Whiplash Tips/Facts

Dr. Monti Sorem here from Crossroads ProCARE in the Olympia/Lacey area. With the changing weather it is more likely that accidents will happen.
Last month, we discussed 10 facts about whiplash in attempt to dispel the myths about this topic. Due to the amount of information available, we couldn’t cover them all. So, here are 10 more interesting facts about whiplash:

Much has been published on the association between ongoing whiplash symptoms and litigation. There is now plenty of evidence that ongoing whiplash injury related symptoms occur regardless of the presence or absence of litigation.
The concept of a delay in symptoms means minimal injury is dispelled. In fact, it’s considered “the norm” that symptoms are delayed.
Mild traumatic brain injury (MTBI) or post-concussive syndrome can occur as a result of whiplash trauma. The good news is that, in most cases, recovery occurs within the first 3 months.
In the European Spine Journal, a recent study reported that between 1 and 2 years after a whiplash injury, 22% of patients’ conditions worsened. Condition deterioration at the 2 year mark has also been reported in other studies.
More detailed studies that followed whiplash patients through time, reported that 45% remain symptomatic at 12 weeks (3 months) and 25% at 6 months. Others reported the recovery time in most “minor cases” is 8 weeks (2 months), time to stabilization (not recovery) in the more severe cases was 17 weeks (4 months), and in the most severe category, 20.5 weeks (5 months). Hence, the concept that whiplash, like all other injuries heal in 6-12 weeks is challenged (note, there is little support for this common myth).
Each year, approximately 1.99 million Americans are injured in motor vehicle collisions.
Since 1990, a mean of 40% of a pool of whiplash patients from all vectors of collision (that is, rear, front or side impacts) were still symptomatic at a 2 year follow up. 59% of ONLY rear-end collision patients remained symptomatic at a 2 year follow-up.
Although these estimates vary, approximately 10% of WAD (whiplash associated disorders) injured subjects become disabled to a point of not being able to continue working.
Children who sustain whiplash injuries display sleep disturbances, nightmares, difficulty talking to parents and friends (brain injury), mood changes, poor academic performance and fears of participating in higher impact sports. Moreover, children tend to be overlooked in the evaluation and treatment process since they tend to complain less.
If the size of the 2 impacting vehicles is the same, an 8 MPH impact produces 2 times the force of gravity. When the bullet vehicle is larger than the target vehicle, the difference increases dramatically.
We realize you have a choice in where you choose your healthcare services. If you, a friend or family member requires care for whiplash, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

Hey, Dr. Monti Sorem, here from the Crossroads ProCARE clinic in Lacey, Washington. The fall is marathon, 10K, half-marathon season! It is great to see people from all walks of life and fitness levels get out and start running to compete in these events. It also means that I am seeing an increase of injuries. Last week alone I treated two patients with plantar fascitis from training.

Most of these individuals are using training guides from expert runners that focus on distance and volume of running but don’t address muscular preparation or recovery. If I had to put my finger on the biggest problem it is the lack of preparation before each run, which causes many of these ailments. Of course I recognize that footwear, weight, running surface, foot biomechanics, etc. all play a role but…….movement preparation is key.

Movement preparation is not doing the same old static stretches we were taught in high school before you go out running. You know, calf stretch against the wall and hamstring stretch. These stretches actually decrease muscle strength and possibly do nothing to help. Instead, a series of movements should be performed that actively take your joints and muscles through a full range of motion and stimulate proper motor (activity) patterns of your muscles. This will increase performance and theoretically decrease injury rates.

In Mark Verstegen’s book, Core Performance, this movement preparation is detailed with pictures and descriptions of each move. You can get this book on amazon.com or at barnes and noble in Olympia. If not, just email me and we will set up a time to go over this training method.

Best of Luck!

Monti Sorem DC, CSCS, EMT-B

Hey, Dr. Monti Sorem, here from the Crossroads ProCARE clinic in Lacey, Washington. The fall is marathon, 10K, half-marathon season! It is great to see people from all walks of life and fitness levels get out and start running to compete in these events. It also means that I am seeing an increase of injuries. Last week alone I treated two patients with plantar fascitis from training.

