After a car accident your ‘to do list’ may be long – get your car fixed, find an attorney, file a claim with your insurance agent, find a rental car to get to and from work, etc. For most, the damages to your body are less of a concern in the initial stages following an accident. Unfortunately, many do not know where and how to find treatment for their injuries. Without the guidance of someone who understands the system, it’s possible to get taken advantage of as there are extensive legal businesses built around profiting from MVAs. In this post I’ll describe some of the most common injuries sustained during MVAs, as well as give you insight into the medico-legal process and how to make sure you get the care you deserve.
Opt into MedPay
In Colorado it is state law every insurance company provides their drivers with a minimum $5,000 Medical Payments Coverage (MedPay) policy in addition to their automobile liability policy¹. MedPay should be included on any insurance policy by default and is against state law for an insurance company to deny a customer MedPay. The $5,000 policy provides coverage for the driver, as well as the passengers in the insured driver’s car, regardless of which party is at fault. MedPay even covers you when you’re in a car that isn’t your own. Unlike other medical insurance, MedPay never carries a deductible or co-pay in the policy and is available immediately following the accident². Colorado MedPay covers payments related to bodily injury, sickness, or disease resulting from the ownership, maintenance, or use of the motor vehicle. Colorado MedPay can be used to cover accident related expenses such as emergency or trauma care, ambulance rides, emergency room care, imaging services (X-rays, CT scans, or MRI’s), and conservative care treatments from chiropractors, massage therapists, and physical therapists.
Despite being mandated by Colorado state law, some insurance companies find ways to avoid providing their customers with the required $5,000 MedPay coverage. I’ve had numerous patients tell me they unknowingly opted out of their MedPay coverage before being told what the payment meant or included. Insurance companies in Colorado are required to include MedPay by default into any new policy, however, if you’ve opted out in the past, the insurance company is not required to remind you of MedPay or to ask if you want to opt in. If you use MedPay for an accident where you were not at fault your insurance company cannot raise your premium following the accident. I highly recommend calling your insurance agent today and making sure you have not opted out of MedPay. MedPay should be of little or no extra cost to your policy, and will provide you with much needed, immediately available funds following an accident.
Common injury patterns with MVAs
The injuries sustained in even minor MVAs can be severe. Many patients I’ve treated for a MVA report little to no pain the day of the accident, with symptoms hitting them hard the following morning. The shock involved with being in an accident is one explanation for the latency of symptoms, and oftentimes the brain is focused less on pain in the body and more on the financial and legal implications of the accident. Pain typically starts in the spine, with symptoms radiating down the extremities as the full effects of the injury are realized. I recommend waiting 2-3 days following a MVA to receive treatment. Waiting will ensure the treating physician gets the full picture of your injuries and can determine the appropriate treatment approach.
The most common type of injury sustained during a MVA is a whiplash type injury. Whiplash involves a sudden acceleration – deceleration force on the spine and muscles. Cervical acceleration – deceleration injuries are very common in MVAs and the whiplash injury causes tearing of muscle and ligament fibers. The muscles damaged in a cervical acceleration – deceleration injury are typically the cervical deep neck flexors which include the longus colli, longus capitis, and also the sternocleidomastoid. These muscles are extremely important for normal biomechanical function of the cervical spine. Weakness and inhibition of these muscles due to injury can lead to instability in the cervical spine and poor healing outcomes. Exercises targeting the function of these muscles are critical following a MVA and the guidance of a trained therapist is recommended to determine which exercises will be most beneficial.
Concussions are another possibility after a MVA and are most often associated with a blunt force trauma to the head against the steering wheel, dash, side window, or even an airbag. If the patient lost consciousness due to head trauma and post concussive symptoms are severe, a CT is recommended to rule out a more serious pathology such as an internal hemorrhage inside the brain. Any concussion, no matter how severe, deserves attention. Less severe cases warrant a neurologic examination by a trained therapist to assess for damage to the brain, spinal cord, or peripheral nerves. Some of the assessments used include a cranial nerve examination, ocular examination, and a high index neurologic exam that includes skin sensation, muscle testing, and deep tendon reflexes. The patient should also be taken through a verbal Sport Concussion Assessment Tool (SCAT 5) which helps determine severity of concussion and also to track treatment progress. Treatment of concussions often requires a nutritional component and an anti-inflammatory diet free of refined sugar and highly processed vegetable oils. High dose EPA/DHA from fish oil and vitamin D is also recommended to help heal brain tissue. Finally, our clinic uses a class 2 therapeutic infrared laser that can safely penetrate the skull and help to heal brain tissue via mitochondrial upregulation.
