Rear-end Collisions

Rear-end Collisions

Over the past half-century, hundreds of research studies have sought to detail the mechanisms involved in rear-end collisions. These studies have involved use of live objects (in low-speed rear-end impacts), cadeveric simulations, accelerometry, electromyography, and mathematical modeling. As a result of these studies, we have a better understanding of rear-impact dynamics, but controversy remains. The experts do agree on one point--cervical dynamics during rear-impact scenarios are complex and not entirely understood (e.g., Luan et al 2000).

               Pioneering work by Severy (1955) showed that rear-end collisions cause a sequential acceleration of the vehicle, the occupants trunk and shoulders, and the occupants head. As the vehicle is impacted (e.g., in an automobile rear-end collision), it accelerated first, reaching a peak acceleration of almost 5 g, that is, five times the acceleration of gravity. The vehicle occupant’s shoulders reach their peak acceleration of about 7 g 100 ms later. Finally, the occupant’s head reaches its peak acceleration of greater than 12 g at 250 ms after initial impact. This sequential progression of peak acceleration is evidence of both momentum and energy transfers.

               Response of the cervical spine depends on impact awareness, muscle involvement, and direction of impact (Kumar et al. 2005). In an unaware vehicle occupant, muscles are recruited late during the whiplash episode. Muscle recruitment and tension development may not happen until 200 to 250 ms after impact. Given that much of the critical cervical motion occurs during the first 200 ms, muscle involvement may only play a role in the late stages of whiplash. Injury may have already happened before the muscles become involved (Bogduk and Yoganandan 2001).

               On a positive note, epidemiological evidence suggests that many victims of rear-end collision do not sustain injuries, and most of those who are injured show no long-lasting effects. In one study, 18% of patients had injury-related symptoms 2 years post injury--82% were asymptomatic (Radanov et al. 1995).

               In addition to impact awareness, muscle involvement, and direction of impact, many other factors determine injury risk in rear-end impacts: vehicle mass, velocity, and ability to withstand crashes; road conditions; use of restraint systems; and the passenger’s or driver’s body and head position at impact, neck rotation, gender, history of neck injury, and age.

How do occupants sit in vehicles relative to occupant space?

How do occupants sit in vehicles relative to occupant space?

People sit differently in car seats, in part due to personal preferences, habit, body profile, car interior dimensions, seating angle, and other factors. All one has to do is simply look at other drivers on the road to realize that there is a vast amount of differences in the way people sit in vehicles--even in similar types of vehicle--or observe how people sit at home and work. Some prefer the seat to be vertical while others like to recline the seat. Others like to sit straight while others lean sideways. Some people constantly move around in their vehicle, seldom maintaining a stationary posture, while others look like they are made out of stone and rarely move about. Gender has been shown to be a significant factor in seating positioning. Cullen et al evaluated 2.935 cars in the U.K. and U.S. to see how adults sit in their vehicles. The 5^th percentile female sat 24 cm (9.45 in) closer in the U.K. study and 32 cm (12.6 in) closer in the U.S. study, when measuring the distance between the nasion and the steering wheel, than the 95^th percentile male occupant. Drivers sat closer to the dash than passengers, and non-driver passengers were more likely to be out-of-position. The physician needs to consider the environment of the occupant compartment when evaluating an injury.

CRASH-RELATED FACTORS

CRASH-RELATED FACTORS

Numerous crash-related factors have been investigated for their predictive capacity. Some of these include the vehicle being stationary when hit, a frontal collision, a rear-end collision, side or other collision, being unprepared for the collision, no seat belt use and no head restraint. However, few of these factors have demonstrated significant predictive power. The exceptions to this are not wearing a seat belt, which was reported to nearly double the risk of developing persistent pain or disability. This is an interesting finding as, in certain jurisdictions where compulsory seat belt use is legislated, the voluntary admission of not wearing a seat belt would not be expected to be common, particularly in jurisdictions operating under a fault-based system. Thus, it is possible that the risk of developing a chronic condition associated with not wearing a seat belt may be even higher than that reported by Walton and colleagues. Scholten-Peeters et al. reported some limited prognostic value for accidents that occur on a highway, but also reported that there was strong evidence that rear-end collisions have no predictive value for poor functional recovery.

Thus, the weight of evidence indicates that crash-related factors are of limited value in attempting to predict poor recovery following whiplash injury.

SOCIODEMOGRAPHIC FACTORS

The predictive capacity of sociodemographic factors has been studied extensively in musculoskeletal pain conditions, and whiplash is no exception. Older age (>50 years), while showing predictive 

Multiple-Vehicle Collisions

Multiple-Vehicle Collisions

  

    Multiple collisions, in which a vehicle is submitted to one or more successive collisions after the initial collision, are of special significance as far as the types of occupant injuries and the injury severity are concerned. One of the primary concerns for multiple impacts is the risk of the first impact resulting in the occupant being out-of-position (OOP) for the second crash. In addition, having injuries from a second impact superimposed upon injuries from the first impact may significantly alter the nature and extent of injuries, depending upon the circumstances. In some instances, the doctor will be confronted with a patient who has been involved in a multi-vehicle collision and has been requested to determine if the first or second crash was responsible for the injuries or the respective percentage of causation. The doctor’s opinion may be needed to determine apportionment for each collision. If two insurance carriers are involved, they may want to pass the blame for injuries to the other carrier. From a biomechanical perspective, multiple collisions are very challenging. Several issues that need to be considered:

               A) delta-V for first impact and the subsequent crash(s)

               B) mass ratios of the vehicles involved for each impact

               C) vehicle rotation for each crash, if occurring, and if so, how severe

               D) types of vehicles involved (i.e., SUV vs. a passenger car in a side impact). Height issues between the two vehicles and aggressive designs can result in differing injury patterns.

               E) intrusion extent into the occupant compartment for each vehicle, if any.

               F) contact point on the vehicle relative to the seating position of the occupant and proximity to the contact area, and whether the point of impact (POI) was rigid or soft. Rigid pillars and smaller structures will cause much higher acceleration levels than softer impacts or by larger objects capable of distributing loading over a larger area of the body.

               G) times of occupant acceleration. Longer impacts are better for occupants

               H) OOP issues for occupant at the time of each impact. Both impacts may have OOP issues.

               I) Second injury superimposed on first injury. Doctor needs to consider each impact with its own characteristics. For example, did each impact involve a head strike or did one impact cause inertial loading only? Need to consider the surface size and energy absorbing quality for each impact as well.

               J) Type and severity of first injury can make second impact more or less likely to cause other injuries.

               K) Patterns of injury related to vector of each crash.