Most of these individuals are using training guides from expert runners that focus on distance and volume of running but don’t address muscular preparation or recovery. If I had to put my finger on the biggest problem it is the lack of preparation before each run, which causes many of these ailments. Of course I recognize that footwear, weight, running surface, foot biomechanics, etc. all play a role but…….movement preparation is key.

Movement preparation is not doing the same old static stretches we were taught in high school before you go out running. You know, calf stretch against the wall and hamstring stretch. These stretches actually decrease muscle strength and possibly do nothing to help. Instead, a series of movements should be performed that actively take your joints and muscles through a full range of motion and stimulate proper motor (activity) patterns of your muscles. This will increase performance and theoretically decrease injury rates.

In Mark Verstegen’s book, Core Performance, this movement preparation is detailed with pictures and descriptions of each move. You can get this book on amazon.com or at barnes and noble in Olympia. If not, just email me and we will set up a time to go over this training method.

Best of Luck!

Monti Sorem DC, CSCS, EMT-B

Hey Dr. Monti Sorem from Lacey, Washington here. I just got back from Finland for the 86th ISDE. The ISDE is the “olympics of motorcycling” with over 50 nations competing for a world trophy. It is the oldest motorized competition in the world and is wildly popular in europe.
I am very fortunate to have worked with some of the world’s fastest off-road motorcycle racers and so have been invited for the last 2 years to be on the Team USA medical staff. After riding for 8 hours every day, they were sore and beat up to say the least.

I spent most of my nights doing tissue treatment and my mornings taping people up using Kinesio Tape and Mconnell taping methods.

One Club rider, Michael Sanders, had a broken collarbone before the ISDE, but he rode anyway. What a mad man! He came to Doc Mcgee and I on day 4 and it wasn’t looking good, but with a team effort Doc Mcgee was able to numb up the area and I was able to tape him up to take some of the strain off. Not only did Michael finish this extremely tough event ( about 20% do not finish) he finished just outside of the silver medal. Attached is his photo.

Hope all is well with everyone.

Dr. Sorem

http://www.facebook.com/coachdoctor#!/photo.php?fbid=10150271414258995&set=a.174725343994.124210.752878994&type=1&theater

Dr. Monti Sorem here from Lacey, Washington. Here is a cool review of some very important studies. In my experience, I have rarely seen positive results with patients using muscle relaxers.

http://www.uschirodirectory.com/index.php/chiropractic-research/item/306-low-back-pain-chiropractic-vs-muscle-relaxants

Dr. Monti Sorem from Lacey, Washington here. When I am not treating patients at Crossroads ProC.A.RE I am trying to read as much as possible.

I was emailed at summary of headache research. In chiropractic we have had lots of anecdotal research of chiropractic reducing or eliminating headaches, but now we have really good evidence support this.
In 1998 and study by Nelson et al show that 8 weeks of manipulative therapy was 57% more effective than drug therapy for long term outcome of headache sufferers.

Recently, a 2011 study by Bryan et al showed that manipulation is effective is reducing headache symptoms.

If we examine the side effects of common drugs for migraines/headaches and the effectiveness of chiropractic it is easy to see that chiropractic should be the first line of defense and drugs should be second.

Disc Surgery (Discectomy,) Sciatica (Leg Pain) & Lumbar Disc Herniation

Surgery vs. Chiropractic Care

by

Monti Sorem DC, CSCS, EMT

Chiropractor Olympia, Lacey and Tumwater

60% of Surgical Candidates Avoid Surgery with Chiropractic

According to a group at MayoClinic.com (2010), “Sciatica refers to pain that radiates along the path of the sciatic nerve and its branches — from your back down your buttock and leg. The sciatic nerve is the longest nerve in your body. It runs from your spinal cord to your buttock and hip area and down the back of each leg. Sciatica is a symptom, not a disorder. The radiating pain of sciatica signals another problem involving the nerve, such as a herniated disk” (http://www.mayoclinic.com/health/ sciatica/DS00516).

