Thursday, March 5, 2015

Whiplash

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Whiplash is a slang term for an injury to the neck that’s typically associated with a motor vehicle collision (MVC). A better term for “whiplash” is “whiplash associated disorder” (WAD) as it includes specific history and exam findings. There are usually two phases to an MVC: 1) an acceleration phase that is followed by 2) a deceleration phase. Injury can arise during either phase depending on the following: 1) The direction or angle of the collision (head-on, rear-end, T-bone, etc.); 2) The size of the bullet vs. target vehicle; 3) The speed the vehicles are traveling; 4) The size of the injured person’s neck (short/stocky vs. long/thin), 5) Head rotation at impact; 6) Position of the headrest (ideally ≤1 inch from the back of the head and raised up to bottom of the ears); 7) The angle and “springiness” of the seatback; 8) Seat belt use and position; 9) Collision anticipation, 10) Condition of the road (dry vs. wet/slippery), and more!

Anatomically, injury can occur to muscles and/or their tendon attachments, the ligaments that firmly hold bone to bone, the fascia (or the covering of the muscles), the bones, the joints, the skin, the nerves, and/or blood vessels. It all boils down to the ten or more factors listed above, and as discussed in last month’s topic on PTSD, depending on whether concussion occurs and how well the injured person reacts or copes with the injury (the psychosocial part). Obviously, A LOT of factors drive the outcome of a whiplash injury!

One of the more vulnerable parts of the neck that is frequently injured are the small facet joints and/or their coverings (called joint capsules). This is referred to as a WAD II injury. Picture a vertebrae as a bony tripod with one leg being big and wide representing the vertebral body and shock absorbing disk. This large leg is the main weight-bearing part of the tripod supporting up to 80% of the weight. The other two legs represent the facet joints that lie in the back of the vertebrae that open and close as we look down (opens) and look up (closes). When we turn our head, the movement primarily occurs in the first two vertebrae high up in the neck. Injury here most commonly occurs when the head twists or rotates, which can result from either the angle the chest portion of the seat belt lays against and/or if the head is rotated upon impact, such as looking in the rear view mirror. In other words, it’s probable that head rotation occurs in MOST motor vehicle collisions due to the seat belt’s angled position as it crosses the chest. When this twisting / rotation movement of the head occurs suddenly, it can result in brain injury or concussion, as studies show that delicate axons and nerve fibers can literally twist and tear due to this rotational component of the injury. Also, it’s WELL ESTABLISHED that the head DOES NOT have to hit anything to cause a concussion injury, as simply the force of the brain hitting the inside walls of the skull is enough to do this!

Another slightly less common WAD injury involves the pinching of the nerve root as it exits the spine (referred to as a WAD III injury). Think of the nerves as wires between a switch and a light, each having a specific area that they “run” (innervate). For example, if tingling/numbness occurs in the thumb and index finger, it can mean the C6 nerve could be interfered with at some point in between the spine and the fingers. We also test specific muscles for weakness associated with each individual nerve to identify the main culprit! When a nerve gets pinched, sensory and/or motor deficits can occur, which is validated by the neurological examination. The disk is basically like a “jelly donut” where the jelly is located in the central part of the disk and held in place by a tough fibroelastic tissue (called the annulus fibrosis). When this “jelly-like” substance (called nucleus pulposis) breaks through the tough, outer “annulus” and pushes against the nerve, loss of sensation and/or specific muscle weakness can occur. As chiropractors, we will carefully examine you and render many highly effective treatment methods!

The Silent Whiplash

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If you’ve watched small kids tumble and play, it can seem pretty rough to an adult. As we age, we know that balancing on our heads or whipping our necks around can only cause trouble. Most adults understand this point but seem to think children are more immune to problems for some reason. But is this plausible? Are kids really injury-proof? Not likely and recent research shows that degeneration of the spinal disks can occur at a much earlier age than previously thought. MRI studies of child athletes show this to be the case.
So what happens when a kid takes a whollup to the head, or slips and falls onto the kitchen floor? Besides a blow to the head, the neck can, and does, get injured from these types of forces. Because of a child’s age, the pain may only last a few days, but a silent problem can develop. A small sprain to the ligaments of the neck that hold the vertebrae in their proper position can only be diagnosed through x-ray, but most kids don’t get films taken. When the pain goes away we think the actual problem has gone away too.
Over time, the improper alignment and disrupted motion can lead to degeneration arthritis. This, in turn, will lead to stiffness and interfere with our quality of life.
So can a whiplash be a silent injury? Most likely yes, but over time it will eventually rear its ugly head. Then, when we finally visit a doctor, we are told of disk degeneration and we really don’t know why this is the case. Is it old age? Well, the disks that are not degenerated are the same age as the disks that are a problem. So it really can’t be an old age problem. Maybe it’s an older discovery, but the problem existed long before. These minor tumbles and whiplashes we experience in our youth do have lasting consequences.

Wednesday, March 4, 2015

Some Pediatric Research for Variety of Issues.

