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.
“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.
He, G., & Xinghua, Z. (2006). The numerical simulation of osteophyte formation on the edge of the vertebral body using quantitative bone remodeling theory.�Joint Bone Spine 73(1), 95-101.
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.
There are many factors that play a role in the dynamics of collisions. These include vehicle design and type, speeds, angles of approach, kinetic & potential energy, momentum, acceleration factor, friction… the list is quite long. There are a few constants in which we are curious. These constants are the building blocks of the planet and they make the world of collisions quantifiable and predictable.
Within this two-part series we will explore the factors which have the most influence in low speed collisions and how these factors are associated with injury. Note: nothing about these writings is inclusive, there is too much material to explore in depth. The objective of these writings is to present the concepts.
Conservation of Momentum & Auto Accidents
In this writing the subject of exploration is conservation of momentum and how it relates to low speed collisions and bodily injury of the occupant. Conservation of momentum is built on Sir Isaac Newton’s third law. Newton’s third law says “For every action there’s an equal and opposite reaction”.
In the interest of exploring conservation of momentum in a simple format, we aren’t likely to investigate and explain the history and physics of momentum; for this conversation, we’ll concentrate on the relationship to crash dynamics. It is momentum to speed collisions’ relationship that helps enlighten and is the causal factor of the injuries people who have held tight to the argument that is deceptive that no damage = no injuries.
While there is a formula and derivation, neither is needed just yet. For now, we’ll simply use the concept as follows: The momentum going into a collision can be accounted for in the outcome or the energy going in to the accident, must be accounted for at the end of the incident and that and what was exposed to and/or absorbed that energy.
Let’s apply some perspective to this notion with the following example.
Let us say we are standing at around a pool table and we are going to try the winning shot of the eight ball into a corner pocket. Following the cue ball is struck, we have and another. After the cue ball strikes the ball, then it stops moving and the eight ball begins moving. In this scenario the cue ball before the collision’s momentum is the same as the momentum of the eight ball after the collision[1]. The eight ball rolls to the corner pocket.
The transfer is extremely efficient due in part to the fact that neither pool balls can deform. Some of the energy would be used to perform this and less if either pool ball could deform. The National Highway Transportation Highway Safety Administration (NHTSA) mandates minimum performance standards for passenger vehicle bumpers. Vehicle bumpers are tested with 2.5 mph (3.7 fps)[2] impact equipment that has the same mass as the test vehicle. The test vehicle is struck with its brakes disengaged and the transmission in neutral. There’s no offset between the automobile and the barrier.
Performance Standards for Vehicle Safety
The NHTSA outlines acceptable damage to your vehicle’s various systems after the tests. Successful completion of these tests mandate operation of systems that are particular. The factory adjustment of the vehicle’s braking, steering, and suspension must be unaltered. In other terms, in order for a vehicle to pass these tests it canhave no change in its structure. If changes did occur the system that is braking, steering, and suspension would be out of factory adjustment.
The NHTSA isn’t alone in low rate bumper testing. The Insurance Institute for Highway Safety (IIHS) also conducts low rate bumper tests. The IIHS’s test rates are conducted at 6 mph (8.8 fps)[3] and the goal is to determine which vehicles have the least damage and therefore cost the least to repair. The vehicle ratings are proportional to the estimated cost of repair. The more costly the repair, the lower the rating.
While the vehicles used in the IIHS testing all show signs of contact with the barrier, none of the vehicles suffer harm which deforms the structure of the vehicle. Don’t have any change in its structure affecting the system, steering, and suspension, just as with the NHTSA the vehicles tested by the IIHS.
The lack of change in the structure (deformation) drives a test vehicle to accept the momentum transfer in the testing equipment. Further, the test vehicle is free to move after being destroyed. This testing scenario is like that of the cue ball and eight ball.
If a vehicle doesn’t deform during a low speed collision, then it will experience a change in speed (or velocity) very quickly; Consequently, the occupant(s) also experience this exact same change in speed. The key factor in these examples is that the mass of testing equipment and their vehicles involved, but what happens when the masses change?
