash was absorbed by the bumper. In the second, some of the energy was bled off into the two vehicles, but much of it was transmitted into your body causing your neck to deform into the “S” configuration resulting in injury.
Another consideration is that while a bumper may look undamaged from the outside after a collision, inside under the skin, the foam or plastic may be crushed or cracked. This is not seen from the outside, so photographs would make it appear as if no damage was sustained. Still further, the bumper may appear intact, but on unibody vehicles, the unibody may be bent or deformed by a collision. This may not be apparent and some auto repair facilities may miss it.
So what does this mean? It means that if you are rear-ended and your bumper is cracked, dented, or misplaced at all, your collision involved speeds in excess of 15 mph. That’s 3 times the human threshold for injury if we use the 5 mph figure. In reality, the proven threshold is only 2.5 mph, so a collision of 15 mph is 6 times the threshold for injury.
Now let’s say your vehicle sustained no visible damage, but your neck hurts after the collision. Does that mean you weren’t really injured? No. It means that the vehicle’s threshold for damage was not exceeded. The impact could have been 10 mph. Too low for bumper damage, but still 4 times the threshold for human injury.
In a low speed collision, the kinetic forces that are transferred from the other vehicle into your vehicle are not dampened or bled off by your bumper. Instead, the force is transmitted through the vehicle, into your seat and to your neck resulting in injury. If your body or neck are jolted or jerked by the impact, an injury could occur.
Another aspect to consider is if your vehicle is moved forward by the impact. An average car weighs close to 4,000 lbs. Let’s say you are hit from behind and your car is pushed forward a few feet, but shows no signs of bumper damage. Is it possible to be hurt? Yes, of course. The force required to move a stationary 4,000 lb object is tremendous. Can you walk up to a car sitting at a red light with its brakes on and shove it forward even an inch? Not likely. A collision that is strong enough to propel a car forward by even inches is plenty enough force to cause a whiplash injury.
So, as you have now learned, there really shouldn’t be any dispute on whether a low speed car accident collision can cause injuries. It has been scientifically proven by several studies. It is also a fact that the speed required to cause bodily injury is quite low, a scant 2.5 mph. It has also been shown that any accident that causes damage to the rear bumper is likely to cause injuries and even in accidents where there is no outward physical damage to the vehicle, there may still be sufficient forces involved to cause bodily injuries.

References
Panjabi MM, Grauer JN (1997): “Whiplash produces a S-shape curvature of the neck with hyperextension at lower levels. ” Spine 22 (21): 2489-94.
Panjabi MM, Cholewicki J, Nibu K, Grauer JN, Babat LB, Dvorak J, Bar HF (1998-12-01): “[Biomechanics of whiplash injury].” Orthopade 1998 Dec; 27(12): 813-9.
Koji Kaneoka, Koshiro Ono, Satoshi Inami and Koichiro Hayashi (99-04-15). “Motion analysis of cervical vertebrae during whiplash loading.” Spine 24(8): 763-770
Characteristics of Specific Automobile Bumpers in Low Velocity Impacts, SAE 940916

Disc Problems

Disc problems can occur from traumatic incidents like Auto accidents, sports injuries and slips and falls. These seem obvious to most.

However, many disc problems can be related to multiple micro-traumas over a long period of time. Types of work, hobbies, sports, exercise and lifestyle can all be contributing factors.

Combine one of the above with a traumatic incident and it’s easy to see that disc problems are not uncommon.

The best way to know if you have a problem in your disc is to have an MRI done of the area of complaint.

The good news is that an MRI will show exactly where and how big the "herniation” or bulge is."

The bad news is that it is an expensive test.

In our office we use X-Ray and orthopedic/ neurological tests to determine if a disc problem may exist.

Whether you use MRI technology or not the answer is almost always the same--CONSERVATIVE CHIROPRACTIC CARE to start. As long as you are progressing well as most of our patients do, an MRI is usually not needed. For the patients with more complicating factors a referral will be made for an MRI or other more detailed tests.

A combination of conservative safe Chiropractic care and therapies such as neck (cervical) and low back (lumbar) traction, or painless muscle stimulation with hot or cold packs can go a long way in controlling the symptoms of disc problems.

We are also always happy to read your MRI report for you in "plain English."

The Docs at North Dallas Chiropractic

HEADACHES

Headaches are the second most common complaint following motor vehicle accidents (MVA's). Like the many other MVA symptoms, headache may not be present immediately following the accident and may take several weeks and often months to eventually surface. Most post-traumatic headaches are thought to originate from the soft tissues and facet joints of the neck as well as injury or irritation to the nerves of the upper cervical spine.
The literature has shown there to be multiple types of headaches which can be experienced following a MVA. These include the following:

  • Cervicogenic Headaches
  • Muscle Tension Headaches
  • Migraine Headaches
  • Myofascial Trigger Point Headaches
  • Site-Of-Impact Headaches
  • Drug-Induced Headaches (following excessive or prolonged analgesic use)

Anatomy of Whiplash

When your body is involved in trauma, your neck is one of your most vulnerable areas. Whiplash, the hard and fast forward-backward movement of the neck, can cause pain that can last well after other injuries have healed. To understand why your neck is so sore, it helps to know the anatomy involved.

Whiplash can be a complicated diagnosis as the doctor tries to figure out exactly which parts of the spine have been affected. And there are a lot of complex parts to your cervical spine—the technical name for your neck. The cervical spine begins at the base of the skull. It contains seven small vertebrae (bones), which doctors label C1 to C7 (the 'C' means cervical). The numbers 1 to 7 indicate the level of the vertebrae. C1 is closest to the skull, while C7 is closest to the chest.

In between each vertebra are tough fibrous shock-absorbing pads called the intervertebral discs. (These discs are what slide back and forth during the trauma.) Each disc is made up of a tire-like outer band and a gel-like inner substance. The outer band is called the annulus fibrosus; the inner part is called the nucleus pulposus.

In addition to bones and discs, your cervical spine also includes the upper region of the spinal cord, eight nerve roots, an elaborate system of arteries and veins, 32 muscles for strength, and numerous ligaments. For such a small area, there is a lot to your neck. That means that there are a lot of parts that can be injured when you have whiplash.

Remarkably, the cervical spine supports the full weight of your head, which is usually about 8 pounds—yet no other region of the spine has such freedom of movement. The cervical spine can move your head in nearly every direction: 90° of forward motion, 90° of backward motion, 180° of side to side motion, and almost 120° of tilt to either shoulder.

