Dr. Dalfino's Non-Surgical Treatment Blog

Whiplash and Work

Does this sound familiar? It’s fictional but a rather typical scenario affecting thousands of American drivers:

“Last week, I was waiting at a red light and a car came up from behind and ran into the back end of my car.  It was a low speed collision without a lot of damage to either of our cars.  Surprising, I felt quite a jolt and my head even hit the headrest.  I didn’t bother getting the name or phone number from the person that hit me because I didn’t hurt at the time and besides, there was no real damage that I could see to my car or the other person’s car.

“About a half hour later, I noticed my neck felt stiff when I turned to check traffic on my right and I felt really sharp pain before I could turn the whole way.  The pain was bad enough to make me yell and when I brought my head back to the front, the pain didn’t go away – in fact it felt worse.  When I woke up the next day, I could hardly turn my head at all and, I had a terrible headache.  The pain was so bad that even 4 Advil didn’t touch it.

“I couldn’t decide what type of doctor to see for this.  I knew if I went to my family doctor, he’d put me on a bunch of pills but I have to drive forty five minutes to my job and I have two small kids that require my attention.  I had seen an ad for a chiropractor a while back and I wondered what they would do for something like this.  I knew I had to do something and fast!

“So I decided to go to a chiropractor a friend of mine recommended and I was really surprised when I got there.  The doctor was really attentive and seemed to know exactly what was going on.  It was explained to me that I may have been hurt MORE than I might have been had the speed of the other car been going even faster because crushing metal absorbs the shock where in my case, no car damage resulted in more shock to me.  This made sense because I had some books on the other seat that flew off when I was hit, which I forgot about until we were talking.  I also learned that even if I knew I was going to get hit, I wouldn’t have been able to brace myself enough to avoid injury as the speed of the force moves the head and neck quicker than what I can tighten my muscles.  The chiropractor showed me some charts that helped explain all this and why my neck hurt and where the headaches come from.  I also learned NEVER assume no car damage means no injury.

“The best part was right after the adjustment, I felt immediate improvement with better movement and less pain. I also was told to put ice on my neck, which helped a lot more than heat did. I’m now doing exercises and really feel good! I can’t tell you how happy I am that I chose a chiropractor to help me!”

Patients who have similar experiences are afraid of having a long, drawn out problem and missing work.  You have many choices when it comes to choosing a health care provider for your injury and other health care needs.  I truly appreciate your trust and confidence in our service when choosing to visit my clinic when you need help!

Please contact our office if you, your family or friends are suffering with injuries sustained in a motor vehicle collision.   

Whiplash Associated Disorders

Is the speed of a car crash directly proportional to amount of injury sustained to the occupants?  One would expect more injury to occur when the speed of the collision is faster. Sometimes, this is the case – especially when car accidents occur at highway speeds. 

However, what about the cases where a patient ends up in a lot of pain even when the speeds are quite slow, especially when there is little to no damage to the vehicle? , The answer to this seemingly paradoxical relationship has to do with plastic vs. elastic deformity. 

This may be more simply understood if you think of “plastic” as something (in this case, your car) breaking apart vs. “elastic” as bouncing off without deforming or breaking apart. Therefore, in plastic deformity, there is more damage to the vehicle and in elastic deformity, there is little to no damage.  When there is more metal crushing or more vehicular damage (plastic deformity), the G-forces associated with the crash are absorbed by the crushing metal, which in turn, exerts LESS G-forces to the contents inside the vehicle (ie, the occupants), resulting in less injury. On the other hand, in the stiffer, less damaged vehicle, the energy is not absorbed by crushing metal (elastic deformity), resulting in the contents or occupants inside the vehicle being jostled or thrown about to a greater extent (due to the higher G-forces are exerted) and are at a greater risk for a higher degree of injury.

To illustrate this point, let’s say that, we have a car that hits a solid brick wall at 10 mph that crushes in the front of the car 5 inches. In the second scenario, let's keep the car at a speed 10 mph, but because of a different car design (stiffer frame such as a solid bumper-to-bumper chassis), the crush in this instance is only 2 inches.

