Category Archives: Car Accident Information Orange County

Dizzy After a Car Accident in Orange County? It Might Be Vertigo…

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Dizziness After a Car Accident Is a Very Common Complaint.

woman with vertigo dizziness nausea treatment orange countyDizziness and nausea treatment in Orange County, CA

There are many causes of dizziness or vertigo after an auto accident injury:

  • Concussion
  • Disc herniation
  • Neck sprain
  • Inner ear problem called BPPV

This article discusses BPPV or Benign Paroxysmal Positional Vertigo. This can be a mild dizziness on moving your head to a debilitating problem preventing most activities. Whether the symptoms are mild or severe, the good news is there are fairly simple treatments that can fix the problem.

It Starts in Your Ear…

In your inner ear there is an organ system that senses where you are in space and tells the brain. When you move your head a gelatin-like substance that has tiny crystals embedded on top moves hair cells that detect movement. If the system is working ok, normal head movements can be made without causing dizziness. A common problem can occur though, that causes a malfunction in the system. If your head is shaken very hard, some of the crystals may dislodge and find themselves where they don’t belong. If enough of them are loose they can clump together into a stone. This can cause changes in fluid flow so that when your head moves the fluid continues to flow abnormally and your brain detects motion even though you are no longer moving your head. Your brain becomes confused and you interpret this as dizziness or vertigo. Along with the vertigo you will often also have a rapid twitching or cycling of the eyes from side to side called nystagmus. This results in blurred or double vision.

What’s it Feel Like to Have BPPV?

Dizzy. Nauseous. If you are suffering from BPPV the main symptom is dizziness or feeling like the room is spinning whenever you move your head or change positions from down to up or side to side. You may have double vision, many people become nauseated and some actually vomit because the symptoms of BPPV are so severe. A common complaint is “I get dizzy when I turn in bed and can only lie on one side or I have to sleep with my head propped up.” Others will say, “I get dizzy and feel like I’m going to fall whenever I try to get up out of a chair.”

These symptoms are also associated with low blood pressure, iron deficiency anemia and certain medications, especially drugs acting on the heart. It’s important to distinguish between these other causes of dizziness because they can be very serious.  If your doctor has already told you, you have vertigo and given you a prescription for anti-vert and not done the treatment suggested in this article, you may want to give this a try to see if your BPPV goes away and you will not need the drugs any longer.

What Causes BPPV?

This vertigo problem can seemingly come out of nowhere with no known precipitating event. Elderly patients are more likely to suffer BPPV with no identified cause. The older we get the easier it is for this to occur. In younger people it is very often the result of your head being shaken or jolted quickly such as after a slip and fall, a sports injury, car accident, having your head tilted back too long at the dentists or hair salon, bumpy mountain bike rides, body surfing, bouncing as in aerobics or Zumba, etc. The sudden movement of the head causes embedded crystals to break off and wander into the canals. If enough of them do this and they coalesce into a sizeable little rock (otolith) they can wreak havoc with the fluid movement in your ear and create dizziness.

How Do You Diagnose Benign Vertigo?

The description you give to the doctor is a strong indicator; sudden onset dizziness on turning your head with recent accident or bumpy activity, no changes in medications recently, etc

Once BPPV is suspected, it is definitively diagnosed with a simple maneuver called the Hallpike Test or Dix-Hallpike Test. This is a provocative test, meaning it is designed to specifically re-create your dizziness in order to determine if it is BPPV and which ear is involved. It can be both ears! Your dizziness and nausea will be aggravated by this test, but it is crucial to properly diagnosing your condition and the good news is, the test is halfway to the treatment and resolution of your vertigo because the treatment will immediately follow the test and only take a short time.

The Hallpike test involves turning your head 45 degrees and lying on your back with your head still in 45 degrees rotation while your head is dangled over the edge of the table or bed. Your head is held in this position for up to 30 seconds to see if your vertigo worsens and most importantly, your doctor is looking for “nystagmus” or a rhythmic jumping of the eyes. If this occurs it indicates that is the problem side. The test is repeated to the opposite side just in case you have it on both sides.

test for vertigo dizziness bppv

What is the Treatment for BPPV?

