AUTO ACCIDENT
8 Reasons Why You Need to See a Chiropractor After an Auto Injury
Over 1 million people are injured in rear-end car crashes each year in the US, and many of these result in some kind of pain. Even a low speed crash can result in abnormal motion of your head and neck, resulting in torn ligaments and muscle tissue.
If you’ve been in a crash, you need to get effective treatment and chiropractic is a proven safe and effective way to recover from all of the most common types of pain experienced after a crash:
1.Early intervention boosts recovery rates – Research shows that the sooner you get treatment after a crash, the better your chances of recovery.
2.High success rate – A 1996 study found that over 90% of whiplash injury patientsimproved with chiropractic care.
3.Headache – The most common symptom after an auto injury and one that chiropractic is very effective at treating.
4.Neck pain – 90% of patients report neck pain after a car accident, and we’re trained to treat this kind of pain.
5.Back pain – Injury to your low back is common during these types of crashes, and chiropractic has been shown to be the most effective way to treat acute or chronic back pain.
6.Dizziness – Many cases of dizziness or vertigo caused by car crashes originate in the neck, and, again, something that chiropractic is perfect for.
7.Radiating pain – This is another common problem we see in our clinic and one that we’ve helped many patients recover from.
8.TMJ pain – Jaw pain is another common symptom we see in our office, and it also oftentimes starts with neck injury from a collision.
Chiropractic works by restoring your body’s natural function and helping your body heal itself without risky drugs or surgery, and it’s the perfect way to recover after something as traumatic as a car crash.
Written by: Michael Melton on October 26, 2015.
Chronic Neck Pain After Auto Injury
Rear-end collisions are very common in our suburbs and cities. Traffic is crowded and unpredictable, and crashes are frequent. The National Transportation Safety Board statistics report that there are roughly 1.7 million rear-end collisions each year, causing 1,700 deaths and 500,000 injuries.
Now a new Canadian study finds that a significant percentage of people injured in these types of crashes end up with some kind of chronic pain.
The report was conducted at the University of Alberta, and it looked at 268 people who had suffered a grade 1 or 2 neck injury from a car crash. These are the least severe kinds of injury, as the scale also includes grade 3 and 4.
The patients were surveyed at 3 months, 6 months, and at 1 year post-injury, and they were asked, “Do you feel that you have recovered from your injuries?”
The above graph shows the percentage of patients who reported pain at the different follow-up surveys. The study found that 1-year after the crash, 18% of patients still reported pain. This confirms what previous research has found. A British research paper from 2009 reported that as many as 5% of patients might have permanently disabled from a crash, and that a significantly more than 5% have nagging symptoms, even 10 years or more after the initial injury.
Previous research shows that the keys to preventing chronic neck pain from a crash is to get early treatment focused on mobilization of the spine.
Ferrari R. A prospective study of the 1-year incidence of fibromyalgia after acute whiplash injury. Rheumatic & Musculoskeletal Disease 2015; doi:10.1136/rmdopen-2014-000007.
Bannister G, Amirfeyz R, Kelley S, Gargan M. Whiplash injury. Journal of Bone and Joint Surgery 2009;91B(7):845-850.
Written by: Michael Melton on October 29, 2015.
Significant Spinal Injury Resulting From Low-level Accelerations: A Case Series of Roller Coaster Injuries
Freeman MD, Croft AC, Nicodemus CN, Centeno CJ, Elkins WL.
Department of Public Health and Preventive Medicine,
Oregon Health Sciences University School of Medicine,
Salem, OR, USA.
drmfreeman@earthlink.net
OBJECTIVES: To describe a cohort of significantly injured roller coaster riders and the likely levels of acceleration at which the injuries occurred, and to compare these data with contemporary efforts to define a lower limit of acceleration below which no significant spinal injury is likely to occur.
DESIGN: A retrospective case series of roller coaster ride-induced significant spinal injuries.
SETTING: Injury incident records and emergency medical service records for the Rattler roller coaster in San Antonio, TX, were evaluated for a 19-month period in 1992 and 1993. Medical records for the more significant injuries were also reviewed and the specific injuries were tabulated, along with the demographics of the cohort.
