Atlanta Car Accident Information

Auto Injuries:

According to the Insurance Research Council, nearly 1/3 of all claimants injured in motor vehicle accidents (MVA's) seek treatment from doctors of chiropractic. This is an impressive number given that the National Safety Council (NSC) has determined there to be more than 12 million MVA's annually involving
more than 20 million vehicles.

The reason individuals like yourself choose chiropractic care for treatment of injuries sustained in MVA's is simple - chiropractic care is exceptional in the treatment of soft tissue injuries, especially of the spine. Since the most common injuries associated with MVA's are sprains and strains of the spinal muscles and ligaments, it's only natural that chiropractic be the treatment of choice.
Many studies have also found individuals injured in MVA's prefer chiropractic care for the treatment of their injuries. One such study evaluated 190 whiplash injury victims and found those who received chiropractic care reported treatment satisfaction of 100%.

1.Balla JI, Iansek R. Headaches arising from disorders of the cervical spine. In: Hopkins A, ed. Headache: Problems in Diagnosis and Management. London: WB Saunders; 1988.

Minimum Accident Speed to Cause Injury:

Minimum Accident Speed to Cause Injury:Studies involving live humans have demonstrated that a motor vehicle accident of as little as 5 mph can induce cervical (neck) injury. However, other studies have shown that cars can often withstand crashes of 10 mph or more without sustaining damage.
Motor vehicle accidents can result in a number of very diverse and complex injuries and symptoms. This is due to the diversity of factors involved with the each MVA - i.e. vectors of the collision, size of the vehicles involved in collision, preexisting health conditions of victims, age of victims, size and strength of victims, etc.

Whiplash:

The Forwards-flexion and/or backwards-extension of the neck essentially
results in a soft tissue sprain/strain injury to the structures within the cervical
and upper thoracic spinal regions. When the initial impact occurs and the head
is forced in either excessive flexion or excessive extension, protective
reflexes cause the muscles of the neck to forcefully contract which "whips" the
head back in the opposite direction. The resulting injury often leads to
numerous symptoms, many of which are confusing and poorly understood.
Symptoms following a "whiplash" accident include:

neck pain, tenderness, achiness and stiffness

cervical muscle spasms

tenderness and nodules in superficial cervical musculature

cervical reduced range of motion

post-traumatic headaches (including migraine and muscle-tension headaches)

shoulder and interscapular pain

hand and finger pain, numbness and tingling

blurred vision

difficulty swallowing/feeling of lump in throat

dizziness and balance problems

lightheadedness

post-traumatic depression and cognitive problems

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.

Back Pain:

In addition to whiplash/neck pain and injuries, the mid and lower back are also frequently injured in motor vehicle accidents (MVA's).

Mid Back Pain:

The mid back or thoracic spine is most commonly injured as a result of the asymmetry of most seat belt designs. As the torso moves forward the seat belt locks and the torso is forced to stop at the end of the shoulder strap. Because the shoulder strap crosses only one shoulder (usually the left), the side without a strap (usually right) is able to travel forward further which results in a forward flexing and twisting injury to the mid back.

Lower Back Pain:

The lumbar spine is also frequently injured, but the mechanism differs from the above. As the torso and pelvis move forward the pelvis is stopped by the lap belt. However, the torso continues to move forward which producing a shearing force in the lumbar spine. These injuries often result in lumbar disc injuries.

Chiropractic care is a safe, natural, noninvasive, and addresses the cause of the symptoms. Our treatments also include active patient participation, and in some cases, lifestyle modifications. While we do focus on eliminating pain early on, we realize that in addition to pain - optimal tissue healing, restoration of normal function, and prevention of future recurrences and reinjuries - are equally important.

We also incorporate many natural and safe adjunctive therapies into our treatment plan to further assist in the healing process. Some common adjunctive therapies include ice therapy, heat therapy, physical therapies like therapeutic ultrasound and muscle stimulation, spinal traction, soft tissue mobilization, spinal exercises and stretches, and nutritional supplementation.