Unfortunately, this flexibility makes the neck very susceptible to pain and injury, such as whiplash. In whiplash, those 15 pounds are dramatically tossed frontwards then backwards—that's one important reason to wear seatbelts properly and use airbags whenever possible.
spineuniverse.com

Neck and Mid Back Pain


NECK AND MIDBACK PAIN

Collisions that occur during sporting events, slips, falls or Automobile crashes can all have a damaging effect on your neck and back. Reduction of the normal neck (Cervical) curve, repetitive micro-traumas ie. long hours on the computer, driving in traffic, traveling by car or plane, lifting heavy or awkward objects or constant stress of work, family and everyday life can also be directly related to neck and back pain.

Pain can be dull or sharp, boring or burning, constant or intermittent. As the problem progresses, numbness and or tingling can be felt in the upper back, arms and even in to the hands.

NOTE: Many patients who come in for Carpal Tunnel treatment are amazed to find out that the problem is actually a pinching of the nerves in the neck and NOT a wrist or hand problem.

Through careful evaluation of your neck and upper back, we can pinpoint the problem areas and have great success in correcting the CAUSE of our Patients symptoms.

The Docs at North Dallas Chiropractic

Why should i get an attorney after an Auto/Car accident for my injuries?

An attorney helps with all aspects of an auto/car accident claim or injury. They keep an individual from spending countless hours on the phone with insurance adjusters that really don't care about your well being. It also helps to keep stress levels down and allow you to concentrate on recovery and getting well. Our office only works with the best attorneys/lawyers in Dallas/Fort Worth. We have learned through trial and error, who best takes care of our patients. They also make sure that all your medical bills are settled. This allows you to be additionally stress and medical bill free at the end. We also help those who are not able to treat in our office, who are in need of an attorney. We are here to help!!! So don't hesitate in calling and making an appointment to get examined and also ask about scheduling a free consultation with a reputable attorney. You only have one body, so you need to take care of it. Call Today!!! (972)215-7720

Also see our web page for more information:
WhiplashtreatmentDallas.com

Tuesday, July 26, 2011

Auto/car Accidents and whiplash treatment

If you have been involved in a car accident, whiplash injuries need to be taken very seriously. Because symptoms of a whiplash injury can take weeks or months to manifest, it is easy to be fooled into thinking that you are not as injured as you really are.

Too often people don't seek treatment following a car accident because they don't feel hurt. By far, the most common injury to the neck is a whiplash injury.Whiplash is caused by a sudden movement of the head, either backward, forward, or sideways, that results in the damage to the supporting muscles, ligaments and other connective tissues in the neck and upper back.


Unfortunately, by the time more serious complications develop, some of the damage from the injury may have become permanent.Numerous studies have shown that years after whiplash victims settle their insurance claims, roughly half of them state that they still suffer with symptoms from their injuries. If you have been in a motor vehicle or any other kind of accident, don't assume that you escaped injury if you are not currently in pain. Contact us today!


Numerous studies have shown that years after whiplash victims settle their insurance claims, roughly half of them state that they still suffer with symptoms from their injuries.


Call Today!!
(972)215-7720
Our Website

Brain injury due to auto/car Accidents

Diffuse Axonal Injury
The brain consists of billions of nerve cells located in the gray matter which communicate with distant nerve cells through long nerve fibers called axons, composing the white matter. Severe sudden twisting or torquing of the brain, as occurs in a sudden acceleration/deceleration - whiplash -- accident, can stretch, twist, and damage these delicate axonal fibers. Under the microscope the axonal damage is called Diffuse Axonal Injury (DAI). Although diffuse axonal injury generally results from a severe whiplash injury that renders a patient comatose, recent studies have shown that diffuse axonal injury can also occur - but to a lesser degree -- when there has been only brief loss of consciousness (LOC). Because Diffuse Axonal Injury causes microscopic damage, it cannot be visualized on CT or MRI scans.

A second method of how the brain can be injured in high speed velocity change scenarios (a fall from a great height, high speed car accident) is called “Isotropic Stress.” Whereas diffuse axonal injury involves the deforming or stretching of the brain tissue, resulting in tearing, isotropic stress causes damage through a “pulse” or “pressure wave” that moves through the brain at extraordinarily high speeds. The damage is caused by a sudden change in the density of the inside of an individual brain cell. The instant compression causes damage to the internal structures of the brain cells.

Many of these same types of injuries have been discovered and treated in veterans returning from the Iraq war. They have often been exposed to the proximity blast of explosive charges. The pressure or pulse from the explosion moves through their body and as it move through the brain it causes damage to the cells. Although many of these soldiers look “fine” and have no bleeding, they can and will suffer serious brain injury as a result.

Because of the large number of veterans injured in this way, lots of research is being done on this type of brain injury at the present time and there should be studies available for an update on this new insight into TBI in mid-2008.

Braininjury.com

Closed head injury due to Auto accidents

Closed head injury from car accident incidents occurs when a victim's head violently impacts some internal portion of a vehicle, is struck by a moving object during collision, or strikes any other non-moving object in the course of a motor vehicle accident. Closed brain injury from car accident incidents results in damage to the skull, brain, or scalp, but does not penetrate the skull. Closed head injury from car accident incidents may be difficult to diagnose because there might not be any visible external injury that indicates head trauma.

Closed head injury from car accident injuries that results in brain injury is most commonly known as a concussion. A concussion can range from mild to critical in terms of severity. Concussion closed head injury from car accident incidents can result in a temporary loss of consciousness or coma, or symptoms may not appear for some time after the initial trauma. Bleeding and swelling of the brain can occur from this type of closed head injury from car accident incidents when the brain is violently jolted back and forth in the skull upon impact. Even a mild concussion can result in subtle brain damage.

Brain damage in a closed head injury from car accident incidents can have physical, cognitive, and psychological repercussions. The physical characteristics of a closed head injury from car accident incidents can occur immediately following the initial accident or can worsen in the period following the accident. Physical repercussions of a closed head injury can include: headaches, paralysis, coordination difficulty, weakness, sensory problems, nausea, and difficulty sleeping.

Concussion related brain damage in a closed head injury from car accident incidents can also impede on a victim's cognitive abilities. This can greatly affect one's ability to work or attend school following a car accident. Problems with attention and concentration, difficulty with both short and long term memory functions, trouble reasoning and problem solving, and reduced information processing may all be cognitive impairments that develop after a closed head injury from car accident incidents.

The consequences of a closed head injury from car accident incidents can also intrude on a victim's personal relationships and psychological well being. People who have suffered these types of head injuries may experience changes in their personality. Closed head injury from car accident victims may suffer increased irritability, anxiety, and dis-inhibition. These victims may lack adequate coping mechanisms and social skills as a result of their injuries.
Victims who have suffered closed head injury from car accident incidents may be eligible to seek compensation for their damages if the accident was the result of another party's negligence. This liable party may be another driver or it may be the producers, distributors, or repair people responsible for the defective auto parts that caused the car accident. Victims of closed head injury from car accident incidents can seek compensation for medical expenses, loss of income or earning potential, property damage, and pain and suffering.

