Dr. Kevin Kerchansky 2013-08-23 00:30:37
Guide to Soft Tissue Injuries and Treatment Soft tissue injuries stemming from motor vehicle accidents are one of the most commonly mistreated injuries in clinical practice today. Treatment time frames range from two weeks to two years. Office visits range from twelve to two hundred and twelve. Modalities used vary widely and the timing at which they are used has no consistency between providers. One would think that the severity of the accident would help predict the path that an injured claimant would take; however, I have found that is far from the truth. In the absence of fracture, dislocation and any other significant trauma, most claimants are diagnosed with sprain/strain injuries. In most instances this is accurate and the physiology of these injuries will be detailed a little later. Although the diagnosis is accurate, many practitioners do not employ methods to assess the severity of the sprain/strain. The injured person then gets placed into a system of care that is independent of severity, and never attempts to derive the severity of that injury. Assessing the severity of a rear-end acceleration-deceleration injury to the cervical spine can be complicated. The ligaments, facets and discs may or may not be affected in these sprain/strain diagnoses. When these structures are affected one would anticipate a longer recovery time. If an injured person presents the day after a rear-end collision, they likely have diffuse swelling in the affected area which will create false positives on orthopedic testing. To overcome these potentially false tests that indicate a greater severity of injury, the claimant should be reexamined after the initial phase of care oriented at decreasing pain, inflammation and swelling. This examination should take place approximately two weeks after the onset of treatment. This coincides with the physiological responses that the body is undergoing during the initial phase of repair. A sprain/strain injury begins with an acute inflammatory response marked by swelling, pain, redness and/or warmth. This phase typically lasts up to 72 hours. Blood vessels dilate to facilitate the delivery of healing elements while debris from damaged tissue is removed. Treatment during this timeframe should be focused solely on pain reduction, while minimizing peripheral inflammation and swelling. A repair phase begins around 48 hours after injury and lasts up to six weeks. The remainder of the debris is cleaned out and the body begins to lay down new tissue to replace the damaged tissues. The new tissues are similar to patching up a hole in drywall. The mesh patch is placed on the wall and mud is applied; however, no one sanded the area yet, and the patch is nowhere near the strength of the surrounding drywall. Your body does the same thing. Immature collagen tissues are utilized for repair and they do not have the same tensile strength or orientation as the adjacent fibers. During this phase of care it is important to implement therapies that will assist the body’s physiological processes. In conjunction with manipulation and manual therapies, passive modalities, such as electric stimulation and ultrasound, are warranted in the beginning of this phase. They should be discontinued no later than four weeks after the injury. Treatment should transition to a more active protocol during this phase to continue assisting the body in tissue repair. Therapies such as myofascial release, trigger point therapy, massage therapy, manipulation/mobilization, stretching, active range of motion exercises and lower level spinal stability exercises should be implemented as soon as possible. In other words, the drywall can be sanded down, smoothed out and prepared for painting. The remodeling phase of tissue repair begins around three weeks after the injury, and can last 12 months or more depending on the reference. During this time, the body remodels the new tissue in order to increase functional capacity and withstand the stresses placed upon it. Therapy should coincide with the physiology and be strongly oriented toward active rehabilitation. Spinal stability exercises, core activation, proprioception exercises, active range of motion exercises, and manual therapies (manipulation/mobilization, soft tissue) are necessary during this phase. Just because the body remodels for up to 12 months does not mean that care is required. If a home exercise program is implemented early and updated as the patient goes through an active rehabilitation program, they will be left with the home exercise program to continue their success long after they were released from care. There are always other lifestyle factors such as age, smoking, obesity, systemic illnesses, and treatment compliance that affect the outcomes as well, but the variation should be much more standard. In the many cases I have reviewed, the treatment is far too passive. The research indicates that these passive therapies can feel good for the patient, but provide no therapeutic value once the body is remodeling. When overused they can lead to physician dependency and chronicity of symptoms. An active care program is essential to successfully rehabilitate these sprain/ strain injuries. Dr. Kevin Kerchansky, D.C. is a board certified diplomate to the American Chiropractic Rehabilitation Board and is certified by the American Board of Independent Medical Examiners in the field of chiropractic medicine. He serves as the director of rehabilitation at a multidisciplinary pain management facility in Tempe, Ariz. He lectures nationally on the functional rehabilitation of injuries, and has a history performing records reviews and IME’s in liability and workers’ compensation cases. This includes deposition and trial experience. For more information please contact David Klecka via email at firstname.lastname@example.org or at (602) 282-3346.
Published by Target Market Media . View All Articles.
This page can be found at http://digitaleditions.walsworthprintgroup.com/article/MEDICAL-LEGAL+SUPPORT/1485969/172403/article.html.