Triad Pain Management Clinic is focused on handling your Personal Injury or Motor Vehicle Accident injuries. We work on lien as well as directly with your insurance company, which means there will be no out of pocket expense for you. We work very hard to resolve your pain, heal your injuries, as well as make it as painless as possible to settle your case.

You will receive quality care at a modern state of the art facility under the combined care of qualified physicians and certified staff. Our multi disciplinary clinic offers services provided by Medical Doctors, Doctors of Chiropractic, and a Naturopathic Physician as well as an Athletic Trainer, Licensed Massage Therapists, and other certified staff members. Our primary objective is your health and helping you to return to the quality of health and life you maintained before your injury.

Our practice has a successful track record in not only being able to rehabilitate patients post injury but also in having solid medical research to back our treatment plans. We want to make sure that the treatment you receive after an accident is the care that you expect and deserve.

Several studies show that different types of medicine may affect different people better than others. Among the beneficial types of treatment for Motor Vehicle Accidents studies show acupuncture, chiropractic, soft tissue rehabilitation, massage, and medical management can all be used to treat whiplash injuries. We have spent 10 years at Triad focused on offering all the options to our patients, so no matter which treatment will work best for you, you can get that care with us. Our multi disciplinary approach is what sets us apart from the rest!

One of the most common injuries sustained in a motor vehicle accident is whiplash.

A whiplash injury is defined as: a neck injury caused by a sudden jerking backward, forward, or both, of the head. There are many unknown symptoms attributed to whiplash, it is very important to be well informed about your injuries so they do not go untreated. Numerous studies have shown that years after whiplash victims settle their insurance claims; roughly half of them state that they still suffer with symptoms from their injuries. If you have been involved in a car accident, whiplash injuries need to be taken very seriously. These types of injuries can take weeks or months to be noticeable, leading most patients to believe they were not as seriously injured as they really were.

Here are some symptoms to look for right after an accident as well as in the weeks and months to follow:

• Neck Pain
• Headache
• Fatigue
• Shoulder Pain
• Anxiety
• Interscapular Pain
• Low Back Pain
• Sleep Disturbance
• Upper Limb Paresthesia
• Sensitivity to noise
• Impaired Concentration
• Blurred Vision
• Irritability
• Dysphagia (difficulty swallowing)
• Dizziness
• Forgetfulness
• Upper limb pain
• Upper limb weakness
• Tinnitus (ringing in ears)
• Jaw/Facial Pain (TMJ)

If you are experiencing one or more of the following you may have sustained a whiplash injury. Here are some frequently asked questions & answers you may find helpful.

What kind of doctor should I see for treatment of my whiplash injuries?

The appropriate doctor to treat whiplash injuries depends on the nature of your injuries, and could include a chiropractor, an orthopedist, or a neurosurgeon to name a few. It is very important to seek treatment from a doctor who understands all the complexities of whiplash injuries and who knows how to treat the condition properly. All too often patients are told they only need to take pain medication for a short period of time and their symptoms will go away on their own. Often this is not the case, and, unfortunately the patient does not get the proper care right after their injury, when that treatment is the most critical.

The treatment recommended for whiplash injury varies widely among health care practitioners. Perhaps partly as a result of a relatively large body of existing junk science literature, there are many who believe that whiplash injuries do not occur or that they do not benefit from any type of treatment. In emergency rooms around the country, common advice is to go home, apply an ice pack, take anti-inflammatory medication, and to consult with the family doctor if symptoms persist beyond two weeks. Unfortunately, this advice is probably responsible for at least some of the more than 30% of whiplash victims who never fully recover or the 10% or more who become disabled. Rational therapeutic intervention during that initial two weeks can greatly reduce the likelihood of long-term symptoms. However, while there have been a small number of studies which have looked at the question of which treatment is best, most have been plagued with design errors which have made interpretation difficult at best, and none have had any success in measuring honest differences in treatment types. Our purpose here, therefore, is simply to describe the various types of care offered to whiplash victims. As is usually the case in medicine, not all patients will respond the same to a particular treatment approach.