Symptoms of Whiplash

Whiplash is a term used most often to describe the symptoms resulting from a car accident. A victim of whiplash may experience any or all of these symptoms:

* Headaches
* Pain in the shoulders
* Pain between the shoulder blades
* Pain in one or both arms
* Fatigue
* Dizziness
* Vision problems
* Ringing in the ears (tinnitus)
* Poor concentration or memory
* Neck pain/stiffness
* Tight and/or sore muscles
* Tenderness in the muscles
* Low back pain
* Sleep disturbance
* Loss of motion in the neck

It's Best to See a Doctor
Even without symptoms, it is a very good idea to see a doctor in the case of a car accident. There can be damage without symptoms, or there can be delayed symptoms. Your doctor can help to determine the location and extent of the damage and develop an appropriate treatment plan.

According to a study done in 2006 at the Medical College of Wisconsin, whiplash due to a rear end collision can be prevented with positioning of the head close to the headrest

WHAT IF I WAS IN AN AUTO/CAR ACCIDENT ? What do I Do?!

Unfortunately, studies show that most of us will be in an auto accident at some point in our lives. The only question remaining, is how bad will it be?
The following are important things to remember if you are involved in an auto accident:

1. Seek treatment as soon as possible.
If there is a chance you may be seriously hurt, you should go to the Emergency room at your local hospital. There they can rule out fractures and life threatening injuries.

2. If you are still experiencing pain and discomfort a few days to a couple weeks later, than you should come to our office to find out if you have any structural damage.
NOTE: The longer you wait after an accident to come to our office, typically the longer it takes to get you better.

3. Most auto insurance companies have what is called Personal injury Protection/Med Pay. This means that your bills will be paid up to 100% up to a certain limit. Our office can check that for you.

4. If the accident was not your fault. The other party's auto insurance should cover your health care expenses in our office. We do all of the paperwork for you.

5. At the accident scene, get as much information on the other driver or drivers as possible. An accident report by Police is always helpful, but not required to have a case.

6. You should never settle with an insurance company before you have had us evaluate your injury for you. If you settle before your injury is fully resolved, you will be completely on your own and will have to pay out of pocket for your care.

7.Dealing with insurance companies can be difficult after an auto accident. We have a number of reputable and highly qualified Attorneys who we can refer you to for a complimentary consultation. Hiring a reputable Attorney essentially takes you out of the direct bargaining process with the insurance company and all the paperwork and phone calls associated with that and lets you concentrate on healing.

8. Injuries sustained after a car-accident if left untreated can lead to spinal degeneration and a host of other problems for years to come.
FINAL NOTE: We find that many people involved in an auto accident that WAS THEIR FAULT never get treatment.
This tends to be due to the fear that their insurance will go up after a claim is filed.
Your PIP (Personal Injury Protection) is why you have auto insurance in the first place.
Many insurance companies will not raise your rates after 1 or even 2 accidents in the same year.

THE INJURIES SUSTAINED IN AN AUTOMOBILE ACCIDENT CAN CAUSE A HOST OF PROBLEMS FOR YEARS TO COME, OR EVEN THE REST OF YOUR LIFE.
YOU OWE IT TO YOURSELF TO COME IN AND GET CHECKED.


Call our office today at (972) 215-7720.

Personal Injury Protection (PIP)

The Texas Department of Insurance requires automobile insurance carriers in our state to issue all automobile policies it writes at least $2500 worth of coverage and you have this coverage unless you reject it in writing. Most people are unaware of this coverage or even know what it is and therefore very few people use it. You end up paying for coverage that they don’t inform you about and you’re entitled to.

Why? Insurance is not understood and most people rely on their agent and claims adjusters to advise them on what to do after an accident. Insurance is a multi-billion dollar industry and are in business to make money. They keep their costs down, less payout, more profits and bonuses at the end of the year. Good for them and not for you.

What is PIP?

PIP is no fault coverage similar to health insurance but on your auto policy for your injuries and your passengers injuries. This coverage is available regardless who is at fault. Yes, you can be the cause of the accident and you will still be covered. There’s no deductible and no co-payment. There is other separate coverage that will cover the other party if you were at fault. If you do not have PIP then you could still be covered if you were in an accident in another state besides Texas. You may also be covered if you were hit in a crosswalk by a car or on a bicycle or borrowing someone else’s car.

What will a claim do to my insurance rates and policy renewal?

Under section 5.7016 of the Texas insurance code, automobile insurance carriers cannot non-renew you for filing one PIP claim in a 12 month period. Also, it is unlikely that they would raise your rates for a sole PIP claim.

Why doesn’t the other guy’s insurance pay for my medical expenses and why should I use my insurance?
Medical treatment is expensive and you are liable for the costs. There is a chance that the other party may never pay for your medical expenses leaving you a financial burden. PIP gives you peace of mind that your medical bills are covered. If you use your health insurance, you may have to pay a deductible and co-pays to your doctor and if the health insurance finds out that you were in an accident they could request to be reimbursed. Some people get referred to a medical provider by their attorney and the medical provider agrees to be paid months or even years later. Since there are a limited number of medical providers who agree to this arrangement, your choice and quality of healthcare may be limited. The answer is to use your PIP coverage so you will not have to pay for medical expenses out of your pocket and get the best possible healthcare treatment available for you and your family’s injuries caused by the accident.

Numerous studies have shown that years after whiplash victims settle their insurance claims, roughly half of them state that they still suffer with symptoms from their injuries.


If you have been involved in a car accident, whiplash injuries need to be taken very seriously. Because symptoms of a whiplash injury can take weeks or months to manifest, it is easy to be fooled into thinking that you are not as injured as you really are.
Too often people don't seek treatment following a car accident because they don't feel hurt. By far, the most common injury to the neck is a whiplash injury.Whiplash is caused by a sudden movement of the head, either backward, forward, or sideways, that results in the damage to the supporting muscles, ligaments and other connective tissues in the neck and upper back.

Unfortunately, by the time more serious complications develop, some of the damage from the injury may have become permanent.Numerous studies have shown that years after whiplash victims settle their insurance claims, roughly half of them state that they still suffer with symptoms from their injuries. If you have been in a motor vehicle or any other kind of accident, don't assume that you escaped injury if you are not currently in pain. Contact us today!

What to Do If Injured in an Accident and Suffer From Whiplash

The term "whiplash" was first used in 1928 to define an injury mechanism of sudden hyperextension followed by an immediate hyperflexion of the neck that results in damage to the muscles, ligaments and tendons – especially those that support the head. Today, we know that whiplash injuries frequently do not result from hyperextension or hyperflexion (extension and flexion beyond normal physiological limits), but rather an extremely rapid extension and flexion that causes injuries.