               L) other human and vehicle factors.

              

               Temming and Zobel used a Volkswagen database of 1,620 occupants who suffered cervical spine injuries, concluding that about 23.5% of occupants in passenger cars were involved in at least one additional collision and 5.6% of occupants had a third impact following the initial crash. Another study found that multi-vehicle collisions occur in about 15% of total crashed, and the second collision speed has been found to be just as high as or higher than the first crash 43.2% of the time. An example is the rear-end collision in which one car is pushed into a vehicle ahead, and is struck on the side of the vehicle in the intersection, starting a chain reaction of traumatic events. Otte et al. concluded that injuries may be caused by almost all parts of the interior, due to actual impact situation and the consequent relative motion of the occupants.

               Fat et al. analyzed CCIS-UK data of 1,295 crashes looking for multiple impacts. Their study found that a secondary impact with another vehicle occurred in 22.6% of crashes and an additional 6.1% were involved in a third impact. The study concluded that there was a higher risk of occupants being seriously injured in multiple impacts, with the head having the highest frequency. The most common double impact events happened in frontal crashed followed by side impacts or side impacts followed by another side impact.

Crash Speeds and Injury Risk: Epidemiologic and Forensic Considerations Crash-related injuries are the most frequently litigated type of injury in the United States, primarily due to two facts: motor vehicle crashes are one of the most common sources of injuries in society, and many crash-related injuries result from negligence of another individual. Litigation naturally produces a polar alignment of opinion, with one side favoring the plaintiff and the other side favoring the defense. There is no question as to which side has the greatest economic leverage, as auto insurers are multibillion dollar corporations with the added advantage of legislatively-mandated insurance coverage for any vehicle being operated on a public roadway. Thus, if an individual is legally operating a motor vehicle in the United States, that individual almost certainly is paying premium dollars to an insurance company. For many years, insurers have invested premium income in a variety of financial instruments and in times of positive economic growth this has proven an effective strategy for increasing their income. In times of stagnant or negative economic growth, insurers must look for other ways to increase profits to satisfy cost-of-living increases for their employees, as well as continuing profits for their owners and investors. This has led to a more recent method, which is to aggressively reduce payments on claims. One of the most effective methods for reducing such payments is to deny payment based on an allegation that a claim is fraudulent or “built up.” No one would argue with the premise that an insurer has the right to protect itself from fraudulent claims, and insurers have capitalized on this right by expanding their definition of what they consider as a fraudulent or built up claim, definitions that are not necessarily validated with data indicating that such claims are necessarily specious. A prime example of this expanded definition is the minor impact soft tissue (MIST) claims management protocol initiated by Allstate Insurance in the mid-1900s and adopted by virtually every other US insurer to one extent or another. The premise of this program is that the amount of vehicle damage is an indicator of whether or not a crash could have or should have resulted in an injury. Thus, according to claims adjuster training, an occupant who claims an injury with no more than bumper damage to his or her vehicle is automatically considered to be a likely fraud, despite the presence of medical documentation of injury. The result of this strategy is that, without any valid scientific medical documentation to support their position, the insurance industry has drawn an arbitrary line as to the type of injury claims they will pay versus those they won’t. The real criterion is more likely based in the types of cases insurers believe they are most likely to win in front of a jury: those in which an injury claim can be made to appear counterintuitive or contrary to the “common sense” of a layperson. The defense of the litigation of such cases has generated an entire cottage industry in and of itself, with “biomechanists” and “biomechanical engineers” (increasingly referring to individuals with little or no training in these fields) claiming that injuries cannot occur in minimal damage crashes because experimental studies of human volunteer crashes and cadaver, dummy, and animal experiments have somehow proven otherwise. The basis of the MIST defense is the precept that there is a minimum force threshold below which no injury is likely to occur, and that the force threshold coincides with a round money figure in vehicle damage (typically $1000 or less) regardless of the vehicle. Recent trades in litigation practices have illustrated the fact that minimal damage crashes are merely a beachhead in injury threshold defense practices. An increasing practice for many defense experts is to claim that no injury is possible in minimal damage crashes and that no permanent injury is possible in larger crashes without fracture or dislocation. Experts who regularly work for the defense in crash injury litigation must rely on an insistence that there is a legitimate scientific basis from which to claim that a crash injury threshold below which injury cannot or is unlikely to occur exists for certain crashes. This premise is fallacious, as numerous epidemiologic studies demonstrate that a variety of injuries can and do occur in a variety of crashes. However, many experts obfuscate this fact with references to government standards and research that refers to injury thresholds. The use of technical jargon to obscure a complete lack of valid basis underlying opinion is called “junk science,” and courts regularly exclude such testimony once it is revealed as such. The purpose of this chapter is to help the reader understand the foundations for references to “injury thresholds,” how they are developed, and why they are not applicable to victims of real-world crash-related trauma. While the information in this chapter was derived from a variety of sources, the majority of data regarding real-world crashes have been published by the National Highway Traffic Safety Administration (NHTSA) from the data collection efforts represented in their National Automotive Sampling System (NASS). Additionally, NHTSA collects data on vehicle crashworthiness with their frontal and side barrier tests. The literature cited in the chapter comes from the Society of Automobile Engineers (SAE), the Association for the Advancement of Automotive Medicine (AAAM), the International Research Council on the Biomechanics of Impact (IRCOBI), as well as a variety of trauma-related biomedical journals. From the onset, the reader should understand that the purpose of examining injury thresholds is to aid in the design of safer vehicles, and it is to this end that all such criteria have been designed. No injury criterion has ever been developed with the intention of denying the likelihood of injury in an occupant after one has been diagnosed by a clinician, yet this is how it is currently used in the defense of crash injury litigation. The majority of crashes occur at relatively lower speed impacts, and as the speed change of collisions increases there are significantly fewer collisions. The majority of injuries also occur in relatively low speed crashes, although the most serious injuries do occur in higher speed crashes. The greatest proportion of the crash injury literature focuses on the minority of crashes that result in more severe to fatal injuries, and thus the literature is somewhat at odds with what the average clinician sees outside the emergency room on a regular basis. In the succeeding parts of this chapter that deal with the literature on injury thresholds, it will become readily apparent that these “thresholds” were not designed to be, not can they be used as a means of determining whether a specific injury may have occurred in a specific case. As mentioned earlier, thresholds are derived from experimental rather than observational data, and are used to design and test vehicles for safety. The term or concept of “threshold” requires explanation anytime it is used. For example, it can refer to the level of frontal crash severity at which it is estimated there is less than an 80% risk of serious head injury, or it can refer to the speed change in a rear impact collision below which an injury to a crash test volunteer is highly likely to sustain injury. Without the specific parameters of the threshold, it is meaningless information. This is not to say that the use of experimental data does not allow for the assessment of relative injury risk prospectively for certain crashes. For example, it can be reasonably projected that, in a vehicle with a low head injury criterion (HIC) score in frontal crash test, there will be fewer severe head injuries than in a vehicle with a higher HIC for equivalent crash severities. However, it cannot be concluded that no serious head injuries will occur in the vehicle with the lowest HIC--regardless of collision speed--since the specific conditions of a crash and occupant cannot be predicted with 100% accuracy. The most egregious application of injury thresholds is as a means of denying the possibility of a medically-proven injury. Probability or risk of injury is only a tool for projecting a distribution of outcomes, and can never be used retrospectively to deny an outcome. After an injury has occurred in a crash and been medically validated, the “risk” if injury is 100% and it cannot be altered by prior outcomes. The appropriate use of probability can be compared with the game roulette. For a roulette wheel with 100 slots, it is reasonable to conclude that the pre-spin odds of the ball dropping into any particular slot are 1 in 100. After the ball drops into a particular slot the pre-spin odds are irrelevant to the outcome.

