Important Questions your Doctor should Know
- Of the more than 70 published outcome studies, what proportion of them have demonstrated that the vast majority of whiplash injuries resolve within 6-12 weeks? Can you cite any of these studies?
- Of these same studies, what has been the proportion of persons who never recover fully?
- What is the proportion of those who become disabled?
- Of the vehicular variables including collision speed, angle of impact, relative vehicle size, head restraint geometry, use of seat belts, and seat position, which is the most deterministic in terms of injury risk?
- Of the known human risk factors, which one has shown a two-to-one risk in nearly every published study? Can you cite this literature?
- What does IIWPG stand for?
- According to the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and its Associated Disorders, are radiographs considered appropriate in the management of grade 1 neck pain?
- What is the approximate risk for stroke or serious injury from cervical spine manipulation?
- Why do some studies show an inversion of risk as the collision speed increases?
- Can you identify three major reasons (related to vehicles) for the increase in whiplash injuries in the past two decades?
- What proportion of asymptomatic persons will have a cervical disc herniation?
- According to White et al., linear translation of one cervical vertebra on another as seen on a motion radiograph measuring 3.5 mm or more is considered an unstable segment.
- We keep hearing that cars are safer today than ever before and that the death toll on American highways is the lowest it's ever been. So shouldn't whiplash injuries also be on the steep decline?
- When there is no damage to the vehicle, an injury is very unlikely. True?
- While whiplash injuries to the neck are possible in some instances, back injuries in a rear impact collision are highly unlikely because the back is protected by the car seat.
- If the struck car has a 5 mph-rated bumper and there is no visible damage, it means that the closing velocity would have been less than 5 mph, and that would imply that the delta V or change of velocity would have been less than 5 mph. True?
- The threshold for injuries in rear impact collisions has been established through crash testing to be above a 5 mph delta V.
- The IIHS bumper tests give a dollar figure for estimated repair. If the same year, make, and model car in a real world collision sustains less damage than this published figure, we can then assume that the collision speed would have been less than the one used in the IIHS test.
- If the airbag in the bullet (striking) vehicle did not deploy, it means that the collision speed would have been under 12 mph.
- The physical forces and loads imposed on a person in a low speed collision are similar to those of everyday activities.
- About 50% of all asymptomatic persons have at least one disc herniation.
- The fact that the rear-ended person more often reports injuries than the person hitting him is proof of the fact that these injury claims are fraudulent.
- Research has rather definitively shown that persons who develop long-term symptoms more often have psychological disorders as compared to those who recover quickly.
- The SOB (slipped off brake) defense. My client stopped 5-7 ft behind the plaintiff at the traffic signal, and then his foot slipped off the brake momentarily, allowing his car to just roll forward under idle and "tap" the plaintiff's bumper.
- Can you explain the difference between velocity and acceleration?
- Is there a third derivative of position change that is clinically relevant?
- How does the material property called viscoelasticity explain how human soft tissues can be injured, even in relatively low velocity collisions?
Answers
- Precisely zero.
- About 50% will have some level of residual symptoms.
- About 10% will be disabled, although the reports have varied.
- Head restraint geometry.
- Female sex.
- International Insurance Whiplash Protection Group, a research consortium.
- No.
- Based on the most definitive study to date, the risk is equal to that of being treated by a GP.
- Within a range of crash speeds spanning the point were crush damage begins to occur, we see in some studies an actual reduction of risk with increasing speed. Although this trend eventually inverts again, this paradoxical phenomenon is most likely due to the increased ride down provided by the crushing structure and the absorption of some energy in that process.
- Increasing overall vehicle stiffness, increased stiffness in car seats, and decreasing compliance of bumper systems.
- Only 8%. This compares to about 19% for the lumbar spine. But you heard it was about 50%, didn't you?
- Technically, they reported a lower number, but the 3.5 mm accounts for geometric radiographic distortion. Most importantly, though, one cannot combine forward and rearward translation in order to reach 3..5 mm.
- They SHOULD be, but are not chiefly because of the factors identified in #10 combined with the lack of progress in head restraint/seat design by most manufacturers..
- Not true. Our large meta-analysis demonstrated that fact (Croft AC, Freeman MD. Correlating crash severity with injury risk, injury severity, and long-term symptoms in low velocity motor vehicle collisions. Medical Science Monitor. 2005;11(10):RA316-321).
- Not so. In fact, outcome studies consistently show that low back injuries are present in 25-45% of whiplash claims. The forces and loads on the lumbar spine are surprisingly large, and the kinematics complex.