Due to their complicated nature and profound impact on peoples lives, few topics in health care generate as much controversy as whiplash injuries. Unlike a broken bone where a simple x-ray can validate the presence of the fracture and standards of care can direct a health care professional as to the best way in which to handle the injury, whiplash injuries involve an unpredictable combination of nervous system, muscles joints and connective tissue disruption that is not simple to diagnose and can be even more of a challenge to treat. In order to help you understand the nature of whiplash injuries and how they should be treated, it is necessary to spend a bit of time discussing the mechanics of how whiplash injuries occur.

The Four Phases of a Whiplash Injury
During a rear-end automobile collision, your body goes through an extremely rapid and intense acceleration and deceleration. In fact, all four phases of a whiplash injury occur in less than one-half of a second! At each phase, there is a different force acting on the body that contributes to the overall injury, and with such a sudden and forceful movement, damage to the vertebrae, nerves, discs, muscles, and ligaments of your neck and spine can be substantial.

Phase 1
During this first phase, your car begins to be pushed out from under you, causing your mid-back to be flattened against the back of your seat. This results in an upward force in your cervical spine, compressing your discs and joints. As your seat back begins to accelerate your torso forward, your head moves backward, creating a shearing force in your neck. If your head restraint is properly adjusted, the distance your head travels backward is limited. However, most of the damage to the spine will occur before your head reaches your head restraint. Studies have shown that head restraints only reduce the risk of injury by 11-20%.

Phase 2
During phase two, your torso has reached peak acceleration - 1.5 to 2 times that of your vehicle itself - but your head has not yet begun to accelerate forward and continues to move rearward. An abnormal S-curve develops in your cervical spine as your seat back recoils forward, much like a springboard, adding to the forward acceleration of the torso. Unfortunately, this forward seat back recoil occurs while your head is still moving backward, resulting in a shearing force in the neck that is one of the more damaging aspects of a whiplash injury. Many of the bone, joint, nerve, disc and TMJ injuries that I see clinically occur during this phase.

Phase 3
During the third phase, your torso is now descending back down in your seat and your head and neck are at their peak forward acceleration. At the same time, your car is slowing down. If you released the pressure on your brake pedal during the first phases of the collision, it will likely be reapplied during this phase. Reapplication of the brake causes your car to slow down even quicker and increases the severity of the flexion injury of your neck. As you move forward in your seat, any slack in your seat belt and shoulder harness is taken up.

Phase 4
This is probably the most damaging phase of the whiplash phenomenon. In this fourth phase, your torso is stopped by your seat belt and shoulder restraint and your head is free to move forward unimpeded. This results in a violent forward-bending motion of your neck, straining the muscles and ligaments, tearing fibers in the spinal discs, and forcing vertebrae out of their normal position. Your spinal cord and nerve roots get stretched and irritated, and your brain can strike the inside of your skull causing a mild to moderate brain injury. If you are not properly restrained by your seat harness, you may suffer a concussion, or more severe brain injury, from striking the steering wheel or windshield.

Injuries Resulting from Whiplash Trauma
As we discussed briefly in the introduction, whiplash injuries can manifest in a wide variety of ways, including neck pain, headaches, fatigue, upper back and shoulder pain, cognitive changes and low back pain. Due to the fact that numerous factors play into the overall whiplash trauma, such as direction of impact, speed of the vehicles involved, as well as sex, age and physical condition, it is impossible to predict the pattern of symptoms that each individual will suffer. Additionally, whiplash symptoms commonly have a delayed onset, often taking weeks or months to present. There are, however, a number of conditions that are very common among those who have suffered from whiplash trauma.

Neck pain
It is the single most common complaint in whiplash trauma, being reported by over 90% of patients. Often this pain radiates across the shoulders, up into the head, and down between the shoulder blades. Whiplash injuries tend to affect all of the tissues in the neck, including the facet joints and discs between the vertebrae, as well as all of the muscles, ligaments and nerves.

Facet joint pain is the most common cause of neck pain following a car accident. Facet joint pain is usually felt on the back of the neck, just to the right or left of center, and is usually tender to the touch. Facet joint pain cannot be visualized on x-rays or MRIs. It can only be diagnosed by physical palpation of the area.

Disc injury is also a common cause of neck pain; especially chronic pain. The outer wall of the disc (called the anulus) is made up of bundles of fibers that can be torn during a whiplash trauma. These tears, then, can lead to disc degeneration or herniation, resulting in irritation or compression of the nerves running through the area. This compression or irritation commonly leads to radiating pain into the arms, shoulders and upper back, and may result in muscle weakness.


Damage to the muscles and ligaments in the neck and upper back are the major cause of the pain experienced in the first few weeks following a whiplash injury, and is the main reason why you experience stiffness and restricted range of motion. But as the muscles have a chance to heal, they typically don’t cause as much actual pain as they contribute to abnormal movement. Damage to the ligaments often results in abnormal movement and instability.

Headaches
After neck pain, headaches are the most prevalent complaint among those suffering from whiplash injury, affecting more than 80% of all people. While some headaches are actually the result of direct brain injury, most are related to injury of the muscles, ligaments and facet joints of the cervical spine, which refer pain to the head. Because of this, it is important to treat the supporting structures of your neck in order to help alleviate your headaches.

TMJ problems
A less common, but very debilitating disorder that results from whiplash is temporomandibular joint dysfunction (TMJ). TMJ usually begins as pain, clicking and popping noises in the jaw during movement. If not properly evaluated and treated, TMJ problems can continue to worsen and lead to headaches, facial pain, ear pain and difficulty eating. Many chiropractors are specially trained to treat TMJ problems, or can refer you to a TMJ specialist.

Brain injury
Believe it or not, mild to moderate brain injury is common following a whiplash injury, due to the forces on the brain during the four phases mentioned earlier. The human brain is a very soft structure, suspended in a watery fluid called cerebrospinal fluid. When the brain is forced forward and backward in the skull, the brain bounces off the inside of the skull, leading to bruising or bleeding in the brain itself. In some cases, patients temporarily lose consciousness and have symptoms of a mild concussion. More often, there is no loss of consciousness, but patients complain of mild confusion or disorientation just after the crash. The long-term consequences of a mild brain injury can include mild confusion, difficulty concentrating, sleep disturbances, irritability, forgetfulness, loss of sex drive, depression and emotional instability. Although less common, the nerves responsible for your sense of smell, taste and even your vision may be affected as well, resulting in a muted sense of taste, changes in your sensation of smell and visual disturbances.

