Crash Course: Physical Therapy after a Motor Vehicle Accident

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Statistically speaking, every person traveling in a motorized vehicle will be in an accident at one point in their lifetime. On average, there are more than 6 million car accidents on the roads annually (1). According to the 2015 census, there are approximately 2.4 million people in the Portland region (2). That is a lot of impending injury! Post-accident care for non-fatal crash injuries can range from a same day ER visit to a primary care physician visit a week later with medications, Xrays or MRIs frequently prescribed. This initial medical care to rule out red flags is important especially considering advanced age, high speed collision, paresthesias or numbness/tingling, and if mobility is extensively limited. Though, this is often the end point of treatment for most individuals and they are left to guide their own care. Typically, massage and chiropractic treatment is the duo of care accessed, yet more and more people are realizing that there is something missing in their recovery and that is the restoration and rehabilitation of functional strength that was lost after the accident. Without functional strength retraining under the guidance and expertise of a physical therapist, healing can be severely delayed and result in, among other issues, loss of job attendance and revenue. In 2010, motor vehicle crashes in the United States equated to almost $1 trillion in productivity loss (3). Yet, a lot of physicians do not prescribe physical therapy, especially for the “minor injuries” with little to no pain at all.

depositphotos_36839587_originalSay what?

You might be surprised to have just read that I suggested physical therapy for “no pain at all” after a motor vehicle accident. Pain is a peculiar thing. Initial pain from an injury can be present or not depending on inflammatory processes ignited, pain processing per individual, and sometimes severity of injury. I am eluding to the idea that the absence of pain does not equate to non-injury. There is research that demonstrates decline in muscle activity post MVA resulting in diminished muscle bulk over time and this almost always leads to significant dysfunction and pain down the road with additional loss of productivity at work, participation in recreational activities, and altered daily lifestyle. In the neck, for example, post MVA MRI assessments of injury to the cervical spine in relatively “injury-free” individuals revealed swelling in the major deep cervical flexor muscle (4). Swelling within a muscle renders it dysfunctional and muscles so close to the spine have basically ZERO leverage to be able to just “come back on their own” with daily movement and typical exercise approach. The longus colli muscle is responsible for supporting the neck the way the abdominal core supports the trunk. It provides crucial stability for the cervical spine to disallow shearing forces with the day to day insults, let alone more aggressive endeavors in recreation like running, soccer, crossfit, and yoga, to name a few.

 

086-cartoon-businessman-shoulder-debt-boxBaby Bye, Bye, Bye.

Without proper rehabilitation of these deep neck flexors and core musculature, they will remain inhibited and atrophy as a result. Say goodbye to these deep, small, essential muscles and prepare to welcome the beast that is pain. Or…. seek the care that you need. An orthopedic physical therapist is trained to screen for red flags that would prevent one from being able to participate in a rehab program at that current time and help get you the right care. They will examine the pathoanatomical causes of symptoms and are uniquely trained to tease out the impairments and dysfunctions from the crypt! The sooner one seeks treatment, the less underlying dysfunctions that set in and cultivate. This equates to less down time from life, less $USD spent on playing catch up in care, and happier, pain-free people in the long run. If you have or know someone who has had a motor vehicle accident, we at Therapydia would be happy to help with an assessment and treatment as needed. Give us a call or email us to get started.

 

 

 

 

  1. http://www.lawcore.com/car-accident/statistics.html
  2. http://www.oregonmetro.gov/news/portland-region-nears-24-million-residents-growing-41000-last-year
  1. http://www.rmiia.org/auto/traffic_safety/Cost_of_crashes.asp
  2. Deepak Takhtani, Eduardo Scortegagna, Oguz Cataltepe and Sathish Dundamadappa. MRI Findings of Injury to the Longus Colli Muscle in Patients With Neck Trauma. Neuroradiology/Head and Neck Imaging, August 2016, Volume 207, Number 2.

Telemedicine: Case Study

Therapydia TelemedicineWhat is Telemedicine?

With the advancement of technology coupled with the limitations that physical therapy health care providers are encountering via insurance limitations telemedicine allows patients immediate access, near and far, to get specific health care advice, prescriptions of movement and consultations which could prevent unnecessary diagnostic tests and measures.