- Not true. Many 5 mph-rated bumpers in our tests withstood multiple collisions at those speeds and higher.
- This is another incorrect citation of this important literature, as well as a careless extrapolation to the real universe of crash victims. These crash test studies have more often than not reported some mild symptoms characteristic of an injury, although reportedly none have required treatment. These studies, however, are not representative of a large range of real world collisions and extrapolation of their data should be made with caution.
- This is actually a common ploy used by many accident reconstructionists, but it is deceptive because the IIHS tests involve four collisions into rigid barriers and cannot be justifiably compared to a single impact with another vehicle.
- Many believe that airbags are designed to deploy at certain threshold crash speeds. This is not the case. Their deployment is based on the slope of the acceleration curve only such that one could conceivably have a relatively severe crash in terms of property damage with no airbag deployment.
- This is a commonly applied defense position, but the literature purporting this connection is conceptually flawed and is usually mischaracterized.
- Yet another urban legend. This may be the most common of its ilk. I discuss the genesis of this myth because it is an interesting phenomenon, but no study ever actually reported this as stated.
- A convenient deception in the defense of claims, but the fact is that the forces and loads imposed upon the struck driver are many times those of the striking driver as our research clearly demonstrated (Croft A, Haneline M, Freeman M. Differential occupant kinematics and forces between frontal and rear automobile impacts at low speed: evidence for a differential injury risk. Paper presented at: International IRCOBI Conference on the Biomechanics of Impact; September 18-20, 2002; Munich, Germany).
- Interestingly, all of these studies suffer from two significant shortcomings: (1) none of them have resorted to actual psychiatric examinations by qualified practitioners; instead these conclusions have been based merely on simple questionnaires; and (2) these questionnaires were developed and validated within a medically healthy population; some of the responses that would be expected in many whiplash patients (e.g., loss of ability to concentrate, insomnia, frustration, etc.) are interpreted as elements of a psychological disturbance.
- This has become the most popular defense strategy in recent years. It is easy to deal with from a physics and mathematics standpoint based on what we know about the acceleration of passenger vehicle under idle on level pavement and normal human reaction time.
- It is an important-and fortunately simple-relationship. But they are quite different with velocity as the first derivative of position change with respect to time, and acceleration being the second. Think of velocity as the rate of change of position and acceleration as the rate of change of velocity.
- Yes. The third derivative is called jerk or jolt. It's the rate of change of acceleration and it's important because it helps us understand how soft tissue injures occur.
- The simplified answer is that viscoelasticity is a property that combines a viscous or rate dependent property with an elastic one. Human soft tissue have this property and, as such, their ability to withstand a dynamic load is rate-dependant. Think of Silly Putty!
Severe Whiplash and Soft Tissue Car Accident Injuries are Treated Most Effectively by Chiropractors
- Chiropractic is the Treatment of Choice for Serious Whiplash and Soft Tissue Injuries
- Serious ligament damage may occur from car accidents where the patient is rear ended with their head rotated and are caught by surprise
Our patients have
told us that they felt better faster and were able to stay pain-free for longer with chiropractic care for whiplash and soft tissue injuries than with general medical care. Medical doctors
often just prescribe pain medicine to treat the symptoms, whereas chiropractors may have a better chance of getting to the source of the pain.
We have demonstrated an excellent history of caring for patients who were pursuing personal injury insurance claims.
There are three aspects to maximizing your chances for a prompt physical recovery and satisfactory monetary recovery.
- The first is to select a doctor who is competent to find and treat your injuries, and who will support your efforts to recover in a personal injury insurance claim;
- The second key is to follow the doctor's advice and to treat as suggested-don't be a cowboy and go it alone, ignoring his instructions, because failure to follow your doctor's orders is ammunition for the insurance defense and the IME doctor;
- The third is to ensure that your doctor properly documents your injuries and continued pain and suffering during your injury recovery: on the patients' side we teach how to do this properly and appropriately.
The car accident victim has a number of choices in managing her medical care. This is true even if you only have one insurance company to pay your chiropractor and medical bills. Even with
no insurance available, there are means of obtaining medical care, especially with chiropractors inasmuch as they are more willing to take a lien on the claim to secure payment for
services.
Moreover, your choice is not just whether to obtain medical or chiropractic care or not, it is also a choice as to the type of doctor you want to see. For the majority of whiplash and soft
tissue car accident injuries, it has been our members' experience that chiropractic care, acupuncture, and spinal rehabilitation therapy provide a better physical recovery rate than the
conservative treatment by an orthopedic surgeon or a general medical practitioner, who will just have you popping pills and perhaps trying physical therapy.