Dizziness
Dizziness following a whiplash injury usually results from injury to the facet joints of the cervical spine, although in some cases injury to the brain or brain stem may be a factor as well. Typically, this dizziness is very temporary improves significantly with chiropractic treatment.

Low back pain
Although most people consider whiplash to be an injury of the neck, the low back is also commonly injured as well. In fact, low back pain is found in more than half of rear impact-collisions in which injury was reported, and almost three-quarters of all side-impact crashes. This is mostly due to the fact that the low back still experiences a tremendous compression during the first two phases of a whiplash injury, even though it does not have the degree of flexion-extension injury experienced in the neck.

Recovery from Whiplash
With proper care, many mild whiplash injuries heal within six to nine months. However, more than 20% of those who suffer from whiplash injuries continue to suffer from pain, weakness or restricted movement two years after their accident. Unfortunately, the vast majority of these people will continue to suffer from some level of disability or pain for many years after that, if not for the rest of their lives.

Whiplash is a unique condition that requires the expertise of a skilled health professional specially trained to work with these types of injuries. The most effective treatment for whiplash injuries is a combination of chiropractic care, rehabilitation of the soft tissues and taking care of yourself at home.


Chiropractic Care
Chiropractic care utilizes manual manipulation of the spine to restore the normal movement and position of the spinal vertebrae. It is by far the single-most effective treatment for minimizing the long-term impact of whiplash injuries, especially when coupled with massage therapy, trigger point therapy, exercise rehabilitation and other soft tissue rehabilitation modalities.

Soft Tissue Rehabilitation
The term ‘soft tissue’ simply refers to anything that is not bone, such as your muscles, ligaments, tendons, nervous system, spinal discs and internal organs. During a whiplash injury, the tissues that are affected most are the soft tissues, the muscles, ligaments and discs in particular. In order to minimize permanent impairment and disability, it is important to use therapies that stimulate the soft tissues to heal correctly. These include massage therapy, electro-stimulation, trigger point therapy, stretching and specific strength and range of motion exercises.

Home Care
The most effective chiropractic care and soft tissue rehabilitation will be limited in its benefit if what you do at home or at work stresses or re-injures you on a daily basis. For this reason, it is important that your plan of care extend into the hours and days between your clinic visits to help speed your recovery. Some of the more common home care therapies are the application of ice packs, limitations on work or daily activities, specific stretches and exercises, taking nutritional supplements and getting plenty of rest.

Medical Intervention
In some severe cases of whiplash, it may be necessary to have some medical care as part of your overall treatment plan. The most common medical treatments include the use of anti-inflammatory medications, muscle relaxants, trigger point injections and, in some cases, epidural spinal injections. These therapies should be used for short-term relief of pain, if necessary, and not be the focus of treatment. After all, a drug cannot restore normal joint movement and stimulate healthy muscle repair. Fortunately, surgery is only needed in some cases of herniated discs, when the disc is pressing on the spinal cord, and in some cases of spine fractures.

Thursday, July 21, 2011

What is Personal Injury Protection (PIP)

The Texas Department of Insurance requires automobile insurance carriers in our state to issue all automobile policies it writes at least $2500 worth of coverage and you have this coverage unless you reject it in writing. Most people are unaware of this coverage or even know what it is and therefore very few people use it. You end up paying for coverage that they don’t inform you about and you’re entitled to.

Why? Insurance is not understood and most people rely on their agent and claims adjusters to advise them on what to do after an accident. Insurance is a multi-billion dollar industry and are in business to make money. They keep their costs down, less payout, more profits and bonuses at the end of the year. Good for them and not for you.

What is PIP?

PIP is no fault coverage similar to health insurance but on your auto policy for your injuries and your passengers injuries. This coverage is available regardless who is at fault. Yes, you can be the cause of the accident and you will still be covered. There’s no deductible and no co-payment. There is other separate coverage that will cover the other party if you were at fault. If you do not have PIP then you could still be covered if you were in an accident in another state besides Texas. You may also be covered if you were hit in a crosswalk by a car or on a bicycle or borrowing someone else’s car.

What will a claim do to my insurance rates and policy renewal?

Under section 5.7016 of the Texas insurance code, automobile insurance carriers cannot non-renew you for filing one PIP claim in a 12 month period. Also, it is unlikely that they would raise your rates for a sole PIP claim.

Why doesn’t the other guy’s insurance pay for my medical expenses and why should I use my insurance?

Medical treatment is expensive and you are liable for the costs. There is a chance that the other party may never pay for your medical expenses leaving you a financial burden. PIP gives you peace of mind that your medical bills are covered. If you use your health insurance, you may have to pay a deductible and co-pays to your doctor and if the health insurance finds out that you were in an accident they could request to be reimbursed. Some people get referred to a medical provider by their attorney and the medical provider agrees to be paid months or even years later. Since there are a limited number of medical providers who agree to this arrangement, your choice and quality of healthcare may be limited. The answer is to use your PIP coverage so you will not have to pay for medical expenses out of your pocket and get the best possible healthcare treatment available for you and your family’s injuries caused by the accident.

Mercury insurance: Kind and Generous?

This individual handled her case on her own and it was a nightmare. Let us help you get well and help you take the headache out of this situation and set you up with a reputable attorney, so you can focus on getting well.

 

Jennifer Evans Gardner: Mercury: Kind and Generous

Mercury Insurance is so generous.

On Tuesday, California voters will get the chance to vote on Prop 17, which Mercury, out of the goodness of their hearts, has spent some $10 million on. Those crazy kids. All to save us money.

Unless you live under a rock, you've heard about this initiative, which if passed, will allow insurance companies to raise premiums on drivers who, for any reason, didn't have insurance coverage at some point in the past five years. They're calling it a "loyalty discount."

Well, duh, you say. Mercury doesn't want to save us money.

But it's not just Prop 17... Mercury doesn't appear to like paying legitimate claims either. I would know. I'm a Mercury insured.

Two years ago, I was rear-ended by another Mercury insured while sitting at a stop sign, an accident that resulted in a neck injury. No problem, I thought. Two civilized individuals, both insured by the same company - why would there be a problem? I got my car repaired, then contacted Mercury to let them know they needed only to reimburse my out-of-pocket medical expenses - nothing else.

Know what they said?

The generous folks at Mercury offered me about half of what I had paid out of pocket. In other words, I would only have to pay a few thousand dollars for being rear-ended. Lucky me!

Wait a minute... isn't that what insurance is for, I asked? Why do I make those monthly payments, if not to keep from going into debt in case of an accident? Apparently not. Even though I had gone to my doctor of 25 years, a reputable physician in Beverly Hills, in their eyes, I had "over-treated," so I was out of luck.