PARTICIPANTS: There were 932,000 riders of the Rattler roller coaster, estimated to represent between 300,000 and 600,000 individual riders.
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: Injury incident reports and medical record review.
RESULTS: It is estimated that there were a total of 656 neck and back injuries during the study period, and 39 were considered significant by the study inclusion criteria. Seventy-two percent (28/39) of the injured subjects sustained a cervical disk injury; 71% of these injuries were at C5-6 (15 disk herniations, 5 symptomatic disk bulges) and 54% were at C6-7 (11 disk herniations, 4 symptomatic disk bulges). In the lumbar spine, the most frequent injury was a symptomatic disk bulge (20% of the cohort), followed by vertebral body compression fracture (18%), and L4-5 or L5-S1 disk herniation (13%). Accelerometry testing of passengers and train cars indicated a peak of 4.5 to 5g of vertical or axial acceleration and 1.5g of lateral acceleration over approximately 100ms (0.1s) on both.
CONCLUSIONS: The results of this study suggest that there is no established minimum threshold of significant spine injury. The greatest explanation for injury from traumatic loading of the spine is individual susceptibility to injury, an unpredictable variable.
The Cost Effectiveness of Chiropractic Care for Auto Injuries
By: Dr Gary Robertson DC
Automobile accidents are unexpected and unfortunate events that often result in traumatic injuries and create a devastating impact on people and families. The effects of an auto accidents may impact victims lives in a number of ways including increased stress, pain, injuries, medical and financial problems. Treatment may not only becomes difficult, it also can be very expensive. Chiropractic care is considered to be one of the most effective ways to treat auto accident injuries and, in addition to it’s effectiveness, chiropractic treatment is significantly more cost effective.
A number of studies have concluded that chiropractic treatment of accident injuries was more effective than other treatment methods. In addition to the higher success rate, the studies also showed a significant difference of cost incurred in chiropractic and conventional treatments. An analysis of Florida Workers’ Compensation Medical Claims for Back Related Injuries indicates the treatment cost was about 58% lower in case of chiropractic treatment as compared to the other treatment methods. In addition to lower costs, patients disability duration was over 51% shorter for the patients who received chiropractic treatment.
In a cost per case analysis of Utah Industrial Back injury claims in 1988, the average compensation cost paid out to the medical doctors was $668.39 whereas the average compensation cost paid to the patients who got the chiropractic treatment was only $68.38.
In a 1992 Australian study, it was noted that patients receiving chiropractic treatment for their injuries were seen 75% less frequently than those who were treated with medication and other types of medical treatment. Costs of care for patients treated with chiropractic were only 1/4 the cost s of the comparitive medical care.
As illustrated in several studies all over the world, the chiropractic treatment has been consistently found to be the most cost effective treatment with the shorter disability periods of auto accidents victims.
Chronic Spinal Pain: A Randomized Clinical Trial Comparing Medication, Acupuncture, and Spinal Manipulation
Chronic spinal pain: a randomized clinical trial comparing medication, acupuncture, and spinal manipulation.
Giles LG1, Muller R.
Author information
1National Unit for Multidisciplinary Studies of Spinal Pain, The University of Queensland, The Townsville Hospital, Australia. lgiles@austarnet.com.au
Abstract
STUDY DESIGN:
A randomized controlled clinical trial was conducted.
OBJECTIVE:
To compare medication, needle acupuncture, and spinal manipulation for managing chronic (>13 weeks duration) spinal pain because the value of medicinal and popular forms of alternative care for chronic spinal pain syndromes is uncertain.
SUMMARY OF BACKGROUND DATA:
Between February 1999 and October 2001, 115 patients without contraindication for the three treatment regimens were enrolled at the public hospital’s multidisciplinary spinal pain unit.
