Sunday, December 8, 2013

WHAT IF I WAS ONLY "STIFF OR SORE" FOR A FEW DAYS, BUT NOW HAVE NO PAIN? OR, WHAT IF I HAD NO PAIN AT ALL IN THE FIRST PLACE?

A delay in the onset of pain is also extremely common, and is very well documented in the scientific literature. In addition, due to joint injuries, auto accidents can cause posttraumatic osteoarthritis. For those that have been in a traumatic accident, the arthritic process often develops much more quickly (at an earlier age) than in people who have not experienced auto accident trauma.
Osteoarthritis (degenerative arthritis) tends to cause pain on a daily basis and is progressive. Over time, it can ruin your posture (giving you a slumped or humped back appearance), limit your pain-free range of motion, and make it difficult to participate in many enjoyable activities.
 
Osteoarthritis involves the discs and other tissues of your spine and leads to progressive symptoms including chronic stiffness, pain, inability to perform simple tasks comfortably, including walking, sitting, sleeping, and/or moving the joints in your arms and legs. Even simply turning your head to one side or the other can be extremely painful, or even impossible.
 
When you injure yourself, your body will compensate for the injured area by trying to guard it. This puts pressure on other parts of your body to help stabilize your spine and keep you upright as much as possible. This pressure is the tightening of the muscles, tendons, and ligaments opposite the injured area, which pulls the joints of the spine out of alignment and puts painful pressure on the nerves in your back and neck. 

If not treated properly, this frequently causes a "domino effect" that leads to progressive musculoskeletal imbalance as well as the associated arthritic complications described above.

SHOULD I SEE AN ATTORNEY BEFORE MY EVALUATION?

Patients have important legal as well as health care needs that need to be addressed. In most cases, it is important to be evaluated by a clinic first. That way the findings from your exam will give you the information you need in order to decide on which attorney is necessary.
If you already have an attorney, the office will send detailed reports to your attorney as you are undergoing treatment to keep your legal  counsel apprised of your progress. Upon completion of treatment a final narrative report is then forwarded to the patient's attorney documenting any permanent damage or functional loss. 
An attorney who specializes in injury accidents is a wise choice in these circumstances. They know the law and your rights and are better equipped to communicate with aggressive or intimidating insurance representatives to help you get the care and other benefits to which you are entitled. In these cases, the office can refer you to a reputable and qualified attorney.

Why an MVA can't always be Measured as to the extent of injury, But the Insurance company will try for their own Gain

Dynamic Chiropractic – January 15, 2010, Vol. 28, Issue 02
Study Confirms Flaws in Standard MVC Defense Strategy
By Arthur Croft, DC, MS, MPH, FACO