I had a choice. I could accept their offer and eat the difference, or I could sue them. However, with some research, I discovered countless similar complaints... it seemed that this was actually a pattern with Mercury; and that if I did venture to sue them, I would likely spend years in depositions and a trial, not something I had the time or the patience for.

In a phone interview, Naomi Seligman, Director of Public Affairs for Consumer Watchdog, a non-partisan consumer advocate organization, said, "there are hundreds of complaints lodged against Mercury for everything from discrimination to trying to weasel customers out of claims money." I was hardly unique.
I decided to sue them in small claims court.
I know what you're thinking. You can't sue an insurance company in small claims court! True. But if you sue their insured, Mercury will send a representative. Not for you, silly -- for the other guy.

Of course, small claims court is for quick, no-frills citizen vs. citizen hearings; however, Mercury found a loophole. In fact, the Mercury representative in my case seemed to know a lot of folks at the courthouse, and admitted to the defendant that he was "a regular."

My "Mr. Smith Goes to Washington" (or "Ms. Evans-Gardner Goes to Van Nuys") moment was a proud one. I showed up in court with a thick file of color-coded exhibits, my witnesses, and a kick-ass closing argument, if I do say so myself. I greeted the defendant, apologizing for having to drag him into court. He was cordial, but embarrassed. An insured driver, he would have also hoped to avoid such a situation.

A Mercury rep, holding an official-looking briefcase, stuck out his hand with a big smile. "Good morning, I am Mr. S, here from Mercury Insurance on behalf of Mr. X." "Oh, good morning," I replied. "Are you here for me, too?"

He looked puzzled. "You?" he smirked.

"Well, I'm your insured, too." I looked around the room. "Is there a Mercury guy for me?" He looked flustered. "Gosh," I said. "Could there be a conflict of interest?"

He proceeded to advise me, kindly, mind you, that I had little chance of winning and suggested I accept their settlement. "No, thank you," I answered politely.

"I see you have your husband and son here," said Mercury Man. Well, yes, I explained. Not only were they witnesses, but this was also a teaching moment for my 12 year-old. I looked him straight in the eye, adding, "I want my son to see that when someone tries to take advantage of you, you stand up for yourself." He sputtered something about how, as a parent, he appreciated that. I wondered how his parental ethics figured into bullying a victim into paying for her injuries.

To make a long story short, my Perry Mason moment never happened. The commissioner simply looked at the evidence and awarded me the maximum amount, plus court fees.

In other words, I beat Mercury's scrawny ass.

All I had to do was sit back and wait for my check, right? Wrong. It didn't come. I couldn't believe it. Could Mercury really be so bold as to violate a Superior Court order?
I called Darrel Ng, Press Secretary for the California State Department of Insurance, who said, "Mercury has been fined $500,000 in the past five years for claims handling practices, among other things." Guess they don't mind breaking a few rules.

Meanwhile, $500,000 over five years? That's just $100,000 per year, a downright bargain for Mercury, whose profits were reported at over $400 million last year.

Turns out, Mercury isn't all that generous after all. Spending millions to save us money? That's a good one. The question is: how many voters will they fool with their misleading ads and ballot language?
I finally received my check the other day, exactly two years after the accident, and though my neck still hurts, that's a load off my mind. By the way, I'm shopping for a new auto insurance company... any suggest
ions?

FACTORS INFLUENCING INJURY TOLERANCE

A number of factors influence the extent and severity of injuries experienced by victims of motor vehicle accidents. The following list contains many of the most important factors influencing injury severity and prognosis:

  • how long after the accident treatment was initiated
  • the type of treatment received
  • patient compliance to the treatment plan
  • the nature of the accident (frontal, rear, side impact collision or a combination)
  • severity of accident (i.e. automobile speeds)
  • the size and speed of your vehicle and other vehicles involved
  • whether or not seat belts were worn
  • whether you were aware of the impending accident
  • the height of the head rest
  • the age of the individual (elderly and children more susceptible to the forces involved in MVA's)
  • the size and strength of the individual - more specifically, their spinal musculature
  • the presence of preexisting spinal conditions

Findings from a recent Canadian study, published in the Journal of Clinical Epidemiology, indicate that the following patient and crash characteristics lead to a poorer prognosis:

The prognosis for recovery was poor if:
  • there were additional injuries besides whiplash,
  • the patient was female, elderly or had dependents,
  • the crash was severe, involved a truck or bus,
  • the injured party was not wearing a seat belt.
Patients who lacked full-time employment, collided with a moving vehicle, or were hit head-on or perpendicularly were also at greater risk of a poor prognosis compared with other patients.

EXTREMITY PAIN, NUMBNESS and TINGLING

Extremity symptoms such as arm and hand pain, numbness and tingling are common following motor vehicle accidents (MVA's). They are caused by thoracic outlet syndrome, myofascial adhesions, muscular trigger points, and spinal disc lesions. It's important to note that these symptoms are commonly not experienced until weeks or even months after the injury. A study, published in the Britain Journal of Rheumatology, involved 37 motor vehicle injury patients and found 35% had an onset of arm and hand symptoms (upper extremity symptoms) beyond 3 months of the accident.
This reinforces the need for proper and full treatment of MVA injuries. Failure to receive appropriate treatment (where injured tissues are fully healed and tissue functioning is adequately restored) is a major contributor to the development of these symptoms.

Auto/Car Accidents

If you have been involved in a car accident, whiplash injuries need to be taken very seriously. Because symptoms of a whiplash injury can take weeks or months to manifest, it is easy to be fooled into thinking that you are not as injured as you really are.

Too often people don't seek treatment following a car accident because they don't feel hurt. By far, the most common injury to the neck is a whiplash injury.Whiplash is caused by a sudden movement of the head, either backward, forward, or sideways, that results in the damage to the supporting muscles, ligaments and other connective tissues in the neck and upper back.

Unfortunately, by the time more serious complications develop, some of the damage from the injury may have become permanent.Numerous studies have shown that years after whiplash victims settle their insurance claims, roughly half of them state that they still suffer with symptoms from their injuries. If you have been in a motor vehicle or any other kind of accident, don't assume that you escaped injury if you are not currently in pain. Contact us today!

Numerous studies have shown that years after whiplash victims settle their insurance claims, roughly half of them state that they still suffer with symptoms from their injuries.

What is Peripheral Neuropathy?

Peripheral neuropathy describes damage to the peripheral nervous system, which transmits information from the brain and spinal cord to every other part of the body.

