Back Clinic Personal Injury Chiropractic Team. Injuries from an accident can not only cause physical harm to you or a loved one, being involved in a personal injury case can often be a complicated and stressful situation to handle. These types of circumstances are unfortunately fairly common and when the individual is faced with pain and discomfort as a result of trauma from an accident or an underlying condition that has been aggravated by the injury, finding the right treatment for their specific issue can be another challenge on its own.
Dr. Alex Jimenez’s compilation of personal injury articles highlights a variety of personal injury cases, including automobile accidents resulting in whiplash, while also summarizing various effective treatments, such as chiropractic care. For more information, please feel free to contact us at (915) 850-0900 or text to call Dr. Jimenez personally at (915) 540-8444.
Clay-shoveler’s fracture is a breakage of the vertebrae in the spine as a consequence of stress in the neck or upper back. It is often described as a steady fracture during the process of a vertebra happening at C7 or C6, classically at some of the cervical or thoracic vertebrae.
Clay-shoveler’s fracture usually occurs in laborers who engage in tasks involving lifting weights with the arms stretched. Examples of these actions include physical activities like shoveling soil, rubble or snow up and over the head backwards, using a pickax or scythe, and pulling out roots.
Back in Australia in the 1930s, men digging deep ditches tossed clay 10 to 15 feet above their heads using long handled shovels. Rather than separating, the clay would stick to the spade; the employee would hear a pop followed by a sudden pain between the shoulder blades, making them unable to continue working.
Mechanism of Injury: Clay Shoveler’s Fracture
The mechanism of injury is thought to be secondary to reflex and muscle strain through the supraspinous ligaments with force transmission.
The spinous process is pulled on by the enormous force. The fracture is diagnosed by plain film examination. The shear power of the muscles (trapezius and rhomboid muscles) yanking on the spine at the bottom of the neck actually tears from the bone of the spine.
Symptoms of clay-shoveler’s fracture include burning, “knife- like” pain in the level of the fractured spine between the top shoulder blades. The pain may increase with repeated action that strains the muscles of the upper back. The broken spine and muscles that are nearby are exquisitely tender. Often these injuries found incidentally years later when the cervical spine is imaged for other explanations and only are unrecognised in the time.
Acutely, they tend to be associated with:
Motor vehicle accidents
sudden muscle contraction
Blows into the spine
Radiographic Features
The fracture is seen on lateral radiographs as an oblique through the spinous process, usually of C7. There’s usually substantial displacement. Other radiographic characteristics of the fracture include ghost signals on an AP view (i.e. double spinous process of C6 or C7 caused by displaced fractured spinous process).
Clay Shoveler’s Fracture
Atypical Clay Shoveler’s Fracture
While the extreme pain slowly subsides in days to weeks, the region may intermittently develop burning pain with certain activities that involve prolonged extending of their arms (such as computer function).
No therapy is required for most patients. Physical therapy, pain drugs, and massage can be of help. Surgical removal of the suggestion of the spine is performed for anyone who have pain.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
By Dr. Alex Jimenez
Additional Topics: Automobile Accident Injuries
Whiplash, among other automobile accident injuries, are frequently reported by victims of an auto collision, regardless of the severity and grade of the accident. The sheer force of an impact can cause damage or injury to the cervical spine, as well as to the rest of the spine. Whiplash is generally the result of an abrupt, back-and-forth jolt of the head and neck in any direction. Fortunately, a variety of treatments are available to treat automobile accident injuries.
In the prior composing we created the foundation of the significance of tire pressures. Specifically, we demonstrated that a third of the vehicles on the street and additional only a third of those vehicles have an underinflated tire and a warning light, respectively.
We also know a 20% decrease in pressure results in substandard performance, these are the factors we’re likely to explore.
Underinflated tires have a different profile and contact patch with the road.
Where the tire meets the roadway is known as the contact patch. Maximizing the touch patch affords the motorist the most performance, specifically steering and braking. What happens if we reduce the contact patch? Under inflation does that.
The contact patch is what connects the vehicle to street, when a tire is properly inflated ( other variables being ignored), the scooter can provide 100 percent of the contact patch (and also the friction between the tire and the roadway) to steering, braking or a combination of both. If the pressure drops performance is also reduced and the contact patch is reduced – but by how much? There are schools of thought on this and a ton of research, for our argument we’ll say tires will have a reduction in performance.
