Chiropractic Facts

Chiropractic Facts

Chiropractic care has been known to help many people suffering from a wide variety of nerve/muscle/joint-related conditions. If the chiropractor examines a person and finds joint dysfunction, nerve irritability and/or connective tissue abnormalities related to the problem area, it is likely that chiropractic care will help.

Chiropractic services are in high demand. Tens of millions of Americans routinely opt for chiropractic services and this number is rapidly growing. In 1993, more than 30 million consumers made chiropractic a regular part of their health care program.

Chiropractic utilizes a "hands on" active approach. The principle treatment is adjustment/ manipulation of the spine and supportive soft-tissue techniques. There is a focus on lifestyle counseling, prevention, and patient responsibility for health (for example, in the areas of posture, diet, exercise, stress-reduction, etc.).

All treatment is based on an accurate diagnosis of your back pain. The chiropractor should be well informed regarding your medical history, including ongoing medical conditions, current medications, traumatic/surgical history, and lifestyle factors. Although rare, there have been cases in which treatment worsened a herniated or slipped disc, or neck manipulation resulted in stroke or spinal cord injury. To be safe, always inform your primary health care provider whenever you use chiropractic or other pain relief alternatives.

Doctors of chiropractic provide effective, low-cost health care for a wide range of conditions. Studies conducted according to the highest scientific standards and published by organizations not affiliated in any way with chiropractic institutions or associations continue to show the clinical appropriateness and effectiveness of chiropractic care. One of the most recent, funded by the Ontario Ministry of Health, stated emphatically that:

The process of chiropractic adjustment is a safe, efficient procedure which is performed nearly one million times every working day in the United States. There is a singular lack of actuarial data that would justify concluding that chiropractic care is in any way harmful or dangerous. Chiropractic care is non-invasive, therefore, the body's response to chiropractic care is far more predictable than its reactions to drug treatments or surgical procedures. Of the nearly one million adjustments given every day in this country, complications are exceedingly rare. Perhaps the best summary statement on the subject of safety was published in 1979 by the Government of New Zealand which established a special commission to study chiropractic. They found:

"The conspicuous lack of evidence that chiropractors cause harm or allow harm to occur through neglect of medical referral can be taken to mean only one thing: that chiropractors have on the whole an impressive safety record."

Neck Pain Facts

Neck Pain Facts

Neck pain is a very common problem and the chances that it is caused by serious disease are very rare. Health practitioners can help suggest possible ways to control your pain and advise you of ways to deal with the pain and get on with your life. It is normal to worry about the cause of your pain and the impact it may have on your life. Talking with your healthcare provider about these worries and concerns can be helpful. You will usually find there is no serious cause of the pain and that there are ways to relieve the symptoms and get you back to your normal activities.

Often neck pain episodes will get better on their own as nature takes its course. It’s important to stay as active as possible as the old adage of bed rest and trying to completely avoid pain is not the best advice. Most people do just fine by staying active, coping the best they can, and modifying daily activities as to not re-agitate the tender tissues.

Back and neck pain are the most common chronic pain conditions. Back and neck pain can arise from soft tissues, bony parts of the back and neck, and joints holding the spine in alignment. It can arise directly or indirectly from the discs in the back or neck, and it can occur when nervous tissue, normally protected by the bones of the vertebral spine, is compressed by those bony elements.

The most common symptoms of neck pain are pain, stiffness, muscle spasm, clicking and grating, numbness or tingling, dizziness and/or blackouts.

Neck pain can also come from conditions directly affecting the muscles of the neck, such as fibromyalgia and polymyalgia rheumatic. Neck pain is also referred to as cervical pain.

What is a traumatic event?

What is a traumatic event?

A traumatic event occurs when the forces experienced during the various stages of the collision are greater than what is tolerable or is beyond the stress/strain threshold for the specified region of the body or type of tissue. These forces may cause minor (AIS 1 level) injuries, having no risk of fatality, and at the same time may present the occupant with sub catastrophic injuries, including strains, sprains, contusions, bruising and swelling and resultant symptoms and findings consistent with a WAD. Just because an injury or the cause of a patient’s subjective complaints is not objectively seen does not mean that it doesn’t exist. Unfortunately, current technology is not sensitive enough to detect some types of injuries. More severe injuries may also occur, resulting in more obvious injuries, including fractures, bleeding, organ disruption, and death.