More than 100 types of peripheral neuropathy have been identified, each with its own characteristic set of symptoms, pattern of development, and prognosis. Impaired function and symptoms depend on the type of nerves -- motor, sensory, or autonomic -- that are damaged. Some people may experience temporary numbness, tingling, and pricking sensations, sensitivity to touch, or muscle weakness. Others may suffer more extreme symptoms, including burning pain (especially at night), muscle wasting, paralysis, or organ or gland dysfunction. Peripheral neuropathy may be either inherited or acquired. Causes of acquired peripheral neuropathy include physical injury (trauma) to a nerve, tumors, toxins, autoimmune responses, nutritional deficiencies, alcoholism, and vascular and metabolic disorders. Acquired peripheral neuropathies are caused by systemic disease, trauma from external agents, or infections or autoimmune disorders affecting nerve tissue. Inherited forms of peripheral neuropathy are caused by inborn mistakes in the genetic code or by new genetic mutations.

Is there any treatment?

Chiropractic brain based therapy helps in adopting healthy habits -- such as maintaining optimal weight, avoiding exposure to toxins, following a physician-supervised exercise program, eating a balanced diet, correcting vitamin deficiencies, and limiting or avoiding alcohol consumption -- can reduce the physical and emotional effects of peripheral neuropathy. Systemic diseases frequently require more complex treatments.
There are therapies for many forms.

Get Examined after a Car/Auto Accident!

Untreated, many people suffer with headaches, back, and neck pain for years after an accident. Chiropractic patient care has been shown to provide effective relief from the sprain and strain resulting from motor vehicle accident injuries.

Whiplash injury is the effect of sprain and strain in the neck, and results from injury to joints, nerves, ligaments and muscles of the cervical spine.

When there is an impact to the vehicle, most often from the rear, and the neck is "whipped" back and forth, this is technically termed hyperextension and hyperflexion of the cervical spine. Nerves are often injured during this process and can cause a radiation of pain to the arms or legs, nausea, dizziness, blurred vision or other symptoms.

skull neck bonesWhen viewing a x-ray of the neck after a whiplash injury, there is most often a loss of the natural curvature, or lordosis. Medical radiologists will note this condition when reading a patient's x-rays, disregarding whiplash as they do not consider it momentous, and some ignore whiplash altogether if it does not present itself in an X ray. Conditions can present themselves after a patient has been released and made a settlement without an attorney. This means that they have to take care of all the medical bills themselves if not covered.

Unfortunately, if this condition is left untreated after the swelling goes down, whiplash injury can contribute to many different symptoms and health problems that can lead to arthritis in the spine that could have been prevented.

Specialized Chiropractic care provides relief of pain, removes pressure or "pinching" that can cause damage to nerves, and prevents the proliferation of spinal arthritis by normalizing the movement of individual segments of the spine, thereby resolving the "wear and tear" that otherwise occurs.

Chiropractic treatment truly rehabilitates the areas of injury, by helping to restore the natural curves of the spine, along with exercises and other positive treatment. It is rare that in this type of treatment you will hear a Chiropractor say to you, "you have to learn to live with it."

Most vehicle insurance companies will cover the fees for Chiropractic treatment applied for in full for injuries resulting from motor vehicle accidents, either through third party or State or medical pay type insurance, or both.

Look for a Chiropractic office that can provide service to verify insurance coverage and to directly bill the carriers involved as a courtesy to their patients. You need to be able to pursue the care you need without the stress of handling insurance and related concerns. You can choose to handle the financial aspect of care on your own or in whatever ways you choose.

Motor vehicle accidents can cause injury and pain in other areas of the spine and body. Patients often complain of associated shoulder pain, upper back pain, lower back pain, and pain to the hips and legs. When multiple areas of the spine are involved, the condition is more complex. Treatment may need to be over a period of weeks, usually resulting in the patient getting full movement and full recovery.

Monday, July 18, 2011

Migraines and Headaches

Migraines and headaches are NOT the result of an Aspirin shortage. They are NOT normal, and everyone does NOT have them.
A frequent and overlooked cause of Migraines and other headaches is the malfunction of the spinal bones in the neck and upper back.

When the bones of the spine lose their normal position or motion, sensitive nerves and blood vessels to the head can be affected. When spinal nerves and related tissues are stretched or irritated, they can produce Migraines and other types of headaches. Aspirin and other medications may cover up these warning signs, but do not correct the underlying structural CAUSE.

Many people experience correction and long term relief through Chiropractic care, without the short and long term side effects that accompany ALL pain medications.
Call our office to have your type of Migraine or Headache diagnosed and discover the life changing experience many of our Migraine / Headache patients have found.

The Docs at North Dallas Chiropractic

What is Personal Injury Protection (PIP)

The Texas Department of Insurance requires automobile insurance carriers in our state to issue all automobile policies it writes at least $2500 worth of coverage and you have this coverage unless you reject it in writing. Most people are unaware of this coverage or even know what it is and therefore very few people use it. You end up paying for coverage that they don’t inform you about and you’re entitled to.

Why? Insurance is not understood and most people rely on their agent and claims adjusters to advise them on what to do after an accident. Insurance is a multi-billion dollar industry and are in business to make money. They keep their costs down, less payout, more profits and bonuses at the end of the year. Good for them and not for you.

What is PIP?

PIP is no fault coverage similar to health insurance but on your auto policy for your injuries and your passengers injuries. This coverage is available regardless who is at fault. Yes, you can be the cause of the accident and you will still be covered. There’s no deductible and no co-payment. There is other separate coverage that will cover the other party if you were at fault. If you do not have PIP then you could still be covered if you were in an accident in another state besides Texas. You may also be covered if you were hit in a crosswalk by a car or on a bicycle or borrowing someone else’s car.

What will a claim do to my insurance rates and policy renewal?

Under section 5.7016 of the Texas insurance code, automobile insurance carriers cannot non-renew you for filing one PIP claim in a 12 month period. Also, it is unlikely that they would raise your rates for a sole PIP claim.

Why doesn’t the other guy’s insurance pay for my medical expenses and why should I use my insurance?

Medical treatment is expensive and you are liable for the costs. There is a chance that the other party may never pay for your medical expenses leaving you a financial burden. PIP gives you peace of mind that your medical bills are covered. If you use your health insurance, you may have to pay a deductible and co-pays to your doctor and if the health insurance finds out that you were in an accident they could request to be reimbursed. Some people get referred to a medical provider by their attorney and the medical provider agrees to be paid months or even years later. Since there are a limited number of medical providers who agree to this arrangement, your choice and quality of healthcare may be limited. The answer is to use your PIP coverage so you will not have to pay for medical expenses out of your pocket and get the best possible healthcare treatment available for you and your family’s injuries caused by the accident.

Why an MVA can't always be Measured as to the extent of injury, But the Insurance company will try for their own Gain

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.