Analyzing an Automobile Accident
But what does this actually mean in the real world? Let say a car traveling at 20 miles with tires was successful and needed to swerve to prevent a collision. The same vehicle with underinflated tires could successfully avoid the same collision at no longer than 17 mph. Let us increase the rates, 55 mph properly inflated collision avoidance becomes collision avoidance.
How about braking? If a vehicle with properly inflated tires could stop in 200 feet (roughly 70 mph), then the identical vehicle with under inflated tires will require 230 feet.
Rollovers turned into another related concern. Aside from the contact patch, appropriate inflation also affects rigidity and stability. In simple terms as a bicycle is asked to alter direction (steer), then an underinflated tire will bend enough to allow the sidewall touch the roadway surface and lift the touch patch from the roadway. In extreme instances, the tire will separate out of the rim allowing the rim to dig in the roadway surface. The photo below depicts a sidewall that is currently experiencing this condition.
The tires in this photo are still able to perform well, in part due to the very little side wall and lack of extreme under pressures. Increasing the sidewall, very similar to SUV or a truck, magnifies the bend and distortion.
The last thing to touch on is that the increase of blowouts. Underinflated tires put pressure inside the tire on the tire structure and boost heat. These variables can, and do, raise the probability of a tire failure by causing or exacerbating the layers of material inside the tire.
Proper tire inflation is among the single most significant routine maintenance activity, and ironically, one of the most ignored tasks and when contemplating causality, the tire pressure ought to be assessed to help rebuild the whole picture of this accident. Tire pressure should be taken into consideration when determining is the arbiter of the culpable party and slide and distances marks.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
Additional Topics: Auto Injuries
Whiplash is a commonly reported injury after an individual has been involved in an automobile accident. During an auto accident, the sheer force of the impact often causes the head and neck of the victim to jerk abruptly, back-and-forth, causing damage to the complex structures surrounding the cervical spine. Chiropractic care is a safe and effective, alternative treatment option utilized to help decrease the symptoms of whiplash.
There’s a lot of information about tires, far beyond the reviews and recommendations on a variety of websites. Here we’ll talk about, from a post-collision perspective, car specifications, standard tire information, and how tire pressure monitoring systems (TPMS) work. We will then analyze how tire pressures relate to automotive collisions.
Vehicle Specifications
Vehicles offered in the United States have a placard in the driver’s door jamb or internal door. This placard contains some advice we need to explore the tires including the vehicle manufacturer recommended load rating tire size, and tire pressure. Here’s an example:
(there’s a second placard particularly for tires but this should be supported contrary to the above mentioned placard as the next one does not include any vehicle identifying information such as a VIN. In this picture the last six digits of the VIN have been omitted.)
Tire Size
The majority of modern tires have writing on the sidewall which explains the tires measurements as well as other critical characteristics. What does it imply? Sizes for front and back are recorded. The 265 is the width, in millimeters, of the face. The next number, 70, is that the height of the tire sidewall for a percentage of the tread face (in this instance 70 percent of those 265). The “R” creates the tire structure a radial. Finally, the 17 is sized diameter in inches.
Tire Pressure
Notice that the listed tire pressure is assumed to be chilly. Tires have to sit at least eight hours from direct sunlight before they are deemed enough. Gases expand as they are heated and also the minimal cold pressure is put so that the scooter will be at the optimal pressure once at operating temperature; accordingly, if a bicycle is at or below the minimum and is at operating temperature, the strain was lower when the tire was cold.
Tire Pressure Monitoring System (TPMS)
The TPMS became a mandated normal after the fallout of the Ford Explorer & Firestone bicycle event. The federal government needed a system that would alert drivers to “non” tire pressure(s). There are two types of systems. The first type is called “direct measurement” and it uses a detector inside each tire which relays the strain. The second kind is known as “indirect dimension” and it utilizes the anti-lock brake method to determine if a tire is spinning faster than others. A bicycle with air pressure that is less will have a diameter that is smaller and will spin faster; this difference can be calculated by the brake system.
The gap in either system comes when we examine how this system decides to warn the motorist. Because the pressures at a tire can differ for a few reasons (we only discussed how temperature is one of these) that the TPMS doesn’t search for a single pressure, but rather an array or minimum strain. The setup within the computer of the vehicle only illuminates the warning light when a tire’s pressure is outside the specifications that are preselected.
Many studies by the national authorities, independent organizations, and tire producers all support substandard performance of tires where the tires are below the recommended pressure. The research have three points of discussion.