The Cervical Spine

 The Cervical Spine

Axioms of Cervical Spine Assessment

1.      Cervical spine syndromes are extremely common and are probably the fourth most common cause of pain.

2.      At any given time, 9% of men and 12% of women have neck pain with or without arm and hand pain, and 35% of the population can remember having had neck pain at some time.

3.      The cervical spine is the origin of a large proportion of shoulder, elbow, hand, and wrist disorders.

4.      Most people who develop pain in the neck do not seek medical attention because they regard such pain as a part of life, so they simply wait for it to disappear.

Disc Injuries in Side Impacts/Rear 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 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.

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.

Vehicle Impact speeds are usually needed for a biomechanist to determine occupant motion and forces experienced during the crash

Vehicle Impact speeds are usually needed for a biomechanist to determine occupant motion and forces experienced during the crash

Traffic accident reconstructionists are primarily used to determine the impact speeds and the delta-V for the vehicles involved in the crash. In the majority of crashes, the accident reconstructionists will use information from skid marks, road surface friction, pre-impact and post-impact directions for each vehicle, point of impact, distances that each vehicle moved after the collision, crush width and depth, and other factors to determine the impact velocities and delta-V’s. This information may be noted in the police report, medical records, repair estimates, photographs, or in recorded statements or depositions of parties involved in the crash. In essence, kinetic energy and/or momentum are used by these experts to establish their database as well as using crash tests to compare with the actual collision. The type of crash and facts in the case establish the approach that the reconstructionist will use. These speeds are then used by the biomechanics experts for their determination of injury mechanisms, forces, and injury risks.

               Since 1977 all new production vehicles have event data recorders (EDRs) or “Black Boxes” that collect impact data and make decisions about whether to deploy or to not deploy the frontal airbag in a crash. However, only a limited number of manufacturers have provided private industry, including police departments, with a decoder device and software to access the data on the module. For and General Motors have led the industry by providing the private industry with the ability to download the data from the EDRs. At present, these “Black Boxes,” are limited to recording the delta-V of the vehicle, seatbelt use/nonuse, airbag enabled/disabled, time of impact relative to airbag deployment , the status of the brakes (on or off), and the percent of throttle use/engine RPM and vehicle speed before the algorithm is activated. There are many varieties of EDRs available and there is no standardized format among the different manufacturers for storing and retrieving the electronic data. EDRs have differing data parameters between models and manufacturers, and this some measure average acceleration values whereas others only show peak acceleration values. Differing levels of delta-Vs or acceleration thresholds for activation as well as recording time can be set. These systems have to be customized for the size of the vehicle. Airbag deployment protocols will differ in small cars compared to a large SUV. If the data from an EDR is properly evaluated, it can provide an impartial source of evidence for the reconstruction and biomechanics community. EDR data has been successfully used as evidence in trails. Most consumers are not aware of these recorders in their vehicles, and it may come as a surprise for all parties that one exists. If anyone is aware that an EDR is present in a case, it is critical to get signed authorization by the owner of the vehicle, or owner’s counsel, before retrieving electronic data from EDR or removing the recorder, and to make certain to document the “chain of evidence,” that is, who removed and has the device, making certain there has been no tampering or misuse of the EDR. EDRs continue to evolve and the data from the device are considered to be accurate and therefore reliable for its intended purposes. According to a recent NHTSA working group, the owner of the vehicle owns the data from the EDR. More information on EDR benefits versus limitations can be found on the Internet. The manner in which the EDR was removed, how the device has been stored, and how the downloaded data (evidence) has been protected is critical for criminal cases.