Acupuncture- Traditional needle acupuncture is often helpful in relieving the pain of an acute cervical spine injury such as whiplash. It has also been shown to be of benefit for chronic neck pain. Readers are referred elsewhere for more information about this ancient healing practice. Acupuncturists generally have a four-year undergraduate degree and a four-year degree in Oriental Medicine, although variations exist.

Chiropractic- The primary tool of modern chiropractors is spinal manipulation or, in the parlance of the profession, spinal adjusting. Chiropractors also utilize a variety of physical medicine and rehabilitation approaches, along with nutritional advice to strengthen and balance the body. They may utilize traditional modalities such as ultrasound, diathermy, microcurrent stimulation, laser therapy, traction, and heat and cold applications in addition to spinal manipulation.

Chiropractors usually have a four-year undergraduate degree in addition to their four-year Doctor of Chiropractic (DC) degree. Many also go on to complete diplomates in a variety of specialties including orthopedics, radiology, neurology, nutrition, and internal medicine, most of which require an additional three to four years of post-doctoral study and additional board examinations.

As mentioned, there are few studies of the efficacy of the various treatment approaches to acute whiplash, but there are two studies in which the effectiveness of chiropractic care for chronic whiplash injury has been demonstrated. In the study of late whiplash it was reported that chiropractic care was effective in 93% of cases. In a subsequent study, the authors classified the 93 late whiplash patients into three groups: Group 1, with 50 patients, was roughly the equivalent to grade 2 CAD by definition; Group 2, with 32 patients, was roughly equivalent to grade 3 CAD; Group 3, described as having an unusual complex of symptoms that included blackouts, visual disturbance, nausea, vomiting, chest pain, and non-dermatomal pain distributions, did not really conform to any of the CAD grades. Following treatment, improvement was noted in 72% of the patients in Group 1, 94% of the patients in Group 2, and 27% of Group 3, with one patient made worse. Most practitioners would concede that managing late whiplash patients is a more challenging than managing acute cases.

Chiropractic care utilizes manual manipulation of the spine to restore the normal movement and position of the spinal vertebrae.  It is by far the single-most effective treatment for minimizing the long-term impact of whiplash injuries, especially when coupled with massage therapy, trigger point therapy, exercise rehabilitation and other soft tissue rehabilitation modalities.

Medicine- There are many different medical specialties, but the specialties most likely to treat whiplash are general or family practice, orthopedics, neurology, and physical medicine and rehabilitation, with the latter usually having the most to offer these patients. Beyond pain management, medical practitioners may refer patients for a number of sessions of physical therapy, which might include exercises, stretching, deep tissue massage or mobilization, and many of the modalities listed in the preceding paragraph.

Physical medicine and rehabilitation specialists are often called upon to provide special fluoroscopic-guided injections into the epidural space, to provide diagnostic anesthetic blocks, or to provide radiofrequency ablation of the nerves innervating the facet joints.

Medical doctors usually have a four-year undergraduate degree and a four-year medical degree, and many have also completed diplomate programs (residencies) in the various specialties. Registered physical therapists (RPT) are not physicians and are generally not licensed to provide spinal manipulation. They usually have a four-year undergraduate degree in physical therapy, although there are graduate programs available as well.

One survey study provides some food for thought when it comes to selecting a practitioner. A significant number of medical specialists who frequently treat or examine whiplash patients (nearly half of the surveyed orthopedic surgeons) endorsed the belief that long-term pain and suffering is more the result of secondary gain, psychiatric disorders, or socioeconomic stress. While there are such cases, there is no basis for believing this is the norm. Yet attitudes such as these would seem to undermine or even prevent the rendering of effective care. Patients should always feel confident that their physicians have their best interests at heart.