Crash Speeds and Injury Risk: Epidemiologic and Forensic Considerations

Crash-related injuries are the most frequently litigated type of injury in the United States, primarily due to two facts: motor vehicle crashes are one of the most common sources of injuries in society, and many crash-related injuries result from negligence of another individual. Litigation naturally produces a polar alignment of opinion, with one side favoring the plaintiff and the other side favoring the defense. There is no question as to which side has the greatest economic leverage, as auto insurers are multibillion dollar corporations with the added advantage of legislatively-mandated insurance coverage for any vehicle being operated on a public roadway. Thus, if an individual is legally operating a motor vehicle in the United States, that individual almost certainly is paying premium dollars to an insurance company.

             
For many years, insurers have invested premium income in a variety of financial instruments and in times of positive economic growth this has proven an effective strategy for increasing their income. In times of stagnant or negative economic growth, insurers must look for other ways to increase profits to satisfy cost-of-living increases for their employees, as well as continuing profits for their owners and investors. This has led to a more recent method, which is to aggressively reduce payments on claims. One of the most effective methods for reducing such payments is to deny payment based on an allegation that a claim is fraudulent or “built up.” No one would argue with the premise that an insurer has the right to protect itself from fraudulent claims, and insurers have capitalized on this right by expanding their definition of what they consider as a fraudulent or built up claim, definitions that are not necessarily validated with data indicating that such claims are necessarily specious.

            
A prime example of this expanded definition is the minor impact soft tissue (MIST) claims management protocol initiated by Allstate Insurance in the mid-1900s and adopted by virtually every other US insurer to one extent or another. The premise of this program is that the amount of vehicle damage is an indicator of whether or not a crash could have or should have resulted in an injury. Thus, according to claims adjuster training, an occupant who claims an injury with no more than bumper damage to his or her vehicle is automatically considered to be a likely fraud, despite the presence of medical documentation of injury. The result of this strategy is that, without any valid scientific medical documentation to support their position, the insurance industry has drawn an arbitrary line as to the type of injury claims they will pay versus those they won’t. The real criterion is more likely based in the types of cases insurers believe they are most likely to win in front of a jury: those in which an injury claim can be made to appear counterintuitive or contrary to the “common sense” of a layperson.

             
The defense of the litigation of such cases has generated an entire cottage industry in and of itself, with “biomechanists” and “biomechanical engineers” (increasingly referring to individuals with little or no training in these fields) claiming that injuries cannot occur in minimal damage crashes because experimental studies of human volunteer crashes and cadaver, dummy, and animal experiments have somehow proven otherwise. The basis of the MIST defense is the precept that there is a minimum force threshold below which no injury is likely to occur, and that the force threshold coincides with a round money figure in vehicle damage (typically $1000 or less) regardless of the vehicle. Recent trades in litigation practices have illustrated the fact that minimal damage crashes are merely a beachhead in injury threshold defense practices. An increasing practice for many defense experts is to claim that no injury is possible in minimal damage crashes and that no permanent injury is possible in larger crashes without fracture or dislocation.

             
Experts who regularly work for the defense in crash injury litigation must rely on an insistence that there is a legitimate scientific basis from which to claim that a crash injury threshold below which injury cannot or is unlikely to occur exists for certain crashes. This premise is fallacious, as numerous epidemiologic studies demonstrate that a variety of injuries can and do occur in a variety of crashes. However, many experts obfuscate this fact with references to government standards and research that refers to injury thresholds. The use of technical jargon to obscure a complete lack of valid basis underlying opinion is called “junk science,” and courts regularly exclude such testimony once it is revealed as such. The purpose of this chapter is to help the reader understand the foundations for references to “injury thresholds,” how they are developed, and why they are not applicable to victims of real-world crash-related trauma.

             
While the information in this chapter was derived from a variety of sources, the majority of data regarding real-world crashes have been published by the National Highway Traffic Safety Administration (NHTSA) from the data collection efforts represented in their National Automotive Sampling System (NASS). Additionally, NHTSA collects data on vehicle crashworthiness with their frontal and side barrier tests. The literature cited in the chapter comes from the Society of Automobile Engineers (SAE), the Association for the Advancement of Automotive Medicine (AAAM), the International Research Council on the Biomechanics of Impact (IRCOBI), as well as a variety of trauma-related biomedical journals.

             
From the onset, the reader should understand that the purpose of examining injury thresholds is to aid in the design of safer vehicles, and it is to this end that all such criteria have been designed. No injury criterion has ever been developed with the intention of denying the likelihood of injury in an occupant after one has been diagnosed by a clinician, yet this is how it is currently used in the defense of crash injury litigation.

             
The majority of crashes occur at relatively lower speed impacts, and as the speed change of collisions increases there are significantly fewer collisions. The majority of injuries also occur in relatively low speed crashes, although the most serious injuries do occur in higher speed crashes. The greatest proportion of the crash injury literature focuses on the minority of crashes that result in more severe to fatal injuries, and thus the literature is somewhat at odds with what the average clinician sees outside the emergency room on a regular basis.

             
In the succeeding parts of this chapter that deal with the literature on injury thresholds, it will become readily apparent that these “thresholds” were not designed to be, not can they be used as a means of determining whether a specific  injury may have occurred in a specific case. As mentioned earlier, thresholds are derived from experimental rather than observational data, and are used to design and test vehicles for safety. The term or concept of “threshold” requires explanation anytime it is used. For example, it can refer to the level of frontal crash severity at which it is estimated there is less than an 80% risk of serious head injury, or it can refer to the speed change in a rear impact collision below which an injury to a crash test volunteer is highly likely to sustain injury. Without the specific parameters of the threshold, it is meaningless information.