71 percent of drivers check tire pressure less than a month.
More than 1/3 of passenger cars surveyed had at least one tire at or below 20 percent of their placard.
Only 36 percent of vehicles tested would find a warning light at 20 percent or more below the placard.
The first point is not a surprise. The absence of frequent tire pressure maintenance is part of why the federal government mandated the TPMS system. The next point is also not surprising. If the majority (71\%) does not regularly check tire pressure, it should be anticipated tires are below the recommended pressure. The point is that the one we want to concentrate on. We want to focus on this fact since the majority of passenger car worries are 30 PSI; 20 percent less is 24 PSI.
If 100 passenger vehicles were on the road, 36 of these would have a minumum of one tire at 20\% below the placard pressure. Of those 36 vehicles, just 13 of them would have a warning light. (For the record it’s not much better for your light truck / SUV category.)
So now we know a third of those vehicles on the street have an underinflated tire and additional only a third of those vehicles have a warning light. The question is does 6 PSI thing? Yes, it does. Testing done by Goodyear and the NHTSA supported decrease in managing a reduction in pressure results in greater stopping distances, increase in blowouts, lower fuel economy, and tire wear.
Putting it All Together
The National Highway Transportation Safety Administration (NHTSA) also regularly studies tire related accidents. 1 study found approximately 9 percent of all collisions are tire related. In 2012, out of the 5.6 million authorities reported accidents, 504,000 were related.
For simplicity, we will assume each the accidents involved one car making the total 5.6 million. 725,000 would possess the warning lighting if we utilize the proportions more than 2 million would have at least one tire that is underinflated, in the table. Increasing the amount of vehicles only increases the statistics.
When deciding causality, you will find 504,000 tire related collisions as reported previously and also this misunderstood and often overlooked fact is omitted when attempting to determine the culpable party. It’s because of this that upkeep that tire pressures should be ascertained immediately post-accident rather than only focus on skid marks (though they are equally important in the equation important) because demonstrative evidence when trying to reconstruct accidents in the pursuit of discovering causality.
In Part 2 we will discuss how these variables affect tire performance that further provides demonstrative evidence to the accident reconstructionist, accident investigator and lawyer.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Whiplash is a commonly reported injury after an individual has been involved in an automobile accident. During an auto accident, the sheer force of the impact often causes the head and neck of the victim to jerk abruptly, back-and-forth, causing damage to the complex structures surrounding the cervical spine. Chiropractic care is a safe and effective, alternative treatment option utilized to help decrease the symptoms of whiplash.
Why do they deploy in some instances and not others?
The module monitors various vehicle systems and contains a threshold for deployment; in simpler terms, this usually means the collision must meet specific settings to deploy an airbag. The idea is exactly the same while the system of every automobile brand is specifically different from the next.
If the collision, as computed by the module, is intense enough, it’ll deploy the appropriate airbag(s). The module has the final say when an airbag is deployed, this is software & hardware dependent.
The module can understand, through onboard accelerometers, changes in the vehicles direction and speed. The module constantly calculates these changes and when it “sees” a switch beyond preset thresholds it begins to track, quite tightly, the fluctuations (this is called algorithm enablement). If it establishes that the changes meet the standards for airbag deployment, it’ll deploy the appropriate airbag(s).
Many vehicles also have failsafe sensors mounted in the car that are designed as a secondary mechanical and/or diagnostic triggering system. These detectors are mounted under the radiator, when crushed or damaged, they force an airbag deployment, generally on the vehicle’s front.
People also often ask whether the vehicle detects if a chair is occupied, in order to deploy an airbag. The driver�s seat is obvious, beyond this, the front passenger seat has a pressure sensor in it which can tell when a predetermined amount of weight is on it, and the rest of the seats use the seatbelt latch (vehicle specific). When you’re driving a vehicle, the module also monitors the status of the pressure sensors and seatbelts, it then uses this data to make the best choice possible about which airbags to deploy and when.
Collision Report Explanations and What to Expect
I’m frequently asked about a specialists report, but the most frequent subset questions are on the lack of aid for findings from the report. Since it is of private & professional interest I have chosen to tackle this question.
“I got this collision pro’s report but there does not seem to be any explanation for his findings, is this normal?”
Yes and No. Yes, this occurs; no, it’s not standard. All professional disciplines of post primary education are based in criteria that were scholarly & accredited.