How long will it take to get better?
Tissue healing times are different for every patient and depend on age, injury history, genetics, nutrition, and lifestyle status. The severity of the accident and associated discrepancies in physical forces placed on the body are also a factor. As a general rule, the below gives the healing times for different tissue in the body which may be injured in a MVA³:
Muscle Strain (Grade 1): 0-2 wk
Muscle Strain (Grade 2): 4d-3mo
Muscle Strain (Grade 3): 3wk-6mo
Ligament Sprain (Grade 1): 0-3d
Ligament Sprain (Grade 2): 3wk-6mo
Ligament Sprain (Grade 3): 5wk-1yr
Many insurance companies try to fit every client into the same recovery timeline which is not realistic. If you are still in pain and someone handling your case says you need to be finished with care, advocate for yourself and demand the care you need.
At our clinic we use passive therapies such as acupuncture/dry needling, active release technique, therapeutic laser, cupping, and instrument assisted soft tissue manipulation among others to help you heal faster. We also use a wide variety of physical rehabilitation exercises to treat the specific deficits caused by the MVA. The focus of care after a MVA is to build strength, stability, and resilience in the cervical and lumbar spine and other body regions affected by the accident. Our goal is to make the patient stronger and more functional than they were before the accident.
Post written by Dr. Riley Kulm, DC. Check out his bio here.
Sources and References
With the recent passing of Colorado Proposition EE, Tobacco and E-Cigarette Tax Increase for Health and Education Programs Measure (2020), the cost of using tobacco products in the state of Colorado is higher than ever. For smokers in Colorado, the estimated increase in taxes will be $222 in the state budget year 2021-22, increasing to $291 by state budget year 2027-28¹. The minimum price for a pack of cigarettes will be $7 in 2021, and will increase to $7.50 by 2024². Tobacco products will see the current 40% tax rate increase to 62% by 2027, and the new nicotine tax aimed at e-cigarettes will be applied at 30% starting in 2021 and go up to 56% starting in July 2024. These taxes are mainly incurred on Coloradans in lower income brackets. Of the 14 percent of Coloradans who use tobacco products, 80% of those individuals make less than $40,000 per year. Financial incentives aside, smoking is the leading cause of preventable death in the US, accounting for 1 out of every 5 deaths in the US each year or 480,000 deaths³. For context, the covid-19 pandemic has taken the lives of 269,763 Americans in approximately the last year⁴, many of whom were significantly immunocompromised and suffering from two or more comorbidities. These statistics beg an important question – why is smoking cessation not a greater public health concern?
Why you should quit smoking
Smoking is strongly linked to chronic diseases such as cancer, heart disease, and stroke. Smoking damages your hair, skin, and nails leading to premature aging on the inside and out. Smoking eats away at the cartilaginous cushioning between our joints and promotes arthritis and joint pain. Smoking promotes a chronic chest and neck dominant breathing pattern leading to headaches and muscle tightness in the upper shoulders and neck. Second hand smoke exposure can create these problems for family members and friends.
The detrimental effects of smoking are related to oxidative stress, which occurs when the delicate balance between pro-oxidant and antioxidant systems in our bodies can no longer be maintained. Regular smoking increases the amount of reactive oxygen species (free radicals) in the body, overwhelming the antioxidant defense systems in the body. Free radicals are circulating molecules that have an unpaired electron. In an attempt to bind the unpaired electron, free radicals steal electrons from normal, healthy cells in the body and alter their structure and function. Damaged cells do not function properly and are flagged by the immune system for destruction resulting in widespread inflammation. Damaged cells can also become cancerous as normal cell replication processes are disrupted. The cell walls of our arteries and veins are damaged by smoking, increasing the likelihood of artheroscletoric plaque formation and subsequent heart disease and stroke. The good news? Your body starts healing within one day of quitting smoking.
