Drive Carefully

     As a Doctor of Chiropractic at Accident and Injury Chiropractic, I see a lot of people who have been injured in a car wreck.  Although most of those I treat were injured by someone else's neglegence, it would appear that many who get injured could have avoided the accident by being a little more watchful and basically, careful.  Yes, many accidents are totally unavoidable but by being watchful and anticipating others just a bit, one can avoid many accidents.
     In my younger days I drove a motorcycle quite a bit to and from work and school, on some very busy and somewhat dangerous roads.  Driving a motorcycle is unique in that even a slight fender bender type of accident can be deadly.  On a motorcycle one must practice the most defensive of driving strategies.  At a red light, when it turns green, I would always hold off on going until I gave any other traffic one more look.  All too often a car would speed through the intersection a full second or two after I had the green to go.  Had I gone, even though I then had the right of way, I would certainly have been killed or severely injured.  The point being, if we drove our cars as if we were on motorcycles, many accidents would be avoided all together.
     I have heard many stories of people taking their right of way only to be hit by other vehicles which failed to yield that right of way.  Had they simply waited a bit or yielded themselves a bit, the entire accident would have been avoided.  I am reminded of the driver who slammed into a vehicle blocking a road to turn across traffic.  The driver who did the slamming had the right of way, true, but seeing the vehicle pulling out or even looking as if they might, the driver could possibly have avoided the collision by simply slowing a bit to see what that other vehicle was going to do before assuming the right of way.
     I'm not an attorney but I have heard it said that the law requires all drivers to maintain an adequate lookout for situations such as I have described here.  And that brings me to speed limits.  People just drive too fast.  A speed limit is not the speed one should actually drive, it is the maximum allowable speed IF it is safe to do so.  There are many places where the posted speed limit is just too fast for the street in question.  Drivers should think about that as they approach intersections.
      Then we come to rain and wet roads.  I was driving with my daughter a couple of nights ago in some pretty steady rain.   Visibility was not too bad but the rain was steady and at times heavy.  I was amazed at how fast traffic was going on both the streets and freeways.  Many were exceeding the speed limits and driving as if there was actually no change in traction or visibility as the rain continued to pour down.  I spent most of the night avoiding others in my efforts to get to where we were going.  Incedentally, we saw quite a few accidents.
     So, to make a long story short, if we would just drive more watchfully much as a person on a motorcycle should and most do, the number of accidents would be reduced significantly.  Assume the other guys are going to do what they shouldn't, assume they are talking on their cell phones or are being distracted in some form or fashion and many, many accidents can be avoided.  Drive like an old codger?  No.  Just drive safe.
      But if the unavoidable happens and an injury occurs, get to the doctor as soon as possible.

Knee Injuries in a Car Wreck?

     It is not unusual for people to sustain injuries to their knees in car wrecks.  Knees hit dashboards, front seats if a person is in the back seat, doors in side impacts, even stick shifts and steering wheels.  When a patient braces for an impact or during an impact, the compressive forces of the bracing can damage the cartilages of the knees, known as the meniscus.  In other words, there are many ways the knees can get injured.
     Treatment, as always, involves an initial examination, possibly x-rays or MRI to determine the exact nature of the knee injury.  If there are tears in a ligament or cartilage, we will usually begin some form of therapy and in most cases refer the patient to an orthopedist to see if there are other treatments needed in addition to the therapies we provide at the Accident and Injury clinic.  In most cases all of the treatment needed for an injured knee can be taken care of here with your doctor of chiropractic; physical therapies, active rehab, therapeutic exercises, etc.
     So yes, when you get into an accident and you are being evaluated for the first time, if your knee also hurts in addition to your other injuries, be sure to tell your doctor of chiropractic.  I have, many times, had patients limp in, only to tell me about their neck hurting but never mention their knees.  That is, until I ask them why they are limping. 
     As always, if you are in a car wreck and have pain, get to the doctor as soon as possible.

My Doctor is a Chiropractor. Do I need to see a specialist?