             
This is not to say that the use of experimental data does not allow for the assessment of relative injury risk prospectively for certain crashes. For example, it can be reasonably projected that, in a vehicle with a low head injury criterion (HIC) score in frontal crash test, there will be fewer severe head injuries than in a vehicle with a higher HIC for equivalent crash severities. However, it cannot be concluded that no serious head injuries will occur in the vehicle with the lowest HIC--regardless of collision speed--since the specific conditions of a crash and occupant cannot be predicted with 100% accuracy.

             
The most egregious application of injury thresholds is as a means of denying the possibility of a medically-proven injury. Probability or risk of injury is only a tool for projecting a distribution of outcomes, and can never be used retrospectively to deny an outcome. After an injury has occurred in a crash and been medically validated, the “risk” if injury is 100% and it cannot be altered by prior outcomes. The appropriate use of probability can be compared with the game roulette. For a roulette wheel with 100 slots, it is reasonable to conclude that the pre-spin odds of the ball dropping into any particular slot are 1 in 100. After the ball drops into a particular slot the pre-spin odds are irrelevant to the outcome.

Crash-related injuries are the most frequently litigated type of injury in the United States, primarily due to two facts: motor vehicle crashes are one of the most common sources of injuries in society, and many crash-related injuries result from negligence of another individual. Litigation naturally produces a polar alignment of opinion, with one side favoring the plaintiff and the other side favoring the defense. There is no question as to which side has the greatest economic leverage, as auto insurers are multibillion dollar corporations with the added advantage of legislatively-mandated insurance coverage for any vehicle being operated on a public roadway. Thus, if an individual is legally operating a motor vehicle in the United States, that individual almost certainly is paying premium dollars to an insurance company.

            
 For many years, insurers have invested premium income in a variety of financial instruments and in times of positive economic growth this has proven an effective strategy for increasing their income. In times of stagnant or negative economic growth, insurers must look for other ways to increase profits to satisfy cost-of-living increases for their employees, as well as continuing profits for their owners and investors. This has led to a more recent method, which is to aggressively reduce payments on claims. One of the most effective methods for reducing such payments is to deny payment based on an allegation that a claim is fraudulent or “built up.” No one would argue with the premise that an insurer has the right to protect itself from fraudulent claims, and insurers have capitalized on this right by expanding their definition of what they consider as a fraudulent or built up claim, definitions that are not necessarily validated with data indicating that such claims are necessarily specious.

            
 A prime example of this expanded definition is the minor impact soft tissue (MIST) claims management protocol initiated by Allstate Insurance in the mid-1900s and adopted by virtually every other US insurer to one extent or another. The premise of this program is that the amount of vehicle damage is an indicator of whether or not a crash could have or should have resulted in an injury. Thus, according to claims adjuster training, an occupant who claims an injury with no more than bumper damage to his or her vehicle is automatically considered to be a likely fraud, despite the presence of medical documentation of injury. The result of this strategy is that, without any valid scientific medical documentation to support their position, the insurance industry has drawn an arbitrary line as to the type of injury claims they will pay versus those they won’t. The real criterion is more likely based in the types of cases insurers believe they are most likely to win in front of a jury: those in which an injury claim can be made to appear counterintuitive or contrary to the “common sense” of a layperson.

             
The defense of the litigation of such cases has generated an entire cottage industry in and of itself, with “biomechanists” and “biomechanical engineers” (increasingly referring to individuals with little or no training in these fields) claiming that injuries cannot occur in minimal damage crashes because experimental studies of human volunteer crashes and cadaver, dummy, and animal experiments have somehow proven otherwise. The basis of the MIST defense is the precept that there is a minimum force threshold below which no injury is likely to occur, and that the force threshold coincides with a round money figure in vehicle damage (typically $1000 or less) regardless of the vehicle. Recent trades in litigation practices have illustrated the fact that minimal damage crashes are merely a beachhead in injury threshold defense practices. An increasing practice for many defense experts is to claim that no injury is possible in minimal damage crashes and that no permanent injury is possible in larger crashes without fracture or dislocation.

            
 Experts who regularly work for the defense in crash injury litigation must rely on an insistence that there is a legitimate scientific basis from which to claim that a crash injury threshold below which injury cannot or is unlikely to occur exists for certain crashes. This premise is fallacious, as numerous epidemiologic studies demonstrate that a variety of injuries can and do occur in a variety of crashes. However, many experts obfuscate this fact with references to government standards and research that refers to injury thresholds. The use of technical jargon to obscure a complete lack of valid basis underlying opinion is called “junk science,” and courts regularly exclude such testimony once it is revealed as such. The purpose of this chapter is to help the reader understand the foundations for references to “injury thresholds,” how they are developed, and why they are not applicable to victims of real-world crash-related trauma.

             
While the information in this chapter was derived from a variety of sources, the majority of data regarding real-world crashes have been published by the National Highway Traffic Safety Administration (NHTSA) from the data collection efforts represented in their National Automotive Sampling System (NASS). Additionally, NHTSA collects data on vehicle crashworthiness with their frontal and side barrier tests. The literature cited in the chapter comes from the Society of Automobile Engineers (SAE), the Association for the Advancement of Automotive Medicine (AAAM), the International Research Council on the Biomechanics of Impact (IRCOBI), as well as a variety of trauma-related biomedical journals.

             
From the onset, the reader should understand that the purpose of examining injury thresholds is to aid in the design of safer vehicles, and it is to this end that all such criteria have been designed. No injury criterion has ever been developed with the intention of denying the likelihood of injury in an occupant after one has been diagnosed by a clinician, yet this is how it is currently used in the defense of crash injury litigation.

             
The majority of crashes occur at relatively lower speed impacts, and as the speed change of collisions increases there are significantly fewer collisions. The majority of injuries also occur in relatively low speed crashes, although the most serious injuries do occur in higher speed crashes. The greatest proportion of the crash injury literature focuses on the minority of crashes that result in more severe to fatal injuries, and thus the literature is somewhat at odds with what the average clinician sees outside the emergency room on a regular basis.