In the first example, the acceleration is found to be 8 G’s of force. In the second example, acceleration is equals about 20 Gs of force. Thus, a collision with the same velocity, but with a crush amount smaller by 2.5 times will have a resulting G force 2.5 times larger.

Facts such as these are VERY important for you, your family and your doctor to appreciate, especially if there is legal action being taken in the case.  Therefore, it is important for you to choose a health care provider who understands and appreciates the potential impact this information carries when addressing your health related needs and communicating this information to others involved in a case.
Robbins MC. Lack of relationship between vehicle damage and occupant injury. SAE 970494

Please contact our office if you, your family or friends are suffering with Whiplash Associated Disorders or injuries that were sustained in a motor vehicle collision.

Minimizing Your Risk for Whiplash

While it is hard prevent someone from crashing their car into your car, there are some things you can do to minimize whiplash injuries.

The first preventive measure is making sure your seat is upright and the head rest touches the top of your head. If there is a lot of distance between your head and the rest, it will do little to help in the event of a collision. Also, if the headrest is too low, in can act as fulcrum, leveraging your neck into a worse position, and increasing injury risk.

Another thing we can do minimize injury risk is being in the best possible shape prior to the trauma. Research has shown people with good aerobic fitness seem to be more resilient after whiplash accidents.

If you are aware you are about to be hit, it is probably best to remain in a neutral position with eyes facing forward. People with their head turned prior to impact seem to have worse ligament injuries.

If you can afford it, a larger car will lessen the momentum of your vehicle after a collision. There are now vehicles with whiplash-protection seats (e.g. Saab) that dampen the effects of rear end-accidents. Frontal collisions tend to be less severe to the neck if the speeds are equal because the chin can hit the chest preventing forward motion of the neck. Rear-end and side-impact collisions do not have this benefit.

Unfortunately, there are many simply unavoidable risk factors. Women and children seem to be more vulnerable, possibly because of the increased head to neck size ratio. Also if you've ever had a head or neck trauma before and or have a degenerated disk in the neck, these factors elevate your risk for a more pronounced injury. Other factors that can slow your recovery include wearing a neck brace/collar, taking to bed rest, or getting vertical traction treatments. Inhibiting movements can feel good initially but is not good in the long term because of decreased muscle function and strength. Getting diagnosed as soon as possible can determine the best course of action for getting you to back to a speedy recovery. Just letting things go is rarely a good solution.

If you've been injured in a whiplash and need to discuss your health concerns, just call 203-922-9277 to make a complimentary consultation appointment.

The Neck is Your Life Line

The nervous system is the master control network for your body, directing virtually every function and action, from monitoring your life needs, to precisely responding to threats to your health.

Each system, from your heart and blood vessels, to your digestive and immune systems, is directed through nerve impulses originating in your brain or spinal cord that travel through its protective bony structure: the spinal column.

The neck region is the most vulnerable region of the spine to injury. Indeed, even death can be brought through significant trauma to the neck. When the trauma is not fatal, the consequences can still be severe, such as when paralysis strikes.

Most people will not experience these severe injuries, however sprains of the delicate ligaments with subluxation (misalignment) do commonly occur. Despite the injury being smaller, their location (the neck) makes their impact more profound. Functions throughout the body can be impaired when the nerves in the upper neck are compromised.

Within chiropractic, there are specialists who focus their entire care on the uppermost two vertebrae of the spine.

Because every nerve passes through the neck, if irritation or compression is present, virtually any system of the body can be affected. The point being is that a neck disorder will not necessarily just cause neck pain or headache. Dizziness, digestive problems, fatigue, high blood pressure and generally reduced quality of life are some of the symptoms patients commonly experience.

If you have suffered a severe whiplash, you may have noticed far more than a stiff neck. Indeed, recent research suggests whiplash needs to more thought of as a whole body disorder.