Once the side is figured out, your doctor will then perform what is called “Epley’s Maneuver” or “canalith or otolith repositioning maneuver.” This procedure is similar to the Hallpike test in that you are quickly brought back with your head lying over the edge of the exam table with your head turned to the bad side. You are held in this position for up to 2 minutes or when dizziness and nystagmus stops.  Your head is then turned to 45 degree angle the opposite angle with head hanging and held another 2 minutes. You may feel dizziness moving. You are then directed to roll onto the side you are turned to with your head facing down towards the table and hold for 2 minutes. Lastly, you are brought upwards to a sitting position holding your head turned. You then straighten out your head and look forward and sit for about 10 minutes. It is important not to tilt your head up or down while waiting for the 10 minutes. Afterward, if your symptoms recur, your doctor will repeat the procedure on subsequent visits until no symptoms return.

Tips for After the Treatment

  • Avoid tilting head back or forward for the rest of the day.
  • Avoid sudden head movements for a day or two
  • Avoid activities that cause a lot of bumping or vibration for a day or two
  • Avoid sleeping on the affected side for about a week

If the symptoms return, go back to your doctor right away and have the procedure done again. In some cases you may need to have this done 3-5 times. The majority however clear up after only 1 session.

Benign Paroxysmal Positional Vertigo can be a very scary and disabling condition. Luckily it is fairly easy to diagnose and treat without drugs or surgery. If you’ve suffered from vertigo you might want to consider getting checked for BPPV.

Dizziness and nausea treatment in Orange County, CA. Dr Barry Marks, Chiropractor, car accident whiplash and brain injury doctor Orange, CA

 

How Long Should Chiropractic Treatment Be for Whiplash Injuries?

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How Long Should Chiropractic Treatment Be for Whiplash Injuries?

Chiropractic Treatment Duration for Whiplash Injuries

After a car accident, one of the most common questions that arise is how long treatment should go on. As a patient you may be concerned because treatment takes up a lot of your time. Your attorney will want to know because it affects the outcome of your case. Insurance companies want to know and often cite too much treatment was an argument to minimize your case.

Professional Practice Guidelines

You first need to understand that a doctor specializing in car accident treatment does not just treat you “willy-nilly.” Whiplash specialist doctors use “guidelines” to tell them an expected range of treatments that are appropriate based on your individual injury. Professional practice guidelines are a set of parameters derived through studying the medical and scientific literature. Guidelines are then submitted to other researchers, institutes or licensing boards for comments and approval. If the guidelines are considered useful and well documented, they may be officially adopted by the profession.

When it comes to chiropractic treatment of whiplash and other injuries from car accidents, there are a few guides to consider. The most well received, best documented and universally accepted guidelines are the “Croft Guidelines.”

Croft Guidelines

In 1993, Arthur Croft, D.C., M.S., M.P.H., F.A.C.O., F.A.C.F.E., published a set of management guidelines in the ACA Journal. These guidelines have also been published in Whiplash Injuries: the Cervical Acceleration/Deceleration Syndrome, second edition, in 1995 and in a recent Canadian practitioner’s guide to whiplash injuries, sanctioned by the Canadian Chiropractic Association.

The Croft Guidelines have been a part of our literature now for over 2 decades. No competing guidelines relative to whiplash treatment have been published during that time. Several American state chiropractic organizations and associations, as well as in at least one Canadian province, have adopted the Croft Guidelines.

The vast majority of true car accident injury experts rely on the Croft Guidelines to determine the severity of their patient’s injuries and an estimate on how long treatment may take.

Using the Croft Guides for Duration of Treatment

The first step is to determine the “severity” or “how bad” an injury is. In a previous post, I outlined how the Croft Guides gives specific factors to use to determine severity of injury. See “How Bad is My Car Accident Injury?” for details.