METHODS:
One of three separate intervention protocols was used: medication, needle acupuncture, or chiropractic spinal manipulation. Patients were assessed before treatment by a sports medical physician for exclusion criteria and by a research assistant using the Oswestry Back Pain Disability Index (Oswestry), the Neck Disability Index (NDI), the Short-Form-36 Health Survey questionnaire (SF-36), visual analog scales (VAS) of pain intensity and ranges of movement. These instruments were administered again at 2, 5, and 9 weeks after the beginning of treatment.
RESULTS:
Randomization proved to be successful. The highest proportion of early (asymptomatic status) recovery was found for manipulation (27.3%), followed by acupuncture (9.4%) and medication (5%). Manipulation achieved the best overall results, with improvements of 50% (P = 0.01) on the Oswestry scale, 38% (P = 0.08) on the NDI, 47% (P < 0.001) on the SF-36, and 50% (P < 0.01) on the VAS for back pain, 38% (P < 0.001) for lumbar standing flexion, 20% (P < 0.001) for lumbar sitting flexion, 25% (P = 0.1) for cervical sitting flexion, and 18% (P = 0.02) for cervical sitting extension. However, on the VAS for neck pain, acupuncture showed a better result than manipulation (50% vs 42%). CONCLUSIONS: The consistency of the results provides, despite some discussed shortcomings of this study, evidence that in patients with chronic spinal pain, manipulation, if not contraindicated, results in greater short-term improvement than acupuncture or medication. However, the data do not strongly support the use of only manipulation, only acupuncture, or only nonsteroidal antiinflammatory drugs for the treatment of chronic spinal pain. The results from this exploratory study need confirmation from future larger studies. The Healing of Injured Soft Tissues
ChiroTrust
In this months issue we’re going to touch on area of patient treatment that has undergone enormous leaps and bounds in our understanding over the last decade. An area I will refer to as “Post-Traumatic Soft Tissue Injury”.
Even with recent breakthroughs in understanding the physiology of repair (and possibly because of these RECENT breakthroughs) there is a considerable amount of misunderstanding regarding soft tissue injury and its repair.
The most common (almost knee-jerk) misconception is that injured soft tissue will heal in a period of time between four and eight weeks.
Frequently it is claimed that injured soft tissues will heal spontaneously, leaving no long-term residual damage, and that treatment is not required. This type of information is extremely misleading and confusing to both doctor and patient alike.
Published articles and books concerning the healing of injured soft tissues (Oakes 1982; Roy and Irving 1983; Kellett 1986; Buckwalter/Woo 1988, Majno 2004) indicate that the time frame for such healing is approximately one year.
Needless to say the difference between a recovery time of 4-8 weeks and 12 months dramatically impacts both clinical practice and expected outcomes.
Healing Takes Place In Three Specific Phases. Soft Tissue Healing Phase #1 Acute Inflammatory Phase.
This phase will last approximately 72 hours. During this phase, after the initial injury, an electrical current is generated at the wound, called the “current of injury.”
This “current of injury” attracts fibroblasts to the wound (Oschman, 2000).
During this phase there is also initial bleeding and continual associated inflammation of the injured tissues. Because of the increasing inflammatory cascade during this period of time, it is not uncommon for the patient to feel worse for each of the first three days following injury.
Because there is disruption of local vascular supplies, there is insufficient availability of substrate (glucose, oxygen, etc.) to produce large enough quantities of ATP energy to initiate collagen protein synthesis to repair the wound.
After 72 hours following injury, the damaged blood vessels have mended. The resulting increased availability of glucose and oxygen elevates local ATP levels and collagen repair begins by the fibroblasts that accumulated during the acute inflammatory phase.
Soft Tissue Healing Phase #2 Phase Of Regeneration
During the regeneration phase the disruption in the injured muscles and ligaments is bridged. Some references call the regeneration phase the phase of repair, which creates confusion about the timing of healing (Jackson, 1977).
“Repair” connotation is that the process has completed, which, as we well see, is not the case. The fibroblasts manufacture and secrete collagen protein glues that bridge the gap in the torn tissues. This phase will last approximately 6-8 weeks (Jackson, 1977).
