A PARADIGM SHIFT

FACTS, MYTHS AND THE UNTOLD TRUTH

DR HENRI MARCOUX, DC, FACO, FCCO(c)

DEFINITIONS

-WHIPLASH IS WHAT HAPPENS WHEN THERE IS RAPID VIOLENT ACCELERATION/DECELERATION IN A FLEXIBLE STRUCTURE.

A WHIPPING ACTION!

-THE TERM IS COMMONLY USED TO DESCRIBE AN INJURY TO THE NECK USUALLY AS A RESULT OF A REAR-ENDING WHILE IN AN VEHICLE.

-THE TERM IMPLIES A VIOLENT ACTION THAT FORCES THE ARTICULATIONS OF THE CERVICAL SPINE TO FLEX (FORWARD) AND EXTEND (BACKWARD) BEYOND THE NATURAL RANGE OF MOTION FOR FORWARD BENDING AND BACKWARD BENDING.

-THESE JOINT INJURIES MAY ALSO OCCUR IN SIDE BENDING MOTIONS OR COMBINATIONS OF FLEXION/EXTENSION WITH LEFT/RIGHT LATERAL BENDING.

-THE LOWER BACK IS USUALLY ALSO HURT BY THE SAME MECHANISMS

What Are the Symptoms of Whiplash?

Symptoms may be delayed for 24 hours or more after the initial trauma. However, people who experience whiplash may develop one or more of the following symptoms, usually within the first few days after the injury:

Neck pain and stiffness that gradually gets worse

Headaches

Pain in the shoulder or between the shoulder blades

Low back pain

Pain, weakness or numbness in the arm and/or hand

Dizziness or lightheadedness, vertigo, nausea

Difficulty concentrating or remembering

Irritability, insomnia, fatigue, blurry vision

Pain and disturbance to the jaw and chewing

SYMPTOMS OF WHIPLASH CONTINUED

Pain, numbness and weakness in legs

Difficulty swallowing due to injured throat muscles

Retropharyngeal swelling complicating swallowing

Feelings of deep general anxiety

Depression

Fear of getting into a vehicle or travel anxiety

Signs of spinal cord injury that may include hyperactive tendon response, abnormal plantar responses, sphincter disturbances suggestive of spinal cord injury

Symptoms may be severe, but examination may not reveal any abnormality

COMMON MYTHS

THAT THE NECK IS THE ONLY AREA INVOLVED

THAT YOU FULLY RECOVER FROM WHIPLASH INJURY

THAT ANALGESIC DRUGS AND EXERCISES ARE THE TREATMENTS OF CHOICE

THAT ANTI-INFLAMMATORY DRUGS ARE OF GREAT IMPORTANCE CLINICALLY

THAT THE USE OF CERVICAL COLLARS IS USELESS AND MAY BE HARMFUL

SPINAL ANATOMY

NORMAL CERVICAL CURVATURE

NORMAL NECK ANATOMY, ARTERIES AND CO-VERTEBRAL JOINTS

CERVICAL SPINE VIEWS LATERAL VIEW ANTERO-POSTERIOR VIEW

CERVICAL SPINE NEUROLOGY

BRACHIAL PLEXUS INTERACTIONS

BRACHIAL PLEXUS IN FULL GLORY

LUMBAR SPINE

PELVIC STRENGTH

PELVIC STRENGTH

LUMBAR PLEXUS

INTERACTION BETWEEN CRANIAL NERVES AND SPINAL NERVES AND TRAPEZIUS AND STERNO-CLEIDO MUSCLES

TEMPORO-MANDIBULAR JOINT AKA JAW

How do court stenographers keep a straight face?

ATTORNEY: Doctor, before you performed the autopsy, did you check for a pulse?

WITNESS: No. ATTORNEY: Did you check for blood pressure? WITNESS: No. ATTORNEY: Did you check for breathing? WITNESS: No. ATTORNEY: So, then it is possible that the patient was alive when you began the autopsy? WITNESS: No. ATTORNEY: How can you be so sure, Doctor? WITNESS: Because his brain was sitting on my desk in a jar. ATTORNEY: I see, but could the patient have still been alive, nevertheless? WITNESS: Yes, it is possible that he could have been alive

and practicing law.

