So You Have Been In A Collision in Bellingham
Let’s start off with some basic anatomy and function of a joint. Muscles are bundles of dense connective tissue which cross joints in order to move bones within their designed ranges of movement.
Ligaments are bundles of dense connective tissue which cross joints to connect one bone to an adjacent bone in order to prevent bone movement outside of the bones’ designed ranges of movement. In other words, ligaments are stabilizing braces which try to prevent forceful injuries.
When a muscle is forcefully strained it will elastically recover better than a tendon or ligament can recover because an active muscle has a greater blood supply than a sprained passive tendon or ligament.
The cervical spine contains 14 ligaments whereas the rest of the spine contains 10 distinct ligaments for each interlocked pair of vertebrae called a motor unit.
When ligaments are forcefully lengthened beyond their recoverable elastic ranges they will not recover to their normal length. When the strain rate is 2-5 times greater than the ability of the ligaments to stretch, they tear, thereby creating a permanent injury which is not fixable. “Permanent” means permanent bone changes [Wollf’s Law], permanent loss of function, and permanent pain in association with premature bone degeneration [Wolff’s Law] (references available on request).
Therefore, any kind of forceful physical trauma which sprains a tendon or ligament beyond its ability to recover can remain painful for decades when subject to the normal forces of daily living (references available on request).
To get you off to a good start and to avoid future misinterpretation/confusion strong case documentation, especially objective x-ray data, is required right from the beginning, thus avoiding a future “nightmare.”
The acquisition of and distribution of that objective data plainly enables all involved parties (the patient, the patient’s family, the automobile insurance companies, attorneys, and other healthcare practitioners) to be on the same level playing field as everybody has been provided the acquired objective findings. The level playing field is created because the objective facts are not based on personal or biased opinion as a fact is a fact.
The majority of Life Chiropractic’s automobile injury patients have presented all or some of the following measurable data (facts and statistics collected together for reference or analysis):
- clear, measurable x-ray evidence of cervical spine (neck) and/or lumbosacral spine (low back) of post-traumatic spinal ligament damage/laxity to sub-failure
- based on the measured spinal deformation during flexion/extension x-ray views, Whole Person Impairments of varying degrees can be derived via AMA guidelines
- the permanence of post-traumatic ligamentous laxities to sub-failure (references supplied on request)
- computer-measured muscular weakness
- computer-measured diminished active ranges of motion with or without the presence of subjective pain/discomfort sensations
In order to develop a realistic treatment plan and prognosis (the likely course of a disease or ailment) Life Chiropractic utilizes the following consensus-derived published guidelines:
- “Agency for Healthcare Research and Quality” (AHRQ). U.S. Department of Health and Human Services. (ICA Best Practices . . .; Council on Chiropractic Clinical Practice Guidelines . . .; ICA of California Whiplash Guidelines . . .
- “Croft CAD Classification System”
- “Croft Frequency and Duration of Care in CAD Trauma”
- American Medical Association “Guides to the Evaluation of Permanent Impairment Fifth Edition” utilized for Impairment Rating Purposes - as they are the acknowledged authoritative guidelines for Impairment Findings and Ratings, thereby helping Life Chiropractic to establish the severity of the patient’s condition and any Impairments by consensus rather than personal opinion.
These guidelines are just that, guidelines, and are not a prescription, as everybody responds differently due to the varying degrees of the capacities of the individual’s internal resources (the thickness and strength of tendons and ligaments, the size of the bones, and the numbers of functional muscle fibers and nerves, the quality of the injured dense connective tissues and joints), and history such as past physical training, and trauma history.
In summary, without measurable, objective data it is very tough for the involved parties (the patient, the patient’s family, the automobile insurance companies, attorneys, and other healthcare practitioners) to arrive at a reliable/agreeable consensus on a particular case’s treatment management and legal resolution. Thus the common adversarial nature of many legal proceedings where personal opinions rule the day can be successfully avoided, thus preventing a “nightmare.”
Plus, with the objective data the patient and the practitioner are able to have realistic ongoing discussions regarding diagnoses, treatment plan, prognosis, low-risk incremental progressions of supervised physical training intensities, volumes, varieties, etc., at-home physical training responsibilities, findings of regular progress examinations and alteration of treatment/physical training approach(es) if warranted.
Ligaments are the secondary stabilizers of the joint while muscles are the primary joint stabilizers. When objective x-ray evidence of post-traumatic ligamentous injury/spinal instability or aggravation of a previous non-symptomatic injury is obtained, the spinal muscles require ongoing supervised and at-home specific physical training to develop strength-endurance/improved spine stability function of the primary stabilizers of the spinal joints, the spinal muscles. The end results = a more stable spine and extinguished or diminished symptoms.
Finally, for ongoing communication purposes, the practitioner and patient are required to provide regular updates via the patient’s subjective reporting of the following factors:
- Interference of Activities of Daily Living
- Duties under Duress
- Loss of Enjoyment
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