How does acupuncture help you stop smoking?
Acupuncture helps you quit smoking by decreasing the mental and physical stress involved with quitting, as well as helping to diminish cravings. The most powerful detox points for alcohol abuse, drug addiction, and nicotine are located on the ear. The treatment of these areas is referred to as auricular acupuncture, and the protocol I use is based on the National Acupuncture Detoxification Association (NADA) nicotine cessation protocol. I also incorporate specific body points which help improve blood flow, decrease stress, and increase the likelihood of successfully quitting. Additionally, we use semi permanent acupuncture needles (seeds) which are implanted into the ear like a small piercing and stay there for 3-5 days providing constant stimulation of the acupuncture point. I use seeds at the designated nicotine point which is located on the lower tragus and can be manually stimulated by the patient when a craving is felt.
Combining acupuncture with patient education seems to be more effective than acupuncture or education alone⁵. I encourage my patients to adopt some of the strategies found on state sponsored quitting websites, like Colorado QuitLine. Beneficial strategies I’ve used with patients include telling loved ones when and why you are going to quit, making a list of all of the items or experiences you can buy with the money normally spent on tobacco, disposing of all tobacco or tobacco related products at the house or in the car, setting a strict quit date instead of trying to slowly wean yourself off, and to write out a daily health journal to track improvements in energy, mood, and pain levels.
I recently treated a patient at the clinic for smoking cessation. For this case study, we will refer to the patient as Laura. Laura is a middle aged female who has been a pack a day smoker for 20 years. She was spending upwards of $1,000 per month on tobacco products. Laura came to me wanting more than anything to quit smoking. She had tried everything from nicorette to patches, and had even tried hypnosis. However, nothing seemed to work and the nicorette made her nauseous. She was open to the idea of acupuncture because it had been a helpful treatment for a low back injury I was seeing her for. We settled on a treatment plan of 8, 30 minute visits over a 4 week period. Laura set her quit date in conjunction with her first day of acupuncture.
Within a week, the immediate improvements in her health were palpable. Her skin was clearer and was less red and inflamed. Her stiff and leathery muscles felt relaxed and pliable. Her breathing was slower, deeper, and less labored. She seemed less stressed, and had a calm nature about her. The acupuncture helped her deal with the day to day stress of quitting, and also mitigated cravings and withdrawal symptoms. On top of this, the chronic low back pain she was experiencing dramatically improved as her body’s internal healing mechanisms were better allowed to do their job. Overall, her transformation was inspirational. It motivated me to want to help more people struggling with nicotine addiction create lasting change in their lives. I’m happy to report it is now 3 months since her quit date and she has not had a cigarette since.
If you or someone you know smokes and wants to quit but doesn’t know where to start, please direct them to this article or me personally. It would be a privilege to assist you or a loved one quit for good and to help you realize the immense financial and health benefits of quitting today.
Post Written by Dr. Riley Kulm, DC. Check out his bio here.
Sources and References
- Colorado Proposition EE, Tobacco and E-Cigarette Tax Increase for Health and Education Programs Measure (2020)
- Proposition EE: Taxes On Nicotine Products, Explained
- Centers for Disease Control and Prevention, Current Cigarette Smoking Among Adults in the United States.
- CDC COVID Data Tracker
- Auricular Acupuncture, Education, and Smoking Cessation: A Randomized, Sham-Controlled Trial
You’ve heard the stories, watched the YouTube videos, and maybe even experienced it yourself. The ‘pop’ or ‘crack’ made during a chiropractic adjustment is a mystery to most people. Are the bones cracking? The joints popping? The ligaments snapping? Where is the noise actually coming from? When a chiropractor delivers a high velocity, low amplitude thrust (HVLA) to a specific joint, there is often an audible sound associated with the adjustment. What is really causing this noise? Read on to find out more!
To understand where the noise in a chiropractic adjustment comes from, it’s important to first define the engineering phenomenon called ‘cavitation.’ Cavitation refers to air pockets or bubbles formed in response to a rapid change in the pressure of a liquid. Cavitation is often seen with underwater propellers, where bubbles are formed in response to the rapid change in water pressure caused by the spinning propeller. As pressure increases, these bubbles can burst, releasing a shockwave of energy. The field of engineering views the cavitation as a negative phenomenon to be avoided, because the energy released by the bursting bubbles can damage the propeller by subjecting it to uneven stress.