Mechanics of Motor Vehicle Collisions

THE DYNAMICS OF WHIPLASH A WHIPLASH INJURY OF THIS MAGNITUDE CAN

OCCUR IN 1/10 OF A SECOND OR LESS

THE IMPORTANCE OF HEAD RESTS

DEGENERATIVE JOINT DISEASE

AKA SUBLUXATION DEGENERATION

COMPLICATIONS WITH NECK INJURIES

SPINAL RELATIONSHIPS

ONE OF THE IMPORTANT FUNCTIONS OF THE SPINE IS TO GIVE US THE ELONGATION NECESSARY TO KEEP US UPRIGHT AGAINST GRAVITY.

THIS PROCESS BEGINS IN THE FEET AND GIVES THE PELVIS THE FOUNDATION TO EFFECTIVELY ELONGATE THE SPINE ESTABLISHING A BOND BETWEEN BOTH ENDS OF THE SPINE.

THIS RELATIONSHIP EXISTS BETWEEN THESE VERTEBRAE IN AN ORDERLY FASHION.

LUMBAR 5 TO L2 REFLECT THE ALIGNMENT OF CERVICAL 1 AND DOWN TO CERVICAL 5-6.

WHO WE REALLY ARE IN LIFE

WE ARE ALL A MANIFESTATION OF ALL THAT WE HAVE EXPERIENCED, INCLUDING THE GOOD AND THE BAD

OUR POSTURE REFLECTS THIS REALITY AND BECOMES IMBEDDED IN OUR CONNECTIVE TISSUES

CONNECTIVE TISSUES INCLUDE BONES, LIGAMENTS, TENDONS, MUSCLE, SKIN AND FASCIA

WHIPLASH INJURY FINDS US THE WAY WE ARE AND DETERMINES HOW WE ARE HURT

CONNECTIVE TISSUE MEMORY

CONNECTIVE TISSUE MEMORY

DYNAMICS OF ACUTE STRESS

1- INVESTIGATION, CAUTION

2- BRACING, DISLIKE, PRIDE

3- RIGIDITY, AVERSION, FEAR

DYNAMICS OF CHRONIC STRESS

4-BRACING, SPASTICITY

5- WITHDRAWAL, SUBMISSION

6- COLLAPSE, DEFEAT, RESIGNATION

POSTURAL DYNAMICS

WE ARE A COMBINATION OF THESE DIFFERENT POSTURES AS WE ARE ALWAYS UNDER SOME DEGREE OF EMOTIONAL STRESS!

AS WE AGE, THE DOMINANT PATTERN TAKES OVER AND IS MANIFEST AS THE GETTING OLD PROCESS IN OUR CONNECTIVE TISSUES

THIS IS SEEN AS A HARDENING OR A SOLIDIFYING OF OUR CONNECTIVE TISSUES AND WE BECOME LESS FLEXIBLE AS WE AGE

WHILE THIS HARDENING IS MITIGATED BY OUR PHYSICAL CONDITION, OUR FITNESS LEVEL, OUR DIET, OUR ATTITUDES, OUR FLEXIBILITY AND OUR LIFE EXPERIENCE, THIS PROCESS IS REFLECTED IN OUR EMOTIONAL LIFE.

ALL EMOTIONS ARE PHYSICAL

ANY INJURY SUSTAINED WILL BE INFLUENCED BY THESE POSTURAL DYNAMICS AND CAN SERVE TO DETERMINE THE

SEVERITY OF ANY INJURY, PHYSICAL OR EMOTIONAL

COLLAPSE, DEFEAT, RESIGNATION

-ABDOMINAL POUCH COLLAPSES

-DIAPHRAGM FLATTENS IN INSPIRATION WHILE THE CHEST IS DEFLATED -UPPER CHEST NO LONGER MOVES -BUCKLING OF THE LEGS -WEAKNESS, NO EXCITATION EX: DESPAIR, APATHY, DEFEAT, RESIGNATION -ALL EMOTIONS ARE PHYSICAL AND CONVERSELY, ALL PHYSICAL DEPICTS EMOTIONAL CONSCIOUSNESS

10 Myths 1. Minor damage to the vehicle means

inconsequential injury to the occupant.