At the end of 6-8 weeks, the gap in the torn tissues is more than 90% bridged. Many will erroneously claim this to be the end of healing. However, it clearly is not. There is a third and final phase of healing. This phase is called the phase of remodeling.
Soft Tissue Healing Phase #2 Phase Of Remodeling
The phase of remodeling starts near the end of the phase of regeneration. During the phase of remodeling the collagen protein glues that have been laid down for repair are remodeled in the direction of stress and strain.
This means that the fibers in the tissue will become stronger, and will change their orientation from an irregular pattern to a more regular pattern, a pattern more like the original undamaged tissues.
Proper treatment during this remodeling phase is very necessary if the tissues are to get the best end product of healing. It is during this remodeling phase that the tissues regain strength and alignment. Remodeling takes approximately one year after the date of injury.
It is established that remodeling takes place as a direct byproduct of motion. Chiropractic healthcare puts motion into the tissues in an effort at getting them to line up along the directions of stress and strain, thereby giving a stronger, more elastic end product of healing.
stages
Traditional chiropractic joint manipulation healthcare is directed towards putting motion into the periarticular paraphysiological space.
The concept of paraphysiological joint motion was first described by Sandoz in 1976, and is explained well by Kirkalady-Willis 1983 and 1988, by Kirkalady-Willis/Cassidy 1985, and in the 2004 monograph on Neck Pain (edited by Fischgrund) published by the American Academy of Orthopedic Surgeons (see picture).
These discussions clearly show that there is a component of motion that cannot be properly addressed by exercise, massage, etc, and that this component of motion can be properly addressed by osseous joint manipulation.
Therefore, traditional chiropractic osseous joint manipulation adds a unique aspect to the treatment and the remodeling of periarticular soft tissues that have sustained an injury.
There are some problems associated with the healing of injured soft tissues. Microscopic histological studies show that the repaired tissue is different than the original, adjacent, undamaged tissues.
During the initial acute inflammatory phase there is bleeding from the damaged tissues and consequent local inflammation. This progressive bleeding releases increased numbers of fibroblasts into the surrounding tissues.
Chemicals that are released trigger the inflammation response that is noted in cases of trauma. Subsequent to the inflammatory response and to the number of fibrocytes that are released into the tissues, the healing process is really a process of fibrosis.
Fibrosis
In 1975, Stonebrink addresses that the last phase of the pathophysiological response to trauma is tissue fibrosis. Boyd in 1953, Cyriax in 1983, and Majno/Joris in 2004 note that there is tissue fibrosis subsequent to trauma.
This fibrosis of repair subsequent to soft tissue trauma creates problems that can adversely affect the tissues and the patient for years, decades, or even forever.
Fibrosed tissues are functionally different from the adjacent normal tissues. The differences fall into two main categories:
Fibrosis Category 1:
The repaired tissue is weaker and less strong than the undamaged tissues. This is because the diameter of the healing collagen fibers is smaller, and the end product of healing is deficient in the number of crossed linkages within the collagen repair.
Fibrosis Category 2:
The repaired tissue is stiffer or less elastic than the original, undamaged tissues. This is because the healing fibers are not aligned identically to that of the original. Examination range of motion studies will indicate that there are areas of decrease of the normal joint ranges of motion.
In addition, Cyriax notes “fibrous tissue is capable of maintaining an inflammatory response long after the initial cause has ceased to operate.”
Since inflammation alters the thresholds of the nociceptive afferent system, physical examinations in these cases will show these fibrotic areas display increased sensitivity, and digital pressure may show hypertonicity and spasm.
This increased sensitivity can be documented with the use of an algometer, which is a device that uses pressure to determine the initiating threshold of pain.
Because the fibrotic residuals have rendered the tissues weaker, less elastic, and more sensitive, the patient will have a history of flare-ups of pain and/or spasm at times of increased use or stress.
These episodes of pain and/or spasm at times of increased use or stress of the once damaged soft tissues is the rule rather than the exception, and a problem that the patient will have to learn to live with.
It is likely that the patient will continue to have episodes of pain and/or spasm for an indefinite period of time in the future. It is probable that the patient will have a need for continuing care subsequent to these episodes of pain and/or spasm.