HEADACHES

Headaches are the second most common complaint following motor vehicle accidents (MVA's). Like the many other MVA symptoms, headache may not be present immediately following the accident and may take several weeks and often months to eventually surface. Most post-traumatic headaches are thought to originate from the soft tissues and facet joints of the neck as well as injury or irritation to the nerves of the upper cervical spine.
The literature has shown there to be multiple types of headaches which can be experienced following a MVA. These include the following:

  • Cervicogenic Headaches
  • Muscle Tension Headaches
  • Migraine Headaches
  • Myofascial Trigger Point Headaches
  • Site-Of-Impact Headaches
  • Drug-Induced Headaches (following excessive or prolonged analgesic use)

Soft Tissue Injuries From A Low Impact Auto Accident

A low impact auto accident is generally defined as an incident that takes place at speeds less than 10 miles per hour (mph). This type of collision usually causes the least amount of damage to the vehicles involved. Body injuries can result from any accident and that includes ones that occur with vehicles going less than 10 mph. Soft tissue injuries are the most common problem for those involved in a low impact accident.

A motor vehicle accident that takes place at speeds between under 10 mph often brings about little visible damage to the cars involved. Sometimes due to the fact that minimal damage was done to vehicle the injuries to the people in the vehicles are overlooked. This does not mean that bodily injury did not occur to the passengers during the crash.


While an automobile is built to take a slow 5 to 10 mph crash that is not necessarily true for your body. In a low impact accident a person’s soft tissue can be damaged.The back and neck are the usual problem spots for soft tissue injuries. Soft tissue is basically a person’s ligaments, tendons and muscles. Soft tissue injuries are typically classified as contusions or bruises, sprains or strains.


A contusion is an injury to the soft tissue caused by blunt force. This force produces pooling of blood around the injury causing discoloring of the skin. This is commonly is referred to as a bruise. Bruising can be found in different shapes and colors.


A sprain is an injury to a ligament often brought about by a wrench or twist. A sprain can be a simple sprain, a partial tear or a complete tear. This can happen to various parts of a person’s body during an accident. It is not uncommon for a person to twist in their seat as a vehicle strikes theirs during the incident.


A strain is an injury to the muscle or tendon caused by overuse, force or stretching. The force of the car crash can push on a person’s soft tissue or cause parts to stretch in an abnormal way.Muscles and tendons support your bones. A strain may cause a partial or complete tear in the muscle and tendon combination.


The neck of a car occupant can whip forward causing the most common rear impact injury known as whiplash. General Motors (GM) did a study regarding crashes at speeds below eight mph. GM found, to no surprise, that injuries do occur at such low speeds. The study also showed that whiplash injuries account for more than half of all injuries connected to vehicular accidents.


Although these types of injuries are characteristically classified as minor nearly 30 percent of those hurt in low speed collisions have reported having neck pain up to three years later. This injury is likely to be worse in those that experienced a rear end collision. Depending on the age of the person this injury could cause a permanent disability.


A motor vehicle can take the force of a low speed collision without showing much damage due to the advances car manufacturers have made in the construction of their vehicles. When a collision does occur the force of the accident pushes inertia somewhere and once the automobile has taken part of that energy away the occupants take the rest. These forces are what can cause people bodily harm even in a crash of below 10 mph.Soft tissue injuries can occur to those involved in a low speed impact and though these injuries might be hard to see they exist.

Anatomy of Whiplash

When your body is involved in trauma, your neck is one of your most vulnerable areas. Whiplash, the hard and fast forward-backward movement of the neck, can cause pain that can last well after other injuries have healed. To understand why your neck is so sore, it helps to know the anatomy involved.

Whiplash can be a complicated diagnosis as the doctor tries to figure out exactly which parts of the spine have been affected. And there are a lot of complex parts to your cervical spine—the technical name for your neck. The cervical spine begins at the base of the skull. It contains seven small vertebrae (bones), which doctors label C1 to C7 (the 'C' means cervical). The numbers 1 to 7 indicate the level of the vertebrae. C1 is closest to the skull, while C7 is closest to the chest.


In between each vertebra are tough fibrous shock-absorbing pads called the intervertebral discs. (These discs are what slide back and forth during the trauma.) Each disc is made up of a tire-like outer band and a gel-like inner substance. The outer band is called the annulus fibrosus; the inner part is called the nucleus pulposus.


In addition to bones and discs, your cervical spine also includes the upper region of the spinal cord, eight nerve roots, an elaborate system of arteries and veins, 32 muscles for strength, and numerous ligaments. For such a small area, there is a lot to your neck. That means that there are a lot of parts that can be injured when you have whiplash.


Remarkably, the cervical spine supports the full weight of your head, which is usually about 8 pounds—yet no other region of the spine has such freedom of movement. The cervical spine can move your head in nearly every direction: 90° of forward motion, 90° of backward motion, 180° of side to side motion, and almost 120° of tilt to either shoulder.


Unfortunately, this flexibility makes the neck very susceptible to pain and injury, such as whiplash. In whiplash, those 15 pounds are dramatically tossed frontwards then backwards—that's one important reason to wear seatbelts properly and use airbags whenever possible.

spineuniverse.com

Why should i be examined after a auto/car accident?

What are the symptoms of whiplash?

The most common symptoms related to whiplash include:

* neck pain and stiffness,

* headache,

* shoulder pain and stiffness,

* dizziness,

* fatigue,

* jaw pain (temporomandibular joint symptoms),

* arm pain,

* arm weakness,

* visual disturbances,

* ringing in the ears (tinnitus), and

* back pain.

In the more severe and chronic case of "whiplash associated disorder" symptoms can include:

* depression,

* anger,

* frustration,

* anxiety,

* stress,

* drug dependency,

* post-traumatic stress syndrome,

* sleep disturbance (insomnia),

* and

* social isolation.

How is whiplash diagnosed?

After an accident the patient may be taken to the hospital and/or a Chiropractor's office to be examined. The doctor will examine the patient to determine if they have any injuries that require treatment. Based on the symptoms and examination findings the doctor may place a collar on the neck for additional support. The doctor may also obtain x-rays of the neck to check for more serious injury. The most important first step is to make sure there is no major injury to the neck, head or the rest of the body requiring immediate treatment.

If the x-rays are normal but the patient continues to have neck pain, the doctor may keep the cervical collar in place and see the back in the office in about a week for an additional examination. At that time the doctor may obtain new x-rays to see if there have been any changes. If the doctor is still concerned about soft tissue injuries, he or she may obtain either x-rays with the head leaning forward and backwards (dynamic x-rays) or obtain an MRI (magnetic resonance imaging study). These dynamic x-rays or MRI scans are better able to detect injuries to the soft tissues of the neck, especially instability, that may not been seen with normal x-rays of the neck.