Collison reconstruction specialists are no different. While not necessary part of an graduate or undergraduate curriculum, the training and instruction they have is based on exactly the identical licensed & scholarly training and education – because of the correlation, the exact same standard ought to be applied to collision reconstruction professionals. Scholarly research relies on procedures of peer reviewed and investigation, testing, and scrutiny before being approved.
When an expert offers an opinion without saying supporting scholarly documentation it’s not useless, but rather it stands alone; it’s simply his opinion. Conversely, as soon as an expert offers and opinion with proper supporting documentation that was scholarly, expertise, all the work, and research is provided with his opinion.
Additional and Minimal Costs in Auto Accidents
Often times an appraisal for repairs is used to justify “low speed” by citing minimum costs. There are a few points regarding so the question is These to consider:
Is the recorded price on the appraisal an accurate reflection of damage?
The long answer begins with understanding who did the assessment and what is there background? Normally, appraisers are trained by the insurer — as such, decreasing the costs and expenses of repair is at the interests of the insurance company. Secondly, a vehicle is not disassembled to learn if there is any damage, especially in low speed collisions by most appraisers.
The next issue is when replacement parts are required where do they come from? Original Equipment Manufacturer (OEM) components cost considerably more than Equal or Like Quality (ELQ) components, like ELQ components are the preferred choice of insurance businesses. It would cost the industry millions more when making repairs to use OEM parts as opposed to ELQ parts. Along this exact same line, paint’s quality also varies. Paint manufacturers provide paint systems that are very durable and will meet with the OEM specifications paints they also offer more economically tightly or paint which is not quite as durable color matched to the first, and as anticipated, it costs less.
The last problem to discuss is occupation downtime. The longer there is a vehicle in for repairs the more it costs the insurance provider in fees. While a shop can, and will, have a minimum quantity of time to fix the vehicle the insurance company is going to maintain them on this time frame and constantly press to be completed. This drive can make an environment where the repair facility will sacrifice quality of workmanship to finish for a profit margin that is much better.
The above factors greatly dictate the final amount making it overly subjective for a trusted stage to confirm the threshold of harm; in different terms, using “low cost” as a justification for no harm is not appropriate as no causality relationship is different. If a breakdown of the repair invoice is supplied, you efficiently show the bias towards reducing the cost of the repair and can objectively cost the repair components.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
Additional Topics: Weakened Ligaments After Whiplash
Whiplash is a commonly reported injury after an individual has been involved in an automobile accident. During an auto accident, the sheer force of the impact often causes the head and neck of the victim to jerk abruptly, back-and-forth, causing damage to the complex structures surrounding the cervical spine. Chiropractic care is a safe and effective, alternative treatment option utilized to help decrease the symptoms of whiplash.
In the last two writings we explored how low speed collisions can have substantial energy transfers with minimal (if any) damage. Here we will discuss the myth of “no damage = no injury” from a vehicle appearance / design point of view and how it relates to injury in a collision.
So as to get into this subject, we need a little history lesson first. With vehicle style being the topic of focus, the industry exploded after World War II. The jet age influenced bumpers, headlights and taillight’s fins. Something else happened too, for the first time in the automobile’s history, vehicles were more than “around town” horse-less buggies; the power of their engines and speeds potential dawned a whole new arena — security. In the 1960’s vehicle aesthetics began to compromise with safety. Automotive designers started to consider topics like; occupant restraints structural integrity, and crash worthiness.
The industry faced slow growth and change into the 1980’s, each revision or change did bring with it progress and progress but not enough at any one time to be a huge leap forward. The changes which were necessary, were too experimental, too cost prohibitive, or just too market risky. Then in the 1980’s a revolution in business started to take hold — the computer. The personal computer allowed for design changes to be done with efficiency. Once plugged in and switched on the days spend calculating double function and variables became complicated than a few clicks.
The computer made it possible for car manufacturers to reduce years of conventional design and research practices into only a month or two and at the same time it allowed for much more cost effective experimentation and new process development.
No Vehicle Damage Doesn’t Guarantee No Injuries
Now that We’ve completed history 101 let Us discuss the topic of Stage – “no damage = no injury”
Vehicle layout, as an approach or concept, has undergone a considerable overhaul in recent years. The change has influenced the use of bumper covers. The long standing tradition in design is to make them of a alloy and to put the outside or separate from the body. (Consider all those classics in “American Graffiti”). The bumper was designed to function as a compliment to the vehicle’s appearance. The safety perspective was non-existent with respect as they were no longer than a sacrificial lamb to save the body.