Conclusion
When the mass of one vehicle changes the momentum also changes, the more mass the more momentum the vehicle can bring to the event and the greater the injury potential to the occupant. There are many complicating factors that now must be considered regarding injuries beyond the Laws of Momentum when determining trauma like the height, weight, muscle mass, occupant position, kind of seat belt used, etc.. However, the first step is to decide if there was enough energy as an initiating factor in low speed crashes to cause those injuries and to overcome no crash = no injury misconceptions and have a health expert in low speed injuries confirm relationship.
In the next installment, part II, we’ll discuss this in detail and it will necessary for the later subject of occupant injuries.
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:
Insurance Institute for Highway Safety. (2010, September). Bumper Test Protocol. Retrieved from Insurance Institute for Highway Safety: www.iihs.org
National Highway Transportation Safety Administration. (2011, October 1). 49 CFR 581 – BUMPER STANDARD. Retrieved from U.S. Government Publishing Office: www.gpo.gov
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.
Not only do tires play a vital role in the performance of your car or truck, but a lot of information can be garnered about what happened before, during, and after a crash. Tire marks will be explored by us and, generally, what those marks tell us.
First let us discuss where the marks come from. Skid marks are created by the extreme thermal relationship of a tire against the roadway surface during extreme stresses put on the tire, a simpler way to say this is, a tire will “mark” when it nears, or exceeds, the limits of its relationship with the roadway. These marks occur because the oils in the roadway and/or the tire(s) are brought to the surface and “melted or burnt” into the roadway. If a tire is heated enough since the surface of the tire will have changed, it’ll be obvious, it is going to have a spot and obvious abrasions.
Kinds of Skid Marks.
There are three specific kinds of marks we will talk about, these are the most typical four wheeled car and light duty truck marks. (Other vehicles, such as motorcycles, have different specific marks).
Light to Dark or Dark to Light
All marks can be placed into two categories when referencing the management of the vehicle which made them. Light to dark marks (in the direction the vehicle was traveling) support a vehicle making the marks through some kind of deceleration (extra points if you wanted to read “negative acceleration”). Dark to light marks (again, in the direction the vehicle was traveling) support a vehicle making the marks through some form of acceleration, usually excessive wheel spin.
Darker from the Middle, Darker on the Outsides, or Uniform
Marks that are darker in the center indicate a tire that’s overinflated, conversely marks that are darker on the outside edges indicate a tire which is underinflated. Indicate a tire.
ABS Versus Regular Marks
ABS (Anti-lock Brake System) marks are lighter than conventional marks and have more tire tread definition in them, Non-ABS marks rarely have tread definition inside them. ABS marks are also shorter when compared to non ABS marks from a vehicle traveling in precisely the speed.
What else can skid marks tell us?
As you have already found skid marks may tell us about the tires inflation, ABS or non-ABS braking, and direction of travel. Marks can also tell us something when and in which the decision to brake occurred. This is the most under-utilized and under explored aspect even more so in speed crashes. Some basic calculations can be made, using a variety of aspects of the skid marks, to determine where the driver made the decision.
Why is this so important? Consider the following illustration.
This drawing is a timeless teaching example used to demonstrate the value of skid marks. Consider this situation, the blue car says he had the green light and was hit at the intersection. The car says so that that he braked hard he also had the light and saw the car. There isn’t any other evidence or witnesses.
Now the student would be asked to calculate the position of the cars once the decision to brake was created using the beginning of the skid marks, ultimately this would place the vehicles in the place labeled 1.
Now the apparent problem with the red car’s situation now that we have used the skid marks to ascertain where he determined to brake, a construction blocks his view of the blue car (position 1 for both vehicles). This begs the question as to why did he decide then to brake? The answer, the light was red for the red car and the driver was braking for traffic lighting, not the blue car making the red car culpable in this situation as the physical evidence affirms the “at fault” party.