    The simplest answer to that is maybe, maybe not.  Exactly what is a specialist anyway?  Specialists are doctors who essentially treat a very narrow range of conditions.  As far as most of our patient"s and their injuries are concerned, a specialist is usually an orthopedist or neurologist.  Some are orthopedic surgeons or neurosurgeons.  Their specialty is in the treatment of spines, or knees, or maybe just spines or just knees or just hands, etc, etc.
     Of course your doctor of chiropractic is a kind of specialist meaning that we only treat disorders or injuries of the spine or the extremities like the joints of the arms or legs.  We don't call ourselves specialists but that is essentially what we do. 
     So, do you need to see a "specialist"?  Again maybe or maybe not.  Your doctor of chiropractic will examine, diagnose and treat your neck, back, shoulder or knee injury with various physical treatments which are essentially drug free with the exception of patient's possibly taking over the counter medications such as ibuprofen, acetaminophen or even aspirin.  We monitor our patients progress and change their treatment plans accordingly.  If, however, a patient's injury is not improving as quickly as we think it should or if the injury is serious enough to warrant it, we will, in many cases, refer our patients to specialists to see if the specialist can offer other treatments in addition to that which we are doing.  
     Sometimes a specialist will prescribe a medication or suggest some sort of injection to assist the patient's recovery.  On rare instances, the specialist might even recommend surgery.  But the main point is, if you need to see a specialist, your doctor of chiropractic will refer you to one.
     Occasionally we get patients who want to see one right away.  That is usually not a problem.  They simply need to speak with their doctor of chiropractic about it.  There are many good reasons to refer a patient to a specialist for a consultation.

What's a soft tissue injury?

     Every now and then a patient will mention that an insurance adjustor or agent had made the comment that their injury is only a "soft tissue" injury, as if that is not a real or serious injury.  Apparently this is a way some people try to minimize injuries sustained in car wrecks.  They want to paint a picture of a "victim" pretending to be injured; that any treatment is not needed and fraudulently provided by a clinic/doctor.
     Again, as I have said many times about aspects of injuries sustained in car wrecks, nothing could be further from the truth.  Of course injuries like concussions, lacerations, open or gaping wounds and broken bones are by far the most serious and even life threatening, but in low speed impacts and many high speed impacts, they are the exception rather than the rule.  In fact, technically, many of those life threatening injuries are, themselves, soft tissue injuries.
     What are soft tissues anyway?  They are the tissues in the body which are not bone although cartilage, as in the knee, might not be considered soft tissue.  They are the ligaments, which hold the bones together, muscles and tendons, which attach to bones and provide the forces needed to move and, of course, all the other "soft:" stuff like skin and other connective tissues.  We are made of much more "soft" tissue than we are of "non-soft" tissue.
     In car wrecks, the tissues most susseptible to injury are the ligaments, tendons and muscles as well as the cartilages of the joints like the knee or shoulder.  The big problem with these tissues is that they tend to heal rather slowly if at all.  In most cases damage to these tissues is replaced not with healthy tissues but with scar tissue which is not as flexible or strong as the original. 
     After an injury to these tissues the body surrounds them with an inflammatory process which promotes the formation of this scar tissue form of healing.  Therapies provided in our clinic help to promote repair with more normal, functional tissues rather than stiff, inflexible scar tissue.  These same therapies also help restore normal motion and function to joints associated with these tissues.
     To the "non-believer" I simply point to the treatment of athletic injuries by sports teams with millions of dollars invested in the performance of their athletes.  The injuries these athletes sustain are, for the most part, soft tissue injuries.  The treatments they receive for their injuries are essentially the same treatments we provide for our patients injured in car wrecks.  No one questions the need for treatment of the athletes injuries and thus I don't think anyone should question the need for the treatment of soft tissue injuries sustained in car wrecks; nor should they question or try to minimize these types of injuries either.

I am hurting after a car wreck but my car isn't damaged.

