Rehabilitation following an accident is one of the primary steps an
individual should take, especially if painful symptoms develop. A car accident,
for instance, can cause numerous injuries which may require a variety of
rehabilitation procedures. From chiropractic care and physical therapy to
medical doctors, many healthcare professionals frequently treat injuries
resulting from auto collisions. However, chiropractic treatment is the most
common form of rehabilitation chosen by individuals who’ve been involved in a
car crash.
A chiropractor specializes on treating musculoskeletal injuries and
conditions, focusing on restoring the health of the spine and its surrounding
structures naturally. After an automobile accident, many individuals experience
soft-tissue injures. Some common soft-tissue injuries include whiplash, neck
pain, back pain, muscle soreness or tightness.
Rehabilitation after any type of accident causing damage and/or injury
to the body is essential for the individual to record the incident in order for
the insurance company to follow through with the proper compensation.
Individuals who never visit a healthcare professional for their injuries can
often have a difficult time dealing with their personal injury claim as its
necessary to prove there was an injury after an auto accident or any other type
of accident. In the case an individual suffers a visible wound, such as a bone
fracture or a head injury, as a result of a car crash, the specialists in the
emergency room are trained to properly treat these types of injuries but,
soft-tissue injuries can be difficult to detect using an X-ray. Therefore, it’s
crucial to follow up with a chiropractor or physical therapist to diagnose any
possible underlying injuries or conditions which may have resulted from the
incident and continue with rehabilitation treatment as soon as possible.
The main goal of rehabilitation is to reduce and/or eliminate the painful
symptoms caused by an injury or condition after an accident, ultimately helping
restore the individual’s mobility and function. With proper documentation of
all medical procedures received, a personal injury claim can be pursued
accordingly with the insurance company.
There are numerous rehabilitation procedures which can be used to treat
whiplash, neck pain and back pain, among other types of injuries and conditions
resulting from an auto accident, including chiropractic care and physical
therapy, although these aren’t limited to only treating symptoms caused by an
auto collision. Whiplash, neck pain and back pain can also occur as a result of
an accident during an athletic sport or from any physical activity. Regardless
of the cause of the injury, rehabilitation procedures can be very similar in
nature, especially when treating neck injuries and symptoms.
Neck Pain and Auto Injuries
The Stages of Rehabilitation
Due to an excess of weight or force, a prolonged exposure to specific
positions and postures, whiplash and external forces, such as vibrations and G
force, athletes can also have just as high a risk of experiencing neck injuries
as victims of an automobile accident. Regardless, rehabilitation procedures can
be applied to all neck dysfunctions, from acute injuries to simply increasing
the peak performance of an athlete or individual. As with all injury management
processes, it’s essential to understand the type of injury the individual has
suffered and which type of rehabilitation plan would be most appropriate to
their specific grade of injury, by both the individual and high performance team
or coach, if any. The rehabilitation process can be divided into four stages: early
management, initial rehabilitation, rehabilitation progression and return to
performance.
Early Management
The first
stage of rehabilitation, early management, should be started immediately after
the athlete or individual has experienced any mild to severe cervical or head
injuries and they’ve been properly diagnosed by a qualified healthcare
professional. The key goals in this phase of rehabilitation following a neck
injury include, reducing the pain, muscle spasms and other painful symptoms as
well as restoring the body’s original range of motion. While high quality
evidence on the correct management of acute cervical pain is lacking, evidence
supports utilizing a combination of therapeutic treatments, such as
chiropractic adjustments, massage, electrical stimulation, heat for temporal
relief, range of motion exercises and occasional analgesics through the
recommendation of a healthcare professional. The individual should also receive
postural education to ensure there aren’t any compensatory dysfunctions
throughout their body, most commonly among the shoulder and/or the thoracic and
lumbar spine, as a result of the injury.
In the early
management stage, the initial treatment should be carried out with the neck in
a neutral alignment and with the head in a position of eliminated gravity to
reduce any nerve root, disc or facet joint irritation as well as limit the
involvement of overactive muscles. Gentle, range of motion exercises can have
great analgesic benefits and should be practiced as soon as possible to make
sure there’s no aggressive stretching as a result of a muscle spasm, which can
ultimately reduce the stability of the neck. Studies have indicated that among
individuals with neck pain, the fundamental stabilizers surrounding the
cervical spine are inhibited, therefore, these must first be retrained before
proceeding with further rehabilitation procedures.
Deep neck
flexor training programs can begin immediately and utilizes a pressure cuff to
work through progressive pressure increases and holds. Once the individual or
athlete can achieve this, avoiding compensation strategies, the routine should
be performed independently and constantly throughout the day and can then be
progressed to more challenging positions involving increased weight and force.
After
reducing the acute symptoms of neck pain, restoring the mobility and function
of the cervical spine and its surrounding structures are necessary before the individual
or athlete can return to their specific sport or daily lifestyle. If one can
activate and maintain deep neck flexors, the athlete or individual can continue
to the next stage: initial rehabilitation.
Initial Rehabilitation
This stage
of rehabilitation, the initial rehabilitation, is important towards building the
strength of the neck without exposing the muscles to any unnecessary, excessive
forces. Monitoring and screening should be utilized where available to further
assist the programming. Full range of motion and strengthening exercises should
continue throughout this stage.