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MRI Demonstrates Alar Ligament Damage

MRI Demonstrates Alar Ligament Damage

Spine Journal published a paper on November 15, 2006 (Volume 31(24), pp 2820-2826) titled Magnetic Resonance Imaging Assessment of Craniovertebral Ligaments and Membranes After Whiplash Trauma. The authors evaluated the upper cervical spines of 92 chronic whiplash patients and 30 matched control patients. All patients were 2-9 years chronic with normal x-rays. The paper was particularly interesting because it identified a serious injury that often times goes unidentified in clinical practice. The injury they were looking for in this paper involved the Alar ligaments which support the upper cervical spine and skull

The Alar ligament provides significant support to the cervicocranial junction. The two alar ligaments connect the sides of the dens (on the axis, or 2nd cervical vertebra) to tubercles on the medial side of the occipital condyle (the base of the skull). They are short, tough, fibrous cords that attach the skull to C1 vertebra and function to check side-to-side movements of the head when it is turned. The alar ligaments are also known as the "check ligaments of the odontoid."

The study reviewed the literature and looked at whiplash imaging and the associated anatomic and morphologic findings. The authors conclude that there is a correlation between clinical impairment and morphologic findings. Furthermore, they concluded that whiplash trauma can damage soft tissue structures of the upper cervical spine, particularly the Alar ligaments.

To make the diagnosis, special MRI protocols need to be applied. Proton-density weighted sequences of 2mm or less are the format of choice and they should be performed on a high field magnet (preferably 1.5 Tesla)

Here are some of the observations of the authors:
1. “Most investigators who have studied the natural history of whiplash patients have found long-term symptoms in 24% to 70%, among whom 12% to 16% are severely impaired many years after the accident interfering with their job and everyday activities.”
2. The prevalence of the cervical facet joint as an anatomic source of chronic pain after whiplash trauma pain is 60%.
3. Whiplash trauma can cause structural changes predisposing to premature degenerative disc disease.
4. One study found that “10% of patients with normal radiographic findings in the acute stage of whiplash injury developed new degenerative changes at 2- to 3-year follow-up.”
5. Flexion and extension x-rays in chronic whiplash syndrome tend to show “significantly decreased range of motion in chronic whiplash syndrome compared with asymptomatic individuals.”
6. “The Alar ligaments are the main restraints to axial rotation and lateral bending in the upper cervical spine.”
7. CT documented increased upper cervical rotation toward one side indicates Alar ligament injury with laxity on the opposite side.
8. 33% of patients with chronic neck pain from whiplash have increased rotation of the upper cervical spine.
9. Rotation of more than 7° at C0-C1 and more than 54° at C1-C2 (on CT rotational scanning) is considered to be a pathologic instability.

A rotated head position was associated with more severe lesions after rear-end collisions when compared to frontal collision (93.8% vs. 31.8%). They also found that the injuries were present in a rotated head position far greater than when the head was in a neutral position.

So what does all this mean to you and your clients? It suggests that patients with clinical findings suggestive of upper cervical instability should be worked up more diligently than routine post-traumatic neck pain. Special MRI procedures need to be ordered with specific orders from the doctor as to how the test should be performed and what they are looking for on the exam. As important, you should make sure your doctor is aware of these potential injuries and orders the proper tests on select populations of patients