The seemingly complex, or perhaps even inscrutable, calculus of what practitioners term personal injury is, in truth, deceptively simple. However, while it keeps getting simpler, many practitioners and lawyers feel hopelessly wrapped around the axle of this puzzling system. The net result is abandonment of needful patients and clients, with a corresponding loss of revenue stream. Consider just a few facts. Motor vehicle collisions are a leading cause of injury in the U.S. and constitute one of our most burdensome public health dilemmas. With 3 million such injuries each year, a total recovery proportion of only about 50 percent, a permanent disability proportion of 10-12 percent, coupled with the fact that many of the injured are young and have many quality life years to lose, the $43 billion annual price tag is hardly surprising.1
Auto insurers make every reasonable effort to insulate themselves from their liability. Some would argue that they engage in efforts most of us would consider unreasonable, if not downright unsavory or unethical. Regardless of your personal judgment, most would agree that over the past two decades, the insurers’ concerted and very expensive campaign to limit claims has been fairly successful.
With Allstate taking the vanguard position with their now-famous three Ds – delay, deny, and defend – most major auto insurers have since instituted similar policies, and the plaintiff persona-injury bar has more often withered than weathered. With a loss of potential legal representation, plaintiffs have had fewer alternatives for compensation. This often has meant that needed health care resources are simply not available to them, which contributes further to the doleful outcome statistics mentioned above. Since inaugurating its get-tough policy in the mid-1990s, which was described by its consulting firm as a transition “from good hands to boxing gloves,” Allstate has reportedly posted surprising high profits.2 Other insurers have not failed to notice.
The Standard Defense and the Importance of Delta V
How could any of this possibly be simple? One need look no further   than the essential game plan of most defense lawyers: deception, dissimilation and obfuscation. It requires a team of experts from the   fields of medicine (including chiropractic), accident reconstruction and biomechanics who have collectively developed what I consider to be the standard defense strategy. It continues to be the most successful and widely used strategy today, having become the world standard.
This has fostered a small research industry dedicated to the production of pro-defense literature to aid in the cause. Most is junk   science. Make no mistake, insurers have the best researchers money can buy and they know how to get published. As a result, even many clinicians remain split on critical issues depending on which brand of literature they rely upon. I note, with all due respect to the Insurance Institute for Highways Safety (IIHS) and members of the International Insurance Whiplash Protection Group (IIWPG), that their research activities are quite laudatory and most welcome. However, there is just a bit of schizophrenia in this industry when it comes to research. While the valid research of the IIHS and the IIWPG is squarely aimed at reducing the industry payout problem by reducing the number of actual injuries, the “other” research seems to be aimed at providing verisimilitude for company experts to wield in courtrooms to sway jurors toward defense theories.
The standard defense has three parts and is based on the ultimate playing field: a court of law, and, in particular, the biases and naivete (i.e., the normal lack of specific factual information in the field of crash traumatology) of jurors. Polls suggest that Americans are also divided on the question of whiplash injuries. As many as 60-70 percent consider it either definitively or very likely a non-injury, but merely an opportunity to bilk insurers at the expense of the rest of us policy-holders who subsidize the system through the increasing premiums we must pay. Thus, jurors are easily misled by the standard defense strategy because it merely reinforces that which they already believe.
The first and most fundamental part of this strategy is to demonstrate that the forces of the collision would not have been of a sufficient magnitude to cause injury. The common currency for this discussion is the plaintiff vehicle’s delta V or change in velocity. For this, an accident reconstructionist is usually employed.  Because reconstructionists are rarely allowed to provide opinions as to injury risk, they are often followed by a biomechanist, who is granted more latitude to venture into the discussion of injury risk. In some cases, they are allowed to consider medical records, MRIs, etc., in forming their opinions. Finally, the defense physician (DC, DO or MD) adds the icing to the cake, testifying that either there was no injury or that there was a minor straining-type injury that has long since resolved.
When pre-existing conditions are present, the plaintiff’s complaints are often attributed to them rather than the injury. Company doctors will typically also be of the opinion that a large portion of the medical expenses claimed by the plaintiff are unnecessary, unreasonable,and represent unwarranted treatment and diagnostics. Note that low back injuries are virtually never admitted to be causally related to low-velocity collisions. I have written a paper on this subject which is available upon e-mail request at drcroft@san.rr.com .3