In the early 1970’s federal mandates designed to make vehicles safer forced the producers to engineer larger and much more structurally sound designs. The most noted changes where the moving of bumper away from the body itself to an essential part of the car’s body. This “afterthought” look borrowed from the truck world was the standard until the late 1980’s. Three things changed in the 1980’s: First, bumpers began to move to behind urethane bumper covers in usage.
This gave a look to vehicles and assisted with aerodynamics. Because aesthetics were no more part of the equation, bumpers became stronger and included the use of energy absorbing material between the bumper structure and the bumper cover. Finally, automotive paints had also advanced, including the ability to resist cracking & flaking, and paint had become elastic.
These changes also had another positive side effect; because of the elastic properties of urethane and the paint, minor collisions, even those which damaged the bumper behind them, no longer seemed as serious. Often times a bumper cover needed more than some paint and prep, where past designs necessitated changing the bumper.
The largest change between older design and the new one, is the inherent elasticity of the new bumper covers. These covers can, and do, rebound into the design they have been formed in and the use of paint that is elastic means the paint is likely to rebound as well. The assessment of speed from damage is currently poorer while signs of impact are evident. Obviously when a steel bumper is distorted it remains that way leaving no room for underestimation.
Notice how we have not discussed these design changes have gained energy transfer; and this isn’t any mistake. There are no groundbreaking points. Changes in vehicle design is not going to ease violation of laws of physics. All these design changes is make the energy transfer in a low speed crash less costly and less apparent.
Evaluating Vehicle Damage
However, there are Just demonstrable measures that can be taken to assess the effects of energy transfer in no apparent damage collisions:
Remove the cover of the bumper and inspect the materials below the “skin” of the bumper for internal damage
Check the angle of the passenger seat. The factory at a angle and when the occupant is thrown backwards, often the seat angle changes rendering evidence of force transfer sets seats
Have the swivel tested with a laser apparatus most repair shops use to make sure the frame of the car is “plumb.” Even a 1-degree variation will be evident and often the chassis gets distorted and that requires energy transfer.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
Additional Topics: Weakened Ligaments After Whiplash
Whiplash is a commonly reported injury after an individual has been involved in an automobile accident. During an auto accident, the sheer force of the impact often causes the head and neck of the victim to jerk abruptly, back-and-forth, causing damage to the complex structures surrounding the cervical spine. Chiropractic care is a safe and effective, alternative treatment option utilized to help decrease the symptoms of whiplash.
“The clinical diagnosis shows a disc bulge in their neck and some arthritis, so their neck symptoms are not associated with the crash. Lots of folks have those and do not have pain although it could be a minimal herniation. It’s our diagnosis that it was there before the crash.” This statement from an adjuster is an argument that has been made for many years, allowing insurance companies to inappropriately reduce settlements to their clients based on the client’s inability to prove when or how the damage or injury occurred. To factually counter this sort of statement, an individual must use imaging and age dating to discuss causality. Without medical experts utilizing the current medical and academic research available, it will continue to be difficult for any argument to be made explaining effects of these injuries and their mechanism based on fact vs. rhetoric.
Imaging of the spine is critically important in most cases of injured clients. In cases, imaging is necessary for proper diagnosis and future management of injuries. Imaging needs to be performed as per the academic and modern criteria to ensure an accurate diagnosis. The most common injuries in car accidents are spinal related, and the simple imaging available includes x-rays, CAT scans and magnetic resonance imaging (MRI), allowing medical providers to make an accurate diagnosis, when medically indicated.
Every medical provider has a permit to see and treat automobile related injuries. However a “license” is not the same as “specialization.” By way of example, though psychiatrists may have a license to do heart surgery and are MDs, it would not be in the patient’s best interest. Nor would I go to a spine surgeon for psychological concerns although they are licensed to treat medical conditions. In spinal trauma, certain suppliers specialize in connective tissue injuries of the spine, allowing us to go one step farther in diagnosis, prognosis and management, including “age-dating” these generally found disc and ligament injuries.