doctors chiropractors

Alec Khlebopros, DC	Chiropractor in Charlotte, NC
Anthony Howe, DC	Chiropractor in Jonesville, FL
Anthony Staiano D.C.	Chiropractor in Atlanta, GA
Antonio Marotta, DC	Chiropractor in Clifton Park, NY
Andre Broussard, DC	Chiropractor in Lubbock, TX
Bob Woolery, DC	Chiropractor in Vallejo, CA
Belinda Mobley, DC	Chiropractor in Seekonk, MA
Benjamin Heath, DC	Chiropractor in Portland, OR
Brett Kinsler, DC	Chiropractor in Rochester, NY
Carmelo Caratozzolo, DC	Chiropractor in Woodbridge, VA
Chris Rizzo, DC	Chiropractor in Leland, NC
Clayton Clark, DC	Chiropractor in San Antonio, TX
Christopher Connelly, DC	Chiropractor in Stone Mountain, GA
David Young, DC	Chiropractor in Indiana, PA
Edward Lauterbach, DC	Chiropractor in Palmyra, VA
Edward Harriott, DC	Chiropractor in Mission Viejo, CA
Eric M. Patten DC	Chiropractor in Gulfport, MS
Frank Navratil, DC	Chiropractor in Torrance, CA
George Putnam, Jr, DC	Chiropractor in New Orleans, LA
Jay Hafner, DC	Chiropractor in Lakewood, CO
James Rosenberg, DC	Chiropractor in Boise, ID
John Zimmerman, DC	Chiropractor in Diamond Bar, CA
Jonathan Woodward, DC	Chiropractor in Dallas, TX
Jennifer Frost, DC	Chiropractor in Naples, FL
Kevin Fielden, D.C., J. Reed, D.C.	Chiropractor in Johnson City, TN
Kevin Smith, D.C.	Chiropractor in Venetia, PA
Kevin Venerus, DC	Chiropractor in Livonia, MI
Louis J Cavallo	Chiropractor in Longmont, CO
Marieke Zegelaar, DC	Chiropractor in the Netherlands
Matt Freedman, DC	Chiropractor in Eugene, OR
Michael Schrad, DC	Chiropractor in Longmont, CO
Mike Nemastil, DC	Chiropractor in Lexington, KY
Morgan Baker, DC	Chiropractor in Eagan, MN
Noah Edvalson, DC	Chiropractor in Boise, ID
Pamela Betz, DC	Chiropractor in Leland, NC
Peter Gala, DC	Chiropractor in Parker, CO
Randy Conger, DC	Chiropractor in Fort Mill, SC
Richard E. Rogovin, D.C	Chiropractor in Brandon, FL
Ruby Kevala, DC	Chiropractor in Ventura, CA
Rusty Russo DC	Chiropractor in Metairie, LA
Ryan Betzina, DC	Chiropractor in Lakeville, MN
Ryan Suh, DC	Chiropractor in Manhattan, NY
Scott Garber, DC	Chiropractor in Pittsfield, MA
Steven Gillis, DC	Chiropractor in Los Angeles, CA
Scott Cady, DC	Chiropractor in Sunnyvale, CA
Stephane Provencher, DC	Chiropractor in St. Louis, MO
Scott Stiffey, DC	Chiropractor in St. Louis, MO
Scott Swanson, DC	Chiropractor in San Francisco, CA
Trent Artichoker, DC	Chiropractor in Denver, CO
Tony Kim, DC	Chiropractor in Moreno Valley, CA
Todd Lloyd, DC	Chiropractor in Santa Rosa, CA
ChiroHub	ChiroHub for even more chiros

low back pain - general information

low back pain - general information

how common is low back pain and how long does it last? Low back pain is very common and it's becoming commoner. In the USA the number of people disabled by back pain has grown 14x faster than the general population1, a greater growth of medical disability than with any other disease. 21% of UK adults suffer backache in any fortnight2 and about 2% lose time from work annually with an average duration of nearly 26 days per episode. Happily most back pain gets better fairly quickly - for example one study3 found that of 100 patients consulting their GP, 44% were better within a week, 86% within a month and 92% within two months. It's encouraging too to know that back pain may well become less common4 when one reaches one's 60's and older. Even long term "failed backs" may well ease with time5 - typically with the pain becoming less constant. Despite the body's self-healing abilities, back pain can be hell. How can one get better quicker and reduce the chances of getting further attacks? If one is unlucky enough to have persistent pain, what can be done to help?

