Expert: Dr. Victor Dolan, DC, DACBSP - 12/30/2009

Question
On 12/24 as I was sitting at a red light I took my seat belt off to take something out of my pocket as I reached up to put my belt back on I turned my head slightly to look in my rearview mirror.  What I saw is why I am writing.  A huge pick up truck was headed straight into my car at full speed limit (45 mph).  Life has been very painful since then.  I was of course transported to ER and no fractures that they saw.  On Monday when I was still in massive pain ( even the percocet does not help it just lets me relax for awhile although I am still in pain).  I went to a chiropractor.  He took some more X-rays of my neck and said things did not feel very good in my neck and back.  I went back today to start treatment and he told me he can not start working on my back.  He said he sent my films for digital imaging because I had an issue he does not see often.  He said when he imaged me with my chin lifted up I have a vertebrae that pushes out forward from the rest of my vertebrae.  He explained it to me in layman terms as something like there is a very strong glue that keeps your vertebrae connected to you discs and the glue is not connected so it allows one of my c's(i do not know which one# moves out of place.  He said that he would not adjust me or start any work until he finds out how far it is popping out of place and that is the purpose of sending my films to Wisconsin for this special imaging.  Have you heard of this type of thing could you maybe give me a little information on it if you have heard of it.  I am so tired of being in pain and right now it feels like it will never end.  Everyone around me #family) tells me that as each day goes by I am getting better and I try to tell them it is actually the same or worse at sometimes than when the accident happened.  It really stinks to be someone who always wears a seatbelt and have it off at the moment that some one decides they can drive through you and a red light.  I appreciate your time.

Answer
car accident, whiplash, staten island auto accident, staten island whiplash, vertebral subluxation complex, cervical sprain- strain, http://www.SIautoaccident.com cervical hyperflexion-hyperextension injury, cervical acceleration- deceleration injury, pinched nerves, cervical brachial neuritis, spondylolisthesis, anterolisthesis, retrolisthesis, staten island car crash,




Hello Margie,

I am very sorry to hear of your automobile accident, and especially sorry to hear of the circumstances--- you are stopped properly at a red light, momentarily have the seat belt unbuckled, and having your head turned.

Even with all of the Staten Island Auto Accident that I see in my chiropractic office,,, rarely do I hear such a co- incidence of bad luck.

".....Life has been very painful since then......"- this is certainly NOT unusual!  Cervical sprain- strains, commonly called 'whiplash' in the past, often have pain appearing hours, days, weeks, even months AFTER the injury!  Soft tissue injury (injury to soft tissue, tissue other than the hard (osseous) bone tissue), soft tissue injury can take a while to really hit it's peak.

Unfortunately soft tissue injury, such as 'whiplash' in the past was looked upon as a fakers complaint.  This was not true then, it is not true now.  

When we break a bone--- it is usually very easy to see on Xray/ CT scan/ MRI.  When we break a bone we can 'see' it immediately on an Xray, and usually have severe pain.  Notice I have used the word --usually-- a couple of times, because even with a fracture, even with a broken bone- sometimes we need sophisticated testing (CT scan, MRI, Bone Scan) or TIME (to see the healing reaction = callus formation) to be sure about broken bones.  With soft tissue injuries, there are no easy tests to 'see' the damage right away.

Cervical hyperflexion- hyperextension injury may not even be painful for days or weeks later!
That is why 'whiplash' got a bad-- 'fakers' name.

Unfortunately-- you may be hurting a LOT now,,,, and you may continue to hurt a LOT for quite a while-- days or weeks!

"....I was of course transported to ER and no fractures that they saw.....", as explained above, fractures are much easier to see immediately.  Soft tissue will NOT be seen upon Xray.


".... He took some more X-rays of my neck and said things did not feel very good in my neck and back.....".  Your Doctor took additional Xrays, perhaps from different angles, perhaps with you flexing your head forward, extending your head backwards, perhaps rotating your head, perhaps laterally flexing your head left and right.  Perhaps the Doctor of Chiropractic did video flouroscopy--- Xray while you moved your head/ neck around.  These tests, these views, these positions are a more in-depth study of your spine.  Unfortunately, sometimes the Emergency Department (ED) in the hospital does the minimal study.