Understanding Age-Dating of Injuries
To understand age-dating, one wants to have a basic medical understanding of anatomy and physiology, and what tissue is commonly injured and the probable “pain generator”. Since neck injuries are the most common injuries cervical joints will be our focus. Related to anatomy, every set of two vertebrae in the neck is connected with three joints; two facet joints and a single disc. These joints allow for normal movement of the spine (mobility). There are multiple ligaments that are responsible for stability and hold together these joints. The correct balance of mobility and stability is critical when looking at the part of patient’s injuries, meaning that too little or too much movement in spinal joints can lead to pain, secondary to damaged tissue. The tissue most commonly hurt in a car crash is nerve, ligament, disc, facet and muscle/tendon. Spinal cord and bone injuries also happen although less frequently. To determine causality, the supplier should comment on what tissue is injured, and also use imaging to help determine if this injury occurred (age-dating).
There are two fundamental problems that must be addressed. Fardon and Milette (2001) reported, “The phrase ‘herniated disc’ does not infer knowledge of cause, relation to trauma or activity, concordance with symptoms, or need for treatment” (p. E108). Simply having a disc herniation’s presence, without a physical exam or without symptom documentation that is appropriate, does not allow one to comment on the cause of the injury. In a rear impact collision by way of example, even if the diagnosis is confirmed, additional criteria will need to be fulfilled to answer the question of “Was there sufficient force generated into the vehicle and the occupant to induce the cervical/lumbar herniation?” Fardon, in a follow-up study (2014) reported that disc injury “in the absence of significant imaging evidence of associated violent injury, should be classified as degeneration rather than trauma.” (p. 2531). Thus, we must more objectively define the subjective connotations of “violent injury” and address the issue of “degeneration as opposed to trauma”. Although this statement can frequently be misleading, it gives the trauma trained expert doctor a basis in going forward understanding that every patient’s physiology is unique and not subject to rhetoric, but clinical findings.
Violent injury to the occupant can occur when there are sudden acceleration and deceleration forces (g’s) generated to the neck and head which overwhelm connective tissue or pull them past their physiological limit. To determine the acceleration force, ?V (delta V) is utilized. ?V is the change in speed of the occupant vehicle when it is hit from behind (i.e., going from a stopped position to seven mph in 0.5 seconds because of forces moved from the “bullet” vehicle to the “target” vehicle). Utilizing these data, research allows us to make specific comments related to violent injury. Since the cervical spine is subjected to shearing forces, and compression, tension we are oversimplifying. Along with g-forces and the elastic nature of the majority of rear impact crashes makes it almost impossible to discover an actual minimum threshold for injury even though the literature has given us many examples of low-speed crashes which are dependent not simply on speed, but the mass (weight) of the subject vehicles. Each individual’s susceptibility to injury is unique. While g-forces alone are insufficient to predict injury, Krafft et al. (2002) reported that in low-speed collisions there’s an injury threshold of 4.2 g’s for males and 3.6 g’s for females. Krafft’s analysis is unique in that she has access to insurance data inaccessible to researchers. Panjabi (2004) revealed that forces as low as 3.5g impacts would lead to damage to the front of the disc, and 6.5g and 8g impacts would lead to disc damage posteriorly where the neurological components are.
Diagnosis for Disc and Ligament Injuries
A spinal biomechanical expert can look for evidence that is conclusive by disc and pathology, according to two phenomena. First, it is recognized that the body is electric. We’re measuring activity to diagnose when an EMG is done. Second, there are bioelectrical fields in all tissues. This typical field is disrupted when an injury occurs, and in the case of joints calcium is drawn to the damaged tissue. Issacson and Bloebaum (2010) reported “The particular loading pattern of bone has been documented as a significant piezoelectric parameter since potential gaps in bone have been known to be due to charge displacement during the deformation period” (p. 1271). For the patient, we have the ability to tell just how much of this process has occurred before or after their crash, especially if we take into consideration the tissue damage and signs of bone/calcium deposition.
In addition, the body begins a healing process that includes regeneration and remodeling of the soft and hard tissue as reported by Issacson and Bloebaum (2010). Spinal vertebrae have a unique structure of bone which allows it to adapt to abnormal mobility and stability (injury) by changing shape, which can be found on radiographs or MRI. Moreover, shape will change according to patterns based on the pressure or load it undergoes post-injury. Issacson and Bloebaum stated that “Physical forces exerted on a bone change bone structure and is a well-established principle…” (p. 1271). This is a further understanding of a scientific principle called Wolff’s law established in the 1800’s. Because we know what “normal” is, when we see “abnormal” findings as a result of mechanical stress we could broach the topic of an acute injury versus a degenerative process being the cause of the abnormality and create specific medical predictions accordingly.