We take these injuries in our office and address them in both a specific and comprehensive manner. Most patients who have suffered a neck trauma will require x-rays to analyze the posture of their spine.  X-rays may also need to be taken in motion to test the stability of your ligaments and to determine precise levels of impaired movements. Without this road map, it is difficult to determine how care should be directed and factors that could influence your long-term prognosis, such as degeneration.

Our health care team is dedicated to drugless natural methods to restore vitality. We try to work with your body with techniques that don't carry the all too common side effects commonly seen with long-term drug use or surgery. If you'd like to discuss our non-invasive care approach, just call 203-922-9277 to schedule a complimentary consultation.

"Can Whiplash Hurt Your Shoulder?"

It's probably more common than you think. Whiplash injuries, especially serious ones, are notorious for causing pain and disability beyond the neck. Whiplash is considered a full body disorder and symptoms can range from pain to dizziness, headache and fatigue. Depending on the type of collision and restraints, other body parts may be injured as well. One study (Abbassian A, Giddins GE. Subacromial Impingement in patients with whiplash injury to the cervical spine. J Orthopedic Surgery 2008;3:25.) looked at shoulder complaints in individuals who had suffered a whiplash type of trauma. Out of 220 patients with whiplash, 26% had  shoulder symptoms and 5% had what is known as an impingement syndrome.
Referred pain from the neck and nerve injury to the muscles that stabilize the shoulder can give rise to an impingement syndrome. Also, direct trauma from the pressure supplied by a seatbelt during a frontal impact can cause fracturing of cartilage and sprain of the surrounding ligaments. The pointy top of the shoulder is the acromium and some impingements (binding and compression) can affect the tendons of the rotator cuff or other soft tissues just under this bone. Sometimes a bursa (fluid filled sac) can swell during the night causing pain.
Because most patients with whiplash who have shoulder pain are thought to have referred pain from the neck, an impingement syndrome may be overlooked. This can delay treatment, resulting in prolonged disability, pain, and chronicity.
An MRI may be needed to fully diagnose the problem and confirm the lesion. Sometimes the labrum, cartilage surrounding the bone, can break away causing significant pain. There may be inflammation surrounding the different tendons as they are caught between the shoulder bone and the soft tissues. Most shoulder injuries can be conservatively treated and rarely require surgery.
Chiropractors are trained to differentiate between neck and shoulder problems and provide specific treatments to each area. Sometimes, an adjustment may be needed to align the shoulder joint or neck. In other cases the shoulder can be helped by specific exercises for the rotator cuff muscles. The important part of this issue is first getting the problem properly diagnosed. If you don't know what is causing the pain, it is nearly impossible to have a specific, effective solution.
If you would like to schedule a complimentary consultation to address your health concerns, just call Dr. Dalfino at 203-922-9277 to make an appointment.

"Could Neck Problems Be Affected By Your Posture?"

While most of us have a look in the mirror at least once a day, few of us look at our appearance from a different angle, such as from the side. But, the view from the side can be quite revealing if you suffer from chronic neck pain.

First, note the position of your head in relation to you shoulders. Is it right above the shoulders or does it lean forward from your chest? If it does, this would be called forward head posture, and can come from a problem in your neck. Lower areas of your spine can also cause this problem. Some of us have increased our weight over the years with much of it added to our abdominal region. Because of this increased core weight, the body must counter-balance the weight gain by causing the lumbar spine to "sway- back."

While this “sway-back” problem can create pain this the lumbar spine, it can also have far reaching effects in the posture of the neck. Usually someone with a protruding stomach and sway back will have somewhat rounded shoulders and a forward head posture. If treatment is only directed at the neck without considering how other areas may affect the stability of the neck, then the results may be less than optimum.

In an accident, many areas of the body can potentially be injured.

As a chiropractor, I not only look at your primary injuries but also how mechanically one area of the spine can affect a distant area. These more distant areas can cause neck pain by referral or they can impede complete recovery because the body is compensating for abnormal posture or movement elsewhere.