I would Thank your Chiropractic Doctor for being MORE thorough than the Emergency Department.


".....He said he sent my films for digital imaging because I had an issue he does not see often.  He said when he imaged me with my chin lifted up I have a vertebrae that pushes out forward from the rest of my vertebrae.  ......  He said that he would not adjust me or start any work until he finds out how far it is popping out of place and that is the purpose of sending my films to Wisconsin for this special imaging. ...."-  Your Doctor sounds very thorough and is looking for the best analysis of your problem(s) from EXPERTS in the field.

Many laymen, people in the public, do not realize that Chiropractic Doctors (DCs) have specialties- additional training- just as Medical Doctors (MDs) do.  I do not know the specific facility your Doctor is using in Wisconsin, but it sounds like a specialist.  For the different Chiropractic specialties see:  http://www.acatoday.org/pdf/ApprovedChiropracticSpecialtyPrograms.pdf

It sounds like you may have a cervical vertebrae spondylolisthesis, you talk of one bone in your spine slipping forward over another.  Chiropractors often call this a 'spondylo' (spondylolisthesis).  This can happen from a severe trauma, and could happen in a severe auto accident.  This Xray / CT Scan / MRI scan finding would be STRONG evidence  of traumatic injury, of the type of injury expected in a car crash.

Your Doctor has done the correct thing: performed a more thorough examination, found something more severe than expected, sent out for expert consultation, treated you super conservatively (not adjusting you immediately- not manipulating this possibly unstable joint), is awaiting that expert's opinion, and then will treat you or refer you as is appropriate.

Right now you should be careful and conservative in movement and treatment.  I would recommend talking to your Chiropractor about noninvasive, non-manipulative treatment such as ultrasound, interferential, electrical muscle stimulation, a cervical orthopedic support pillow, perhaps c collar for your neck, the use of ice or moist heat, and then the use of over the counter pain-killers, anti-inflammatories; perhaps a referral to an orthopedist.  Cervical Spondylolisthesis is uncommon, and I think your Doctor's slow, methodical, conservative, thorough care is an appropriate avenue of care.

At the very opening I have listed terms that you may want to 'google', search on the internet that are related to your neck type problems.  Be aware- words matter: spondylolysis is DIFFERENT from spondylolisthesis, different from xxxxxx, different from whatever......

".....I am so tired of being in pain and right now it feels like it will never end....." I am sorry that I do not know of any quick, easy, fast relief from your pain.  Often when we injure ourselves one of the components of the problem, one of the aspects of healing is , , ,  time.



Perhaps this will be of interest:

http://www.faqs.org/abstracts/Health/Cervical-spondylolisthesis-a-case-report-Ch...

http://www.ncbi.nlm.nih.gov/pubmed/472891

http://www.medhelp.org/posts/Back--Neck/cervical-spondylolisthesis/show/438860

None of the nine patients with spondylolisthesis had complaints of neck pain or upper extremity symptoms, and none had a history of rheumatoid arthritis or cervical trauma. http://cat.inist.fr/?aModele=afficheN&cpsidt=1888073

http://www.chiroweb.com/mpacms/dc/search.php?q=cervical+spondylolisthesis&site=C...

http://www.doctorslounge.com/orthopedics/forums/backup/topic-18511.html



In my Staten Island Chiropractic office I hand out informational sheets to my patients, perhaps this will be of help to you:


P.R.I.C.E.  =    
P  protection.   R rest.   I  ice.   C  compression.   E  elevation.

Hurt  yourself ??  injury/ trauma/  bruise/ not even sure - - a broken bone ??

You should certainly get to the Doctor or trained health professional to be examined  if you think it  is  bad  enough.     BUT  in  the  meantime,  some  simple  steps  may  help.   PRICE.
The  PRICE  protocol will usually help just about any musculoskeletal injury.


P = Protection;  protect the area from further injury- stop what you are doing, can you
     pad  or bandage the area ? Tape the area? Do something to protect the area !