            
 In the succeeding parts of this chapter that deal with the literature on injury thresholds, it will become readily apparent that these “thresholds” were not designed to be, not can they be used as a means of determining whether a specific  injury may have occurred in a specific case. As mentioned earlier, thresholds are derived from experimental rather than observational data, and are used to design and test vehicles for safety. The term or concept of “threshold” requires explanation anytime it is used. For example, it can refer to the level of frontal crash severity at which it is estimated there is less than an 80% risk of serious head injury, or it can refer to the speed change in a rear impact collision below which an injury to a crash test volunteer is highly likely to sustain injury. Without the specific parameters of the threshold, it is meaningless information.

             
This is not to say that the use of experimental data does not allow for the assessment of relative injury risk prospectively for certain crashes. For example, it can be reasonably projected that, in a vehicle with a low head injury criterion (HIC) score in frontal crash test, there will be fewer severe head injuries than in a vehicle with a higher HIC for equivalent crash severities. However, it cannot be concluded that no serious head injuries will occur in the vehicle with the lowest HIC--regardless of collision speed--since the specific conditions of a crash and occupant cannot be predicted with 100% accuracy.

            
The most egregious application of injury thresholds is as a means of denying the possibility of a medically-proven injury. Probability or risk of injury is only a tool for projecting a distribution of outcomes, and can never be used retrospectively to deny an outcome. After an injury has occurred in a crash and been medically validated, the “risk” if injury is 100% and it cannot be altered by prior outcomes. The appropriate use of probability can be compared with the game roulette. For a roulette wheel with 100 slots, it is reasonable to conclude that the pre-spin odds of the ball dropping into any particular slot are 1 in 100. After the ball drops into a particular slot the pre-spin odds are irrelevant to the outcome.

SOFT TISSUE WOUND HEALING REVIEW

SOFT TISSUE WOUND HEALING REVIEW

Introduction

               The inflammatory and repair processes are no longer simple events to describe in light of the increased knowledge in this field. The review that follows is only a brief resume of the salient events associated with tissue repair, particularly concerning the soft tissues. For further information, the reader is referred to recent reviews listed at the end of the paper.

               Wound healing refers to the body’s replacement of destroyed tissue by living tissue and comprises two essential components – Regeneration and Repair. The differentiation between the two is based on the resultant tissue. In regeneration, specialized tissues are replaced by the proliferation of surrounding undamaged specialized cells. In repair, lost tissue is replaced by granulation tissue which matures to form scar tissue. This review concentrates on the events and processes associated with the repair process.

               Probably the most straightforward way to describe the healing process is to divide it up into broad stages which are not mutually exclusive and overlap considerably. There are several different ways to “divide up” the entire process, but the allocation of 4 phases is common and will be adopted here – these being Bleeding, Inflammation, Proliferation and Remodeling. 

CLASSIFICATION OF SOFT TISSUE INJURY

CLASSIFICATION OF SOFT TISSUE INJURY

Ligament Trauma

Ligament injury is classically divided into first (mild), second (moderate), and third (severe) degree tears. In a few locations, e.g., the acromioclavicular joint, there is further classification of the degree of displacement and the amount of associated muscle trauma, but these joints are the exception.

First degree injuries entail microscopic stretching or minimal tearing of a few fibers of a ligament. It is a painful injury, but there is little loss of structural integrity. The treatment progress is guided mainly by the athlete’s pain, with anticipated return to full physical activity within 10 days to 2 weeks. Indeed, controlled training may be carried out even before this point. Early protection of the joint with taping or orthoses may be desirable, and frequently little or no interruption of training is necessary.

It is the second degree injury, with moderate tearing of the ligament’s collagenous fibers and some loss of structural integrity, that usually presents the most difficulty for accurate classification. In part it is because the second degree category encompasses a broad spectrum of injury. At the one extreme there is an injury similar to a first degree sprain and at the other a badly torn ligament that is bordering on complete disruption. Underestimating this second degree injury and thus allowing premature resumption of activity may lead to re-injury or possibly conversion to a third-degree situation. Conversely, overestimation of the severity gives rise to unnecessary loss of time from training. These clinical decisions are always difficult, and there is no substitution for the physician’s experience.

In general, second degree tears require 2 to 3 weeks of modified rest and rehabilitation, followed by 2 to 3 weeks of controlled introduction of increasing stress before full training is resumed. It may be as long as 2 to 3 months before full training and competition are allowed, depending on the joint involved, the magnitude of the disruption, and the requirements and stresses of the sport. The more severe second degree tears, along with the third degree injuries, may have a tendency for the healed ligaments to stretch out with time, leading to increasing functional instability, despite excellent rehabilitation and satisfactory early stability.

A third degree injury signifies complete tearing of the ligament with loss of structural integrity. In many situations, it requires complete or modified immobilization of the involved joint for a period of 3 to 6 weeks and frequently surgical intervention. Failure to treat these third degree disruptions adequately lead to recurrent instability and possibly degenerative changes of the involved joint. This long-term implication of degenerative articular surface pathology in inadequately treated or incompletely healed major weight-bearing joints cannot be overemphasized.

It has already been stressed that each structure has an anticipated healing time, and that one cannot accelerate the normal recuperative abilities of the tissues. Therefore, therapy is aimed at optimizing healing conditions. With extra articular collagenous structures, ligamentous strength after tearing is in the region of 60 to 70 percent of normal after 6 weeks of healing. More specifically, there is often a revascularization phase during healing that is usually accompanied by a dramatic reduction of tensile strength. Because this phase usually coincides with the period during which most external supports have been removed, it is mandatory that the physician be aware of the dangers of unduly stretching healing structures at this point. It requires considerable knowledge and skill to balance exercise progression with protection of the vulnerable tissue. It may take up to 3 months before 80 percent of the original strength is acquired. Intra-articular ligaments usually gain tensile strength more slowly. Healing times for intra-articular collagen are such that it may take up to 3 months to achieve 50 percent of the normal strength and 6 months before a functional strength of 70 percent is reached. The reintroduction of stress to the unprotected joints must be planned with these figures in mind. Furthermore, although little is known of the effects of ligament tears on the neural protective mechanism of joints, it is likely that after significant tears there is a distorted or decreased biofeedback. Particularly for the major weight bearing joints, such as the knee and ankle, some specific exercises are needed to either retrain or compensate for this potential loss of sensory information. 

There Is No Typical Human

There Is No Typical Human

               When considering injury causation and any subsequent post-traumatic symptoms/disorders, it is imperative for the physician and biomechanist to remember that there is no “typical” human in a crash environment. If anyone has believed that all persons act equally to varying environments, look at prescribed medications and note how many side effects can occur among a population. If people vary in how they react to the same types of chemicals in a specific medication, the same differences between humans in similar types of traumatic events, such as automobile crashes, will occur. There are several reasons why an individual can be different than what is generally representative of a group of subjects involved in a collision, including:

               A) Different weights of humans

               B) Different human anthropometry. Some humans have shorter/longer legs, arms, torso, etc. This can be completely different in children when compared to adults, as well.