Once your doctor has established the severity as either a Grade I, II, II, IV or V, the doctor consults the guidelines to see the predicted range of treatment numbers and duration. For example looking at the table below, a Grade II injury may require daily treatment (7 times in 1 week) for 1 week, then may require treatment at 3 times each week for 4 weeks or less, then 2 times each week for 4 weeks or less, then 1 treatment per week for 4 weeks or less and finally 1 time per month for 4 months or less. The total duration (TD) of treatment may be upwards of 29 weeks and the total number (TN) of visits may be up to 33 visits.

 Croft guidelines chiropractic whiplash injuries

You will note that I have said “may” and “up to” many times; that is because these are practice guidelines and not rigid rules. Patients may need slightly more or less treatments depending on their individual injuries.  The point is, there are professionally recognized practice guidelines that have been published by medical researchers and experts that assist the doctor, the patient, attorneys and insurance adjusters in understanding the anticipated duration of treatment.

When an automobile insurance adjuster claims that chiropractic treatment has gone on too long, the question is, “based on what?” What guidelines have they used to substantiate their assertion? Most insurers will not cite any guides. Others may try to cite disability guides or other references, but these guides are for work injuries or general non-traumatic neck or back complaints. They are not generally accepted guides specifically for chiropractic treatment of a whiplash injury. Car accident injuries have been shown in the literature to be unlike any other type of injury or cause of neck and back pain.

As the victim of a car crash injury, understanding these guides will help set you at ease knowing that your treatment is being provided in the most scientific and professional manner possible.

Go from How Long Should Chiropractic Treatment Be for Whiplash Injuries? to How Bad is My Car Accident Injury?

 

How Bad is My Car Accident Injury?

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After a car accident, it’s common for patients to ask “How Bad is My Car Accident Injury?”

Car Accident Injury Severity

You might be surprised how the “severity” of or “how bad” your injury is determined. Most people believe it has to do with:

  • How much vehicle damage there is
  • How fast the vehicles were traveling
  • How much pain you are in
  • Whether or not you take an ambulance ride to a hospital
  • Whether or not you miss any work
  • Many other incorrect reasons

How to Determine Car Accident Injury Severity:

Rather than subjective information like the above or from a doctor merely giving an educated guess, true car accident injury specialists such as myself use “professional practice guidelines” or “guides.” Guides are a set of rules for doctors that have been established through scientific research to tell them how to practice. Guides tell a doctor objectively, what the items are that lead to a specific diagnosis. Guides can also give doctors direction on what types of treatment are most beneficial for certain conditions.

To determine the severity of specifically a car accident injury, the most well known and scientifically proven set of guidelines are the “Croft Guidelines.”

Croft Guidelines

The guidelines were published by Arthur Croft, D.C., M.S., M.P.H., F.A.C.O., F.A.C.F.E an internationally known doctor and researcher in the spinal trauma field in 1993. These guides were published in his book, “Whiplash Injuries: The Cervical Acceleration/Deceleration Syndrome,” second edition and have been adopted by many state boards of Chiropractic in the US and Canada. There are other guides used in the profession, but most of them borrow heavily form Croft, therefore the original source is best to use.

Within the Croft Guidelines injury severities are determined by objective findings at the time of the initial examination. It is crucial your treating doctor understand how to do a proper and thorough examination of a car accident whiplash injury since failure to recognize some features of an injury could result in the improper severity, which you will see later, leads to incorrect frequency and duration of treatment and overall prognosis. This is just one among many reasons why auto accident victims need to be evaluated by a true car accident injury specialist and not just any doctor.