R = Rest;  rest the area as much as possible, if a part is damaged, give the body time to
       repair the area

I = Ice;  ice is a potent anti-inflammatory; it will slow swelling, help with pain control
     (ice is analgesic), place ice over cloth over the injured area for 5, 10 minutes, off the
     injured area for 30 minutes; then back on again

C = Compression;  to help prevent swelling compression may be helpful- for example
      if it is an ankle, wrap the ankle with an ace bandage and ice the area.  Many body
      parts may not be applicable to compression.

E = Elevation; again to fight swelling and pain, raising the injured body part above the
      heart may be helpful- ie raise an ankle or knee, you lay down, raise the injured part


PRICE  may  help :    Sprains,  Strains,  musculo-skeletal injury,  bruise,  contusion
Sometimes  a slip, trip, fall, heavy lift, athletic injury, or a motor vehicle accident can cause a bump or bruise, sprain or strain.  Sometimes also involved with the injury is a vertebral subluxation (or other joint subluxation) (subluxation is a mechanical problem- of any joint- and requires a mechanical correction).  In the spine, a sprain/strain  is a misalignment,  a ‘kink’ in the joint, a stretch of the muscles, tendons and/ or ligaments:- more properly termed a Vertebral Subluxation.   Sometimes symptoms can come immediately, sometimes days, weeks or even months later!- Well after the actual trauma !!!

         Spinal = Vertebral   Subluxation   Complex    (a.k.a.  ‘subluxation’)  ;   ( subluxation COULD be any joint )
The vertebral subluxation complex is the underlying cause of many healthcare problems.
A  subluxation  interferes with the proper functioning of the nervous system  (the master system  which controls and coordinates all function within the body)  and may cause various other conditions, symptoms and problems.


This is a serious condition identified by its five parts:

    Spinal Kinesiopathology:
         This is fancy way of saying the bones of the spine have lost their normal motion and position. It restricts your ability to turn and bend. It sets in motion the other four components.

    Neuropathophysiology:
         Improper spinal function can choke, stretch, or irritate delicate nerve tissue. The resulting nerve system dysfunction can cause symptoms elsewhere in the body.

    Myopathology:
          Muscles supporting the spine can weaken, atrophy, or become tight and go into spasm. The resulting scar tissue changes muscle tone, requiring repeated spinal adjustments.

    Histopathology:
         A rise in temperature from an increase in blood and lymph supplies result in swelling and inflammation. Discs can bulge, herniate, tear, or degenerate. Other soft tissues may suffer permanent damage.

    Pathophysiology:
         Bone spurs and other abnormal bony growths attempt to fuse malfunctioning spinal joints. This spinal decay, scar tissue, and long-term nerve dysfunction can cause other systems of the body to malfunction.


The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position.
         Automobile accidents, improper lifting, improper posture, alcohol, emotional stress, chemical imbalances, and long periods of sitting can cause the Vertebral Subluxation Complex.
          Vertebral  Subluxation  cannot be corrected through chemicals (medicine), stretching, yoga, vitamins or physical therapy alone.  Subluxation- a neuro/skeletal/muscular- mechanical- problem requires a mechanical correction-  -  -    a manipulation,     best performed with the chiropractic adjustment.  For good health- Treat the   Cause,  not just the Symptoms.  Sprain/ strain/ bump/ bruise?= may result in subluxation of the nearby joint.  CORRECT the subluxation !!!!

Dr. Victor E. Dolan,   Doctor of Chiropractic;   Diplomate, American Chiropractic Board of Sport Physicians; Diplomate, American Academy of Pain Management; Certified Clinical Nutritionist (IAACN); FIRST  Chief of Chiropractic  in  a  Hospital  in  New York State (DHSI);  As  Seen  in  PREVENTION  Magazine





You may need to utilize pain medications, but be aware-- pain meds take away pain, cover up problems, and may allow you to make your problems worse without even knowing it:


Pain  Killing  medication???  =    16,000  deaths   ( probably  under-reported )
                         DEATH ! ? ! ?    better   watch  out  on  those  medications!!!  

PAIN           Pain  is a  ‘red light on the dashboard’.  

Pain  is  your  body  telling  you  that  something  is  wrong.   
Think  you  should  listen??

That RED LIGHT on the dashboard of your car-
-- do you ignore it until the car breaks down,
or do you get it checked and correct the problem?  

Pain, pain in your body-
-- do you ignore it until your body breaks down,
or do you get it checked and correct the problem?   

