Whiplash

[Julie]

I have a client who was in a car accident several weeks ago. He has a pretty tough case of whiplash, and I've been working with him for about six weeks. While we've seen progress, I'm not sure it is as much as should be. I know whiplash is tough.....but I'm just not sure it is supposed to be *this* tough.

The low back issues seem to have made the most progress. His rib pain is gone, but the neck issues remain. He isn't in much pain anymore, but has some nasty trigger points yet. Both masseters have huge TP's. His symptoms are mainly on the left side - headaches caused by TP's in upper traps, suboccipitals, SCM, scalenes and masseter. He also still has TP's in the left subclavicular and both longus colli. I seem to have worked out the TPs in the suprahyoids, digastric and pterygoids, but don't understand why the others are not responding as well.

Any ideas? He is going to PT, also, and he says they do mostly the same things I am doing. How long is there generally need for treatment after an MVA?

 

[msjinx39]

It can be a very looooooonnnnnnggggg time... I went to PT, Chiro, now MT for my whiplash, I go every 2 weeks, and have in depth work on just my neck and my back. My accident was December 2005, I am feeling better, but if I don't go for my massage I have issues, I really wish I could get in there once a week, but that is just too expensive. I almost feel as if once the damage is done, it is done...

 

[nat]

Thank you - that is both encouraging and discouraging. I want to HELP him! But I also want to know that I am being helpful, even if the results are not what I want to see just yet. Six weeks doesn't mean I'm worthless and just collecting pay because he is in pain, kwim? He sees enough benefit to keep doing this, or rather, he knows how much better he feels when his massages are regular than how he feels if he misses one.

I am wondering, though, if he should get some chiropractic treatment in conjunction with massage.

 

[heather06]

yeah, long time up to two years, dont rule out strength training-very important to the recovery. Trp's in all those muscles really? Are you sure trp's or over stretched damaged muscles?

 

[Loving My Baby Monkey!]

Don't compromise your treatment by sending him to a chiro...it is a soft tissue injury and that is what you are best at not the chiropractor.

 

[Cool B]

Don't compromise your treatment by sending him to a chiro...it is a soft tissue injury and that is what you are best at not the chiropractor.

I can't imagine how chiropractic care could compromise my work with the soft tissue. The chiro would not be trying to deal with the soft tissue, but checking for misalignments and realigning, if need be. Aren't the two therapies complementary?

 

[Jitter]

I can't imagine how chiropractic care could compromise my work with the soft tissue. The chiro would not be trying to deal with the soft tissue, but checking for misalignments and realigning, if need be. Aren't the two therapies complementary?

I was thinking the same thing.

 

[foryourconsideration]

You know that with TMJ, you have to work with the 3 P's..psoas, piriformis and pterhowdoyouspellgoids. Likely too the pelvis is unbalanced with either a rotation or upslip/downslip.

I know that whiplash is not TMJ, but....the same areas are affected, right?

 

[adrian14752]

you have to work with the pterhowdoyouspellgoids.

Oh, man, I don't think we covered these mm. in anatomy class. :

Actually, Mick, that makes a lot of sense that you would want to work the LB, hip, and ab mm. Good thinkin'! t023

 

[pickin5strings]

You know that with TMJ, you have to work with the 3 P's..psoas, piriformis and pterhowdoyouspellgoids. Likely too the pelvis is unbalanced with either a rotation or upslip/downslip.

I know that whiplash is not TMJ, but....the same areas are affected, right?

That does make sense. I haven't paid a lot of attention to his piriformis. Psoas are both definitely hypertonic, and pterygoids have had TP's that are worked out....but I should check to see if they've returned. Thanks!

 

[Yeehawfreesex]

Good tips! The TMJ often takes a thrashing in a whiplash accident, as does the c-spine. If you are able to address the anterior cervical tissues, you often find asymetries in both the soft tissue as well as the vertebrae. Pre-existing vs. new is hard to determine, but work here tends to benefit nicely. Chiropractic can benefit if the displaced c-spine does not come back with the soft tissue work and is hindering motion. I can't agree that the course to recovery is always a long one, though some are. Long duration, low load manual cervical traction to me is the key (MFR guy here) to restoring balance to the neck and region. Pterygoid releases intra-orally and, especially, thoracic inlet releases can really open things up.

 

[Walter]

Question for you regarding the manner in which your client received the whiplash injury: was the auto accident a sideline crash, head-, or t-bone? Each of those, or even worse, a spinning crash, have different variable that can and do add even more insult to the injury. Have had instances in my practice where "unwinding" had to be done to get anywhere in the relief and repair part of the treatments. Have also used Orthobionomy and a "cheaty" craniosacral-like hold [put your hands on the tissues with your hands sandwiching them and just hold still] that seems to help loosen things up enormously when all else fails. The worst case of whiplash I ever worked on I saw within 3 hours of the auto accident the lady was in ---- her car was hit in the R rear quarter panel at 35 mph as she backed out of an angled parking space. She said she could feel her head, neck and entire body being spiraled around under the shoulder restraint system [check the anterior thorax for problems there too!!!] The doctor's office called and sent her straight from there to see me............. the spiraling effect was a monster, but, thankfully it only took 3 1/2 weeks to get it to go away for good.