Consistent with these concepts, a study by Hodgson in 1989 indicated that…
62% of those injured in automobile accidents still have significant symptoms caused by the accident 12 1/2 years after being injured; and that of the symptomatic 62%, 62.5% had to permanently alter their work activities and 44% had to permanently alter their leisure activities in order to avoid exacerbation of symptoms.
One of the conclusions of the article is that these long-term residuals were most likely the result of post-traumatic alterations in the once damaged tissues.
A study by Gargan in 1990 indicated that…
Only 12% of those sustaining a soft tissue neck injury had achieved a complete recovery more than ten years after the date of the accident.
One of the conclusions of this study is that the patient’s symptoms would not improve after a period of two years following the injury.
It is established neurologically (Wyke 1985, Kirkalady-Willis and Cassidy 1985) that when a chiropractor adjusts (specific directional spinal manipulation) the joints of the region of pain and/or spasm, that there is a depolarization of the mechanoreceptors that are located in the facet joint capsular ligaments, and that the cycle of pain and/or spasm can be neurologically aborted. This is why many patients feel better after they receive specific joint manipulation from a chiropractor following an episode of increased pain and/or spasm.
What Is The Basis For The Chronic Post-Trauma Pain Syndromes So Many Patients Suffer From?
A good explanation is found from Gunn (1978, 1980, 1989). He refers to this type of pain as supersensitivity.
The supersensitivity type pain is a residual of the scarring or the fibrosis that was created by the injuries sustained in this accident.
The treatment that we give to the patient for the injuries sustained in an accident is really not designed to heal the sprain or strain but rather, to change the fibrotic nature of the reparative process that has left the patient with residuals that are weaker, stiffer, and more sore.
The actual diagnosis for this type of problem is initial sprain/strain injuries of the paraspinal soft tissues with fibrotic residuals subsequent to the fibrosis of repair of once damaged soft tissues that have left these tissues weaker, stiffer, and more sensitive as compared to the original tissues.
The majority of our efforts in the treatment of post-traumatic chronic pain syndrome patients is in dealing with the residual fibrosis of repair and its associated mechanical and neurological consequences.
These residuals to some degree are most probably permanent. The patient will have to learn to deal with the long-term residuals and the occasional episodes of pain and/or spasm.
However, as noted above, occasional specific joint manipulation in the involved areas can neurologically inhibit muscle tone, improve ranges of motion, disperse accumulated inflammatory exudates, and the patient will have less pain and improved function.
The concepts briefly discussed above are frequently not understood or appreciated. There is a tendency for healthcare providers to not properly examine the patient in order to document these regions of tissue fibrosis and its consequent mechanical and neurological consequences and, therefore, to quote Stonebrink, the real problem is missed.
ranges
References:
Boyd, William, M.D., Pathology, Lea & Febiger, (1952).
Cyriax, James, M.D., Orthopaedic Medicine, Diagnosis of Soft Tissue Lesions, Bailliere Tindall, Vol. 1, (1982).
Fischgrund, Jeffrey S, Neck Pain, monograph 27, American Academy of Orthopaedic Surgeons, 2004.
Gargan, MF, Bannister, GC, Long-Term Prognosis of Soft-Tissue Injuries of the Neck, Journal of Bone and Joint Surgery, September, 1990.
Gunn, C. Chan, Pain, Acupuncture & Related Subjects, C. Chan Gunn,
(1985).
Gunn, C. Chan, Treating Myofascial Pain: Intramuscular Stimulation (IMS) for Myofascial Pain Syndromes of Neuropathic Origin, University of Washington, 1989.
Hodgson, S.P. and Grundy, M., Whiplash Injuries: Their Long-term Prognosis and Its Relationship to Compensation, Neuro-Orthopedics, (1989), 7.88-91.
Kellett, John, “Acute soft tissue injuries-a review of the literature,” Medicine and Science of Sports and Exercise, American College of Sports Medicine, Vol. 18 No.5, (1986), pp 489-500.