Sciatica symptoms include: Pain “…likely to occur along a path from your low back to your buttock and the back of your thigh and calf. Numbness or muscle weakness along the nerve pathway in your leg or foot. In some cases, you may have pain in one part of your leg and numbness in another. Tingling or a pins-and-needles feeling, often in your toes or part of your foot. A loss of bladder or bowel control. This is a sign of cauda equina syndrome, a serious condition that requires emergency care” (Mayo Clinic Staff, 2010, http://www.mayoclinic.com/health/sciatica/DS00516/DSECTION=symptoms).

A prime symptom of sciatica is leg pain in conjunction with herniated discs. As reported by the US Chiropractic Directory in 2010, “Pain radiating down your leg secondary to a herniated disc is a common and often disabling occurrence. A disc in your spine is comprised of 2 basic components, the inner nucleus pulposis that is gelatinous in composition and the outer annulus fibrosis that is fibro-cartilaginous and very strong. When a person experiences trauma and the forces are directed at the spine and disc. The pressure on the inside of the disc is increased (like stepping on a balloon) and the internal nucleus pulposis creates pressure from the inside out. It tears the outer annulus fibrosis causing the internal material to go beyond the outer boundaries of the disc. This has often been misnamed a ‘slipped disc’ because the disc doesn’t slip or slide, it is torn from the trauma allowing the internal material to escape.
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Conversely, a bulging disc, which gets confused with a herniated disc, is a degenerative “wear and tear scenario” that occurs over time with the annulus fibrosis degenerating. This can also be a “risk factor” allowing the disc to herniate with less trauma due to the degeneration or thinning of the disc walls. This, however, is a conversation for another article.
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Lifetime prevalence of a herniated disc has been estimated to be 35% in men and 45% in woman and it has been estimated that 90% of all leg pain secondary to herniated discs occurs at either the L4-5 or L5-S1 levels. It has also been reported that average duration of symptoms is 55.9 weeks, underscoring the critical necessity for finding a viable solution for these patients” (http://www.uschirodirectory.com/index.php/patient-information/item/235-herniated-discs-radiating-pain-and-chiropractic).

It was reported by McMorland, Suter, Casha, du Plessis, and Hurlbert in 2010 that over 250,000 patients a year undergo elective lumbar discectomy (spinal surgery) for the treatment of low back disc issues in the United States. The researchers did a comparative randomized clinical study comparing spinal microdiscectomy (surgery) performed by neurosurgeons to non-operative manipulative treatments (chiropractic adjustments) performed by chiropractors. They compared quality of life and disabilities of the patients in the study.

This study was limited to patients with distinct one-sided lumbar disc herniations as diagnosed via MRI and had associated radicular (nerve root) symptoms. Based upon the authors’ review of available MRI studies, the patients participating in the study were all initially considered surgical candidates.

Both the surgical and chiropractic groups reported no new neurological problems surfaced and had only minor post-treatment soreness. 60% of the patients who underwent chiropractic care reported a successful outcome while 40% required surgery and of those 40%, all reported successful outcomes. Of those patients choosing surgery as the primary means of treatment, 15% reported a failed surgical outcome and then chose chiropractic as a secondary choice. Of those 15% with failed surgeries, all were reported to have performed worse in clinical outcomes.

While it is clear that an accurate diagnosis could dictate that many patients require immediate surgery, many also do not. The above study indicates that a conservative non-operative approach of chiropractic care prevented 60% from needless surgery. While a larger study would give us more information, based upon the outcomes, cost factors and potential increased risks of surgery, it was concluded that chiropractic is a viable, first line treatment option.

These studies along with many others conclude that a drug-free approach of chiropractic care is one of the best solutions for patients with surgical lumbar discs and sciatic pain. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.USChiroDirectory.com and search your state.