               C) Differing heights that may influence the distance between occupant and the interior of the vehicle. For example, a short occupant in a near-sided lateral collision with a SUV would more likely have head injuries than a tall person in the same crash where the rib cage would take the brunt of the injury.

               D) Women have lower center of gravity (cg) than males.

               E) Differing seating locations for occupants

               F) Differing seatback angles for differing occupants

               G) Out-of-position occupants

Vehicle Damage Correlation to Injury Severity

Vehicle Damage Correlation to Injury Severity

               A recent NHTSA report shows that crash characteristics become more favorable for the occupant as the amount of residual deformation increases. This excludes crush intrusion into the occupant compartment. Robbins concluded that in crashes where there is no intrusion into the occupant compartment, “A common misconception formulated is that the amount of vehicle crash damage due to a collision, offers a direct correlation to the degree of occupant injury.” This author further emphasized that the concept of determining injury risk based from crush depth only is false reasoning. Although crush depth can be used for determining delta-Vs and PDOFs, other variables also must be considered before injury severity can be determined accurately. Many automobile insurance companies promote the myth that collision injuries correlate to the vehicle external structural damage and costs of repair, and have taken this position as a matter of policy. A claims adjuster might reject a claim, concluding that since there was only $1,000 worth of damage to the vehicle on a repair estimate, the person could not possibly be hurt, and not authorize any payment for treatment. On the other hand, the same adjuster might assume that since the car was totaled, the occupant must have significant injury, and authorize payment without any dispute. The assumption that the risk of injuries related to the amount of external vehicle damage in all types of crashes has little scientific basis.

               In a recent NHTSA report, Romilly et al. stated, “The mechanics of a high speedcollision are relatively well documented. The vehicle structure deforms, converting the system’s kinetic energy into sound, thermal, and strain energies. The rate of deformation is a result of the vehicle’s stiffness characteristics while the amount of recoverable deformation is a function of its elastic properties. At high impact speeds, very little elastic recovery occurs and the vehicle generally behaves as a plastic body. At low impact speeds, however, plastic behavior may be absent allowing most of the total impact injury to be recovered in elastic rebound. For the occupant, the best ride down profile occurs when the vehicle behaves as a plastic body with large deformations to reduce the overall acceleration. This creates a major dilemma for the manufacturer, occupant, and insurer. Each would like the vehicle to provide the maximum protection for the occupant with the minimum material damage to the vehicle during a collision. As the vehicle becomes stiffer, the vehicle damage costs are reduced as less permanent deformation takes place. However, the occupant experiences a more violent ride-down, which increases the potential for injury. This implies that vehicles that do not sustain permanent damage in low speed impacts produce correspondingly higher dynamic loadings ontheir occupants than those that deform plastically under the same or possibly more severe impact conditions

Disc Injuries in Side Impacts

Disc Injuries in Side Impacts

           

           Side impacts may cause disc injuries to the cervical or back regions. In most cases, there is violent rotational movement of the vehicle and occupant during the impact, causing torsion to the neck and back. In addition, most occupants will have his/her heads turned looking at the bullet vehicle or turned to alert other occupants, resulting in a pre-twisting of the spine will cause annular disc fibers to become taut. One study that confirmed disc injuries conducted near-sided cadaver testing in 14 side impact tests with a delta-V of 50 km/h into a barrier. The most common injury noted in the cervical spine was intervertebral disc hemorrhages (55%), followed by ligamentum flavum injuries.

Disc Injuries in Side Impacts

               Side impacts may cause disc injuries to the cervical or back regions. In most cases, there is violent rotational movement of the vehicle and occupant during the impact, causing torsion to the neck and back. In addition, most occupants will have his/her heads turned looking at the bullet vehicle or turned to alert other occupants, resulting in a pre-twisting of the spine will cause annular disc fibers to become taut. One study that confirmed disc injuries conducted near-sided cadaver testing in 14 side impact tests with a delta-V of 50 km/h into a barrier. The most common injury noted in the cervical spine was intervertebral disc hemorrhages (55%), followed by ligamentum flavum injuries.

Disc Injuries in Rear Impacts

               Disc injuries following rear-end impacts are often observed in clinical practice by physicians, many following in the low-speed delta-V range. I have seen many disc bulging or herniation cases over the years in the delta-V range of 4 to 10 mph. Most of these disc cases had preexisting degeneration in the spine noted with imaging studies or out-of-position issues leading to susceptibility. Smith evaluated 72 real-world rear impacts with accident reconstruction to determine the delta-Vs and the types of injuries that were diagnosed by physicians. Disc bulges or herniations were found in the cervical spine with delta-Vs as low as 8km/h and in the lumbar spine as low as 11.3 km/h. Yoganandan et al. exposed four entire human cadavers to rear impacts with 4.4 to 6.8m/sec (9.8 to 15.2 mph) delta-V and a mean of 3.3 or 4.5g acceleration. After single impact, the cervical spine was analyzed for any traumatic findings using standard radiology and CT scanning. X-ray and CT analysis only found an avulsion fracture of the C5 body and C5-C6 disc distraction injury without a fracture. Then the specimens underwent cry sectioning to determine if any soft tissue injuries occurred that were not noted in the radiological evaluation. Cryosectioning revealed the following: annular tears at C5-C6, diastasis of C1-C2 and C5-C6 zygapophysical joints with associated tears of capsular ligaments, tears of C6-C7 ligamentum flavum, and tear/rupture of C5-C6 anterior longitudinal ligament.

RISK FACTORS FOR ONSET OF WAD

A risk factor for an outcome (i.e. disease/injury) is a factor that is independently associated with the outcome or condition in question. Knowledge of the etiology (cause) of WAD is limited. One reason for this is the difficulty in obtaining accurate and appropriate denominators to calculate risks. Rather than using persons exposed to collisions as the denominator, researchers have used proxies, such as registered licensed drivers, population censuses, or persons involved in collisions where at least one person was injured. Some studies have adjusted for possible confounding factors, while others have not. A confounding factor is an independent risk factor for the outcome and is also associated with the exposure/risk factor of interest. Examples of possible confounding factors include gender, age, pre-collision physical and mental health, and severity and direction of crash impact.

Risk factors for WAD reported in published studies include presence of neck pain prior to the collision, being the driver or the front-seat passenger (compared to the rear-seat passenger), and being exposed to a rear-end collision or frontal collision rather than a side collision. Female gender has been suggested to be associated with a slightly higher incidence of WAD in some studies, but other studies have found no gender differences. All these studies have weaknesses, primarily, the lack of ‘true’ denominators and/or the limited possibility to control for potential confounding factors.