     When a car wreck occurs, if the cars have sustained a lot of damage, it is all too obvious that the drivers or passengers might be hurt.  But many times, the driver and passengers are hurting but the car looks fine.  This is common in what most refer to as fender benders, but make no mistake, if there is pain, then there is probably an injury of some sort.  The best thing to do if you are hurting, no matter how good or bad the car looks, is to get to the doctor for an evaluation.
     It is a misconception that the occupants of a vehicle cannot be hurt if the vehicle itself is not damaged.  A group in California headed by Dr Croft of the Spine Research Institute of San Diego, have run test collisions at low speeds with slow motion camera's focused on the drivers and passengers.  Their findings are remarkable, showing the violent nature of the head and body motion in collisions which leave the vehicles with little or no damage. 
     Certainly, there are many low speed collisions where no one is injured and that is great.  But in many cases such as this, the next day the occupants of the vehicles find that they have neck and/or back pain, headaches and stiffness.  How can this be?  Well, simply put, its basic physics.  For example, when a vehicle is struck from behind, it moves immediately forward whereas the head remains still and from the side has the appearance of being thrown backwards into the head rest.  The head rest then springs the head forward and the head is snapped when the body hits the seat belts, stopping the body's forward motion but not the head's. 
     This type of injury is called an acceleration/deceleration injury, aka - whiplash.  Damage can occur to the ligaments and muscles of both the front and back of the neck.  Basically, its a neck sprain/strain much as it might be if you sprained your ankle.  Over the next few hours to days inflammation builds up around the damaged tissues with swelling, pain and stiffness.  The bad thing about this swelling and pain is that its pressing against your neck, head and even your spinal cord, not just your tennis shoes.
     Interestingly, if there is no damage to the vehicle, then the laws of physics tell us that the force, or more specifically the momentum of the vehicle, is transferred to the occupants. In fact, at these low speeds, if the vehicle body work or bumper were to cave in a bit, there would be a lessening of the impact on the occupants.  But cars bumpers are designed not to cave in and actually spring back, transferring that momentum almost directly to the occupants.
     So, make no mistake, injury can occur even if there is no damage to the vehicles. A person knows it by the pain they might be feeling.  In fact, one should NEVER try to judge injury based upon the amount of damage to a vehicle.  If no pain or stiffness is present and none develops, then there is probably no injury.  But if its there, don't ignore it.  Get to the doctor.

What can I do as a patient to help my injury heal?

     There are many things patients can do to help speed up their recovery from an injury sustained in a car wreck or other accident.  Of course the most important thing is to get to the doctors at Accident and Injury Chiropractic for examination to determine if care is actually needed.  If it is determined that a patient needs treatment, the doctor at Accident and Injury will formulate a treatment plan for you.  The treatment plan will state what types of treatment a patient needs and how often it needs to be performed.
     The next most important thing a patient can do to help recover more quickly is to follow the treatment plan as closely as possible.  Patients should do their best to avoid missing appointments.  If a patient isn't there for care, then they cannot benefit from it and their recovery period will be that much longer or greatly delayed if not actually impeded.  Follow your doctors plan for you.
     Patients are usually advised about things they can also do for themselves at home or work to help their injuries get better.  Thinges like ice packs (cryotherapy) and over the counter medications can be used.  Sometimes a patient will be advised on some stretches or home exercises that they will need to perform on their own at home.  There are many things whicha doctor might have the patients do at home day to day as part of their over all treatment plan in addition to the treatment that is provided at the clinic.
     The important thing is that the patient do as advised, follow the treatment plan and take that positive action towards recovery.

How long does the treatment last?

     The length of the treatment period varies from patient to patient.  Some patients are released from care after only a week or two of care while others might require treatment for as much as a few months.  This variability is due to the variability of patient's unique conditions:  their age, gender, weight, height, physical fitness level, medical history, and in some instances the severity of the accident. 
     Patients are always wanting to know how long they will be treating.  I can make a reasonable estimate based upon the above conditions, but really, it will be determined by how quickly they respond to care.  All treatment is based upon medical necessity.  As long as your doctor believes that you can benefit from the treatments provided, he/she will recommend it to the patient. 
     When a patient reaches a point where there is no longer medical necessity for care, the patient most likely will be released from care.  At that point, your doctor of chiropractic at Accident and Injury will promptly send all of your records to the appropriate person or persons, be it an attorney or an insurance company.

What kind of treatment will I receive at Dr Rayshell's clinic?