               The plaintiff and his or her treating health care providers and expert witnesses have the “burden of proof” in civil cases relating to traffic accidents. In contrast, the insurance industry is not in the business of collecting unnecessary evidence or getting information that can potentially be used against them. This means that if the case goes into litigation, the plaintiff needs to be able to prove his/her injuries. There needs to be enough information in the police report, repair estimate, and photographic evidence for the plaintiff’s reconstructionists to calculate crash speeds so the biomechanist can describe occupant motion and biomechanical aspects of the event. The reader may ask, why do I need to get involved, what should be advised, and if so, how can it be done in a short amount of time? Well, the doctor can greatly aid the case if the patient is advised to take photographs of his/her vehicle as soon as possible. In addition, advising the patient to photograph the vehicle before, during, and after repair is done can useful to the plaintiff’s reconstructionist. Positioning a tape measure next to the damage as each photo is taken clearly indicates where the damage is located and the depth of the crush. These measurements can greatly increase the accuracy of calculating the crash speeds. In most cases where the plaintiff’s vehicle is totaled, the vehicle will be towed to a storage facility and then rapidly sold and removed by companies that scrap the vehicle. After investigating several hundred crashes, I have found a consistent trend for the claims adjusters to take photographs of marginal-to-poor quality and at mostly oblique angles, contrary to published accident reconstruction standards. Several recognized traffic accident reconstruction books have been available to insurance carriers for decades that can be used for training their claims persons. Most certainly these insurance carriers frequently hire defense reconstructionists who have been properly trained in the photographic standards and what is required to make accurate speed calculations from crush analysis. These reconstruction texts have clearly set the standards for taking photographs of vehicles involved in collisions. Either the majority of claims adjusters are trained to take lousy photos or they are not motivated to take views useful for reconstructionists. In vehicles that are towed away and totaled, the speedy sale to contracted companies does not allow time for photographs to be taken in most cases. If the crashed vehicle is in a storage facility, often the owner is either not allowed or strongly urged to not take photos by the persons managing the facility. To provide information for the case, the owner should insist on a photo session of his or her own vehicle. If an attorney is involved at the onset, the defendant’s insurance carrier can be notified that photographs must be taken of the vehicle before any repairs are made or the vehicle is sold.

Inflammatory Reaction

Inflammatory Reaction

              

                Inflammation is a normal and necessary prerequisite to healing. Following the tissue bleeding which clearly will vary in extent depending on the nature of the wound, a number of substances will remain in the tissues which make a contribution to the later phases. Fibrin and fibronectin form a substratum which is hospitable to the adhesion of various cells.

               Complex chemically mediated amplification cascade that is responsible for both the initiation and control of the inflammatory response can be started by numerous events, one of which is trauma. Mechanical irritation, thermal or chemical insult, and a wide variety of immune responses are some of the alternative initiators, and for a wide range of patients experiencing an inflammatory response in the musculoskeletal tissues, these are more readily identified causes.

               There are two essential elements to the inflammatory events, namely the vascular and cellular cascades. Importantly, these occur in parallel and are significantly interlinked. The chemical mediators that make an active contribution to this process are myriad. In recent years, the identification of numerous “growth factors” have led to several important discoveries and potential new treatment lines. 

Four new meningitis cases reported at Ann Arbor hospital

Ann Arbor — Four new cases of fungal meningitis in Michigan have been confirmed at St. Joseph Mercy Ann Arbor, officials said Wednesday.

Lauren Smoker, a spokeswoman for the hospital, said officials have confirmed four more cases of the disease, raising the total number of cases being treated at the facility to 22.

Also Wednesday, state health officials updated the number of Michiganians sickened by the outbreak tied to tainted steroids to 28, including three deaths. Nationally, according to the Centers for Disease Control and Prevention, the outbreak has now reached 137 cases, including 12 deaths.

In Michigan, Lilian Cary, 67, of Livingston County, a 78-year-old Washtenaw County woman and a 56-year-old Genesee County woman have died in the outbreak.

Other states where cases have been found include Tennessee, Virginia, Indiana and Florida. The largest concentration has been in Tennessee, which has 39 cases and six deaths. Michigan is second. Virginia was third with 24 cases and one death.

Most of those cases are believed to have resulted from steroid shots administered to alleviate back pain.

Fungal meningitis is the inflammation of the protective coverings of the brain and spinal cord. It is not contagious, but it can be fatal.

As many as 13,000 people may have received tainted injections nationwide.

In Michigan, four health facilities received shipments of the contaminated steroids.

They are:

— Michigan Neurological Institute in Grand Blanc

— Michigan Pain Specialists in Brighton

— Neuromuscular & Rehabilitation in Traverse City

— Southeast Michigan Surgical Hospital in Warren

CDC reports eighth fungal meningitis death

ATLANTA (WLS) - Health officials estimate that 13,000 people may have been exposed to contaminated lots of an epidural steroid that has been linked to a rare fungal meningitis that has infected 105 people across nine states, killing eight of them. Fourteen new cases and one new death have been reported since Sunday.

Although the number of cases has increased, the outbreak does not include any new states. The number of people with fungal meningitis, which is not spread person-to-person, has grown by 64 percent since Friday.