Kirkaldy-Willis, W.H., M.D., Managing Low Back Pain, Churchill Livingston, (1983 & 1988).
Kirkaldy-Willis, W.H., M.D., & Cassidy, J.D.,”Spinal Manipulation in the Treatment of Low-Back Pain,” Can Fam Physician, (1985), 31:535-40.
Majno, Guido and Joris, Isabelle, Cells, Tissues, and Disease: Principles of General Pathology, Oxford University Press, 2004.
Oakes BW. Acute soft tissue injuries. Australian Family Physician. 1982; 10 (7): 3-16.
Oschman, James L, Energy Medicine: The Scientific Basis, Churchill Livingstone, 2000.
Roy, Steven, M.D., and Irvin, Richard, Sports Medicine: Prevention, Evaluation, Management, and Rehabilitation, Prentice-Hall, Inc. (1983).
Stonebrink, R.D., D.C., “Physiotherapy Guidelines for the Chiropractic Profession,” ACA Journal of Chiropractic, (June1975), Vol. IX, p.65-75.
Wyke, B.D., Articular neurology and manipulative therapy, Aspects of Manipulative Therapy, Churchill Livingstone, 1980, pp.72-77.
Woo, Savio L.-Y.,(ed.), Injury and Repair of the Musculoskeletal Soft Tissues, American Academy of Orthopaedic Surgeons,(1988), p.18-21; 106-117; 151-7; 199-200; 245-6; 300-19; 436-7; 451-2; 474-6.
chiro-trust.org
After My Car Accident, Why Do I Hurt So Much?
ChiroTrust
There are many different reasons why injuries sustained in car crashes result in chronic or long-term pain. First, there are several types of tissues in the neck that can give rise to pain. The most intense pain comes from the tissues with the greatest density of nerve fibers, such as the joint capsules and the ligaments holding the bones of the neck together. There are many ligaments in the neck that are vulnerable to being over-stretched and injured in a motor vehicle collision.
The mechanism of a “whiplash” injury in a rear-end collision is unique. Upon impact, the vehicle rapidly accelerates forward while the head momentarily remains in its original position, resulting in an initial straightening of the neck followed by extension. At the extreme end-range of backward extension motion, the ligaments in the front of the neck are over-stretched and can tear. Within milliseconds, the head is then propelled forwards into flexion which can then injure the ligaments in the back of the neck placing a significant amount of force on the joint capsules and ligaments holding the bones in close proximity. Another reason the neck is injured is the speed at which the head and neck “whip” in the backwards and forwards directions after the impact. This occurs faster than what we can voluntarily contract our neck muscles to resist–within 600 milliseconds! Therefore, even if we brace ourselves in preparation for an impact, we can’t avoid injury to the ligaments and joint capsules. Damage to the ligaments is difficult to “prove” by conventional x-ray, which is why bending views or, flexion/extension x-ray methods are needed. When there is damage to the ligaments, the vertebra will shift forwards or backwards excessively compared to neighboring vertebra. This can be measured to determine the extent of ligament laxity or damage and can help explain why neck pain can be so intense and/or chronic following an automobile collision. Not all car accidents occur from behind. In fact, only about 1/3 occur from this direction. One study investigated which direction created greater degrees of injury and found 57% of chronic pain patients in the study population were involved in rear-end collisions. The study also found that woman are more at-risk than men for whiplash injuries and that frontal and rear-end collisions resulted in significantly higher levels of ligament injury than side impacts
Another well-published reason why neck pain can “hurt so much” after a car crash is that the sensory input from the injured area to the brain can be so extreme that it leaves an “imprint” in the sensory portion of the nervous system and it becomes hypersensitive or sensitized, resulting in a lower pain threshold or being more sensitive to pain. This is similar to the “phantom limb” phenomenon that often occurs after a leg is amputated where the brain still “feels” leg pain after the limb has been removed. This has also been reported to be a reason for the significant constellation of symptoms often accompanying “whiplash” injuries. A partial list of symptoms associated with whiplash injuries includes neck pain, headache, TMJ / jaw pain, dizziness, coordination loss, memory loss, and cognitive difficulty in formulating thought, communicating, and losing your place during conversation.