As I have so many times implored readers – and this fact is never contested even by my small army of industry-affiliated detractors – the entire defense mechanism just described is nothing more than a series of interlocking nonsequiturs. The accident reconstructions and biomechanists provide a very polished and seemingly airtight argument based on what appear to be sound mathematical principles and classical Newtonian physics. This is all very interesting, and would be even more so if it had the additional virtue of being true.
Delta V Not a Valid Gauge of Injury Risk?
But figures don’t always add up, which brings me back to the headline of this article. A new study that provides further compelling evidence that delta V, the keystone in the standard defense strategy, is not a valid gauge of injury risk.4 The authors recruited a total of 57 people within 48 hours of their MVCs. The subjects were recruited either from an engineer’s office for vehicle damage assessment or an ER. The whiplash grades ranged from 0-4 (0 indicating no claimed injury and 4 indicating fracture). The collision types included 13 frontal, 21 rear, 19 side, three multiple crashes and one rollover. There were 25 males and 32 females with a median age of 33.
In all cases a trained engineer determined the delta V by examining both crash vehicles. The VAS and Neck Disability Indexes (NDI) scores were tabulated. The authors found no significant correlation between NDI and delta V, no correlation between whiplash grade and delta V, and only a moderate correlation between VAS reported pain and delta V. However, the R2 value (coefficient of determination) for that correlation was only 0.30, which means that 70 percent of the proportion of the variability of pain severity was not explained by differences in delta V.
There was no lower threshold below which a large proportion would predictably not be injured, nor was there an upper threshold above which most would predictably be injured. This was because some people were injured in very low velocity crashes while others were not injured despite fairly high velocity crashes. The authors commented, “It can be concluded that delta V is an irrelevant predictive value for cervical spine injury after MVA [motor vehicle accident].”
Some specific findings include the following: Cervical spine fractures in frontal crashes occurred in delta Vs of 9.3, 19.9 and 31.1 mph. Fractures in side impacts occurred in delta Vs of 6.2 (z-joint fracture of C4), 9.9 (C7 with dislocation of C6-7), 19.9 (z-joint   fracture of C2), 31.1 (C5 fracture with C5-6 dislocation and paraplegia), 32.3 (rupture of alar ligaments), 36.0 (atlantoaxial dislocation) and 36.6 mph (rupture of alar ligaments). There was a dens fracture in the one rollover with the delta V reported as 9.3 mph. This article is available for free download at www.ncbi.nlm.nih.gov/pmc/articles/PMC2657117.
A related component of the standard defense strategy is the property damage issue. Specifically, the argument goes, when the property damage is minor, an injury is very unlikely. We addressed this issue earlier in a meta-analysis of medical and engineering literature dating back as far as 1970 that failed to provide a clear link between property damage and any of three outcomes: risk for acute injury, degree of injury severity and risk for long-term symptoms.5 As I always caution readers, this lack of correlation considers the genre of collisions producing property damage that would be described as minor or non-severe. Clearly, when crash severity increases beyond this, there is an increased risk for injury or death.
A related interesting paper by Viano and Parenteau demonstrated that more than 60 percent of the National Automotive Sampling System case database for rear impacts are for crashes with delta Vs of under 15 mph. They noted, “In very low speed crashes, advanced age, stenosis and degeneration of the cervical spinal canal can lead to spinal cord injury and paralysis in crashes otherwise not causing injury in normal adults.”6 I would also note that it has been demonstrated rather conclusively that human variables (i.e., risk factors) are more determinative vis-a-vis injury risk than crash metrics in the lower crash-severity range.
In the end, when essential parts of the foundation of the defense strategy are tested, they repeatedly fail to hold up to the scrutiny of hard science. In a court of law, however, if the plaintiff and their experts cannot effectively present the real facts and rebut the junk science, 12 impressionable jurors will decide the outcome of the case based on their perception of the soundness of the arguments they heard. The simple fact is that more often than not, the plaintiff and their witnesses are simply not adequately prepared. Knowledge is power and information is the currency of success.
References
Zaloshnja E, Miller T, Council F, Persaud B. Comprehensive and human capital crash costs by maximum police-reported injury severity within selected crash types. Annu Proc Assoc Adv Automot Med, 2004;48:251-63.
Berardinelli DJ. From Good Hands to Boxing Gloves: The Dark Side of Insurance. Portland: Trial Guides, LLC, 2008.
Croft AC. Low back injuries in low velocity rear impact collisions. Forum, 2009;39(4):33-7.
Elbel M, Kramer M, Huber-Lang M, et al. Deceleration during “real life” motor vehicle collisions: a sensitive predictor for the risk of sustaining a cervical spine injury? Patient Saf Surg, 2009;3(1):5.
Croft AC, Freeman MD. Correlating crash severity with injury risk, injury severity, and long-term symptoms in low velocity motor vehicle collisions. Medical Science Monitor, 2005;11(10):RA316-21.
Viano DC, Parenteau CS. Serious injury in very low and very high speed rear impacts. SAE, 2008;2008-01-1485.