The outbreak of aspergillus meningitis has been linked to spinal steroid injections, a common treatment for back pain. A sealed vial of the steroid, called methylprednisolone acetate, was found to contain fungus, according to the U.S. Food and Drug Administration.

The states with reported cases include Florida, Indiana, Maryland, Michigan, Minnesota, North Carolina, Ohio, Tennessee and Virginia. Tennessee has the most cases, with 35, including four deaths.

"FDA is in the process of further identifying the fungal contaminate," said Dr. Ilisa Bernstein, acting director of the FDA's Center for Drug Evaluation and Research Office of Compliance. "Our investigation into the source of this outbreak is still ongoing."

The steroid came from the New England Compounding Center in Framingham, Mass., a specialty pharmacy that has recalled three lots of the drug and shut down operations. Calls to the pharmacy were not immediately returned and its website is down.

Roughly 75 clinics in 23 states that received the recalled lots have been instructed to notify all affected patients.

"If patients are concerned, they should contact their physician to find out if they received a medicine from one of these lots," said Dr. Benjamin Park of the U.S. Centers for Disease Control and Prevention, adding that most of the cases occurred in older adults who were healthy aside from back pain.

Meningitis affects the membranous lining of the brain and spinal cord. Early symptoms of fungal meningitis, such as headache, fever, dizziness, nausea and slurred speech, are subtler than those of bacterial meningitis and can take nearly a month to appear. Left untreated, the inflammatory disease can cause permanent neurological damage and death.

"Fungal meningitis in general is rare. But aspergillus meningitis -- the kind we're talking about here -- is super rare and very serious," said Dr. William Schaffner, president of the National Foundation for Infectious Diseases and chairman of preventive medicine at Vanderbilt University Medical Center in Nashville. "There's no such thing as mild aspergillus meningitis."

The disease is diagnosed with a lumbar puncture, which draws cerebrospinal fluid from the spine that can be inspected for signs of the disease. Once detected, it can be treated with high doses of intravenous antifungal medications.

"Treatment could be prolonged, possibly on the order of months," said Park, adding that the IV treatment would require a hospital stay.

Unlike bacterial and viral meningitis, fungal meningitis is not transmitted from person to person and only people who received the steroid injections are thought to be at risk.

The FDA has, however, advised health providers to stop using any product made by the New England Compounding Center during the investigation.

Meningitis cases linked to steroids increase; no California cases so far

LAKE COUNTY, Calif. – A meningitis outbreak linked to epidural steroid injections that so far is affecting the eastern half of the United States is continuing to grow, with health officials continuing to monitor patients in the North Coast region who received the steroids.

On Monday, the Centers for Disease Control and Prevention in Atlanta reported that the outbreak of fungal meningitis cases linked to contaminated methylprednisolone acetate injectable steroids had grown to 105 cases across nine states, with eight deaths.

No cases have so far been reported in California, the agency said.

Affected states included Florida, Indiana, Maryland, Michigan, Minnesota, North Carolina, Ohio, Tennessee and Virginia, according to the CDC, which is coordinating the investigation into the outbreak.

The CDC said the manufacturer of the methylprednisolone acetate injections, New England Compounding Center located in Framingham, Mass., began a voluntary recall of the drugs on Sept. 26.

State and federal officials said 75 health care facilities in 23 states received the contaminated product.

In California, four health facilities received the drug, which is used as an epidural injection for chronic pain.

Among them was Ukiah Valley Medical Center, which last week sent out letters to patients notifying them of the issues, as Lake County News has reported.

Also receiving the compound in California were the Cypress Surgery Center in Visalia, the Encino Outpatient Surgical Center and Universal Pain Management in Palmdale, the CDC reported.

To date, no patients have been admitted to UVMC with meningitis-type symptoms as a result of receiving this compound, the hospital said Monday.

Meningitis is a swelling of the meninges, the protective covering of the brain and spinal cord.

The CDC said infected patients have developed a variety of symptoms approximately one to four weeks following their injection. The symptoms include fever, new or worsening headache and nausea. Some also have suffered strokes.

The CDC investigation thus far has revealed that the meningitis linked to the steroid injections was caused by a fungus that is common in the environment but rarely causes meningitis. The source of the fungus, however, has not been identified.

Officials said the fungal meningitis in this outbreak is not contagious.

Anyone who has had one of the epidural steroid injections since May 21 should talk to their doctor immediately if they experience a worsening headache, fever, sensitivity to light, stiff neck, new weakness or numbness in any part of your body or slurred speech, according to the CDC.