As our health care world continues to change I am excited to be part of the Telemedicine movement.

In the past month we had a patient encounter that we felt we important to share for a couple reasons:

  • This case specifically highlights the difficulties that normal people go through when dealing with our current medical model and all the practitioners one may encounter.
  • It also highlights how when patient cases are dealt with properly someone can get more effective treatment regardless of whether someone is local or thousands of miles away.
  • With proper resources and communication people can receive physical therapy via telemedicine and it can be very effective

To protect the patient’s confidentiality names have been omitted, substituted with initials.  DW has agreed for me to post this case and she hopes that it will provide some insight to our Telemedicine process and how it has helped her.

A few weeks ago I received a Facebook message from an old college friend asking if I knew anything about a “rare” diagnosis named “idiopathic lumbosacral radiculoplexus neuropathy”.  Turns out his mother, who lives on the other side of the country, had been diagnosed with this over a year ago and was frustrated with her progressive worsening.  I told him that I had seen thousands of patients with idiopathic back pain that also had some sort of radicular symptoms down the extremities.  In layman terms idiopathic means unknown cause, lumbosacral defines the lower back and pelvic tailbone region, radiculoplexus neuropathy basically is an irritation or inflammation of the nerve bundles that exit from the spine.  It is important to note my friend’s mother, until acquiring this diagnosis was a normal active nurse and after dealing with this diagnosis she had now lost the ability to walk independently or perform many of her prior activities of daily living. I received multiple emails from the son and daughter of the patient, which gave me some insight on the patient’s medical history and timeline of diagnostic tests.  Now through these emails I had found out that over the past year DW had been to multiple doctors, multiple specialists, undergone 7 MRIs, 2 X-rays, formal physical therapy and various prescription medications to help her symptoms without any definitive plan or answers to why she had acquired this “idiopathic diagnosis” or more importantly what to do from today moving forward.

After reviewing the medical notes I set up our first Telemedicine appointment, which was just like any normal evaluation we perform here in our clinic.  Per the patient’s request DW had her daughter present on the video conference as to be an assistant just in case DW would need help with any mobility testing and/or we had technologic difficulties. Normal subjective examination was performed, objective testing, and special tests in order to determine an action plan.  In the hour appointment we spoke of DW’s diagnosis, and I came up with a physical therapy assessment of her orthopedic limitations and her functional impairments.  In addition I gave her some mobility exercises to start on that day that she could perform independently and some exercises that her daughter would assist with.

It is important to note here that in just this first appointment DW and her daughter mentioned that they received more from me in the initial evaluation that they had in the past 6 months. How does this happen?! How can one person see that many doctors, specialists and participate in formal physical therapy without some sort of education, evaluation and proper action plan to address this patient’s needs and goals.

Our next appointment was 1 week later however I told DW and her daughter that we were always available via phone, email, or Facebook messenger if they needed to contact us prior to our next appointment.

The next appointment we learned and witnessed some pretty amazing things. She had gained more mobility in her leg than she had in previous months.  She also mentioned feeling more sensation in her leg something that had been absent for quite some time.  Her mobility was starting to return but her strength and endurance for maintaining these new positions was very poor.  At this appointment she was given a progression from her day one exercises and we planned on meeting in another week.  The next goal would be to stand and be able to shift her weight from one leg to the other.

Next appointment was two weeks later and once again more good news. DW was bearing more weight through her legs with less assistance with her arms on the assistive walker she had been using to stand.  Even better news was that DW felt her muscles in her legs working, something she hadn’t felt in months.  Her ability to transfer from chair to wheelchair, wheelchair to bed, bed to sitting and sitting to standing all improved.  Her strength and endurance were slowly improving but more importantly DW had new hope.  She was seeing progress herself.

Now DW and her daughter were given more exercises to perform daily and DW was instructed that returning to a local physical therapist was the next recommended intervention.  Going to a local physical therapist that understood DW’s needs, goals and progression was crucial to her continued recovery.  In order to assure DW’s transition our office called local physical therapists near to DW, explained to the therapists what we had accomplished in just a few visits & recommended our physical therapy assessment and plan of action and collaborated with DW what she would have to do moving forward from here on out.