      One thing to remember when going to a doctor is that your treatment will be based upon what the doctor feels is medically necessary for your particular injury.  That being said, the doctors will more than likely treat neck sprain/strains very similarly from one patient to another although the patients age and previous medical condition might limit the types of treatments which can be provided.  The same would be true for other conditions as well.
     I mentioned neck sprain/strain because that is the most common injury sustained in a car wreck.  The injury might involve the spine, ligaments of the spine, muscles of the spine or all of the above.  Patients typically have neck pain; sometimes headaches and upper back pain.  There is occasionally some swelling of the surrounding tissues, muscle spasms, tenderness to touch, painful and restricted movement of the neck and sometimes there might even be numbness, burning or tingling in the neck or even in the fingers or hands.  The presentation of these symptoms varies with the patients gender, age, weight, medical condition and the nature of the accident; rear-end collision, side impact, front impact, spinning vehicle, other impacts and even airbags can cause a neck injury.
     Typically, the treatment for a neck sprain/strain is a combination of "modalities" to reduce the above mentioned symptoms.  This can involve electric muscle stimulation to help muscles relax their contracted state and hurt less.  Traction and motion through chiropractic spinal manipulation can be introduced into the neck and spine to increase motion of the joints and reduce the formation of scar tissue or adhesion's of the tissues in the joints and spine which can produce stiffness.  Of course swelling in the joints can also cause stiffness so we usually introduce patients to cryo (ice) therapies and discuss the use of anti-inflammatory medications which can be bought at the local pharmacies without a prescription.  In severe cases your doctor of chiropractic might refer you to a medical doctor or doctor of osteopathy to see if you might need something more than what you might be able to get over the counter at your pharmacy or store.
      As the initial treatment proceeds we try to move our patients into a therapeutic exercise program.  This might involve simple stretches or stretches and resistance exercises performed under the direction our the doctor.  As the patients get better, the stiffness and pain decreases and they are able to function more fully without discomfort.
     When the patient has reached a point of what we refer to as maximum medical improvement, he or she will be released from care.  Usually patients are advised to continue with the exercises or stretches after they are released to help prevent relapses.  Even though a patient might have been released from care by their doctor only a few weeks or a couple of months after their accident, the complete healing process could last as much as a year or two.  During that time it is possible for the condition to "relapse" or become aggravated. If that occurs, simply call your Accident and Injury doctor and he will schedule for you to come in to be evaluated.

No Pain for Several Days After My Accident

     Sometimes when in an auto accident, the occupants of the cars have no reported pain related to the accident.  In most cases this means that they are not hurt, but occasionally, even after three or four days, some will begin to experience back or neck pain.  This is not unusual.  Auto accidents are scary.  They cause us to get excited or fearful.  This can mask the feelings of pain from some injuries.  Also, the symptoms of sprains and strains do not always show up at the time but gradually appear as the inflammation around the injured body part becomes more and more significant.
      If you start to notice stiffness in your neck or back or shoulders a few days after an accident, you should get to a doctor right away.  An examination by a doctor can determine if you have an injury due to your car wreck and provide the best care needed so that it doesn't build into a more debilitating condition.  The sooner you get to the doctor, the better.
     You might be worried that the other guys insurance or even your insurance might not believe you are injured.  Well, I've got news for you, in most cases they are going to act like you are not hurt anyway.  That's why you also need an attorney to handle that third party insurance.  But, remember, if you have PIP or Med-pay insurance, you can get immediate care and since they are also your insurance, they are much less likely to treat you with disrespect regarding your injury. 
     Injuries present in many different ways in people for a variety of reasons.  The delayed onset of pain from injuries such as these is common and in no way implies that you are not injured.  You were in a car wreck, one or two days later you started having pain.  You have been in no other accidents since the car wreck.  Its pretty clear that the pain was brought on by the accident.  Your doctor will need to completely and accurately document this in your records and then he can treat you accordingly.

What is an MRI and do I need one?