In a Monday statement, UVMC said it selected the New England Compounding Center in spite of a 75 percent higher cost for the compounded medication because the center is a specialized “compounding-only pharmacy” dedicated to providing medications and services to patients and prescribers.

“The team of registered pharmacists at UVMC did not choose the product based on price,” according to Heather Van Housen, UVMC’s patient care executive.

“The product was selected because it contains no preservatives or buffers that other pharmaceutical manufacturers offer that may cause higher risk of infection or other complications,” Van Housen said.

Death toll jumps to 11 in meningitis outbreak; 119 people infected

The Atlanta-based CDC released new numbers Tuesday in the meningitis outbreak linked to injectable drugs.

The number of people sickened has now reached 119 cases, including 11 deaths.

New Jersey is the 10th state to report at least one illness. The other states involved in the outbreak so far are Tennessee, Michigan, Virginia, Indiana, Florida, Maryland, Minnesota, North Carolina and Ohio.

Officials have tied the outbreak of rare fungalmeningitis to steroid shots for back pain. The steroid was made by a specialty pharmacy in Massachusetts. At least one contaminated vial was found at the company.

The company recalled the steroid that was sent to clinics in 23 states, and later recalled everything it makes.

The FDA released a list of 34 different drugs Friday that included steroids, epidural anesthetics used to block pain during childbirth, and surgery and saline solutions that are compounded to make different medications. All of these recalled products were made by the New England Compound Center (NECC) in Framingham, Mass., and are administered by injection into the spine.

Health officials say people in 23 states could be affected.

The 23 affected states are: California, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Maryland, Michigan, Minnesota, North Carolina, New Hampshire, New Jersey, Nevada, New York, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Virginia, Texas and West Virginia.

The Atlanta-based CDC asked the clinics, doctors and hospitals in 23 states that have received shipments of medications from NECC to stop using them immediately. Anyone who has received epidural injections since July 1 should watch for symptoms of meningitis. Symptoms include worsening headache, fever, stiff neck, trouble walking or falling and progressing back pain.

To see a full list of the drugs recalled, click here.

No infections have been reported in Georgia, but at least one shipment of the drugs arrived in the state, according to Georgia Public Health Commissioner Dr. Brenda Fitzgerald.

In a letter to WXIA, Dr. Fitzgerals says, "Affected medication was delivered to a healthcare facility in the Macon area and clinicians in that area should be extra vigilant. To date, DPH is aware of no other affected shipments arriving in Georgia."

TENDINITIS AND TENDON RUPTURE

TENDINITIS AND TENDON RUPTURE

               

Inflammatory conditions of the tendons may be acute or chronic. The pathologic reaction is located mainly in the tendon sheath, with tenosynovitis, or paratendinitis.

               Chronis inflammation may precipitate varying degrees of degenerative change in the tendon itself, referred to as tendinosis. The latter may be associated with structural weakening and predispose to partial or complete tendon rupture. Rupture can also occur when sufficient force is applied to normal tendons.

               A normal tendon is characterized by enormous tensile strength. The crimped, ultrastructural makeup of a tendon means that initial stresses are accommodated by straightening out the crimped arrangements of the collagen fibers. Greater loads stress the fibers themselves. Most day-to-day activity and even stressful sporting maneuvers are accommodated in the toe region and early in the linear phase of the stress strain curve for tendon. The linear phase represents ligamentous elasticity, and deformation is reversible. At the high ends of functional loading, plastic deformation and even microfailure may occur. 

Tucker History

Tucker's History Predates the Civil War

In the early 1800s a tall young man from Scotland named Greenville Henderson made his way from the battles of the Indian Wars to his Georgia home. As a reward for his valiant services, the governor of Georgia gave Henderson 3,000 acres of land in what is now known as the Tucker area.

This land, valued at 50 cents an acre, roughly encompassed from east to west the area from Tucker to below Northlake Festival Shopping Center on LaVista Road and north of Henderson Mill Road south to Lawrenceville Highway (U.S. 29). Settling on this tract of land, Henderson operated large apple and peach orchards, corn fields, and a prosperous whiskey and brandy making business. He shipped finished product to Savannah by wagon train in exchange for window glass, salt, sugar, coffee and building brick brought to the Atlantic seaport by boat.