CAN MEDICATIONS AND PAIN PILLS HELP ME GET BETTER?

Medications may mask the pain for a few hours, but they do not aid your body's ability to heal itself, and may hinder the healing process. Medications cannot correct the soft tissue damage that is caused by auto accidents. If you are only taking pills, irritated nerves will continue to cause pain, suffering, and the problems listed earlier. Therefore, the adverse effects of your injuries will continue to plague you until you seek treatment. In certain situations our pain management Doctor will prescribe medication; however, pain medications alone will only mask the symptoms and not treat the problem.  The Doctors in our office work together for the best possible outcome.

Do Not Trust Them!!

It's the insurance companies(adjusters) job to save as much money as possible.  Your well being is not their first priority!!  Also, take into account that you are the injured party trying to get better.  Most insurance companies will try to get you to sign a document that will release them of liability within 2 days of the accident.  Do yourself a favor and get an examination to determine the extent of your injuries.  No one should ever rush you into signing a document without you knowing what you're really signing.  This is a sign that you need to hire the help of an attorney.  So, let us help you with the process!!  We can determine the extent of your injuries and help you find a reputable attorney that specializes in personal injury  claims.  This can happen with no out of pocket cost to you.  All you  have to do is make an appointment and let us handle it from there.  Don't deal with the harassing phone calls from the insurance company.  We do all the paperwork for you regarding your care.  It couldn't be easier!!  We look forward to serving you!!  Call Now!!


(972)215-7720

WhiplashtreatmentDallas.com

Irvingrehabandwellness.com 
SouthDallasChiropractic.com 

The Four Phases of a Whiplash Injury

During a rear-end automobile collision, your body goes through an extremely rapid and intense acceleration and deceleration.  In fact, all four phases of a whiplash injury occur in less than one-half of a second!  At each phase, there is a different force acting on the body that contributes to the overall injury, and with such a sudden and forceful movement, damage to the vertebrae, nerves, discs, muscles, and ligaments of your neck and spine can be substantial.  

Phase 1

During this first phase, your car begins to be pushed out from under you, causing your mid-back to be flattened against the back of your seat.  This results in an upward force in your cervical spine, compressing your discs and joints.  As your seat back begins to accelerate your torso forward, your head moves backward, creating a shearing force in your neck.  If your head restraint is properly adjusted, the distance your head travels backward is limited.  However, most of the damage to the spine will occur before your head reaches your head restraint.  Studies have shown that head restraints only reduce the risk of injury by 11-20%. 

Phase 2

During phase two, your torso has reached peak acceleration - 1.5 to 2 times that of your vehicle itself - but your head has not yet begun to accelerate forward and continues to move rearward.  An abnormal S-curve develops in your cervical spine as your seat back recoils forward, much like a springboard, adding to the forward acceleration of the torso. Unfortunately, this forward seat back recoil occurs while your head is still moving backward, resulting in a shearing force in the neck that is one of the more damaging aspects of a whiplash injury.  Many of the bone, joint, nerve, disc and TMJ injuries that I see clinically occur during this phase. 

Phase 3

During the third phase, your torso is now descending back down in your seat and your head and neck are at their peak forward acceleration.  At the same time, your car is slowing down.  If you released the pressure on your brake pedal during the first phases of the collision, it will likely be reapplied during this phase. Reapplication of the brake causes your car to slow down even quicker and increases the severity of the flexion injury of your neck.  As you move forward in your seat, any slack in your seat belt and shoulder harness is taken up. 

Phase 4

This is probably the most damaging phase of the whiplash phenomenon.  In this fourth phase, your torso is stopped by your seat belt and shoulder restraint and your head is free to move forward unimpeded.  This results in a violent forward-bending motion of your neck, straining the muscles and ligaments, tearing fibers in the spinal discs, and forcing vertebrae out of their normal position.  Your spinal cord and nerve roots get stretched and irritated, and your brain can strike the inside of your skull causing a mild to moderate brain injury.  If you are not properly restrained by your seat harness, you may suffer a concussion, or more severe brain injury, from striking the steering wheel or windshield. 