Another valuable piece of advice is that rubber is biodegradable and there are naturally occurring nitrogen based bacteria that “eat” rubber. These bacteria are competitive and will eat rubber in most environments, therefore if you’re trying to determine causality and the “at fault” party, it is in your best interest to take pictures of the roadway whenever possible. Skid marks are gone in a brief amount of time.
Skid marks are a valuable item of evidence and a great tool for determining many facets in a collision; it is extremely important none of them are overlooked or underestimated.
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.
There are several reasons engineering and accident reconstruction reports are problematic. Let’s address the biggest and first issue, cost. Many attorneys won’t realize the real value of cases if they deal with doctors who do not know how to document the patient’s injuries correctly, leading to issues related to poor documentation management.
This is a massive benefit to the insurance company who have banked on the sloppiness and ignorance of the entire medical-legal community. However, there is a growing number of doctors and attorneys who do know.
In this sense, the insurance carrier knows they’ll pay, a vast majority of this time, a minimum amount for a collision even if the case needs to have a much greater value due to the nature of the injuries. The insurance companies know this for a number of reasons, but the biggest reason is cost, not for them but you.
Accident Reports and Insurance Companies
For the sake of discussion let’s say the average case settles for $15,000. If the collision specialist costs $2,000 to $5,000 (along with the doctors and the other experts), this is an expense which cannot or chooses not to be absorbed by solo attorney’s, smaller and even bigger legal firms. This is known by the insurance company and use it whenever it presents itself.
Why can a “deep pocketed” insurance company afford to pay a specialist on a smaller case? There are few reasons but the two are the insurance companies can absorb the expense of the consultants AND a smaller instances will perform the work, as good faith towards the client, pro bono, in some cases.
Obviously, if the attorney cannot make any money they will not take the situation and paying for a collision professional is a substantial factor in this decision, especially if the defense already has you. This greatly reduces the attorney’s costs per case while making you more valuable as a resource AND affords the attorney the chance to take on cases.
Identifying Inaccuracies
The cost concerns cause a second problem, identifying inaccuracies. I have yet to meet an crash engineering defense pro who will explain the shortfall of a case because it is going to expose their inaccuracies and will not bode well for them regarding referrals. MANY low speed collisions have gaps which must be filled in with information that is vetted and carefully selected. Using generalized data (that is the standard in the industry to work with) is quite dangerous as it makes the difference for results reliability too wide. The results will have margin for error and that margin of error is the difference between being or prevailing on the side and all accepted as accurate, but is not.
In this section we discuss why time is a critical element. In the picture above, we illustrate a train, which collides with a barrier at 100 miles per hour and crushes. The related math demonstrates how increasing the time decreases acceleration (see circled numbers). There is not any room for doubt regarding injury as its speed and acceleration is beyond accepted thresholds. What if the speeds change so they are very close to those injury thresholds?
Consider the second example, here the speed of the train represents final approach to a stop hurdle in which the engineer is a little careless and bumps the cease hurdle. What’s important to notice about this visual is the moment. If we double the time (from .05 to .1) the last g force is halved (resulting in 2.267 g’s). What if there were studies that we could cite which say the time necessary to stop for a train is .075 seconds? The first time value of .05 would be too brief, the second value of .1 would be too big, and both do not fit the cited studies.
In this case the period variable changes a tiny amount but the resulting change in the g forces may no longer be sufficient to substantiate a claim for injury. This is the reason the justification for any values is so significant. If you don’t understand they were selected and why the variables are there, they you do not know if they’re accurate or not. A deviation is often the arbiter in determining if there were sufficient transference of forces needed for 27, in a case for failure or success.
Conclusion
Cost and inaccuracies are a couple of the problems commonly faced by attorneys regarding collision reconstruction. For doctors, there’s now a recognized course to offer you the training to be an collision engineer/reconstructionist and for the attorney, when there is a defense engineer, you should have someone dissecting the math to ensure accuracy because usually the “guestimates” used will work against you in settlement or litigation.