He and Xinghua (2006) studied the predictability of the bone remodeling process and were able to make predictions of pathological changes that will occur in bone, specifically the osteophyte (bone spur) on the edge of a bone structure. Significantly, they noted their findings “confirmed that osteophyte formation was an adaptive process in response to this change of mechanical environment”. They noted that factors are crucial to the morphology of bones, particularly bones such as the femur and vertebrae.
For readers familiar with current academic and medical accepted nomenclature for disc injury, recognized from the combined task forces of the North American Spine Society (NASS), the American Society of Spine Radiology (ASSR) and the American Society of Neuroradiology (ASNR), disc herniations must have a directional component. When this occurs, the additional and abnormal pressure at the level of the disc damage matched with the direction of the herniation will cause that section of the vertebrae.
Thus, if there’s a C5/6 right sided herniation (protrusion/extrusion) secondary to a cervical acceleration/deceleration injury, then only that side of the vertebrae will change shape, creating an osteophyte. Facet arthritis is additionally caused by this compounded loading on the facet joint. This process is very similar to the formation of a callous on your hand or foot. The callous is a recognized and expected tissue response to increased load/friction exposure. Similarly, an osteophyte is a known and anticipated bone response to a rise in load/friction exposure.
At a basic level, the body has an electrical and mechanical response to injury leading to additional stress that leads to calcium (bone) to flow in the region of injury to further support the joint. The joint then abnormally grows, developing a called hypertrophy, degeneration, disc osteophyte complex, or arthritis/arthropathy, common terms seen in the reports of doctor and radiology.
Everybody is subject to these morphological (structural) changes, always and predictably determined by mechanical imbalances in the spine. He and Xinghua (2006) concluded that, “…it will actually take about over half a year to discover the bone morphological changes…” (p. 101). This indicates that it takes approximately six months to get an osteophyte (bone spur) to be demonstrable post-mechanical breakdown or failure. This again provides a time frame to better understand whether pathology of the intervertebral disc has been present for a long period of time (pre-existing) or has been produced as the direct result of the specific traumatic event by deficiency of the existence of an osteophyte, meaning the disc pathology is less than six months old, dependent on location and management of the pathology.
Conclusion
In conclusion, that by definition, a disc is a ligament connecting a bone to a bone and it has the structural responsibility to the vertebrae above and below to maintain the spinal system in equilibrium. Damage to the disc because of a tear (herniation or annular fissure) or a bulge will create abnormal load-bearing forces in the injury site. These present differently based on [1] if traumatic failure on the side of the disc lesion, or [2] if age related, as a general complex. Since other research and human subject crash testing have defined the term “violent trauma” as not being dependent upon the amount of damage done to the vehicle but rather to the forces to which the neck and head are exposed, we can now accurately predict in a demonstrable way the timing of causality of this disc lesion. This depends upon the symptomatology of the the morphology of the structure and is a subject that can be predicated upon speculation or rhetoric.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
References:
Fardon, D. F., & Milette, P. C. (2001). Nomenclature and classification of lumbar disc pathology: Recommendations of the combined task forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology.�Spine, 26(5), E93�E113.
Fardon, D. F., Williams, A. L., Dohring, E. J., Murtagh, F. R., Rothman, S. L. G., & Sze, G. K. (2014). Lumbar Disc Nomenclature: Version 2.0:�Recommendations of the combined task forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology.�Spine,�14(11), 2525-2545.
Krafft, M., Kullgren, A., Malm, S., and Ydenius, A. (2002). Influence of crash severity on various whiplash injury symptoms: A study based on real life rear end crashes with recorded crash pulses.� In�Proc. 19th�Int. Techn. Conf. on ESV, Paper�No. 05-0363, 1-7
Batterman, S.D., Batterman, S.C. (2002). Delta-V, Spinal Trauma, and the Myth of the Minimal Damage Accident.�Journal of Whiplash & Related Disorders, 1:1, 41-64.
Panjabi, M.M. et al. (2004). Injury Mechanisms of the Cervical Intervertebral Disc During Simulated Whiplash.�Spine 29 (11): 1217-25.
Issacson, B. M., & Bloebaum, R. D. (2010). Bone electricity: What have we learned in the past 160 years?�Journal of Biomedical Research, 95A(4), 1270-1279.
Studin, M., Peyster R., Owens W., Sundby P. (2016) Age dating disc injury: Herniations and bulges, Causally Relating Traumatic Discs.