  • Constipation
  • Nutritional Research References for children
    • Barrett, D. (2007). Maximizing the Nutritional Value of Fruits & Vegetables. Center for Excellence in Fruit and Vegetable Quality, University of California, Davis, 40-44.
    • Bruno RS, Traber MG. Vitamin E biokinetics, oxidative stress and cigarette smoking. Pathophysiology. 2006;13(3):143-149.
    • Brigelius-Flohé R, Traber MG. Vitamin E: function and metabolism. FASEB J. 1999;13(10):1145-1155.
    • Brooks, A. (2013). 15 Things Your Doctor Doesn’t Know About Your Child: Questions Answered About Developmental Delays. Dallas, TX: Ingram.
    • Chen TS, Liou SY, Chang YL. Supplementation of Emblica officinalis (Amla) extract reduces oxidative stress in uremic patients. Am J Chin Med 2009;37:19-25.
    • Clark JH, Rhoden DK, Turner DS. Symptomatic vitamin A and D defi ciencies in an eightyear-old with autism. JPEN J Parenter Enteral Nutr. 1993;17(3):284-286.
    • Ip SP, Poon MK, Che CT, et al. Schisandrin B protects against carbon tetrachloride toxicity by enhancing the mitochondrial glutathione redox status in mouse liver. Free Radic Biol Med 1996;21:709-12.
    • Cornish E. Gluten and casein free diets in autism: a study of the effects on food choice and nutrition. J Hum Nutr Diet. 2002;15(4):261-269.
    • Ivanova KG, Stankova KG, et al. The biliprotein C-phycocyanin modulates the early radiation response: a pilot study. Mutat Res 2010;695:40-5.
    • Kay CD, Holub BJ. The effect of wild blueberry (Vaccinium angustifolium) consumption on postprandial serum antioxidant status in human subjects. Br J Nutr 2002;88:389-98.
    • Kondo H, Park SH, Watanabe K, et al. Polyphenol (-)-epigallocatechin gallate inhibits apoptosis induced by irradiation in human HaCaT keratinocytes. Biochem Biophys Res Commun 2004;316:59-64.
    • Lynch, B. MTHFR Research documents. Retrieved December 1, 2014
    • Mangialasche F, Xu W, Kivipelto M, et al. Tocopherols and tocotrienols plasma levels are associated with cognitive impairment. Neurobiol Aging 2012;33:2282-90.
    • McCarty MF. Clinical potential of Spirulina as a source of phycocyanobilin. J Med Food 2007;10:566-70.
    • Milesi MA, Lacan D, Brosse H, et al. Effect of an oral supplementation with a proprietary melon juice concentrate (Extramel) on stress and fatigue in healthy people: a pilot, double-blind, placebo-controlled clinical trial. Nutr J 2009;8:40.
    • Morris, C, Agin, M. Syndrome of Allergy, Apraxia, and Malabsorption: characterization of a neurodevelopmental phenotype that responds to omega 3 and vitamin E supplementation. Alternative Therapies. 34-43, July/Aug 2009.
    • Myrdal, A. American kids’ poor food choices: Fewer than 15 percent eat recommended fruits and vegetables. Retrieved November 20, 2014
    • Pantuck AJ, Leppert JT, Zomorodian N, et al. Phase II study of pomegranate juice for men with rising prostate-specific antigen following surgery or radiation for prostate cancer. Clin Cancer Res 2006;12:4018-26.
    • Pietrzik K, Bailey L, Shane B. Folic acid and L-5-methyltetrahydrofolate: comparison of clinical pharmacokinetics and pharmacodynamics. Clin Pharmacokinet 2010;49:535-48.
    • Prakash L, et al. A “Superfruit” extract from the Ayurvedic Tradition: authenticated and redefined. NutraCos 2009;Sept/Oct:12-15.
    • Rege NN, et al. Adaptogenic properties of six rasayana herbs used in Ayurvedic medicine. Phytother Res 1999;13:275-91.
    • Rickman, J., Barrett, D., Bruhn, C. (2007). Nutritional comparison of fresh, frozen and
      canned fruits and vegetables. Part 1. Vitamins C and B and phenolic compounds. Journal of the Science of Food and Agriculture. 87: 930-944.
    • Sahin K, Tuzcu M, Orhan C, et al. The effects of chromium complex and level on glucose metabolism and memory acquisition in rats fed high-fat diet. Biol Trace Elem Res 2011;143:1018-30.
    • Shih CM, Cheng SN, Wong CS, et al. Antiinflammatory and antihyperalgesic activity of C-phycocyanin. Anesth Analg 2009;108:1303-10.
    • Sokol RJ. Vitamin E and neurologic deficits. Adv Pediatr. 1990;37:119-148.
    • Sokol RJ. Vitamin E and neurologic function in man. Free Radic Biol Med. 1989;6(2):189-207.
    • Stuart EC, Scandlyn MJ, Rosengren RJ. Role of epigallocatechin gallate (EGCG) in the treatment of breast and prostate cancer. Life Sci 2006;79:2329-36.
    • Traber MG, Packer L. Vitamin E: beyond antioxidant function. Am J Clin Nutr. 1995;62(6Suppl):1501S-1509S.
    • Traber MG. How much vitamin E? . . .Just enough! Am J Clin Nutr. 2006;84(5):959-960.
    • Traber MG. Vitamin E, oxidative stress and “healthy ageing.” Eur J Clin Invest.
      1997;27(10):822-824.
    • Traber MG. Vitamin E. In: Shils ME, Olson JA, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams and Wilkens; 1999:347-362
    • UC Davis (2014, November). Center of Excellence for Nutritional Genomics (CENG).
    • Vasudevan M, Parle M. Memory enhancing activity of Anwala churna (Emblica officinalis Gaertn.): an Ayurvedic preparation. Physiol Behav 2007;91:46-54.
    • Vitamin E. In: Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids. Washington, DC: National Academies Press; 2000:186-283.

  • Integrative Pediatrics