One possible risk factor for WAD is the severity of the crash (impact). The biomechanical research on WAD is mainly based on experimental studies using cadavers, volunteers and simulation experiments. So far, the injury mechanism has not been established as a known risk factor. Reasons for this may be that there are different injury mechanisms occurring with different crash types. Car occupant acceleration, velocity and rebound are all factors that should be considered. In much of the research, a major focus is on rear-end injury mechanisms despite consistent findings that rear-end collisions are only responsible for 40-55% of all cases of WAD in MVCs. However, there are some promising results from actual rear-end collisions in that the redesign of headrests and seats so that head/neck extension is limited in rear-end collisions has reduced the incidence of WAD. Before firm conclusions about the magnitude of such preventive interventions can be drawn, larger studies with well-defined outcome measures and controls for potential confounding factors are needed.

20 Things You Might Not Know About Alcohol

1  Sobering disclaimer: The family of compounds known as alcohols are all toxins that can kill you, whether instantly, quickly, or gradually.

2  Yet one of them—ethyl alcohol, or ethanol—is a staple of the human diet. Archaeologist Patrick McGovernspeculates that fermented beverages were made as early as 100,000 years ago, when people first spread out of Africa.

3  The seeds Johnny Appleseed sold to farmers throughout Ohio and Indiana produced apples that were inedible, but perfect for making hard cider.

4  According to the Drunken Monkey Hypothesis, our zest for alcoholic beverages derives from our distant ancestors’ impulse to seek the ripest, most energy-intensive fruits.

5  Designated driver at the zoo: The Malaysian pen-tailed treeshrew routinely chugs the equivalent of nine glasses of wine a night in naturally fermented nectar, and yet it remains fully functional.

6  For a treeshrew, that is.

7  Fermentation occurs when enzymes, typically produced by yeast, convert sugar molecules in grapes or grains into ethanol.

8  That process can also happen in your digestive system, spiking every 100 ml of blood with 0.01 to 0.03 mg of alcohol.

9  Seriously, officer! Japanese doctors have observed patients with “auto-brewery syndrome,” in which high levels of candida yeast in the intestines churn out so much alcohol that they can cause drunkenness.

10  No digestion required. Ethanol is such a small, simple molecule—just two carbon atoms, six hydrogens, and a spare oxygen—that it pours directly out of the stomach and small intestine into the bloodstream.

11  A lean, muscular person will be less affected by drink than someone with more body fat: Water-rich muscle tissues absorb alcohol effectively, preventing it from reaching the brain.

12  Drunkenness is considered an impairment of the neurons in your head, but Australian researchers recently reported that part of the feeling may result instead from the effect of ethanol on the brain’s immune system. The finding could lead to new treatments for alcoholism.

13  The times they are a-changin’. In 1895 Anheuser-Busch launched Malt-Nutrine, a 1.9 percent-alcohol-content beer prescribed by physicians as a tonic for pregnant women and a nutritional beverage for children.

14  Until 1916 whiskey and brandy were listed as scientifically approved medicines in the United States Pharmacopeia.

15  Drinking and driving: Surplus wine in Sweden is distilled into ethanol, mixed with gasoline, and sold to service stations.

16  Ethanol was widely used as an industrial fuel in America until a tax on alcoholic beverages, levied to help pay for the Civil War, prompted a switch to kerosene and methanol.

17  Methanol, a distillation 
of wood pulp, can destroy the optic nerves. “Blind drunk” was Prohibition-era slang for damage 
caused by drinking grain alcohol that had been cut with methanol by unscrupulous bootleggers.

18  Interstellar brewery: The nebulas where stars form abound with hydrogen, carbon, and oxygen, 
the atomic building blocks of alcohol.

19  Sure enough, astronomers found vast quantities of ethanol—as much as that in 400 trillion trillion beers—
in G34.3, an interstellar cloud some 10,000 light-years from Earth.

20  Resolution for 2012: Don’t stare at the cork. The 
carbon dioxide in champagne bottles creates 90 pounds of 
pressure per square inch, three times the pressure in automobile tires. Flying corks can cause retina detachment, double vision, and blindness. 

The Role of the Patient

No matter what else you do for yourself—diet, exercise, meditation, etc.—your body and mind can function more effectively when there is less distortion and less tension in your spine.

There is no substitute for the Chiropractic adjustment. With precise adjustments, it is possible to restore this softness and breadth to persons of any age or condition. All bodies naturally return to a state of more ease when the blockages are removed. Healthy people have spines that are softer, supple, and have more breadth than people who are experiencing more dis-ease.

As a Chiropractic patient, your awareness of healthy choices and practicing these will create a successful balance in your life. Wellness is a choice and the process of seeking more information on how to improve your physical, emotional, spiritual, social, and environmental well-being.

Reports from diverse spiritual traditions suggest the contemplation of subtle energies accelerate one’s development, especially along the spiritual and subtle cognitive lines. There is an innate intelligence organizing the body, and it is superior to the conscious thinking mind, Chiropractic care helps you to align with the flow of this inner intelligence and ideally with the infinite wisdom infusing all matter.

The central focus of the doctor of Chiropractic is to optimize patient health by correcting, managing, or minimizing vertebral subluxation through the Chiropractic spinal adjustment. Included in the Chiropractic philosophy is the notion that the least invasive form of treatment should be utilized before more invasive forms of treatment. The body should be given a chance to heal from the natural innate processes prior to provocation from more dangerous and harmful therapies. This can ONLY be accomplished if there is an intact structural environment housing the nervous system, allowing for proper communication between organ systems. If all else fails, then allopathic remedies are justified.

All of creation is emerging from the same source; everything is interconnected and affects everything else. Healing is a process of reintegrating mind, body, and spirit. To measure whether the healing is progressing, ask: “Are you finding out more about yourself?”

Overcoming Chiropractic Fear

If you have never been to a chiropractor before, it is only natural to have some apprehension on your first visit. If you are suffering from neck or back pain, visiting a chiropractor can alleviate and even eliminate pain, and yet some people are simply afraid to go. This is especially true if you don’t know what to expect. Knowledge is power and getting the facts and understanding what will happen can help you overcome your fear.

Book a Consultation

One of the best things you can do to overcome your fear of the chiropractor is to book a consultation appointment. Make sure when you book the appointment you let them know about your concerns. A good chiropractor will sit down with you and explain to you about chiropractic care, what it is and what will happen during your first adjustment. They will let you know that being adjusted does not cause any pain and in fact relieves it. They should be able to answer any questions you might have and may even have additional brochures or short movies for you to watch.