Most commonly,
when managing joint injuries, isometric strengthening can be recommended but is
often overlooked following many types of neck injuries. Generally, these will
begin in a neutral, gravity-eliminated position and then progresses to standing
followed by sport-specific or daily, challenging positions. For example, in the
winter sliding sport Skeleton, the athlete needs to maintain a certain neck
position in relation to the sled. Also, motorcyclists must maintain a specific
neck position while on a bike, requiring their balance to be challenged
alongside strengthening. Additionally, it’s essential to consider introducing
helmets or headgear at this stage of rehabilitation.
Initial
rehabilitation strength training should begin at a medium volume with low
intensity before being gradually increased in terms of repetition, length of
contraction and sets. Throughout this stage, athletes and individuals should be
monitored for any symptoms, including neck pain and loss of their restored
range of motion and flexibility. During an assessment, particular
considerations should be made to stabilize the torso and minimize lower
extremity involvement in order to ensure a proper strengthening of the neck.
Rehabilitation Progression
During this
stage of rehabilitation, rehabilitation progression, when a full range of
motion has been achieved in the neck, the focus should then progress to
eccentric and concentric neck strengthening exercises. This is frequently an
area which is characterized as a weakness through screening and can therefore
be utilized for performance development as well as a return from injury.
The
individual’s background should be carefully considered before establishing the
correct programming. For instance, rugby players often have significantly more
exposure to neck strength training as compared to a young gymnast returning
from injury.
Strengthening
exercises and therapies within this stage should have a higher volume with
medium intensity and these should be carried out using manual or dynamometry
resistance. Cable machines, such as those found in a gym, may lead to overload
but these can be utilized as a progression. The principles of overload should
be maintained with neck strengthening and gradual improvements can be expected
to occur progressively rather than in sudden spikes in training. This is
considerably important when understanding the anatomy and the need for
stability across many important joints surround the cervical spine.
Once a base
strength has been regained, neck training can begin. With contact sports,
tackle bags can be used to replicate controlled contact. Divers can also return
to low board dives and drivers can follow simulation work. If athletes and
individuals are exposed to external forces, such as G force and vibration, this
may also be replicated as rehabilitation and injury prevention. If the
individual continues to experience no symptoms, their strength can be compared
to baseline measures, they have no change in the function of other structures
of the body, and they’ve participated in controlled, normal training
situations, including additional external forces, then the individual can
continue to the next stage of rehabilitation: return to performance.
Return to Performance
The final stage of the rehabilitation process for neck injuries, return
to performance, combines the strength training the individual or athlete has
been previously practicing but, with an emphasis on the restoration of specific
abilities required for them to return to their specific sport or daily
lifestyle, along with allowing them to regain confidence while having specific
forces being applied against their cervical spine. Integrating unexpected
strengthening loads may be important at this stage of the rehabilitation
process. A previous study indicated that training focusing on the initial
activation of the muscles surrounding the cervical spine can support the
structures against impacts to decrease neck and head injuries caused by
automobile accidents and sports alike. This training mode is frequently practiced
in rugby prior to going into a contested situation, prior to heading into a football
match and also when tumbling in gymnastics. By incorporating training
approaches, such as isometric, isokinetic strengthening, exposure to vibration
and impacts in and out of specific sports activities, individuals have a higher
chance of adapting neural elements resulting in optimal motor skills, muscular
control and coordination.
The return to performance stage of rehabilitation can be utilized with
any injury, including automobile accident injuries. The general programming should
be focused on the athlete or individual while involving the entire team or
group, if any. The individual should be physically and psychologically ready to
return to their daily lifestyles or specific sport with all strength, skill and
confidence issues taken care of to properly reduce their chance of further
injury and increase the individual’s performance on return.
Depending on the severity of the injury, sport and position the athlete
or individual is returning to, the return to performance protocols may vary
greatly from one another. The correct timing of post-injury neck training
should be carefully considered when programming as part of a strengthening
regime. Neck strengthening is known to cause fatigue and strength can be initially
reduced for up to a day. For this reason, heavy neck strengthening training
exercises and therapies followed by the return to performance stage of
rehabilitation protocol should be avoided to reduce the chance of further
injury.
Furthermore, individuals involved in sports with heavier schedules and less recovery
days should consider focusing on heavier neck strengthening in pre or
mid-season breaks to properly benefit from these stages of rehabilitation. This
should also be essential when evaluating the athlete under different levels of
tiredness to ensure they are strong enough to withstand the forces they are
exposed to while competing.
In conclusion, all neck injuries, whether they’re caused as a result of
an automobile accident or due to a sports related injury, should be diagnosed
and treated immediately in order to prevent further injury. Rehabilitation
should progress from regaining the individual’s range of motion and flexibility
as well as strengthening the neck and its surrounding structures, to sports
specific training. A chiropractor also specializes on restoring the individual’s
original condition before a neck injury by carefully adjusting the spine,
primarily the cervical spine in this case, helping to restore mobility and
flexibility as well as decrease the irritation and swelling which could be
causing the painful symptoms. Overall health is important, and after being
involved in an automobile accident or suffering a sport related injury, getting
a proper diagnosis and following through with rehabilitation can help ensure
the athlete or individual heals as quickly as possible.
By Dr. Alex Jimenez