Pain,  
do you cover up the pain by taking a painkiller?  
Take a painkiller,
mask the pain,
and allow a problem to progress in your body?


                             NOTICE  ON  PAIN  RELIEVERS:
 
Label changes ORDERED by FDA;  the FDA announced proposed label changes for OTC over-the-counter pain relievers to  include the potential for stomach bleeding and liver damage (FDA news  206- 207;  12-9-06) ;
SIXTEEN THOUSAND DEATHS: "Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective medications for the treatment of many chronically painful medical conditions. However, it is estimated that 25% of all serious adverse drug reactions involve NSAIDs, with more than 100,000 hospitalizations and 16,000 deaths occurring annually due to NSAID-induced gastrointestinal (GI) events."----- http://hhc.sagepub.com/cgi/content/abstract/13/6/468   Home Health Care Management & Practice, Vol. 13, No. 6, 468-475 (2001)  Motrin, Advil = NSAIDS

The  American Heart Association issued a scientific statement   recommending medical doctors change the way they prescribe OTC pain relievers from a first choice    to an alternate of recommending non-pharmacologic treatment (AHA statement  2-26-07).

NSAID Acceleration of ARTHRITIS; an important side effect of Aspirin and other NSAIDS is that it will inhibit cartilage repair and accelerate cartilage  destruction ( Journal of Rheumatology, 1982; 9: 3- 5 ).   Many times people take NSAIDS  for  the pain of Arthritis,  not realizing these drugs may make the underlying condition worse.   These medications  cover  up  the  pain,  and  cause  the  problem  to   worsen.

Pain  can  often  be  the  result  of  the  Vertebral  Subluxation  Complex.

Vertebral  Subluxation           (  ‘VSC’ ,    ‘subluxation’   )
Vertebral Subluxation  is  actually  a  quite  common  condition.   Doctors of Chiropractic look for pathological conditions which may require referral to other specialties,   and also look for ‘Subluxation’. Other disciplines look for pathology, but overlook the importance of alignment and movement in the spine which affects our nervous system  (the master control system- ALL health disciplines learn this).  VSC- ‘Subluxation’ – can be the cause of many symptoms and conditions.

Only  a  Doctor of Chiropractic  will  evaluate  and  treat  for  VSC,   as  well  as  other  pathology.

The course of VSC is highly variable.   Some patients with VSC literally cannot walk, yet other patients with similar test findings may be able to run marathons or lift heavy weights.    Some patients immediately develop symptoms related to the VSC,  some patients take years to develop symptoms.  Some people suffer for only a few days with pain and symptoms, some people suffer for months.  Some people recover in days, some take months or years, depending upon severity of the condition.
              A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates all function within the body) and may cause various other conditions, symptoms and problems.
The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position.  When subluxated, joints are in a stressed, vulnerable, compromised condition.  Subluxation may cause Arthritis, Disk Herniation, or aggravate such conditions.
       Vertebral  Subluxation   cannot   be corrected through chemicals (medicine), stretching,  yoga,  vitamins  or  physical  therapy  alone.       Subluxation- a neuro/skeletal/muscular-    mechanical-    problem  requires  a    mechanical correction-  -  -    a manipulation,         best  performed  with  the  chiropractic  adjustment.

Dr. Victor E. Dolan,   Doctor of Chiropractic;   Diplomate, American Chiropractic Board of Sport Physicians; Diplomate, American Academy of Pain Management; Certified Clinical Nutritionist (IAACN); FIRST  Chief of Chiropractic  in  a  Hospital  in  New York State (DHSI);  As  Seen  in  PREVENTION  Magazine


I hope these information handouts help in some small way.


I wish I could give you a miraculous cure. I know of none.

Your DC sounds like a good, thorough, concerned, conservative Doctor.  Ask questions!, communicate with him(her), and be patient.


I hope this information helps. do not hesitate to RE-contact me here at
allexperts if more info is needed.

Thank You for the Question.

Good Luck, Happy Holidays, and a Healthier New Year !!!!!!

Dr. Victor Dolan, DC
Email newsletter: . . . . . .drvictordolan.chiroweb.com
informative website (videos): . . . www.SIautoaccident.com