A joint is formed when two bones come together or ‘articulate.’ The surface of a bone comprising one half of a joint is called an articulating surface and is aligned with the articulating surface of another bone. Joints in the spine and extremities are referred to as synovial joints. There are several types of synovial joints in the body such as the ball-and-socket joint (hip joint, shoulder joint), hinge joint (elbow), and the pivot joint (between C1 and C2 vertebrae), among others. Despite having different shapes and planes of movement, all synovial joints share some common characteristics. Synovial joints are encased in a fibrous joint capsule called the articular capsule. Within the articular capsule is viscous liquid called synovial fluid. Synovial fluid is the consistency of egg-whites and its main purpose is to lubricate the joint, reducing friction and stress between the two surfaces of the joint. Healthy levels of synovial fluid help keep our joints moving freely and prevent the formation of arthritis.
Putting it all together
The phenomenon of cavitation is observed in the human body. When a chiropractor delivers an adjustment, the therapeutic goal is to gap or widen the two joint surfaces, resulting in a decrease in pressure within the joint capsule. The pressure decrease occurs within the synovial fluid, and bubbles are formed in response to this change in pressure. The bubbles rapidly collapse on themselves, releasing a shockwave of energy. The collapse of the bubbles and subsequent release of energy is believed to cause the audible pop or crack caused by the chiropractic adjustment. The noise made during a chiropractic adjustment is caused by the bursting of small bubbles within the synovial fluid of a joint in response to a rapid change in fluid pressure. Damage to the joint does not occur like it does to the propeller. The cavitation associated with the propeller takes place thousands of times per minute, whereas most patients get adjusted twice per week at the most. As such, regularly self adjusting your spine can lead to an array of negative outcomes. For more information, please reference my blog post, The Dangers of Self Adjusting. Lastly, to determine how frequently you should get adjusted, review my blog post, How Often Should I Get Adjusted?
Post written by Dr. Riley Kulm, DC. Check out his bio here.
Patients often ask what the ideal treatment frequency is for getting adjusted. However, if you asked ten different chiropractors this question, you might get ten different answers. Within chiropractic, many different technique systems and schools of thought exist. Chiropractic treatments and treatment plans are not standardized within the profession and there is a high level of variability from doctor to doctor. With this in mind, the answer to how often you should get adjusted is it depends on your situation. Factors such as your age, health status, activity level, and diagnosis all factor into how often you need to be adjusted. For this post, I will address the question for someone who has mild or no symptoms and is looking to chiropractic for maintenance care and promoting overall health. To begin, I’ll describe the typical treatment plan for a new patient at our clinic.
Typical Treatment Plan
When a new patient comes to our clinic with a common complaint such as low back, neck, knee, shoulder, or elbow pain, we typically see them twice a week for 1-2 weeks, once a week for 3-4 weeks, and then reassess after 6-8 visits over 4-5 weeks. Adjustments will be performed at each visit. If the patient is markedly improved, we will push visits out 2-3 weeks and start seeing them on a less regular basis. Most patients feel substantial relief in just 2-3 visits, however, the underlying functional issues (posture, movement, breathing) causing the injury in the first place, take longer to reverse. Once the pain is gone and the patient is passing all of the functional tests relating to the original injury, we place the patient on a maintenance care plan where they come in once a month. The purpose of the maintenance care visit is to make sure the patient has not re-injured themselves or sustained any new injuries. We will also review exercises they have been prescribed in the past and check their spines to see if an adjustment is needed. At our clinic we use a mixture of chiropractic adjustments, physical therapy exercises, nutrition and supplements, and soft tissue therapies such as instrument assisted technique, active release technique, dry needling, laser, and acupuncture. By combining multiple therapies, we decrease healing times, allowing for a shorter and less costly treatment plan.