2. The victim did not complain of pain at the scene of the accident, so if there was an injury, it must be slight.

3. With a high seat back or head restraint, it is impossible to get whiplash injury

4. The injury is a simple strain or sprain and will heal in 6 to 12 weeks

5. Permanent injuries from a whiplash-associated disorder are very rare.

10 Myths 6. Since there are no objective abnormalities, the victim has no permanent injury.

7. The victim is trying to get a big settlement for a minor injury. Once compensated, the symptoms and pain will go away.

8. The plaintiff had a pre-existing degenerative disc disease. All medical problems are due to that pre-existing condition and are totally unrelated to the collision.

9. Men and women are equally at risk to suffer whiplash injury in a rear impact collision.

10. A whiplash injury does not affect a person’s lower back

MANAGEMENT OF WHIPLASH INJURIES Part 1

THE FIRST PRIORITY IS TO DETERMINE THE EXTENT OF DAMAGE AND IDENTIFY WHICH AREAS ARE HURT. CLINICAL EXAMINATION AND XRAYS ARE THE PRIMARY TOOLS EMPLOYED TO DO THIS.

ONCE THE SEVERITY OF INJURY IS KNOWN, THE FIRST GOAL IS TO CONTROL THE PROGRESSION OF THE INJURY BY CONTROLLING THE INFLAMMATORY RESPONSE TO TRAUMA.

IT IS WELL TO RECOGNZE THAT THE INFLAMMATORY RESPONSE IS THE FIRST LEVEL OF HEALING AND REPAIR AND MUST NOT BE STOPPED, BUT INSTEAD SUPPORTED AND REDIRECTED FOR HEALING.

THE PRIMARY METHOD IS TO USE ICE PACKS TO REDUCE THE SWELLING AND REDUCE THE PAIN AND REST TO PREVENT FURTHER INJURY. ANALGESICS MAY BE USED AT THIS POINT BUT NOT SO STRONG AS TO HIDE THE PAIN SO THAT MOVEMENT DOES NOT AGGRAVATE THE INJURY.

A CERVICAL COLLAR MAY BE OF VALUE FOR PROTECTION DURING SLEEPING AND WHILE RIDING IN THE CAR.

THE USE OF GENTLE MASSAGE TO RELAX MUSCLES MAY BE OF VALUE. GENTLE TRIGGER POINT THERAPY MIGHT ALSO BE USED.

ELECTRO-THERAPIES MAY BE APPLIED AT THIS EARLY POINT OF ACUTE INJURY TO REDUCE INFLAMMATION.

MANAGEMENT OF WHIPLASH INJURIES Part 2

CHIROPRACTIC CARE MAY BE SUCCESSFULLY APPLIED IN THE EARLY STAGES OF TREATMENT FOR WHIPLASH INJURIES.

AS THERE ARE MANY STYLES AND TECHNIQUES IN CHIROPRACTIC PRACTICE, ONLY CERTAIN APPROACHES ARE EXCELLENT IN THE TREATMENT OF ACUTE WHIPLASH INJURY.

FORCEFUL SPINAL MANIPULATION IS CONTRA-INDICATED IN THE FIRST STAGES OF ACUTE NECK INJURY, WHILE GENTLE SPINAL ADJUSTMENT TECHNIQUES ARE FULLY INDICATED RIGHT FROM THE START.

THE USE OF GENTLE CHIROPRACTIC TECHNIQUES PLAY A MAJOR ROLE IN THE HEALING OF SPRAIN INJURIES TO THE SPINE AND RESEARCH STATISTICS HAVE SHOWN THAT CHIROPRACTIC CARE GETS BETTER RESULTS MORE QUICKLY THAN PHYSIOTHERAPY, IN GENERAL.

IT IS A PERSONNAL CHOICE TO CHOOSE CHIROPRACTIC OR PHYSIOTHERAPY FOR ACUTE CARE. HOWEVER, PHYSIOTHERAPY CAN PLAY A MAJOR ROLE IN THE REHABILATATION PROCESS

MANAGEMENT OF WHIPLASH Part 3

CHIROPRACTIC CARE WILL ADDRESS THE INJURED SPINAL SEGMENTS, BUT WILL ALSO ENGAGE IN THE CORRECTION OF THE UNDERLYING PROBLEMS THAT LED TO THE SEVERITY OF THE INJURY. AS THE FOUINDATION LIES, SO THE CHIMINEY GOES.