what causes back pain and how can it be helped? Factors associated with increased risk6 of low back pain and sciatica include physical fitness, body weight, car driving, smoking, height, psychological distress, and age group 30 to 50. Several different structures may be involved in mechanical back pain - for example muscles, ligaments, nerves, joints, discs and bones. Precise diagnosis is typically more a matter of opinion than hard fact7. Happily just as we don't have to know what virus we have and the kind of immune response that it has caused in order to recover from a common cold, so too a diagnosis of non-specific mechanical low back pain is usually quite good enough as a basis for developing effective treatment. When considering how to help back trouble, it is often useful to think in terms of three general areas: the treatment of back pain of recent onset, how to prevent back pain recurring, and how to help persistent long term pain.

recent onset back pain: Remember that the great majority of back pain episodes are likely to get better within days or a few weeks3 even with no specific treatment. Pain can often be eased with medication, massage, and local heat or cold. These measures may well make the back more comfortable, though they probably won't affect the actual speed of recovery itself. Bed rest does have a part to play in back pain treatment, but it should be used sparingly8. For bad back pain with no leg involvement, 2 days rest appears to yield as good results as 7 days. When there is pain radiation to the lower leg, one can try rest for up to 2 weeks. It is probably OK to get up to go to the toilet and possibly for eating too. Resting too much may well prolong the time it takes to get better. If they don't flare the pain too badly or for too long, walking and swimming are likely to help. Take it slowly and build up what you can do. The McKenzie exercises are also worth considering9. Physiotherapy, osteopathy, chiropractic and acupuncture can all at times speed recovery, but acute recent onset back pain usually gets better quite quickly on its own. Unless the pain is particularly bad, it's worth waiting at least a week or two before seeking help.

how to prevent back pain recurring: As a therapist, one of the first questions I would ask here is whether the back is really absolutely fine between attacks. If there are some minor symptoms even between flare ups, then it may reduce future attacks to treat the areas that are still giving trouble. For example one can use physiotherapy, exercises, manipulation, acupuncture or injections. If there are really no symptoms between attacks then treatment by a therapist doing something actively to you is unlikely to be useful. Self-help has much more chance of being effective. Becoming physically fitter10, losing weight, stopping smoking and doing something about stress may all be of use6. So too may modifying working conditions or reducing the amount of time spent driving. Some people find using a lumbar roll11 or changing their sitting position in other ways can be helpful. It clearly makes sense as well to learn correct ways to lift and carry. Increasing physical fitness seems particularly worthwhile as, like stopping smoking, [PTO] increased fitness can be helpful in so many ways (see the companion sheet on How important is physical exercise?). Improved heart-lung stamina is important - as a bonus this also improves one's psychological state and reduces death rates from heart disease and cancer. Strength and flexibility also need to be considered. Unfortunately 80% of adults don't take enough exercise.

coping with persistent pain: Surprisingly pain, distress and disability don't all necessarily worsen and improve together. It's usually more helpful to think in terms of overall quality of life rather than just concentrating on the pain by itself. Surgery has a limited place. It may be useful for well-defined nerve root symptoms. Physiotherapy, acupuncture, manipulation and injections all also have a part to play - so too may transcutaneous nerve stimulation (TENS)12. Gradually increasing strength and fitness is extremely important10. Informed advice about exercise may well be helpful, as too is reducing unnecessary medication. Connie Peck's book13 discusses these and other issues. The Back Pain Association14 is a good source of support and there are local group activities, including hydrotherapy. James Hawkins's tape15 gives useful general advice as well as introducing the use of relaxation. Long term persistent pain is immensely hard to live with. With determination and help it is certainly possible to make the situation considerably better.


books, references & other resources:


1. National Center of Health Statistics. (1981) Prevalence of selected impairment. United States 1977. Hyattsville, Maryland: Dept. Health and Hum. Services. 1981. Nat. Center of Health Statisitics. Series 10, Number 134.
2. Wood,P.H.N. & Baddeley,E.M. (1980) Epidemiology of back pain,in M.I.V.Jayson (ed) The lumbar spine and back pain, 2nd ed., Tunbridge Wells, Pitman.
3. Dillane,J.B.,Fry,J. & Kalton,E. (1966) Acute back syndrome - a study from General Practice, Br.Med.J. 2: 82-4.
4. Hay,M.C. (1974) The incidence of low back pain in Busselton,in Twomey,L.T. (ed) Symposium: low back pain, Western Aust. Inst. Tech., Perth.
5. Crook,J.,Weir,R. & Tunks,E. (1989) An epidemiological follow-up survey of persistent pain sufferers in a group family practice and speciality pain clinic, Pain 36: 49-61.
6. Ernst,E. (1991) Primary prevention of back trouble: what can we tell our patients? Phys Med & Rehabil 2(2): editorial.
7. Jayson,M.I.V. (1984) Difficult diagnoses in back pain, Br.Med.J. 288: 740-1.
8. Spitzer,W.O.,LeBlanc,F.E.,Dupuis,M.,Abenhaim,L.,Belanger,A.Y. et al. (1987) Scientific approach to the assessment and management of activity-related spinal disorders, Spine 12: Number 7S.
9. McKenzie,R. (1985) Treat your own back, 4th ed., Waikanae, N.Z., Spinal Publications. McKenzie has also written a book on self-help neck treatment. Both books should be available at £7.99 each from Ferrier's Ltd, 8 Teviot Place, Edinburgh EH1 2RB. Tel: 031-225 5325. They can no doubt be ordered through other bookshops as well.
10. Rodriquez,A.A.,Bilkey,W.J. & Agre,J.C. (1992) Therapeutic exercise in chronic neck and back pain. Arch Phys Med Rehabil 73: 870-5.
11. Lumbar rolls can be ordered from PO Box 275, West Byfleet, Surrey KT14 6ET. An alternative deluxe lumbar support - the Backfriend - can be bought from MEDesign Ltd, Clock Tower Works, Railway St., Southport PR8 5BB. Tel: 0704-542373. MEDesign also stock a variety of other equipment which can help those with low back pain - ask for their catalogue.
12. Ottoson,D. & Lundeberg,T. (1988) Pain treatment by TENS: a practical manual, Berlin, Springer-Verlag. There are many suppliers of TENS machines. One possibility is the Pulsar range made by Spembly Medical Ltd., Newbury Road, Andover, Hampshire SP10 4DR. Tel: 0264-365741. You may be able to borrow one from a physiotherapy or pain clinic.
13. Peck,C. (1985) Controlling chronic pain, London, Fontana. Out of print, so order a copy through your library.
14. Back Pain Association, 31-33 Park Road, Teddington, Middlesex TW11 0AB. Tel: 081-977 5474. Send SAE for their leaflets. The Lothian Branch of the BPA can be contacted through Mary Taggart, 36 Rosemount Buildings, Edinburgh. Tel: 031-229 8832. They run various activities including a weekly hydrotherapy session at the Astlie Ainslie.
15. Hawkins,J. (1992) Coping with persistent pain, self-help tape available from BHMA, Royal Shrewsbury Hospital South, Shrewsbury, SY3 8XF. Tel: 01743-261155. All proceeds go to help the work of the BHMA, a medical charity.

Atlanta Impairment Rating Disability Rating Doctor

Definitions to understand concerning impairment:

A loss, loss of use, or derangement of any body part, organ system or organ function. American Medical Association: Guides to the Evaluation of Permanent Impairment, fifth edition. Chicago, American Medical Association 2001

A significant deviation, loss or loss of use of any body structure or function in an individual with a health condition, disorder or disease. American Medical Association: Guides to the Evaluation of Permanent Impairment, sixth edition. Chicago, AMA, 2008

An anatomical, physiological, or psychological abnormality that can be shown by medically acceptable clinical and laboratory diagnostic techniques. Social Security Administration (1995)

Definitions to understand concerning disability:

It is an alteration of an individual's capacity to meet personal, social, and / or occupational demands or statutory or regulatory requirements because of an impairment. American Medical Association: Guides to the Evaluation of Permanent Impairment, fifth edition. Chicago, AMA 2001

Activity Limitations and/or participation restrictions in an individual with a health condition, disorder, or disease. American Medical Association: Guides to the Evaluation of Permanent Impairment, sixth edition. AMA, 2008

Disability is the inability to complete a specific task successfully that the individual was previously capable of completing or one that most members of a society are capable of completing owing to a medical or psychological deviation from prior health status or from the status expected of most members of society. American Medical Association: Disability Evaluation, second edition. Chicago, AMA 2003.