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.
There is an assortment of questions which centered around police reports and accident scenes. We’ll address reports exist, how conclusions are made, and what exactly you should take from the role of the police officer and a report as an investigator. This topic can be broken down into lots of classes; here we will concentrate on collision analysis and general reporting.
Why do police take general reports? The brutal answer is because nobody will recall the facts in just two days, much less two decades and they’ll argue it but it’s also because a third party who should be an impartial fact evaluator is needed by society. “Should” is emphasized, but we need to describe what an impartial evaluator of reality is at the context of the writing. We are currently assuming the officer / deputy has training that is sufficient to ascertain what evidence plays into the circumstance. Imagine if you went into a call for attack involving wife and a husband. Upon arrival you are told that the husband is using drugs and sexually assaulting a young child by the wife. When you question the husband he denies the claim and also has the wife’s prescription bottle in his hand — the medicine’s listed side effect is “hallucinations”. This is relevant evidence that the law enforcement officer should weigh in her or his choice.
We are also likely to assume that the officer / deputy doesn’t have any bias or stereotype towards the parties involved OR they perform however recognize it and adjust accordingly. Imagine if the officer went through a tough divorce and from above is female. Does her life have an impact on thinking the husband? What exactly does should she do about it, if it does?
Police Reports After Auto Accidents
Authorities write collision reports for the nation (in which they operate) departments of transportation. The report is designed to collect information regarding roadway design, operator error, alcohol and /or drug use, etc.. One of the concerns that are final is for the report to record for the parties, while significant.
With utilizing report templates, expertise, training, and bias may significantly impact collision reports. Why?
There are many reasons police have errors in their accounts, but by far, the main reason is lack of coaching. To be able to make a police officer, candidates attend an academy that averages some are more. Collision investigation for recruit training is less than a day’s worth of training. In this time the educator should cover everything from scene safety to general hazards to traffic patterns. In reality, unless the student after graduation and into his or her livelihood chooses to attend further training there will be refreshers no updates, upgrades, or continuations to the academy foundation.
Specialty training is imperative to understand the concepts as well as the physics behind a motor vehicle collision and these aren’t part of this basic academy curriculum. Therefore, when determining specifics of the injury it’s critical to determine the extent of training of the police officer.
To address the last point, what you ought to take away from a collision report, we will go over a true case brought to me by one of you.
A while back I was contacted by a physician, his family member had been involved in a collision where she had been rear ended by a truck in heavy traffic; double. The officer their vehicle was launched with the truck behind it in a lane of travel was told by the family member. The vehicle struck on the vehicle while in traffic. The truck driver told the investigating officer he didn’t understand where the vehicle he broke was, but he was coming onto the road through an “on ramp” and thought the vehicle tried to pass him at the shoulder and cut in front of him that is why he broke it.
The investigating officer admitted there were not any marks at the roadway to establish where the event happened but he didn’t write the report in favor of this truck driver. When I inquired about his foundation he told me and his reasoning:
“I wrote that the report in favor of the truck driver based on the damage to the vehicles although I had no formal training on harm interpretation and event correlation and couldn’t establish through signs, in which the vehicles were in the lanes of travel.” In this case the municipality who uses him would be the main problem while the gut reaction would be to blame the officer. This agency has failed to train the officer and also supply guidelines to function inside to him.
All that can be taken away from the crash itself would be the vehicle rear ended the vehicle and it likely occurred as the vehicle driver described in which the vehicle driver admitted not knowing where the vehicle was supposed to begin with.
Conclusion
So what do you remove a police crash report? Those facts that can be verified soundly proof, or by witness reasoned by them both. The police are fact gatherers, not “causality arbiters” and must be utilized as such. The caveat is that there are police specialists who have advanced training in accident reconstruction, crash dynamics and accident investigation. My training makes me to be adept in all those disciplines, but the average police officer is not and shouldn’t be considered as a person.
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.