Surgery is not commonly required for whiplash patients, but may be in instances where disc herniations occur and cannot be managed conservatively or when ligamentous instability requires spinal fusion. When indicated, surgery will be provided by either an orthopedic surgeon or a neurosurgeon. Note that some surgeons specialize in specific areas of surgery. For example, some orthopedic surgeons do not operate on spines at all. Others may specialize in cervical spine procedures.

Multidisciplinary centers- Pain treatment centers are examples of multidisciplinary centers, and usually employ a variety of practitioner types and therapists. This might include neurologists, physiatrists, chiropractors, physical therapists, orthopedic surgeons, exercise physiologists, and psychologists or psychiatrists. Several studies have been published to recommend such centers, although it is important to watch runaway costs when more consults or treatment than might be necessary are provided. Similar working relationships and provider networks can exist less formally in which the primary treating provider manages care by referring to the appropriate specialists around town when necessary and appropriate. In many cases the primary treating practitioner might be a chiropractor or a family practitioner.

A recent comparison of medicine, acupuncture, and chiropractic care- Comparing, in a randomized trial, medication (Celebrex, Vioxx, or paracetamol) to acupuncture and spinal manipulation over the course of 9 weeks in persons with chronic spinal pain (neck to low back pain included), the authors demonstrated a rather profound superiority in chiropractic spinal manipulation. The exception was for neck pain in which acupuncture was found to be superior on the basis of Neck Disability Scores. The average period of chronicity was 4.5 years in the medicine group; 6.4 years in the acupuncture group; and 8.3 years in the chiropractic group. After 9 weeks of care, spinal manipulation had achieved asymptomatic status in 27%, compared to 9.4% for acupuncture and only 5% for medicine. Patients were allowed to change therapy groups if they perceived a lack of effectiveness in their current treatment group. Over the course of the 9 weeks, nine from the medical group, five from the acupuncture group, and two from the chiropractic group changed treatment types.

For more in-depth information of this topic, see Foreman SM, Croft AC (eds): Whiplash Injuries: the Cervical Acceleration/Deceleration Syndrome, 3rd edition, Lippincott Williams & Wilkins, Baltimore, 2001. Other information is available from Whiplash in Hypertext 3.0, a software program available from the Spine Research Institute of San Diego.]

The importance of choosing Triad Pain Management Clinic after an accident is that we have managed, with over a decade of experience, to combine all of the treatments into our protocol. Depending on your injury and how your body heals we will specifically a design a treatment plan for you which includes some or all of the options we’ve discussed here. You will be able to do all of these in the same place, saving you time and the pain of travel.

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.

Injuries Resulting from Whiplash Trauma

As we discussed briefly in the introduction, whiplash injuries can manifest in a wide variety of ways, including neck pain, headaches, fatigue, upper back and shoulder pain, cognitive changes and low back pain.  Due to the fact that numerous factors play into the overall whiplash trauma, such as direction of impact, speed of the vehicles involved, as well as sex, age and physical condition, it is impossible to predict the pattern of symptoms that each individual will suffer.  Additionally, whiplash symptoms commonly have a delayed onset, often taking weeks or months to present.  There are, however, a number of conditions that are very common among those who have suffered from whiplash trauma.

Neck pain

It is the single most common complaint in whiplash trauma, being reported by over 90% of patients.  Often this pain radiates across the shoulders, up into the head, and down between the shoulder blades.  Whiplash injuries tend to affect all of the tissues in the neck, including the facet joints and discs between the vertebrae, as well as all of the muscles, ligaments and nerves.

Facet joint pain is the most common cause of neck pain following a car accident.  Facet joint pain is usually felt on the back of the neck, just to the right or left of center, and is usually tender to the touch.  Facet joint pain cannot be visualized on x-rays or MRIs.  It can only be diagnosed by physical palpation of the area.