How often should a patient get adjusted for maintenance care and promotion of overall health? As stated previously, one chiropractor’s answer may differ from another’s, and our answer is based on the combined clinical experience of nearly a decade from the two doctors at Mile High Spine and Sport, Dr. Ryan Dunn and Dr. Riley Kulm. For maintenance care and promotion of overall health, we suggest patients come in for a full spine assessment and adjustment once per month. Maintenance care visits also include a functional movement exam to see if any limitations in muscle strength, stability, and range of motion exist predisposing the patient to future injuries. The purpose of the full spine assessment and functional movement exam is to identify issues before they surface to help prevent pain or injury. Similar to how it is necessary to go to the dentist every 6 months for a cleaning and exam, you should go to the chiropractor once per month to have your spine assessed for restricted joints and muscle imbalances to help prevent issues down the road. For quality preventative maintenance care, chiropractic is one of your best, and most cost effective treatment plan options.
Can I get adjusted more than once a month?
As a result of the numerous health benefits of getting adjusted, many of our patients decide to come in for adjustments more than once per month. Patients report improvements in breathing, energy, digestion, and sleep following their treatments. If you’d like to learn more about how the chiropractic adjustment can positively affect multiple areas of your health, please check out my post, Beyond Biomechanics: Exploring the Hormonal Benefits of the Chiropractic Adjustment.
From a safety perspective, it is entirely fine to get adjusted on a regular basis. However, I would not suggest getting adjusted more than three times per week as you run the risk of causing hypermobility in the joints. Hypermobility means the joints are moving too much and lack the muscular stability for normal motion and can lead to a variety of orthopedic issues. In general, we rarely see maintenance care patients more than once per week. We encourage patients to come in more than once per month if they find the benefits of regularly getting adjusted enhances their lifestyle and well-being.
Post written by Dr. Riley Kulm, DC. Check out his bio here.
So you’ve recently scheduled your first chiropractic visit. Having never been to a chiropractor before, you aren’t sure what to expect. You’ve seen the YouTube videos, heard many stories, both good and bad, with everyone seemingly having a unique experience with a chiropractor. In this post I’ll outline what you can expect on your first chiropractic appointment.
The following article outlines a typical new patient exam at Mile High Spine & Sport. Most evidence based chiropractic clinics will follow a similar plan for a new patient visit.
History (10-15 minutes)
Once in the treatment room, the doctor will ask you a series of questions related to your area of complaint. Questions asked will include the location of pain and if there are any referred symptoms. Referred symptoms refer to pain, numbness, tingling, and/ or weakness that may be stemming from the main area of pain. The doctor will ask for a detailed description of how the pain came on, whether it happened in a single traumatic incident, or if it came on more gradually over time. The doctor will ask which activities specifically make the pain worse (i.e. sitting vs. standing, bending forward, turning, lifting an object off the floor, etc.) and also if there’s anything specific that makes the pain better (heat vs. ice, Advil, relieving postures or positions, etc.). The doctor will ask about your treatment history – any past injuries or surgeries, and whether any imaging (X-ray, MRI, CT) have been taken recently, so be prepared with this information if necessary.
A doctor who treats the entire body and not just the site of pain will ask you a variety of other questions regarding your overall health and lifestyle choices. The doctor will ask about your diet because the foods we eat can affect the way the body experiences pain and recovers from injury. They will ask about any medications or supplements you are currently taking, as well as what you like to do for exercise because activity modifications may be necessary while you recover from your pain. The doctor will ask about your sleep quality as sleep is the most fundamental human function necessary to heal. Additional questions will be asked regarding any drug/ alcohol/ or tobacco use, as abuse of any of these can magnify the inflammatory pain response and slow healing. Interview over! Now the doctor has a clear picture of your current chief complaint, your past medical history, and knows the kind of lifestyle you are living.
Exam (15-20 minutes)
Vladimir Janda, a renowned Czech physician, always taught that ‘Time spent in assessment, will save time in treatment.’ With this in mind, chiropractors like to perform detailed, in depth exams to determine what specifically is causing your pain or dysfunction. It’s important to assess the entire body and not just the site of pain, because dysfunctions elsewhere in the body may be contributing to the site of pain. For instance, a shoulder problem may be related to poor function of the hip on the opposite side of the body, a chronic knee issue may be stemming from poor ankle mobility on that side, or low back pain may be related to diminished mobility and/or stability in the hips.