X-rays of the full spine can show this abnormal posture as can a detailed postural analysis from our office.

So do you like what you see when you view your posture from the side? If your posture leaves something to be desired, or you're wondering whether your neck problem could be improved by changing another part of your spine, then it is important to be thoroughly checked. Just examining the neck after a whiplash may leave some injuries undiscovered. Are there tender spots in other areas of the spine? Does your overall upright posture seem lacking?

Our office always offers complimentary consultations to address any health concerns you may have. Just call 203-922-9277 to schedule an appointment.

"Five Exercises to Help Your Neck Stay Pain-Free"

The neck is the most flexible part of your spine and just like any other area of the body, movement exercises and good posture are important to maintain its health. Neck pains can be brought on or aggravated by how you treat this vital structure. We often neglect our neck when it comes to exercises, focusing instead on our legs or heart. So try these helpful hints and incorporate them into your daily routine.

Moving your neck slowly through all its ranges is key. It is important to do pure movements rather than combinations, rolling the neck around like a ball and socket joint (such as the hip or shoulder) is to be avoided. Instead, flex the neck forward until your chin touches the top of your chest. Then, slowly bend your neck backwards, chin to the sky These movements should not cause pain if they are done slowly and you have no pre-existing injury.

The next movement is side bending and is accomplished by trying to bend either ear towards the shoulder. Do this in front of a mirror so that you keep your head straight looking forward. Note whether you can do this the same amount to each side.

The last movement is rotation. Simply rotate your chin slowly so that you are looking over one shoulder. None of these movements should cause pain or make you dizzy. If they do, then it's a sign you have a neck injury.

An important aspect of neck function is how the shoulder girdle influences neck posture and motion. Try rolling your shoulders forwards and backwards, stretching slowly, to help ease tension at the neck. General exercises such as fast paced walking or hiking are important for your neck too. Remember, your spine is the core of your body and walking is one of the least "injury-producers," something you can keep up well into your later years.

Lastly, make sure your neck posture is kept upright when you are talking on the phone, driving, reading, doing other tasks, or sleeping.  A very small pillow is usually best for sleeping and neck support pillows are available to help maintain the normal forward arch of the neck. A small pillow will allow your head to ease back, relaxing the muscles at the back of the neck.

If you would like a complimentary consultation at our office to address any health concerns, then just call 203-922-9277 to schedule an appointment.

" Neck Pain Treatment: Results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders "

Whiplash and neck pain are complex injuries involving the delicate soft tissues and the nerves of your neck. Usually, motor vehicle accidents are responsible for these types of traumas. Even low-speed collisions can produce significant injury. People with these types of injuries may have central or back pain, arm pain, and even headaches or dizziness/vertigo.  Some people with minor muscle strains will recover quickly but a large percentage will develop chronic problems leading to suffering that can last for months or even years. Many different doctors, such as chiropractors and medical physicians, osteopaths and surgeons, treat neck pain with a wide variety of methods. It is important to sort out which treatments really work from those that are costly, useless, or even harmful. In addition to treatments provided by doctors, there are many physical therapists, personal trainers, masseuses and any number of home remedies that people seek out in trying to get some relief for their severe pain. To a patient faced with all of these different options in can seem quite daunting to decide which approach to choose since all can seem reasonable. It would be nice if doctors could come to some agreement rather than forcing patients into the health care maze. Fortunately researchers have recently brought some attention to this complicated field. The prestigious medical journal SPINE recently published the results of a best-evidence review of all treatments for neck pain (Hurwitz, et. al. Spine 2008;33:S123-52). The Bone and Joint Decade Task Force reviewed literature of non-invasive treatments (no surgery) from 1980 through 2006. A total of 139 papers were considered scientifically valid for review and covered treatments such as educational videos, mobilization (deep stretching movements), manual therapy (done by hand), low level laser therapy, exercises, and acupuncture. In addition to pain relief, the scientists also considered costs and safety. Their conclusion was that treatments involving manual therapy and exercise are more effective than alternative strategies for patients with neck pain. If you'd like to discuss the adjustment treatments we use in our office, and how they may help you to regain health, reduce pain and improve function, you can call 203-922-9277 to schedule an appointment. Consultations with us are always complementary, because we think it is important for you consider non--drug and non-surgical options for recovering from your whiplash injury.