Understanding whiplash and all of its nuances regarding signs and symptoms, x-ray requirements and measurement techniques, and treatment / management strategies are well understood by doctors of chiropractic. Chiropractors have a unique advantage over other healthcare providers as manual therapies, including spinal manipulation, have been shown to yield higher levels of satisfaction and faster recovery rates compared with other forms of healthcare.
How A Simple Bump Can Cause An Insidious Brain Injury
By Daniel Zwerdling
It’s not just football players or troops who fought in the wars who suffer from brain injuries. Researchers estimate that hundreds of thousands of ordinary people in the U.S. get potentially serious brain injuries every year, too. Yet they and even their doctors often don’t know it.
One such doctor is Bryan Arling, an internist in Washington, D.C. His peers often vote to put him on those lists of “top doctors,” published by glossy magazines.
So it’s ironic that the brain injury he failed to diagnose was his own. And he could have died from it.
Last spring, Arling went looking for some files in his walk-up attic. It was jammed with boxes of Christmas tree ornaments, old clothes and other odds and ends that define decades of family life. After an hour of searching, he found the files in a box, grabbed the folders and stood up. He then felt a shooting pain in the center of his back.
“It’s a pain I’ve had before,” says Arling, who has battled back problems for years. “But it was more intense than I’ve ever had it before.”
He took painkillers and went back to work. Weeks went by, and his back was still hurting him.
“Then I began noticing that I was shuffling. I was so weak I couldn’t carry my plate out to the back deck. I would just drop things. And everybody commented on how I seemed different,” he says.
And gradually, Arling says, his thinking seemed different, too.
“I could make sense of things, I could get things done, I could make decisions,” he says. “But I was slower at what I did.”
Arling thought he was having trouble focusing because his back pain was so intense. So a neurosurgeon, who had treated Arling’s back problems before, ordered an MRI of Arling’s spine — and also his brain. When the MRI technician saw Arling’s pictures taking shape on his screen, he called the radiologist and said, “You need to see this right away.”
The images showed a big, white, lake-like shape where Arling’s brain should have been, inside the top right side of his skull. It was a pool of blood that was pushing down on the brain, causing it to shift from right to left.
An MRI scan shows Bryan Arling’s brain from above. The white-looking fluid is a subdural hematoma, or a collection of blood, that pushed part of his brain away from the skull, causing headaches and slowing his decision-making.
An MRI scan shows Bryan Arling’s brain from above. The white-looking fluid is a subdural hematoma, or a collection of blood, that pushed part of his brain away from the skull, causing headaches and slowing his decision-making.
Courtesy of Dr. Ingrid Ott, Washington Radiology Associates
They sent Arling straight from the MRI to the emergency room at MedStar Georgetown University Hospital. He says as they started prepping him for open brain surgery, the medical staff kept asking about his fall.
“And I said, ‘I haven’t fallen,’ ” Arling says.
Then, just as they were wheeling him into the operating room, Arling remembered: The day he stood up in the attic and threw out his back, he had forgotten he was under the eaves, and had knocked the top of his head against a wood beam. But he didn’t even get a cut, so he forgot about it.
Everybody knows you can get hurt if you fall off a ladder, or slip and bash your head on the ice. But Arling got a kind of brain injury that’s usually more insidious — a subdural hematoma.
A subdural hematoma is different from the typical blast injuries that affected hundreds of thousands of U.S. troops in Iraq and Afghanistan. In those cases, shock waves rattled their brains and caused microscopic damage that’s hard or impossible to detect. It’s also different from the usual football concussions, in which blows to the head damage the brain’s electrical wiring.
The main population at risk for a subdural hematoma is the elderly. To understand why, it helps to picture an aging brain. The brain is wrapped and protected by a membrane called the dura mater. Inside the dura, there’s a network of veins that connect it to the surface of the brain.
How To Detect A Possible Injury
Brain specialists say you should see a doctor if you develop these symptoms:
A headache, even a low-grade headache, that doesn’t go away
Weakness in the legs or arms
Any cognitive changes: You feel, or people say you seem, “different.”