Disc injury is also a common cause of neck pain; especially chronic pain.  The outer wall of the disc (called the annulus) is made up of bundles of fibers that can be torn during a whiplash trauma.  These tears, then, can lead to disc degeneration or herniation, resulting in irritation or compression of the nerves running through the area.  This compression or irritation commonly leads to radiating pain into the arms, shoulders and upper back, and may result in muscle weakness.

Damage to the muscles and ligaments in the neck and upper back are the major cause of the pain experienced in the first few weeks following a whiplash injury, and is the main reason why you experience stiffness and restricted range of motion.  But as the muscles have a chance to heal, they typically don’t cause as much actual pain as they contribute to abnormal movement.  Damage to the ligaments often results in abnormal movement and instability.

Headaches

After neck pain, headaches are the most prevalent complaint among those suffering from whiplash injury, affecting more than 80% of all people.  While some headaches are actually the result of direct brain injury, most are related to injury of the muscles, ligaments and facet joints of the cervical spine, which refer pain to the head.  Because of this, it is important to treat the supporting structures of your neck in order to help alleviate your headaches.

TMJ problems

A less common, but very debilitating disorder that results from whiplash is temporomandibular joint dysfunction (TMJ).  TMJ usually begins as pain, clicking and popping noises in the jaw during movement.  If not properly evaluated and treated, TMJ problems can continue to worsen and lead to headaches, facial pain, ear pain and difficulty eating.  Many chiropractors are specially trained to treat TMJ problems, or can refer you to a TMJ specialist.

Brain injury

Believe it or not, mild to moderate brain injury is common following a whiplash injury, due to the forces on the brain during the four phases mentioned earlier.  The human brain is a very soft structure, suspended in a watery fluid called cerebrospinal fluid.  When the brain is forced forward and backward in the skull, the brain bounces off the inside of the skull, leading to bruising or bleeding in the brain itself.  In some cases, patients temporarily lose consciousness and have symptoms of a mild concussion. More often, there is no loss of consciousness, but patients complain of mild confusion or disorientation just after the crash.  The long-term consequences of a mild brain injury can include mild confusion, difficulty concentrating; sleep disturbances, irritability, forgetfulness, loss of sex drive, depression and emotional instability.  Although less common, the nerves responsible for your sense of smell, taste and even your vision may be affected as well, resulting in a muted sense of taste, changes in your sensation of smell and visual disturbances.

Dizziness

Dizziness following a whiplash injury usually results from injury to the facet joints of the cervical spine, although in some cases injury to the brain or brain stem may be a factor as well.  Typically, this dizziness is very temporary improves significantly with chiropractic treatment.

Low back pain

Although most people consider whiplash to be an injury of the neck, the low back is also commonly injured as well.  In fact, low back pain is found in more than half of rear impact-collisions in which injury was reported, and almost three-quarters of all side-impact crashes.  This is mostly due to the fact that the low back still experiences a tremendous compression during the first two phases of a whiplash injury, even though it does not have the degree of flexion-extension injury experienced in the neck.

Recovery from Whiplash

With proper care, many mild whiplash injuries heal within six to nine months.  However, more than 20% of those who suffer from whiplash injuries continue to suffer from pain, weakness or restricted movement two years after their accident.  Unfortunately, the vast majority of these people will continue to suffer from some level of disability or pain for many years after that, if not for the rest of their lives.

Whiplash is a unique condition that requires the expertise of a skilled health professional specially trained to work with these types of injuries.  The most effective treatment for whiplash injuries is a combination of chiropractic care, rehabilitation of the soft tissues, and taking care of yourself at home. 

Soft Tissue Rehabilitation

The term ‘soft tissue’ simply refers to anything that is not bone, such as your muscles, ligaments, tendons, nervous system, spinal discs and internal organs.  During a whiplash injury, the tissues that are affected most are the soft tissues, the muscles, ligaments and discs in particular.  In order to minimize permanent impairment and disability, it is important to use therapies that stimulate the soft tissues to heal correctly.  These include massage therapy, electro-stimulation, trigger point therapy, stretching and specific strength and range of motion exercises.