Ask Friends, Family and Co-Workers About Their Chiropractic Experiences

Another way to help alleviate your fear is to talk to others who have been treated by a chiropractor in the past or who are currently under chiropractic care. They will be able to tell you their stories of chiropractic success and let you know there is nothing to worry about. This is also a great way to get a referral and just knowing you are seeing a chiropractor that has been recommended can help.

Focus On Pain Relief

The most common reason people visit chiropractors is for back or neck pain relief. If this is you, try to stay focused on the pain relief. So many people continually suffer from neck and back pain that could so easily be alleviated and even eliminated through chiropractic care. Especially if you are seriously suffering, in the end, pain relief should outweigh fear.

Memorial Day Tips & Safety

Each year, thousands of people are involved in traffic accidents during the Memorial Day Weekend. If you are one of these unfortunate people, will you know what to do in the aftermath of a collision? How you react can prevent further injuries, reduce costs and accelerate the clean-up and repair process.

Action Plan to Deal with Accidents:

1. Keep an Emergency Kit in Your Glove Compartment. Drivers should carry a cell phone, as well as pen and paper for taking notes, a disposable camera to take photos of the vehicles at the scene, and a card with information about medical allergies or conditions that may require special attention if there are serious injuries. Also, keep a list of contact numbers for law enforcement agencies handy. Drivers can keep this free fill-in-the-blanks accident information form in their glove compartment. The DocuDent™ Auto Accident Kit ($19.95), supported by AAA and insurance companies, offers a comprehensive kit that includes a flashlight, reusable camera and accident documentation instructions. A set of cones, warning triangles or emergency flares should be kept in the trunk.

2. Keep Safety First. Drivers involved in minor accidents with no serious injuries should move cars to the side of the road and out of the way of oncoming traffic. Leaving cars parked in the middle of the road or busy intersection can result in additional accidents and injuries. If a car cannot be moved, drivers and passengers should remain in the cars with seatbelts fastened for everyone's safety until help arrives. Make sure to turn on hazard lights and set out cones, flares or warning triangles if possible.

3. Exchange Information. After the accident, exchange the following information: name, address, phone number, insurance company, policy number, driver license number and license plate number for the driver and the owner of each vehicle. If the driver's name is different from the name of the insured, establish what the relationship is and take down the name and address for each individual. Also make a written description of each car, including year, make, model and color — and the exact location of the collision and how it happened. Finally, be polite but don't tell the other drivers or the police that the accident was your fault, even if you think it was.

4. Photograph and Document the Accident. Use your camera to document the damage to all the vehicles. Keep in mind that you want your photos to show the overall context of the accident so that you can make your case to a claims adjuster. If there were witnesses, try to get their contact information; they may be able to help you if the other drivers dispute your version of what happened.

5. File An Accident Report. Although law enforcement officers in many locations may not respond to accidents unless there are injuries, drivers should file a state vehicle accident report, which is available at police stations and often on the Department of Motor Vehicles Web site as a downloadable file. A police report often helps insurance companies speed up the claims process.

6. Know What Your Insurance Covers. The whole insurance process will be easier following your accident if you know the details of your coverage. For example, don't wait until after an accident to find out that your policy doesn't automatically cover costs for towing or a replacement rental car. Generally, for only a dollar or two extra each month, you can add coverage for rental car reimbursement, which provides a rental car for little or no money while your car is in the repair shop or if it is stolen. Check your policy for specifics.

Rotator Cuff Tear

Rotator Cuff Tear 

A rotator cuff tear is a common cause of pain and disability among adults. A torn rotator cuff will weaken your shoulder. This means that many daily activities, like combing your hair or getting dressed, may become painful and difficult to do.

Acute Tear: If you fall down on your outstretched arm or lift something too heavy with a jerking motion, you can tear your rotator cuff. This type of tear can occur with other shoulder injuries, such as a broken collarbone or dislocated shoulder.

Degenerative Tear: Most tears are the result of a wearing down of the tendon that occurs slowly over time. This degeneration naturally occurs as we age. Rotator cuff tears are more common in the dominant arm. If you have a degenerative tear in one shoulder, there is a greater risk for a rotator cuff tear in the opposite shoulder -- even if you have no pain in that shoulder.

Your Nervous System

Your nervous system is typically divided into two sections; the central nervous system (CNS) and peripheral nervous system (PNS). The central nervous system is made up of the brain and spinal cord. The peripheral nervous system basically consists of everything else, but is further divided into the somatic and the autonomic nervous system. 

Chiropractic Help For Shoulder Pain

How can chiropractic help my shoulder pain?

The treatment of shoulder pain depends entirely on the cause of the problem. Therefore, it is of utmost importance that you understand the cause of your symptoms before embarking on a treatment program. If you are unsure of your diagnosis, or the severity of your condition, you should seek medical advice before beginning any treatment.

Your chiropractor looks at your overall health, focusing not only on your shoulder, but also on your lifestyle, such as diet and amount of daily exercise. This integrated approach helps determine the best treatment for your shoulder pain. To help identify the cause of your problem, you and your chiropractor will discuss your symptoms and previous injuries, your family health history, and your lifestyle, including recreational and work related physical activities.

Your chiropractor is uniquely qualified to restore the health of your spine and neck. Special chiropractic techniques may relieve the pressure that is causing your shoulder pain. After locating the misaligned vertebrae in your neck, your chiropractor manually applies gentle pressure and repositions the vertebrae. These adjustments can help restore alignment, improve mobility, and relieve pain and stiffness.

Your chiropractor may recommend other types of treatment for relieving your shoulder pain. These may include moist heat, ice packs, massage, traction, or stretching and strengthening exercises. Your chiropractor can discuss these with you.

Shoulder Pain

SHOULDER PAIN 

Shoulder pain is an extremely common complaint, and there are many common causes of this problem. It is important to make an accurate diagnosis of the cause of your symptoms so that appropriate treatment can be directed at the cause. If you are unsure of the cause of your shoulder pain, or if you do not know the specific treatment recommendations for your condition, you should seek medical attention. Treatment of these conditions must be directed at the specific cause of your problem.

You should see a doctor if you experience the following:

1. Inability to carry objects or use the arm

2. Injury that causes deformity of the joint

3. Shoulder pain that occurs at night or while resting

4. Shoulder pain that persists beyond a few days

5. Inability to raise the arm

6. Swelling or significant bruising around the joint or arm

7. Signs of an infection, including fever, redness, warmth

8. Any other unusual symptoms