" Car Accident Insurance; Are You Covered? "

Most states require drivers to carry various types of insurance to protect themselves as well as others who may be involved in an unfortunate accident. Drivers, and the banks that may carry the car's loan, generally think of the vehicle first when deciding on appropriate coverage. While it's difficult to think about, you need to also consider injuries to you and your passengers, and potentially other drivers and passengers, should you be determined to be at fault. Some drivers also carry medical insurance (med pay), which can be accessed for care in the event of an accident. Some items to consider are that vehicle repairs can be quite costly, as can health care. If you are the cause of a multi vehicle accident, minimal amounts of insurance may not cover the costs of repairs for expensive new vehicles. In terms of health care, an ambulance ride with minimal interventions could cost $1000-$1,500 dollars. If you spend a few hours or a day in an emergency room, this could run into the thousands, especially if advanced imaging such as MRI or CT scans are needed. This is just the beginning of your evaluation in a severe accident. Then, there are the costs of care over perhaps months, disability from being able to work and other costs. If a few passengers are involved, the costs can soar. It's important to discuss these issues with your insurance agent. Is your med pay adequate? Sometimes med pay premiums are a cost-effective way to get some additional piece of mind. A $1,000.00 med pay allowance will not last long in today's health care environment.  Chiropractic care, while very cost effective compared to medicine or surgery, can still run into the thousands if severe injuries have resulted from the accident. You may also need to consider uninsured and underinsured coverage should another driver be at fault and not adequately insured. If you've been involved in an accident, our clinic can assist you in getting well. Most patients have a lot of questions about how chiropractic care works and the treatment techniques used in our office. It's important to get evaluated right after an injury to get you feeling well as soon as possible. Doing self-care when the trauma is substantial can lead to more problems if a serious injury is not discovered. To schedule a complimentary consultation with a doctor of chiropractic, just call 203-922-9277 to make an appointment.

" Whiplash and Your Sense of Position & Balance "

Although whiplash injuries are quite common, research is only beginning to describe the diverse symptoms that can develop when the neck has been traumatized. Even minor whiplash such as occurs from sports, can have a significant impact on the delicate structures of the neck. Position sense or balance is how we keep upright and move through space. When it is disturbed we may feel unsettled, dizzy or even get nauseous. Many studies have shown that when the spine is injured, the person's balance can be affected. How is this so? Balance is maintained by a complex interaction between your inner ear, your eyes, and the nerves in your neck (Sports Med 2008;38:101,Armstrong. et al.). When the neck is injured you may use your eyes more to make up any position sense or balance deficits. There are limits to this strategy and as a result dizziness is a big problem in society. About 1/3 of older persons suffer from dizziness, and whiplash or other neck traumas can be a significant factor. A good test to see if your balance is impaired is as follows: Can you stand on one leg for fifteen seconds? Is it equally easy to do this on the other leg or is one side easier to maintain your balance. Can you stand on one leg with your eyes closed? Obviously you should try this very carefully. You may want to do this with a friend nearby so you do not fall. Do you immediately lean and have to put your other foot down? If you cannot stay upright it may be sign that position sense has been affected by a spinal problem. Chiropractic care can improve the posture and mobility of the neck. This may have an impact on balance because joint dysfunction in the neck can send altered nerve signals to brain centers that coordinate position with your eyes and ears. Although there is limited research in this area, most doctors and therapists recognize the importance of introducing movements when a balance problem is coming from a neck injury. It's important to introduce limited movements early following a trauma as long as additional pain is not being provoked.