Naturopathic Care

Complimentary medicine such as prolotherapy can be used to help treat injuries sustained in an auto accident along with chiropractic care. Prolotherapy heals tissue by stimulating repair and regeneration. The solutions used in prolotherapy create inflammation, which is the body’s way of healing damaged tissue. Inflammation increases blood supply and the flow of nutrients. This leads to the creation of new collagen, the protein that makes up ligaments, tendons and cartilage. The result is an increase in strength and thickness of the structures along with stabilization of the joints, thus removing the source of pain. (link to prolo page)

Passive/Active Rehabilitation

Complete chiropractic and rehabilitative care

• Passive & Active Therapy - stretching and strengthening the spine and extremities
• Synergy Protocols - in office complete rehabilitation protocols & equipment
• Spinal Stability – rehabilitation of de-conditioned muscles in the spine after injury
• Core Strength Training - stability ball rehab
• Propioceptive & Neuromuscular - joint and spinal stability of the spine and muscles after injury

Physical rehabilitative therapies to help with pain and healing

• Ultrasound - reduces swelling in a joint due to injury, soften scar tissue from a old injury
• Diathermy- deep heat to reduce swelling, spasm and pain
• Interferential Current - reduces swelling and spasms and promotes healing to a injured site
• Micro Current - reduces pain, promotes healing in muscles and bones
• Pre-Modulation Current - breaks muscle spasm, reduces pain
• Electrical Muscle Stimulation – helps to control pain
• Russian Stimulation - strengthens weak and atrophied muscles
• Therastim - reduces chronic pain due to scar tissue and muscle spasm and increases joint range of motion
• TENS Unit – helps patients to control pain at home
• Hydrotherapy Bed (water massage) – increases circulation and helps to decrease pain and spasm
• Hot Packs - reduces spasm
• Cyrotherapy - reduces pain and swelling
• Intermittent Computerized Traction - decompress disc injuries of neck and back

Manipulation Under Anesthesia

A beneficial procedure for chronic neck, back and joint problems; it is also effective for people with conditions caused by long term disabilities due to accidents or injuries that are not relieved through conservative treatment. MUA can be an alternative for patients facing invasive surgery.

Studies prove when compared to surgery and other procedures, MUA patients return to work faster, have higher activity rates, and longer lasting results. Some conditions benefiting from MUA are fibroadhesion build up; chronic disc problems; herniated discs; chronic re-injury; myofascial pain syndrome; fibromyalgia; failed back surgery; frozen shoulder; headaches/migraines; sciatica; acute and chronic muscle spasm and decreased spinal range of motion. For more information please visit our MUA PAGE.

Home Care

The most effective chiropractic care and soft tissue rehabilitation will be limited in its benefit if what you do at home or at work stresses or re-injures you on a daily basis.  For this reason, it is important that your plan of care extend into the hours and days between your clinic visits to help speed your recovery.  Some of the more common home care therapies are the application of ice packs, limitations on work or daily activities, specific stretches and exercises, taking nutritional supplements and getting plenty of rest.

Medical Intervention

In some severe cases of whiplash, it may be necessary to have some medical care as part of your overall treatment plan.  The most common medical treatments include the use of anti-inflammatory medications, muscle relaxants, trigger point injections and, in some cases, epidural spinal injections.  These therapies should be used for short-term relief of pain, if necessary, and not be the focus of treatment.  After all, a drug cannot restore normal joint movement and stimulate healthy muscle repair.  Fortunately, surgery is only needed in some cases of herniated discs, when the disc is pressing on the spinal cord, and in some cases of spine fractures.

At Triad Pain Management we believe that the correct diagnosis and appropriate treatment plan are absolutely essential to the recovery of any injury with all patients. We offer endless treatment options under one roof and we are committed to creating a plan that works for YOU! If you have any questions about anything you’ve read here please feel free to contact us at anytime.