I’m happy to say that DW had her first physical therapy appointment this week and I received some good feedback from her regarding her first visit.  I plan to follow up with a video conference in the beginning of next year to see how far she has come with her functional mobility and if she is closer to her goal of being able to walk again…

Tips to stay healthy during the holiday season…

Be active, happy and healthy

As the weather is changing and the end of the year quickly approaches there are many of us that are experiencing the holiday work parties, the friendsgiving gatherings, and the eventual holiday hustle to travel, eat, drink and be merry.

With all these increases in tasks and relative decreases in time to complete the parties, shopping and last minute meetings stress is bound to increase.  Statistically the last quarter of the year is when hospitals see a large increase in admissions.  This has been attributed to heart attacks, strokes, and car accidents mostly stress related.  Managing stress through proper planning can prevent these health issues and potential accidents.

Thankfully we only have a few weeks left of 2014 to get through this stressful quarter however here are some gems from the Center of Disease Control and Prevention to use while we close out this year.

Wash your hands to avoid getting a cold of flu

If you haven’t done so already, consider getting a flu shot

Balance your day with work, home, play and rest

Plan properly for those holiday travels

If you are more musically inclined here is The CDC Holiday song on the 12 ways to Health.

Another component to be mindful of is Vitamin D intake.  Living in Oregon most physicians recommend taking Vitamin D supplement due to the lack of Sunshine that the population receives.  In the past 10 years technologic advances have pushed people to spend more time indoors on computers, watching television or spending time on our tablets.  During the winter as temperatures drop and holiday season demands increase people spend less time outside, therefore Vitamin D intake is sparse. This leads to increased reports of depression possibly due to seasonal affect disorder and/or people who may not have friends or family to celebrate the holidays.  This article highlights some good information regarding Vitamin D, SAD and depression.

Lessons to be learned, plan ahead this holiday season, aim to properly balance work, home, play and rest, and get outside and enjoy being active!

Being Thankful

Giving Thanks

I work very hard, and I play very hard. I’m grateful for life.

And I live it – I believe life loves the liver of it.

I live it.

Maya Angelou

 

             As the holiday season approaches there are many things to be thankful for.  I am thankful for my wife, my daughter, my family and my friends.  I am thankful for my health and my ability to help people everyday.  Regardless if you celebrate the Thanksgiving holiday, this time of year presents opportunities to spend time with friends, family, and loved ones.  As a physical therapist and human mechanic my patients constantly remind me to be grateful everyday… my encounters with each person usually consists of painful histories, complex injuries, and devastating changes in lifestyles.  I am blessed to have the ability to actively listen to people’s stories, to objectively change someone’s mobility, to assess and prescribe proper movements in order to return people to pain free function.  I have a job where I am welcomed into people’s lives … and I am given the chance to positively affect their lifestyles.

            I’ve had the opportunity to work with 4-week-old twin babies who were diagnosed with functional torticollis, and a 102-year-old patient who told me his only wish was to be able to attend his great grandchild’s wedding. I have worked with thousands of high school athletes who dream of being the next big superstar, and I have worked with many professional athletes whose drive is to get back to work so that they can keep inspiring the youth.  I have worked with many sick patients with terminal illnesses but yet they still find inspiration within themselves to keep trying, to keep moving.  I have helped many military and first responders to eliminate aches and pains from their daily routines or to recover from traumatic surgeries. I have worked with numerous weekend warriors who struggle with the battle to find a balance between work, family and recreation.  I am thankful for all of my patients, past, present and future.  They are part of who I am and who I want to be.  I am thankful that I have a job I love and that I have a support system that believes in me.  Happy Thanksgiving from Therapydia Portland and I hope you all have a safe and healthy end to 2014.

Why Physical Therapy?

This video from the American Physical Therapy Association helps illustrate just how physical therapy works and why it can benefit a range of physiological issues — from joint pain and sore muscles to sports injuries and even “preventive” measure to avoid surgery. With physical therapy, you don’t have to end up on the operating table.

One of the key differences between physical therapy and, say, visiting the chiropractor, is that physical therapy tends to be less intense. We tend to use less invasive methods to increase your range of motion and flexibility. We’re also a cheerleader for progress that’s with you every step of the way.