References:

1. Mayo Clinic Staff. (2010, April 22). Sciatica, Definition. MayoClinic.com, Retrieved from, http://www.mayoclinic.com/health/sciatica/DS00516

2. Mayo Clinic Staff. (2010, April 22). Sciatica, Symptoms. MayoClinic.com, Retrieved from http://www.mayoclinic.com/health/sciatica/DS00516/DSECTION=symptoms

3. Studin, M. (2010). Herniated discs, radiating pain and chiropractic. US Chiropractic Directory. Retrieved from http://www.uschirodirectory.com/index.php/patient-information/item/235-herniated-discs-radiating-pain-and-chiropractic

4. McMorland, G., Suter, E., Casha, S., du Plessis, S. J., & Hurlbert, R. J. (2010). Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study. Journal of Manipulative and Physiological Therapeutics, 33 (8), 576-584

   Dr. Monti Sorem here in the Olympia, Lacey and Tumwater area.  In my career as a Strength and Conditioning Coach I still run into cross-country and track coaches who refuse to look at the current research promote resistance training into their coaching philosophy. It has been shown that weight training does not improve your VO2 max, but the speed at which you reach VO2 max is significantly improved! Even my patients who like to run often times forget how important weight training is.  With the Capitol City Marathon approaching I thought some might enjoy some research and recommendations regarding this topic.  Look out for some of my friends who I have trained with, if they both win that will give my favorite running couple 8 combined wins! 

   Even distance races (yes, even marathon) have a 5-7% contribution of anaerobic (power and strength) activity

• It makes sense to add in some sort of anaerobic training.
• (Green & Patla, 1992; Hausswirth & Lehénaff, 2001)

-          Techniques to develop muscle strength and power

• Standard Resistance Exercises
  • Closed kinetic chain
  • Movement specificity
  • Multi-joint movements
• Olympic Lifts
  • Focus is on velocity-specific training and maximal muscle power
  • Requires/trains whole-body coordination
• Plyometrics
  • Exaggerates eccentric, isometric, and concentric contractions to stimulate muscle development
  • Utilize stretch-shortening cycle (SSC)
  • Focus is on speed of movement and minimal contact times
  • Running is plyos! 

CONCLUSIONS

-          Supplementing a distance running program with an appropriate strength and power program appears to:

• Not improve or decrease VO_2max
• Improve RE, LT, and vVO_2max, and race time
• Improve 3K-5K race time in a variety of individuals
• Improve short-distance sprinting speed
• Improve muscular strength and power

-          Disclaimer

• Although the research presented is convincing, many studies have small sample sizes, untrained populations, and methodological factors that make interpretation and generalizability of the findings difficult. 
• Anecdotal methods drive research in this area, so I encourage professionals to experiment with new techniques based on evidence- and theory-based principles, then share what you find with the rest of the world.

 Try some of this out and get me some feedback! Good luck.

Hi this is Dr. Monti Sorem. I am a chirpractor in the Olympia/Lacey area.  In addition I have been a collegiate level strength coach and performance coach to several professional athletes.  Recently, I had a patient inquire about chiropractic and exercise for her sister that has multiple sclerosis.

I was reminded of a video from a colleague that can be viewed at http://www.youtube.com/watch?v=QIfP4LElIBc&feature=player_detailpage He practices a method called Chiropractic BioPhysics which is the most researched chiropractic methodology out in practice.  I also utilize the CBP protocol.

As a strength coach, I am reminded of several studies that outline certain exercise strategies pertaining to persons with MS.  Using these methods, participants increased their exercise capacity, reduced fatigue scores and improved overall quality of life ratings. 

There are options for these patients. Feel free to email with any questions drsorem@soremfc.com

Take care,

Monti Sorem DC, CSCS, EMT-B

Chiropractic care improves brain function and the body’s motor or movement ability

Research findings that redefine care for every rehabilitation patient for all motor disorders

According to the Sensory Processing Disorder Foundation (2011), “Sensory processing (sometimes called ‘sensory integration’ or SI) is a term that refers to the way the nervous system receives messages from the senses and turns them into appropriate motor and behavioral responses. Whether you are biting into a hamburger, riding a bicycle, or reading a book, your successful completion of the activity requires processing sensation or ‘sensory integration’” (http://www.learningrx.com/sensory-motor-integration-faq.htm)

According to Wikipedia (2011), “A motor skill is a learned sequence of movements that combine to produce a smooth, efficient action in order to master a particular task. The development of motor skill occurs in the motor cortex, the region of the cerebral cortex that controls voluntary muscle groups” (http://en.wikipedia.org/wiki/Motor_skill).