When the aberrant sequela to victims in car crashes has been investigated, providers often overlook and concurrently underestimate the tissue pathology and resultant biomechanical failures of spinal ligamentous damages commonly known as �strain � sprain.� In addition, the courts have been �blinded� by rhetoric in allowing this pathology to be deemed transient. There is an ever growing body of scientific literature that verifies strain – sprain as permanent pathology, which is the standard being taught in today�s medical and chiropractic academia.
In addition, strain � sprain as sequela to whiplash, renders a 25% whole person impairment based upon the American Medical Association�s Guide to the Evaluation of Permanent Impairment fifth and sixth editions.
Whiplash Associated Disorder Sequela Injuries
Juamard, Welch and Winkelstein (2011) reported:
��Rear end accelerations have been used to study the response of a variety of soft tissues in the cervical spine, including the facet capsular ligament. For simulations of whiplash exposures, the strains in the capsular ligament were found to be two � five times greater than those sustained during physiological motions of the cervical spine. In a similar but separate study, the facet joints of the cervical spine�s that were previously exposed to a whiplash injury ridden exercise under low � level tension and found to undergo elongations nearly 3 times greater than on exposed ligaments for the same tensile loads. Those capsular ligaments were also found to exhibit greater laxity after the purported injury. Since increased laxity may be linked to a reduction in the joints ability to stabilize the motion segment during sagittal motion, this finding suggests that whiplash exposure may alter the structure of the individual�s tissues of the facet, such as the capsular ligament, and/or the mechanotransduction processes that could maintain and repair the ligamentous structure. Accordingly, such an injury exposure could initiate a variety of signaling cascades that prevent a full recovery of the mechanical properties of the tissues of the facet joint.� (Pg 15)
Simply put, if we focus on the last sentence above, this �prevents a full recovery of the mechanical properties of the tissues of the facet joint,� which is referencing the ligaments of the spine that make up the tissues of the facet joint. In lay terms; it means that once injured, a joint is permanently damaged and it is demonstrable on x-rays with an extension and flexion view that does not have to show a full dislocation. Therein lies the core of the issue. Most radiologists are not trained in the latest literature on biomechanical tissue failures and therefore underreport the pathology.
Last month I attended a presentation by Michael Modic MD, Neuroradiology, a nationally renowned educator in neuroradiology who focuses on spondylolisthesis (vertebral segmental abnormal movements) and I asked a simple question �why don�t radiologist report more on abnormal positioning due to biomechanical failure as a result of ligament pathology� and his answer was �because their training focuses more on disease pathology.� Although I agree that is critical, so are biomechanical failures that lead to chronic degeneration, which is epidemic in our society. Simply look at the posture of our elderly for verification and much of that started with a simple �fender bender� years ago where the strain-sprain was either undiagnosed or deemed transient and not treated.
Ligament Pathology Diagnosis and Prognosis
The above scenario is why the American Medical Association values ligament pathology at 25% whole body impairment. There is also a growing body of doctors who are trained and credentialed in Spinal Biomechanical Engineering that understand how to create a diagnosis and prognosis, along with treatment plans around ligament pathology and fully understand the long-term effects of damaged facet joint tissues. These doctors are currently educating, based upon the current scientific literature their respective radiology communities to be able to diagnose and document the full extent of the injuries sustained.
We must also recognize that there is a significant amount of evidence in the scientific literature that verifies ligamentous damage as permanent and refutes the rhetorical claim of �transient.� In the end, it must be the facts of human physiology verified by science that sets the standards of healthcare and not deceptive rhetoric at any level.
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:
Cocchiarella L., Anderson G., (2001) Guides to the Evaluation of Permanent Impairment, 5th Edition, Chicago IL, AMA Press
Juamard N., Welch W., Winkelstein B. (July 2011) Spinal Facet Joint Biomechanics and Mechanotransduction in Normal, Injury and Degenerative Conditions, Journal of Biomechanical Engineering, 133, 1-31
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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