Before the Civil War, Henderson built the historic grist mill on Henderson Mill Creek at the intersection of Midvale Road and Henderson Mill Road. Near the mill was the old frame Henderson Post Office. Mail was brought by horse and buggy from Decatur for people in the Tucker area. The post office was abandoned in 1895 and the mill demolished in 1911. Henderson's home was on a sloping hillside overlooking the grist mill is now the site of St. Bedes Church.

In 1861, the Civil War swept the countryside. Seven of Henderson's sons left to fight in the Confederate Army. Two never returned.

On a hot day in 1864 word came to the Tucker area that the Union Army was advancing on the area. The army of Tennessee under the command of Gen. James McPherson decided to come to the Southeast to cut off the Georgia railroad near Stone Mountain where Atlanta would be isolated from the east. The Federals 15th Army Corps under the command of Maj. Gen. John Logan crossed the Chattahoochee River at Roswell and detoured to Browning's Courthouse in Tucker to give support to Garrard's Army in the destruction of the railroad. This courthouse was recently moved to the grounds of the Tucker Recreation Center on LaVista Road. Garrard's soldiers headed toward Stone Mountain long Fellowship Road on July 18, 1864.

Confederate soldiers under the command of Gen. Joseph Wheeler fought hard to stop the march. The Federal troops reached Stone Mountain and destroyed a two-mile section of the Georgia Railroad tracks, several culverts and the water tank. Approximately 150 of the Confederate soldiers who were killed in defending the railroad are buried in a small cemetery near the mountain.

Meanwhile, the mission at Stone Mountain accomplished, Logan's Federal troops withdrew from Browning's Courthouse in Tucker to Henderson Mill the evening of July 18 to camp near a water supply. Early the next morning Logan's troops joined Blair's Army Corps near Midway Baptist Church (the small church across from Northlake Mall on Henderson Mill Road) and marched toward Decatur to fight in the Battle of Atlanta.

In 1869, four years after the war, Greenville Henderson died. He is buried in a small cemetery off Henderson Mill Road near the intersection of Midvale Road. Buried with him are about 30 relatives including his wife, Nancy, who died in 1892 at the Age of 102.

Growth was steady in the area after 1892 when the Georgia, Carolina and Northern built the railroad through the center of what is now called Tucker. The first business in Tucker was a saloon and horse race track on Fellowship Road. The area had been known as Browning's District until 1907 when the Seaboard Line Railway acquired the railroad and surveyed the unincorporated town of Tucker and named the town after an Officer of the company, Capt. Tucker.

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

Chiropractic Adjustments for Newborns

Greater complications during delivery result in greater neurological insult to the newborn due to injury to the head and neck. Even after vaginal births, 4.6% of term neonates suffer unexplained brain bleeds and 10% suffer neonatal encephalopathy. Because so many children had been injured with forceps deliveries, (facial nerve palsy, tearing of cervical spine musculature) vacuum extraction was developed. Suction cups are placed on the newborn's head, and the baby is literally sucked out of the mother.

When utilized, 120 pounds of pressure goes through the baby's head and neck. Decapitation occurs at 140 pounds of pressure, to give you an idea of the high forces involved. Remember when you were a little girl or boy and there was a new baby you were being introduced to? Our parents always said, "Watch his head-you don't want to hurt him." We're careful because the fontanel's of the skull are so pliable, and the neck and brain are fragile and unprotected. This is why so many babies sustain injuries to their heads and neck during vacuum extraction-the force is far greater than their little bodies can tolerate.

Adjustments to newborns contain only ounces of force. But that force is directed into the spine to facilitate health and remove subluxations. We adjust babies as soon after birth as possible, to alleviate subluxations caused by in-utero constraint and the journey down through the birth canal. There has been a lot in the media lately about children not needing Chiropractic care, but there is no better way to get a head start in life. As you all know, Chiropractic care is not a cure for anything-it is a system of wellness to help us be who we're supposed to be. It is not a cure for ear infections, for colic, for allergies, for asthma, for frequent colds, nor for ADD/ADHD.

When we listen to mothers' stories of their pregnancy, labor and delivery, the children who suffer the most from the above complaints, are the ones who've had the greatest trouble with their births. Even relatively easy deliveries can result in subluxations. That's why every child should be checked, before problems with their health even develop. That's preventive care in the truest sense-preventing subluxations in mothers to prevent subluxations in their babies during childbirth. This is why every woman needs Chiropractic through pregnancy-so that the arrival of their baby is a wonderful experience. 