Best of luck to you and the client!

 

[Jim C]

It was a very straightforward head-on collision, and my client was in the front passenger seat, so the seatbelt was at his left SCM (he was sitting very low) and right lower ribs. He was in the hospital 2 days because there was such swelling over his carotid artery that they had to keep checking to be sure it wasn't leaking.

That does make the pelvic imbalance seem very likely.

Thank you for all your help!

 

[julie j]

Sounds like you are doing everything right. Your client will have to do home care strengthening (if you aren't already having them do it). Core, especially.

From what I've heard and read, and was taught, 75% of MVA's may live with pain for the rest of their lives even with treatment. Now a lot of this I suspect is because clients tend to stop doing their exercises and home care, and get discouraged.

Be patient. You are doing good work. If you are both committed, and your client is willing to work at home, it will happen.

 

[Best_ccb]

Don't compromise your treatment by sending him to a chiro...it is a soft tissue injury and that is what you are best at not the chiropractor.

I can't imagine how chiropractic care could compromise my work with the soft tissue. The chiro would not be trying to deal with the soft tissue, but checking for misalignments and realigning, if need be. Aren't the two therapies complementary?

YES. You really can't have one without the other. This does go both ways

Muscle is innervated by nerves. Nerves get irritated when pressure is put on them. This happens when vertebrae are knocked out of place. This can cause the muscles to spasm. A chiropractor is necessary to "fix" this. In turn, bones (e.g. vertebrae) sit where muscles put them. Muscles will pull on bones at the attachment sites and pull them out of place. Even after the doctor (of chiropractic) fixes the nerve irritation at the vertebral level, muscles may remain in spasm. A massage therapist is necessary. Both are needed, for best results. If you are only doing one of the two, you're missing the big picture

Hugs,
~Jyoti
(current licensed massage therapist AND future doctor of chiropractic)

 

[Buy]

Not with whiplash injury, the problem is inflammation and weakness. Resistance training and soft tissue work is the best not chiro adjustment.

 

[Jesss]

Sorry to disagree with you Office, but as a recent victim of a MVA (6 mos ago) and a LMT, I can say that my chiropractor has become my second best friend. I had severe stair stepping of C-3, 4, and 5 and no amount of massage was going to correct that. I agree with others in believing that chiro and massage go hand in hand. As a therapist, I also find it helpful in my practice to have x-rays to refer to. My palpation skills are pretty good, but it's nice to have something to confirm what I'm feeling. Thank you StressSolutions for the comment about releasing the Psoas and Piriformis for TMJ, I never thought about it, but it makes sense. Great to be able to see the big picture.

 

[Jacquelyn F]

Not with whiplash injury, the problem is inflammation and weakness. Resistance training and soft tissue work is the best not chiro adjustment.

I disagree. Good chiropractic care can help with many of the flexion/extension injuries sustained in MVA's, etc. Keeping the joints mobilized (when called for) increases healing rates and helps with function.

 

[Milk Maid]

I think Cranial Sacral alone or in conjunction with your regular session could be beneficial and healing for your client.

 

[JoAnna]

A question regarding whiplash and a link to swollen lymph node area around the occipitals was posed to me recently. Anyone know or heard of a link between the two? This person may actually come and post a question in the client area but until then I'd like to gather some info.

I think anything is possible...although I can't seem to find any correlation in the materials that are available to me, on lymph nodes/lymphatic system/whiplash pathology, etc.

Here is a quote:
In 2001 I was invloved in a rather nasty car wreck that caused lots of muscle damage in my neck. It tore ligaments at c1-c2 on the left and c5-c6 on the right. Ever since the wreck, I have had problems with the lymph nodes at the base of my skull (right side) swelling and being rather painful. It cycles, but I haven't been keeping track of it (stupid me) to know what triggers it.

Since I have only been having problems with this since the wreck, I am wondering if the whiplash I suffered could have damaged the lymph drainage system in my neck. I know I still have a lot of inflammation in my neck muscles which could account for the swollen lymph nodes, but I haven't noticed a correlation between bad episodes with my neck and the swelling. Especially since all the episodes of swollen lymph nodes is on the right at the base of the skull - the opposite side from where I have most of the pain and muscle spasms.

The doctors don't think much of it. I get the shrug off about it and they don't really answer any of my question. So, I am trying to understand what is going on and trying to figure out something to stop this constant reoccurence.

Anybody know anything about any possible correlation between the two, or good sources on the lymph system that will be more enlightening than what I have read so far? Unless I have some information to take to the doctor, I have a feeling nothing will ever be done about it.

As always, any thoughts are appreciated!

P.S. This person is getting regular Chiropractic care and has had massage therapy in the past . Also reports that Acupuncture treatments did nothing.