IT IS IMPORTANT TO NOTE THAT SERIOUS WHIPLASH INJURIES CAN OCCUR AT LOWER SPEEDS…UNDER 50 KMS…SOME AT 10 KMS.

PERSONS WHO HAVE UNDERLYING SPINAL MISALIGNMENTS FROM ANY CAUSE WILL LIKELY EXPERIENCE MAJOR INJURY FOR LOWER SPEED REAR ENDINGS.

NONE OF THIS IS BLACK AND WHITE. THERE ARE MANY FACTORS THAT CAUSE MISALIGNMENTS OF THE SPINE THAT ARE PRESENT LONG BEFORE THE WHIPLASH AND THESE PLAY A SIGNIFICANT ROLE IN DETERMINING THE EXTENT OF INJURY.

THE ACCIDENT FINDS YOU THE WAY YOU ARE AND AGGRAVATES YOUR BASIC CONDITION.

MANAGEMENT OF WHIPLASH INJURIES Part 4

THERE IS NO QUICK WAY OUT OF A WHIPLASH INJURY. SYMPTOM RELIEF IS NOT THE ANSWER.

THE SYMPTOMS ARE NOT THE PROBLEM…THESE ARE THE SIGNALS THE BODY PRODUCES TO TELL US THERE IS A PROBLEM!

SYMPTOM RELIEF CARE, OR THE SUPPRESSION OF SYMPTOMS SERVES ONLY TO STILL THE BODY’S VOICE WHILE THE DEGENERATION CONTINUES.

WHAT ARE THE GOAL OF CORRECTIVE CHIROPRACTIC CARE OR ANY KIND OF CARE FOR THAT MATTER!

THE GOAL IS TO RESTORE NORMAL FUNCTION AS CLOSE AS POSSIBLE TO WHAT IS NORMAL

IF LEFT UNTREATED THERE IS NO ALTERNATIVE BUT DEGENERATION IN BOTH THE CERVICAL AND LUMBAR

SPINES

TREATMENT OF THE WHIPLASH INJURIES

THERE ARE MANY APPROACHES TO TREAT AND MANAGE CASES OF WHIPLASH INJURIES.

MANY TIMES A COMBINATION SEEMS TO BE THE BEST.

WE RECOMMEND CHIROPRACTIC CARE TO RESTORE A SEMBLANCE OF NORMAL FUNCTION FOLLOWED BY AN EXERCISE REGIME TO STRENGTHEN THE NECK AND LOWER SPINE COMMENSURATE WITH THE DEGREE OF INJURY.

THE DEEPER THE INJURY, THE MORE NECESSARY RESTORATIVE EXERCISES BECOME.

IN MY OPINION, EXERCISES SHOULD NOT BE GIVEN UNTIL THE SPINAL STRUCTURES ARE ABLE TO FUNCTION AS NORMALLY AS POSSIBLE.

OTHERWISE, THE EXERCISES SERVE TO RE-ENFORCE THE ABNORMAL FUNCTION DISPOSING THE PATIENT TO CHRONIC DEGENERATION AND OSTEO-ARTHRITIS.

THIS IS COMPLETELY PREVENTABLE

SPINAL DEGENERATION IS THE CONSEQUENCE OF POORLY TREATED WHIPLASH INJURIES AND/OR SPRAIN INJURIES TO THE SPINE.

DEGENERATION IS COMPOUNDED WHEN THERE IS TEARING OF LIGAMENTS, CARTILAGE INJURY, HAIRLINE FRACTURES, LOSS OF NORMAL FUNCTION AND MISALIGNMENT.

BECAUSE THE DAMAGE IS PERMANENT, IT IS CRITICAL TO HELP THE BODY FIND A NEW NORMAL.

Thank you YOU HAVE BEEN AMAZING!

YOU HAVE BEEN GIVEN A LOT OF HEAVY DETAILED INFORMATION AND VERY FEW DID ACTUALLY FALL ASLEEP!