     Similar to x-rays, an MRI, Magnetic Resonance Imaging, is a way of looking at tissues of the body to see if there are any visible injuries not directly seen on x-ray or on an examination.  The nice thing about MRI is that it can see many tissues and bodily structures which are invisible on an X-ray.
     Sometimes an MRI is necessary and sometimes it is not.  This is determined by your history and the doctor's examination of your injury.  If the doctor feels that the MRI is medically necessary, then he/she will recommend it to you.  In many cases, MRI is the only way a doctor can objectively document your injury.  Tears in ligaments, ruptures or bulges of the intervertebral discs of the spine can only be seen  on an MRI.
     Can an MRI only be performed on the neck or the back?  No.  MRI is very useful for evaluating injuries to the shoulders, knees, wrists and ankles as well.  In fact, after the initial 48 to 72 hours following a head injury has elapsed, MRI is the preferred imaging to rule out such dangers as subdural hematomas, which can be life threatening.
      Another nice thing about MRI is that the MRI doesn't produce harmful radiation.  As far as is known, there are no ill effects of an MRI, although, it is still not used on pregnant women except in the second or third trimesters and then, only with the permission of the patient's pregnancy doctor.
     Accident and Injury's MRI is also an open MRI and thus is less confining. 

I work. Can I still get treated?

     Many people are of the belief that you cannot work if you are being treated for an injury.  Nothing could be further from the truth.  In fact, in many instances, working can also help you to heal better/more quickly/more completely depending upon what type of work you do.  Of course, there are many instances when the doctor will recommend that the patient refrain from work for a period of time to assist in their treatment or to prevent further injury or exacerbation of the injury.  If such is your case, your doctor will give you a note advising your employer that you need to be off work or be allowed to work light duty for a while.
     I always tell patients that I cannot make them take off work or visa versa, I can't make them continue to work.  I can inform them of the risks and what I believe to be a medical concern about their injuries and their work, but I can't make them stop working.  In most cases, working with an injury might be uncomfortable but not necessarily a risk.
     If your injury is caused by someone else and you miss some work, you will want that other guys insurance to pay you back for lost wages.  It is difficult to get them to do this and that is just another reason you will want to have an attorney handling your claim against that other guy's insurance.  But being able to continue to work AND get treatment is many times the optimal situation.  Will the insurance companies say that I am not hurt since I am able to keep working?  They might, but they might say that anyway, working or not.  Don't worry about what they might or might not say.  Just try to follow your doctor's recommendations as best you can..

You're Hurt in an Accident and You're Pregnant

     As you can see, being pregnant doesn't preclude you from being injured in an car wreck and, you'll find out, doesn't prevent you from being treated.  The fact that you are pregnant might and probably will alter how you are treated, or it might limit the types of treatment you can receive, but it in no way prevents you from getting care for your injuries; that is unless your pregnancy doctor has restricted you from treatment.
    That being said, if you are pregnant and get injured in a car wreck, the best thing to do is get immediately evaluated by your pregnancy doctor.  You can ask them about getting your injury treated at that time.  Then, get to the doctor of chiropractic for an evaluation of your injuries and get started treating as early as possible.  If needed, your chiropractor can get in touch with your pregnancy doctor to make sure that you are cleared for the treatment.  The situation will vary depending upon your due date and the severity of your injury.

I'm Getting Calls from Other Doctors After My Accident

     So, you were in an accident and ever since, you have gotten calls from people wanting to  "help you" with your accident.  Some say that you could actually get money for your injury.  Others say that you need to get evaluated for an injury, even if you have no pain.  Some might even claim they are from the insurance company and that you need to go for an evaluation.
     You just have to wonder how they got your number.  If the police came out and did an accident report, your information could have been gotten from that, even though that record is not supposed to be public for at least 30 days.  Or, if you went to an emergency room after your accident, then someone at the hospital could have passed your information on to someone else. That is a violation of patient privacy laws and as I understand it, that is a felony.
     Either way, you can bet they don't have your best interests in mind. The best thing to do is get their name and number then pass it on to local authorities or, if you are already going to a doctor, give it to him and they will pass it on to the appropriate people.  More than likely, they obtained your phone number illegally.  I have had patients tell me that in some cases, these "solicitors" actually showed up at their door, offering to drive them too a clinic right then.
     Stay away from these people.  If a doctor or an attorney has to stoop to this level to get customers, you can bet that they aren't very good, either as a doctor or as a lawyer.