The doctor will start by taking your vitals, which includes blood pressure, heart rate, respiratory rate and body temperature. More specific exams such as an eye exam, cranial nerve exam, ear exam, lung exam, cardiac auscultation, abdominal exam, and nasal exam will performed on an as needed basis.
Next, the doctor will perform a comprehensive neurologic exam. They will test your deep tendon reflexes (think patellar knee jerk as a little kid), muscle testing, and sensation testing of your skin. These tests are meant to test the integrity of your nervous system. Other neurologic tests include single leg balance testing, your ability to stand with the eyes closed, the ability to sense vibration in your fingers and toes, and even your ability to distinguish smells such as coffee and cinnamon. The purpose of these tests are to screen for any pathology that is damaging your central nervous system and may include a disc herniation, spinal or brain tumor, or disease process. The vast majority of neurologic exams come up as normal, and the vast majority of positive findings in a neurologic exam are related to non-pathologic processes that can be corrected in the chiropractic office.
The next portion of the exam is the orthopedic exam. These tests help the doctor figure out exactly which tissues are injured, i.e. is it the meniscus, ACL, PCL, joint, or muscle? Orthopedic exams are meant to elicit pain and will most likely recreate your pain. Do not be worried about these tests damaging your tissues, they are only performed once and will help the doctor figure out the best course of treatment for you.
The final portion of the exam will be the functional movement exam. The doctor will take you through a series of functional tests such as a SL squat, SL balance, lunge, push-up, active range of motion, passive range of motion, and muscle testing among many others. These tests are meant to recreate the demands of daily living and the basic requirements for healthy human movement. When a dysfunction is found in the functional movement exam, the doctor is given valuable insight into which specific exercises will be beneficial for you.
Will X-rays be taken as part of the exam?
At our clinic, we do not take X-rays on the majority of our patients. Most presenting problems can be diagnosed and treated without the use of X-rays. While radiation exposure during an X-ray is minimal, we still opt to only order X-rays or advanced imaging when absolutely necessary. Minor anomalies and asymmetries will be found on the majority of X-rays, but these issues rarely correlate to pain and can often confuse the patient into thinking they should have pain because of what the image shows
Review of findings (5 minutes)
After completing the exam, the doctor will have a solid idea of what is driving the pain and the best course of treatment. The doctor will suggest which tissues are damaged and what other contributing factors are adding to the pain or dysfunction. Additionally, the doctor will explain the different treatments they want to use, including potential adverse side effects such as soreness or mild bruising for 1-2 days after treatment.
Treatment (20-25 minutes)
With the history, exam, and review of findings complete, the doctor can start the treatment. Treatments will address the joints, nerves, muscles, tendons, ligaments, and any movement compensations you may have. The most commonly utilized treatments used at our clinic include:
Active Release Technique (ART) – considered the gold standard in soft tissue therapies.
Dynamic Neuromsucular Stabilization (DNS) – functional movement protocol based on principles of neuro developmental kinesiology.
Instrument Assisted Soft Tissue Manipulation (IASTM) – the use of metal tools to decrease tone of tight and tender muscles.
Acupuncture – needling technique used for thousands of years to treat pain and organ dysfunction. Acupuncture is based on needling along specific ‘meridian’ pathways that have specific uses for healing in the body.
Kinesiology taping – special type of tape that provides support to joints and muscles without causing disuse atrophy of the muscles as is the case with traditional orthopedic braces.
Cupping – effective decompressive technique which lifts the skin away from the muscles allowing increased blood flow and lymphatic drainage at the site of treatment.
Internal medicine blood testing – functional medicine blood testing to assess for specific nutrient deficiencies, digestive irregularities, and hormonal imbalances that can be an underlying cause of pain and chronic disease.
A typical treatment plan at our clinic is 2x/ week for two weeks, 1x/ week for two to four weeks, once every other week for 2-4 weeks, then once a month for maintenance care if the chief complaint pain is resolved. Most patients feel significant relief after 6-8 visits. Additionally, most patients feel even stronger and more flexible compared to their first visit because of the exercises they’ve been given at our clinic.
Now you know what to expect in your first chiropractic visit, hope to see you soon!
Post written by Dr. Riley Kulm, DC MS. Check out his bio here.