Looking at the Croft Guidelines we can see there are five injury grades (severities): Grade I through V. The examination findings are clearly stated on what constitutes a given grade or severity. The most common Grades are II and III. Many Grade I’s do not feel enough pain to see a doctor. This is why using guidelines rather than subjective pain is a better method. Grade V’s are rarely seen in private practices in the initial onset, because they are usually triaged at a hospital and undergo surgery. Chiropractors and other therapists may work with them post-surgically. Grade IV’s are not uncommon in a chiropractor’s or other private practitioner’s office, but not as commonly as II and III. It is imperative the treating doctor can recognize a Grade IV and team treat with orthopedists and/or neurosurgeons since these patients usually suffer from disc herniations, nerve injury or ligament instability that may require surgery.

Croft Guides Car Accident Injury Severity

Common Mistakes in Applying the Croft Guides for Injury Severity

Because most doctors treating car accident injuries are not actual specialists in the field, they do not know how to tell which grade to apply because they do not know how to document things like ligament injury and/or ligament instability so they may not be able to decide between a Grade II and Grade III. When your doctor takes a look at your x-rays (ALL accident cases require x-rays of the spine, period) and you see your neck curve is decreased, flat or reversed, that is a sign of ligament injury. The ligaments running up and down the inside of your spine keeps the proper tension that makes your neck curve properly. This is just one example of how a specialist can do a proper exam and apply the findings to the guides for a well documented severity of injury.

Injury Severity Grading is Important in Car Accident Whiplash Cases

Everything in a personal injury whiplash case flows from the severity grading. Once your doctor knows the severity, he or she will know what treatment types are best, what imaging studies to refer you for, what other specialists need to be consulted, etc. The Croft Guides also tells the doctor what frequency and duration of treatment is typical. Your long-term outlook for recovery (prognosis) is also determined by the grade of your injury.

Remember, these are guides and some patient’s heal faster or slower than others and there are complicating factors that can extend care, but in general, the guides give you, your doctor, your lawyer and the insurance company some notice of what to expect treatment wise.

Of course that is only IF your doctor is aware of these guidelines and knows how to use them. My guess is about 25-30% of chiropractors are aware of the Croft Guides and about 10% actually use them regularly. I would estimate that less than 10% of any medical specialists know of or use these guides. And sadly, maybe 20% of lawyers know of them and less than 10% of the doctors they work with use them. The numbers of doctors who are actually true whiplash specialists are very few. Many doctors treat car collision injuries, but very, very few have actual post-graduate specialty training in this field.

Objective Evidence of Injuries to Prove Your Case and Improve Your Treatment

Rather than just guessing or putting all patients through the same old cookie cutter process, specialists in car accident injuries use professional guidelines to make key decisions about your injuries and treatment. Injury severity is an important first step in the process of documenting your injury that leads to decisions on what type of treatments are needed and the frequency and duration of care.

Go from How Bad is My Car Accident Injury? to How Long Should Chiropractic Treatment Be for Whiplash Injuries?

Types of Rear-Impact Automobile Collisions

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Types of Rear Impact Automobile Collisions and How Bumpers Play a Role

types of rear impact automobile collisions

Scientific and medical researchers have proven over the years that “rear-impact” type collisions produce the most injuries to occupants.

The way your spine is configured, the construction of automobile seats, chassis and bumpers all play a role in how you may become injured in a crash. The fact that a collision is a rear-impact versus a front or side impact, raises the odds of suffering an injury and worsens your prognosis (long-term outlook for recovery).

Car Crash 101

What happens when 2 cars collide? As an example we will say a vehicle is at a complete stop. This is the “target” vehicle. Another vehicle that is moving is known as the “bullet” vehicle. The bullet vehicle strikes the target vehicle in the rear. The moving vehicle has a mass and speed that will deliver a force to the stationary vehicle. This force is energy and according to physics, whatever energy is put into the collision an equal amount must come out of the collision. A minimal part of the energy is dissipated as sound, part of the energy is absorbed by the bullet vehicle deforming and the rest of the energy goes into the struck vehicle. If the struck vehicle crushes, energy will be bled off as the metal and plastic deforms and crushes. After deformation, there may still be energy left over. This energy moves through the chassis of the vehicle, it may make the struck vehicle move forward lessening energy even more. If more energy is left over, that energy causes forces on the occupant’s body and if it is enough, results in tissue damage.