WE CAN HELP YOU TAKE THE GUESS WORK OUT OF DEALING WITH THE INSURANCE COMPANIES!
It's recommended that you do not settle your case before a thorough evaluation by our office. If you settle before your injury is fully diagnosed and treated, you will be responsible for any medical bills you incur in the future.
Our office will work directly with insurance companies to assure that your claim will be effectively documented during your treatment.  We also bill the insurance directly to help reduce the burden on your part.  It is important that you do not cash any checks that the insurance sends to your home.  In many cases, this will release them from any further liability in your care and you will be personally responsible for your medical bills.  If the insurance company is rushing you to settle then they are trying to reduce their  liabilities and may leave you with all the bills.  This could ruin your credit if you have medical bills that are unpaid.  In these cases we can help you find a reputable attorney to help protect you from the insurance companies.

WHAT IF THE INSURANCE COMPANY WANTS ME TO SETTLE?

It's recommended that you do not settle your case before a thorough evaluation by our office. If you settle before your injury is fully diagnosed and treated, you will be responsible for any medical bills you incur in the future.
Our office will work directly with insurance companies to assure that your claim will be effectively documented during your treatment.  We also bill the insurance directly to help reduce the burden on your part.  It is important that you do not cash any checks that the insurance sends to your home.  In many cases, this will release them from any further liability in your care and you will be personally responsible for your medical bills.  If the insurance company is rushing you to settle then they are trying to reduce their  liabilities and may leave you with all the bills.  This could ruin your credit if you have medical bills that are unpaid.  In these cases we can help you find a reputable attorney to help protect you from the insurance companies.

Don't be left out in the Cold if you were in an accident in the icy weather!!

Personal Injury Protection (PIP)

The Texas Department of Insurance requires automobile insurance carriers in our state to issue all automobile policies it writes at least $2500 worth of coverage and you have this coverage unless you reject it in writing. Most people are unaware of this coverage or even know what it is and therefore very few people use it. You end up paying for coverage that they don’t inform you about and you’re entitled to.

Why? Insurance is not understood and most people rely on their agent and claims adjusters to advise them on what to do after an accident. Insurance is a multi-billion dollar industry and are in business to make money. They keep their costs down, less payout, more profits and bonuses at the end of the year. Good for them and not for you.

What is PIP?

PIP is no fault coverage similar to health insurance but on your auto policy for your injuries and your passengers injuries. This coverage is available regardless who is at fault. Yes, you can be the cause of the accident and you will still be covered. There’s no deductible and no co-payment. There is other separate coverage that will cover the other party if you were at fault. If you do not have PIP then you could still be covered if you were in an accident in another state besides Texas. You may also be covered if you were hit in a crosswalk by a car or on a bicycle or borrowing someone else’s car.

What will a claim do to my insurance rates and policy renewal?
Under section 5.7016 of the Texas insurance code, automobile insurance carriers cannot non-renew you for filing one PIP claim in a 12 month period. Also, it is unlikely that they would raise your rates for a sole PIP claim.
Why doesn’t the other guy’s insurance pay for my medical expenses and why should I use my insurance?

Medical treatment is expensive and you are liable for the costs. There is a chance that the other party may never pay for your medical expenses leaving you a financial burden. PIP gives you peace of mind that your medical bills are covered. If you use your health insurance, you may have to pay a deductible and co-pays to your doctor and if the health insurance finds out that you were in an accident they could request to be reimbursed. Some people get referred to a medical provider by their attorney and the medical provider agrees to be paid months or even years later. Since there are a limited number of medical providers who agree to this arrangement, your choice and quality of healthcare may be limited. The answer is to use your PIP coverage so you will not have to pay for medical expenses out of your pocket and get the best possible healthcare treatment available for you and your family’s injuries caused by the accident.