Definitions to understand concerning causation:

An identifiable factor (accident) that results in a medically identifiable condition ( injury or illness).

Causal opinions in reports and testimony must be given in terms of reasonable medical probability or certainty. (more probably than not)

Probability, simply means that something is more likely than not (51% or greater). If the confidence is equal to or less than 50% it is merely a possibility.

A causal relationship is biologically plausible when:

The relationship between the medical condition and the injury can be explained anatomically or physiologically.

The duration, intensity, or mechanism of exposure or injury was sufficient to cause the illness or injury in questions.

There is evidence suggesting that the exposure is consistently or reliably associated with the process under investigation in the population under investigation or in peer-reviewed literature.

Cause and effect are contiguous.

There is literature providing biologic or statistical evidence indicating that the symptoms or disorder could develop as a result of the exposure (coherence).

There is specificity of the association for the injury (i.e., the absence of other factors)

Definitions to understand concerning apportionment:

Once causation is determined and there is probable cause related to the event, then apportionment is evaluated. If there is no causal relationship then apportionment is not necessary.

The extent to which each of 2 or more probable causes are found responsible for an effect (injury, disease, impairment, etc..)

A distribution of causation among multiple factors that caused or significantly contributed to the injury and resulting impairment.

Precipitation - Injury or exposure causes a latent or potential disease process to become manifested.

Acceleration - Injury or exposure hastens the clinical appearance of an underlying disease process.

Aggravation - A permanent worsening of a prior condition by a particular event or exposure.

Exacerbation - A temporary worsening of a prior condition by an exposure / injury.

Recurrence - Signs and symptoms attributable to a prior illness or injury occur in the absence of a new provocative event.

American Medical Association: Disability Evaluation, second edition. Chicago, AMA 2003, page 99 -100.

The phrase "pre-existing condition" often causes confusion for medical-legal-insurance providers.

There are only two types of pre-existing conditions. The first is known as an "inactive" or "dormant" pre-existing condition. The second is known as an "active" or "symptomatic" pre-existing condition.

The difference between an active vs. inactive pre-existing conditions is "like night and day."

This may require a detailed review of past and present medical records.

The "proximate cause" of the present symptoms is the recent trauma, even though the symptoms may be worse or healing may take longer because of a pre-existing condition.

Please call us to make an appointment or ask any questions, 770-469-7330. Common search terms Atlanta Impairment, Atlanta Disability, Disability Doctors, Auto Accident Reports Atlanta Georgia, Atlanta Disability Chiropractors, IME's, Independent Examinations, Disability Reports, and Impairment Reports.

Pain for Philosophers: Online introduction to pain processes

Pain for Philosophers: Online introduction to pain processes

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Neuroplastic Pain

Neuroplastic Pain: Refers to pain cause by OR pain increased because of changes within the nervous system. These structural and functional changes can occur at every level of the nervous system.

Neuroplasticity: refers to the ability of the nervous system to alter its structure and function. Neuroplasticity (also deals with brain plasticity, cortical plasticity and cortical re-mapping) refers to changes that occur in the organization of the brain and entire nervous system as a result of experiences. "Plasticity" relates to the learning by adding or removing connections, or cells.

Neuroplastic changes related to pain can occur at multiple levels of the nervous system. More pain receptors may be in an area, the area of the brain that feels pain increases, the pain sensory system becomes more efficient, and the brain can learn pain.

"Neuroplasticity can make it easier for you to feel tissue damage (acute) pain."

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