There are many variables that dictate how much energy is created in a collision and how much energy there is that can be injurious. Things like size and weights of the vehicles, the speed the vehicles are traveling, how the vehicle’s bumpers line up, if the struck vehicle is manual or automatic transmission, if the road is wet or dry, is the struck vehicle is on an up or down slope, etc. The uniqueness of each crash is because of all the variables that can be involved.

The Role of Bumpers in Rear End Car Accidents

Rear end collisions can be further subdivided and injury potential increases or decreases with each variety. The possibilities of impact types are endless, so we will stick with the most common scenarios seen in the real world that you may become victim to.

Rear-impact, Well Aligned Bumpers That Crush

rear impact auto collision This is the most favorable of “rear enders.” If you have a choice in your car crash, pick this one! When 2 cars collide and the vehicle bumpers are roughly the same height, the bumpers strike each other and do their jobs, namely crush and absorb energy to protect you. Energy is transferred from the striking vehicle into the target vehicle. Energy is absorbed by crush of plastic and metal, sound and some heat. If a lot of energy is dissipated in this way, then less energy is transmitted through the chassis, into your seat and ultimately into your body. More energy to your body means more injury, so we want the bumpers to crush a lot. If each vehicle has crushable bumpers that line up well, the amount of injury you suffer is reduced.

Rear-impact Misaligned Bumpers; Striking Vehicle Hits above Target Vehicle Bumper

rear impact car accident injuryIn this case, the 2 bumpers did not line up well. Maybe the striking vehicle’s bumper hits your bumper, but it mostly goes above it and strikes the rear trunk lid. This is less favorable than well aligned bumpers because the struck vehicle’s bumper did not get to bleed off energy. The rear of the car above the bumper may crush, but it does not contain energy absorbing materials that are scientifically designed to reduce energy, so more energy is sent through the chassis, into the seat and into your body.

Rear-impact Misaligned Bumpers; Striking Vehicle Hits below Bumper (Submarine impact)

rear impact submarine collisionIt’s pretty easy to understand why these are called “submarine” impacts as the striking vehicle is like a sub that hits a ship below the water line. These impacts occur because the striking vehicle is lower than your vehicle or the striking vehicle is hard on the brakes trying to stop so its nose is low on impact. Sometimes the striking vehicle becomes wedged under the struck vehicle. Similar to above, the struck vehicle’s bumper does not get involved to reduce damaging energy, so you get hurt more. An added component that may cause more damage than above the bumper strikes is the force is delivered into the rear and there is an upwards component causing you to feel a quick pop up your spine not just front to back. This results in increased chance of lower back injuries.

Rear-impact, Well Aligned Bumpers, but Struck Vehicle has Steel Bumper or Trailer Tow Package Installed

rear end truck collisionRemember that the more the colliding bumpers crush, the less energy and therefore injury can occur to your body. What happens when the struck vehicle is a pick-up truck or SUV that has a steel, non-deformable rear bumper? These pretty, chrome step-bumpers look nice and can take a beating without showing damage, but what they also do is transmit large amounts of force through the vehicle chassis and directly into an occupant’s body causing damage. These bumpers can be struck at 20 mph and show very little damage. The striking car, if it has crushable front bumper, may look like a bug squashed against a windshield when they hit these bumpers. Having a trailer hitch or tow package also increases the amount of injurious energy into the occupant because they add rigidity to the rear of the vehicle, do not deform and are connected directly to the chassis. The converse of this situation is also true: if a vehicle with a steel, less deformable bumper strikes a conventional rear bumper, the amounts of force delivered by the steel bumper is more than if both cars had crushable bumpers. The frustrating dichotomy of this particular type of rear-end collision is that if you are in a vehicle with a steel bumper and suffer a rear impact, the potential for injury is greatly increased, BUT because there is low property damage, auto insurance adjusters tend to discount these cases. It is important to always take photos at the scene of an accident, not just of your vehicle but of any other vehicles involved as well. Pictures of a severely damaged vehicle that left only a dent on your steel bumper goes a long way to explaining damaging forces involved in the collision.