Studies suggest that as you get older, your brain shrinks and pulls away from the dura, especially after you’re 60 or 70 years old. But the veins keep holding on to both the dura and the brain. So as your brain pulls away, some of those veins become more exposed and more vulnerable.
Researchers say if you simply bump your head on the eaves of your attic, as Arling did, or if you simply start to fall and then catch yourself — so your head doesn’t strike anything, but it jerks in the air — that can be enough force to jostle your shrinking brain.
“And those veins stretch, and you’ll get tearing in those veins,” says Dr. David Cifu, who runs a joint research project studying brain injuries for the departments of Defense and Veterans Affairs.
And because blood from veins tends to ooze, instead of pump as it does from arteries, Cifu says, “when the veins tear, we get a very low-pressure ribbon of blood that’s layering on top of the surface of the brain.”
As that blood starts to pool over days or weeks, it irritates the brain cells. And if the pool’s big enough, it presses on the brain and damages it, much like a tumor.
Researchers studied the problem a few years ago at a sample of 20 percent of the nation’s hospitals. As they reported in the Journal of Neurosurgery, those hospitals alone diagnosed almost 44,000 subdural hematomas in one year. So the researchers estimate there could be more than 200,000 subdural hematoma injuries diagnosed annually at all the hospitals across the country.
They say an unknown additional number of subdural hematomas are misdiagnosed, or simply missed: Half the patients studied have trouble remembering they hit their heads at all.
Like Arling. And like Tom Feild, a retired computer systems analyst who used to work for the VA.
Feild says his own medical mystery began with headaches.
Tom Feild looks at a brain scan with his doctor at Virginia Commonwealth University Medical Center in Richmond, Va. Feild had brain surgery after experiencing a low-grade headache that wouldn’t go away and difficulty driving.
Tom Feild looks at a brain scan with his doctor at Virginia Commonwealth University Medical Center in Richmond, Va. Feild had brain surgery after experiencing a low-grade headache that wouldn’t go away and difficulty driving.
Matailong Du for NPR
“It wasn’t a constant headache — it was a low-grade headache. But it wouldn’t go away,” he says.
Then he was driving his wife on an errand, and he kept drifting across the yellow line.
“I said, ‘Tom, you’re going on their side of the road.’ He said, ‘I know … I can’t seem to help it,’ ” Jody Feild says.
Tom Feild made an appointment with his local doctor. And the next thing he knew, a helicopter was rushing him to Virginia Commonwealth University Medical Center in Richmond. Neurosurgeon Bill Broaddus drilled three holes into Feild’s skull and vacuumed out roughly 8 ounces of blood that had pooled since he developed a subdural hematoma.
Broaddus says before the surgery, he asked Feild what type of accident had injured his head. It took awhile before Feild could remember. He had put a sprinkler away under his porch two months earlier and bumped his head against the floorboards when he stood up before backing out all the way.
“We may see 50 to 100 [similar subdural hematomas] here at this institution every year,” says Broaddus.
Brain specialists say it’s important to view these injuries in perspective: Most people who get a subdural hematoma will never know it. The brain will reabsorb the blood, the victim’s symptoms will disappear, and life will go on as normal. But for tens of thousands of others, it’s serious. Doctors say they often see families who think loved ones are getting dementia, and it turns out they hit their heads and have a bleed. Some victims die.
Researchers like Cifu say you don’t need to consult a doctor the second you get a headache. But they say it’s sensible, and responsible, to follow some simple guidelines: Consult a physician as soon as possible if the headaches don’t go away, or if you begin to have trouble with your balance or feel weakness in your legs or arms. Also, if the way you think starts to seem “different,” Cifu says.
Internist Arling says even if it turns out that you do have a bleed, he’s living proof that these brain injuries can be cured if you catch them in time.
“It’s so easy to come away from a story like mine, and to feel fragile, and so to worry unnecessarily,” Arling says. “The body is phenomenally well-designed, and it has a phenomenal ability to heal itself.”