I Have Previous Injuries. Can I still Get Treatment?

     It is very seldom that I encounter a patient who was never been injured in one way or another.  Previous car wrecks or work related injuries are a part of many peoples pasts and in most cases have very little effect on their care.  It should be noted that just having been injured before doesn't disqualify you from other injuries later in life.  In fact, most injuries resolve completely with proper care and are just an incidental part of your past.
     When you come in to see your doctor of chiropractic at Accident and Injury Chiropractric, he/she will take a complete past medical history at which time we will ask you about any previous injuries.  It is important that you tell your doctor about all of your previous injuries.  If you have been injured in the past but it is not noted in your history, then an insurance carrier might assume that you are hiding it which can make you appear to be dishonest.  The best thing is to be perfectly honest about your history.
      The doctor will also want to know if your previous injuries healed/resolved or if they still cause you problems.  This is very important since your doctor is going to have to attribute your pain and injury to your accident and he might have to take into account that you had pain prior to this accident.  If you do still have pain from a previous injury your doctor will "apportion" that part of your new injury and treatment to your accident based upon your medical history.  So, try not to leave anything out.  If needed, your Accident and Injury doctor can request records from your previous treating doctors to assist in his assessment of your injury as it relates to this accident.
     Previous injuries are simply facts of life that need to be dealt with in an open and honest manner.  In most cases they have little effect upon the treatment of your new injury.

Why go to a Doctor of Chiropractic?

     Doctors of Chiropractic concentrate on the diagnosis and treatment of injuries to the spine and joints; what we call musculoskeletal injuries.  Medical doctors, Doctors of Osteopathy and Physical Therapists also treat musculoskeletal injuries but in different ways.  The MD's and DO's mainly treat with drugs and surgeries.  The Physical Therapist's do physical medicine like Doctors of Chiropractic but are not as thoroughly trained, they do not do chiropractic spinal manipulations and they cannot see patients as an entry level doctor.  In other words, a patient must be referred to a Physical therapist by an MD, DO or Doctor of Chiropractic.
      Doctors of Chiropractic treat their patients with various forms of physical treatments such as electrical muscle stimulation, spinal manipulation, inter-segmental traction and active therapies such as therapeutic exercises/stretches.  If a patient is experiencing a great deal of pain then the doctors of Accident and Injury Chiropractic can refer the patient to an MD or a DO to be evaluated for the need for prescription medications or other forms of care which can be performed in addition to the therapies they receive at the Accident and Injury clinic.  The doctors at Accident and Injury Chiropractic work with other doctors to see that you get the treatment you need to resolve and heal your injury.

How do I Choose a Doctor?

    This is one of the most important aspects of getting your injury treated.  There are many doctors of both medicine and chiropractic who treat auto accident injuries, some who are good and others not so good.  Personally, I think experience is a key factor. The accident and injury doctors such as myself, have treated literally thousands of patients with injuries ranging from neck and back injuries to injuries of the shoulders, knees, wrists, etc.  We handle all aspects of our patients care; examinations, imaging if needed, therapies, referrals to specialists if needed, periodic evaluations to adequately show documentation of our patients progress, and finally, our patients release from care.
     The best advice I can offer is to just come in and have a consultation with one of our doctors of chiropractic.  We will listen to your concerns about your injury and show you how we can help.
     One thing I can tell you is that you should never go to a doctor who calls you out of the blue with knowledge about your accident.  Chances are that those callers got your information illegally from an accident report or a hospital.  This means that someone has violated your privacy.  Especially watch out for calls from people who suggest that they are from an insurance company and want you to go to a doctor to get "checked out".  These solicitors are operating illegally in most cases and need to be avoided.
     At Accident and Injury Chiropractic, many, if not most, of our patients are referred to us by former patients.  Its what we call internal referrals.  These referrals constitute the highest form of complement from our current and former patients.  It means they were highly satisfied with our treatments and care.  Call or come in for a consultation.