Rear-impact Automobile Collisions Summary

Rear-impact motor vehicle collisions have been shown to cause more damage than other types of crashes. Many variables are involved that predict bodily damage by a rear collision. Bumper design and vehicle alignment are a important variables that can predict if the occupant(s) of a struck vehicle will suffer relatively more or less injury. Each car collision is unique due to the myriad of variables involved in car crashes.

If you’ve suffered a car accident in Orange County, help is nearby. Call our office at (714) 938-0575 now and get the help you need from an experienced car accident injury expert.  Any doctor can treat a car accident injury, but only a true car accident specialist knows all the ins and outs and can assist you through this difficult time.

About Car Accident Injuries

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About Car Accident Injuries

About Car Accident Injuries Orange County, CA

Orange County Car Accident Whiplash & Brain Injury Specialist, Dr Barry Marks explains some car accident information that may surprise you

  • Most injuries occur in crashes of 12 mph or less
  • A 3 mph rear impact has been proven to damage neck ligaments
  • Permanent disc injuries reported in slow speed crashes
  • Over 500 deaths in 1999 in Florida due to car accidents of 10 mph or less
  • Japanese study shows you are more likely to suffer complications and prolonged treatment if your car does not show any visible damage, worse than if car is totaled

Car Accidents Must Be Taken Seriously

A sprain or disc injury in the neck may show as a minor stiffness or headache. Later on it may progress to become more painful. Many people are injured and have no idea because the symptoms are subtle at first. Permanent structural damage may occur even in slow speed crashes. Studies have shown once certain supporting ligaments are damaged, your spine is likely to deteriorate within 5-10 years. Very specific types of treatment and home care have been proven to result in more favorable healing and limitation of impairment.

Don’t Go to the Wrong Doctor for Your Car Accident Injury

Most doctors, chiropractors and therapists have no real training in detecting and treating whiplash and brain injuries. They treat them juts like any other type of “sore neck.” This can harm you. Undetected and improperly ligament damage can result in serious adverse affects later on like arthritis disc degeneration and nerve injury. The average general doctor will miss key findings and not provide adequate treatment to your detriment.

Car Accident Injuries Require a Specialist

Believe it or not there are doctors who specialize specifically in car accident whiplash and brain injuries. Through rigorous study of current research, biomechanics, vehicle crash reconstruction, orthopedic and neurologic testing, interpretation of MRI studies, disability and impairment rating, forensic examination and report writing, courtroom testimony and court etiquette, and more topics are required to specialize in this field.

Orange County CA Car Accident Injury Specialist, Dr Barry Marks, DC

  • Chiropractor specializing in trauma since 1986
  • Post-doctorate specialty training in Orthopedics
  • Advanced graduate of Whiplash & Brain Trauma post-graduate program
  • Former Associate Clinical Professor LA College of Chiropractic
  • Certified Industrial Injury Evaluator
  • Qualified Medical Examiner, State of CA
  • Certified in Applied Spinal Disability Rating
  • Post-doctorate studies in MRI spine interpretation
  • Has spoken before groups of doctors and lawyers on matters of car accident injuries, MRI diagnostics, Disc injuries and more

For More Information About Car Accident Injuries Explore the Rest of This Site

If You’ve Suffered an Accident Injury and are Near Orange County, CA Call Dr Marks (714) 938-0575 and Book an Appointment at No Cost to You to Evaluate Your Condition

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Neck Injured? Curve Flat or Reversed? Learn About the Dakota Traction Wedge Here http://www.drmarks.com/dakota-neck-traction.html