Frost, H. M. (1994). Wolff’s Law and bone’s structural adaptations to mechanical usage: an overview for clinicians.�The Angle Orthodontist, 64(3), 175-188.
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Additional Topics: Weakened Ligaments After Whiplash
Whiplash is a commonly reported injury after an individual has been involved in an automobile accident. During an auto accident, the sheer force of the impact often causes the head and neck of the victim to jerk abruptly, back-and-forth, causing damage to the complex structures surrounding the cervical spine. Chiropractic care is a safe and effective, alternative treatment option utilized to help decrease the symptoms of whiplash.
In the prior writing we explored the criteria for vehicle integrity. In this writing we’ll expand on conservation of momentum. You’re encouraged to do so when you haven’t read the previous article.
Expanding on Conservation of Momentum
Remember we previously said, “The momentum moving into a collision could be accounted for at the outcome” when we discussed the concept of conservation of momentum. Here we will introduce the formula and walk through its parts; we have to comprehend this in order to explore each other influence.
The full formula:
Let�s walk through this, on the left side of the equation we have which is the weight of the first vehicle before the collision multiplied by which is the velocity (in feet per second) of the first vehicle before the collision. is the weight of the second vehicle before the collision times which is the velocity (in feet per second) of the second vehicle before the collision. On the right side of the equation we have which is the weight of the first vehicle after the collision multiplied by which is the velocity (in feet per second) of the first vehicle after the collision. is the weight of the second vehicle after the collision times which is the velocity (in feet per second) of the second vehicle after the collision.
Ok, I know this looks very intricate and the explanation is not jumping off the page so let’s write with a bit more ease of comprehension. Let us take the National Highway Transportation Safety Administration (NHTSA) standards for testing and place two of the identical mass vehicles in this. Let us use a 2012 Toyota Corolla, and we will say the other is blue and one is red because we need two of them.
Red Corolla * 5 mph + Blue Corolla * 0 mph = Red Corolla * 0 mph + Blue Corolla * 5 mph
The 2012 Toyota Corolla has a curb weight of 2,734 pounds, substituted in the formula it looks like this:
Now when we do the math to show the conservation of momentum we end up with the following:
20,094.9 + 0 = 0 + 20,094.9
20,094.9 = 20,094.9
Momentum conserved
Now we have proved the concept so we are going to apply it to a collision involving two different vehicles. We will substitute the 2012 red Toyota Corolla for a 2012 red Chevrolet Tahoe. The 2012 Chevrolet Tahoe weighs 5,448 lbs. Now the formula looks like this:
Red Tahoe * 5 mph + Blue Corolla * 0 mph = Red Tahoe * 0 mph + Blue Corolla * 9.96 mph
Now when we do the math to show the conservation of momentum we end up with the following:
40,042.8 + 0 = 0 + 40,042.8[1]
40,042.8 = 40,042.8
Momentum conserved
Three significant points can be observed in this protest.
First, when testing is done notice the change in rate at the Tahoe is 5 mph (5 to 0). This is less than the rates used by the Insurance Institute and we would expect the Tahoe to have minimal damage and no structural deformation.
The second point to note is the change in speed the Corolla experiences, 9.96 mph (0 to 9.96). This change in speed is four times the original.
Conclusion
Finally, neither vehicle exceeds the speed of 10 mph, which the automobile manufactures and insurance institute for highway safety often consider threshold for injury. This confirms that cars can easily deform and residents become injured in low speed crashes once you begin to check out the conservation of energy (momentum) and coefficient of forces moved to the target car.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .� References
Edmunds.com. (2012). 2012 Chevrolet Tahoe Specifications. Retrieved from Edmunds.com: www.edmunds.com
Edmunds.com. (2012). 2012 Toyota Corolla Sedan Specifications. Retrieved from Edmunds.com: www.edmunds.com
Brault J., Wheeler J., Gunter S., Brault E., (1998) Clinical Response of Human Subjects to Rear End Automobile Collisions. Archives of Physical Medicine and Rehabilitation, 72-80.
Additional Topics: Weakened Ligaments After Whiplash
Whiplash is a commonly reported injury after an individual has been involved in an automobile accident. During an auto accident, the sheer force of the impact often causes the head and neck of the victim to jerk abruptly, back-and-forth, causing damage to the complex structures surrounding the cervical spine. Chiropractic care is a safe and effective, alternative treatment option utilized to help decrease the symptoms of whiplash.
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