Chiropractic Care for Children

Chiropractic is not only safe for children, it’s wise. Chiropractic care can help alleviate the aches and pains that result form a misalignment of the vertebrae. Children also suffer from many types of illnesses, from allergies to injuries, that can cause pain and discomfort. Good chiropractic care for children means a practitioner that has experience working with young spines, adapting their training and chiropractic techniques to allow for examinations and adjustments that are gentle and non-intimidating.

Extremely gentle pressure (applied with fingertips or soft hand thrusts) is the most effective method of chiropractic care for children. By examining the spine, and using gentle, yet targeted pressure, cavitation of the joints eases the tension in the joint and releases pressure in the surrounding tissue. Children respond amazingly fast so those pesky aches and pains will be gone in no time.

Numbness and Tingling in Arms or Legs

Arm or Leg Pain, Numbness or Tingling 

Pain and/or numbness and tingling in the arms or legs may directly involve the spine. The nerves that exit the neck and travel down the arms are known as the brachial plexus. The nerves that exit the low back and travel down the legs are known as the lumbosacral plexus. These nerves exit through openings of the spinal column called an IVF (intervertebral foramina) if there is interference with theses nerves it may be the direct cause of the problem. This is usually true when the pain travels down the arm or leg. Any time you have a radiating pain and/or numbness and tingling down the arm or leg, you should be checked by your chiropractor immediately.

Why You Should Not "Pop" Your Own Neck

 The bad news for "self-manipulators." If you are a chronic neck-popper, you are very likely stretching the ligaments which support and stabilize your neck joints. Stretched ligaments result in a condition called hypermobility in which the joints lose their natural springy end play. To someone skilled at feeling joint motion, like a chiropractor, this loss of springiness can be detected. It is sometimes jokingly referred to as “floppy disc syndrome,” although the discs in the neck are not directly affected. As the ligaments become more lax, the small muscles that connect one vertebra to the next become tight. They have to work harder to make up for the loss of stability due to the lax ligaments. This makes your neck feel tight. As the muscle tension builds and your neck becomes more and more uncomfortable, you feel the urge to manipulate your neck. CRACK! The muscles are stretched, they relax, and you feel some relief. Of course, this manipulation also stretched those already loose ligaments, and the vicious cycle starts over again.

Hypermobility can be congenital (i.e., hereditary) or acquired. Teens tend to have hypermobile spinal joints. This is normal and will usually resolve as the skeleton and supporting tissues finish growing. However, if neck cracking becomes a habit, then the problem can continue into adulthood. Clinical evidence suggests that hypermobile spinal joints become arthritic at a faster rate than normal joints. Hypermobility can also result from injuries such as whiplash, or it can be self-inflicted. Some popping in the back or neck occurs spontaneously with movement and may be normal.

Treatment: Chiropractors treat hypermobility with strengthening exercises. If the ligaments are weak and the muscles have to work harder, they will be less tense if they are stronger. Strong muscles don’t have to work as hard as weak muscles, so there is less tension. Hypermobility is also treated with spinal adjustments, a form of manipulation. Although this would seem to be contradictory, sometimes hypermobility can be a compensation for restricted or fixated joints elsewhere in the spine. The adjustments are given only to these joints, not the hypermobile ones.

Of course, the best thing to do is to STOP POPPING YOUR NECK. That’s it. Just don’t do it. Most people who “go cold turkey” will feel worse for a time. But even if no other treatment is given, you will probably feel much better after two or three weeks.

Symptoms of Poor Posture

Years and years of poor posture can trigger a series of symptoms in the average adult. They can start by:

Fatigue – you wake up and don’t feel like doing anything. Your muscles are weak, without energy, and so is your mind. Things lose brightness and taste. You think to yourself: “the solution to this problem would be to do some exercise”,  but ironically the problem is that you don’t feel like going out or doing exercise. A vicious cycle starts, which can only be ended by adopting a good posture.

Tight muscles in the neck, back, arms and legs. You’ll know that you’ve reached this stage because you’ll feel your muscles and ligaments stiff, tight and painful, specially neck and back muscles. That typical image of a person sitting in front of the computer and moving their head to relieve the pain says it all. Most of neck and back problems are the consequence of years of bad posture.

Joint stiffness and pain – this is especially dangerous in later years, because of the risk of arthritis, or what is called degenerative osteoarthritis. Joints are then very sensitive, since they’ve been supporting the weight of the body for years.