According to LearningRX (2010), “Sensory motor integration is the synergistic relationship between the sensory system and the motor system. Since the two communicate and coordinate with each other, if one is problematic, the other can suffer as a result. The two involve receiving and transmitting the stimuli to the central nervous system where the stimulus is then interpreted. The nervous system then determines how to respond and transmits the instructions via nerve impulses to carry out the instructions (e.g. a hand-eye coordination movement)” (http://www.learningrx.com/ sensory-motor-integration-faq.htm).

The synopsis of the above 3 paragraphs is that the human body senses information (sensory processing), processes the information in the brain (sensorimotor cortex), and then sends the information to the part of the body that has to perform a function, such as moving your thumb, walking, talking, picking something up or any other function we do in our lives. As the above paragraph eloquently stated, if any of the 3 areas are not working properly or working not optimally, every part of the system suffers.

In 2010, Taylor and Murphy concluded in their research that chiropractic care improves the functional levels of the motor cortex, premotor areas, and that this improved measurement was maintained after a 20-minute training task, indicating that it wasn’t a transient finding. The authors further offered that the practical applications suggesting that:

1. this alters the way the central nervous system responds to motor training

2. a chiropractic spinal adjustment/manipulation alters the neurological integration at the cortical (brain) level

3. this explains the mechanism responsible for reducing pain levels and increased functional ability after the adjustment/manipulation

4. this explains the mechanism of overuse injuries and chronic pain conditions

The above 4 areas change the way we should approach strategies in rehabilitation for all neurodegenerative and congenital motor and sensory disorders. A list of potential disorders that could benefit in rehabilitation from this research is:

1. muscular dystrophy

2. Duchenne muscular dystrophy

3. myasthenia gravis

4. Parkinson’s disease

5. fibromyalgia

6. multiple sclerosis

7. Huntington’s disease

8. stroke victims

9. all other neuro-muscular diseases

On a clinical note, this author, having cared for muscular dystrophy patients for 30 years, can report that in every instance, the patients were able to ambulate (walk) with greater ease and had significantly more motor control (movement) while under chiropractic care. The goal of rehabilitation in the neurodegenerative patient is to both increase muscle tone and through repetition of activities of daily living, gait training, balance training, speech training and all other motor functions, to help retrain the muscles to maximize the body’s ability to regain those functions. The rehabilitation is essential in most cases and critical to the person regaining an independent life.

The therapist in rehabilitation creates a setting similar to a car or kitchen so that the patient can re-create activities of daily living. In doing these activities with the help of the therapist, the patient is activating stimuli in the sensory nervous system. Touching and movement are senses that the brain has to process and then send impulses back to the muscles to move in order to perform daily tasks. In order for function to be regained maximally, there can be no dysfunction at the spinal level. That dysfunction is defined in chiropractic as subluxation or a vertebrate out of place, negatively affecting the nerve and fixed in the wrong position.

Based upon the research by Taylor and Murphy (2010), if there is a spinal dysfunction (subluxation) it prevents normal impulses from the sensory system and lowers the ability of the brain from functioning at its optimal. Therefore, the most rehabilitation can offer is maximization of the body’s ability at reduced capacity. The implications are staggering as in many cases that could mean no matter the expertise of the therapist or the diligence of the patient, the rehabilitation would not be as successful or could fail if the brain could not function at a higher level.?

Through chiropractic care, the patient can have the ability to function at a higher level and live a “more normal life” with neurodegenerative disorders. The implications go well beyond neurodegenerative disorders and cross over to industry, sports and everyday life. However, that will be discussed in another article.

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References:

1. Sensory Processing Disorder Foundation (2011). About SPD. Retrieved from http://spdfoundation.net/about-sensory-processing-disorder.html

2. Wikipedia (2011). Motor skill. Retrieved from http://en.wikipedia.org/wiki/Motor_skill

3. LearningRX (2010). Sensory motor integration. Retrieved from http://www.learningrx.com/sensory-motor-integration-faq.htm

4. Taylor, H. H., & Murphy, B. (2010). The effects of spinal manipulation on central integration of dual somatosensory input observed after motor training: A crossover study. Journal of Manipulative and Physiological Therapeutics,?33(4), 261-272.