|
 At Peninsula Spine & Sports Rehaibilitation in San Mateo, California, Dr. Rommel Hindocha treats injuries or conditions associated with auto accidents, car accidents, motorcycle accidents, slip and falls, work related injuries, injuries under the California workers compensation system also known as on the job injuries. Typical conditions are: acute and chronic pain, soft tissue injuries, neck and back pain, tingling in the arms or legs, sciatica, disc bulges, disc injuries or herniations, mid back pain, pain between the shoulder blades, whiplash, headaches and migraines. Dr. Hindocha has treated patients working or living in: San Mateo, San Francisco, Daly City, Colma, San Bruno, South San Francisco, Brisbane, Millbrae, Burlingame, Belmont, Redwood City, Foster City, Redwood Shores, San Carlos, Menlo Park, Palo Alto, Sunnyvale, Santa Clara, Mountain View and San Jose.
It is not uncommon for people who have been involved in car accidents to not feel pain immediately. Patients who report no pain, mild pain, "stiffness" or "tension" immediately following an accident is not uncommon. There may be several reasons for that: they may be more concerned about a passenger, family member or child in their car other than themselves. They may have an "Adrenaline" rush in which the body secretes Adrenaline in a "fight or flight response". They may feel confused, dizzy, lethargic or have ringing in the ears which are common symptoms of a concussion. Symptoms can take as little as hours or as long as years to manifest with the most common symptoms occurring within 24-48 hours. If you have been involved in a motor vehicle, car or auto accident, get checked up by a qualified Doctor and monitor your symptoms closely.
While diagnosing these conditions that occur post traumatically (or after an auto accident) is vitally important, your prognosis (your short and long term recovery) is determined in part by several Biomechanical factors. The types of vehicles involved, the speed of the impact, which vehicles were stationary, secondary impacts, deployment of airbags, occupants (drive or passenger) position in the vehicle, which way your head was turned, was the foot on the brake, did you brace or "expect" the impact, did you hit anything in the vehicle, did the seat back brake, etc. If your Doctor is not asking you these and many other important questions, they may not know the extent of the injury or the possible long term effects. Dr. Rommel Hindocha has attended several continuing education training seminars on Biomechanics of Motor Vehicle Injuries, Radiology and Diagnostic Imaging of Traumic Spine injuries and a special event featuring Dr. Arthur C. Croft, DC, MS, MPH, FACO one of the foremost authorities on Whiplash Disorders.
Anatomy of the Back
The 'back' is divided into:
1.) Cervical Spine (the neck) - The cervical spine starts at C1, the vertebrae which is located directly under your skull. There are 7 cervical vertebrae in most people. Symptoms in the neck can refer pain into the shoulders, into the mid-back, into the arms. Nerve irritation from the cervical spine can cause radiating pain, numbness or tingling into the shoulders, arms and/or fingers. Usually, this is in a very specific pattern.
2.) Thoracic Spine (the midback) - There are 12 Thoracic vertebrae in most people. The most common area's affected are thoracic ribs or between the shoulder blades (interscapular pain).
 3.) Lumbar Spine (the low back) - There are 5 lumbar vertebrae in most people. Symptoms in the low back can refer into the flanks, the groin, the hips or into the legs. Nerve irritation from the low back can cause radiating pain, numbness or tingling into the legs, thighs, calves and/or toes. Again, this is usually in a very specific pattern. This is commonly known as Sciatica.
4.) Sacrum and Pelvis (tailbone and hips) - The Sacrum is also known as the tailbone and consists of usually five unfused vertebrae which begin to fuse between ages 16-18 and are usually completely fused into a single bone by age 26. The Pelvic bones are located on either side of the Sacrum. The joint between the Sacrum and the Pelvic bones is called the Sacroiliac joint.
Intervertebral discs are found between each vertebra. The discs are flat, round structures about a quarter to three quarters of an inch thick with tough outer rings of tissue called the annulus fibrosis that contain a soft, white, jelly-like center called the nucleus pulposus. Flat, circular plates of cartilage connect to the vertebrae above and below each disc. Intervertebral discs separate the vertebrae, but they act as shock absorbers for the spine. They compress when weight is put on them and spring back when the weight is removed.
Joints between the bones in our spine are what allow us to bend backward and forward and twist and turn. The facet joints are a particular joint between each vertebral body that help with twisting motions and rotation of the spine. The face joints are part of the posterior elements of each vertebra. Each vertebra has facet joints that connect it with the vertebrae above and the vertebrae below in the spinal column. The surfaces of the facet joints are covered with smooth cartilage that help these parts of the vertebral bodies glide smoothly on each other.
There are five 5 muscle layers surrounding the spine which are the multifidi, rotators, erector spinae, iliocostalis, and quadratus lumborum. These muscles work synergistically to move and support the spine. Although bending forward at the waist doesn't look all that complicated, it is a highly complex sequence of events: the central nervous system (brain and spinal cord) coordinate the precise intensity and timing of contraction of each muscle group to make the spine move as intended.Other soft tissue structures involve ligaments, which restrict and control joint motion, tendons which attach muscle to bone, and joint capsules which surround joints and adding further stability and containing the lubricant, synovial fluid.
The following conditions are associated with auto or car accident and work related injuries:
Whiplash
 Whiplash symptoms are the most common injuries following car accidents. Whiplash, also known as: neck pain, soft tissue injury, "MIST" (Minor Impact Soft Tissue) injury, cervical muscle strain or ligament sprain, muscle pain or cervical spine injury. Whiplash can also be termed a "syndrome" due to its frequent involvement with headaches, shoulder pain and interscapular (between the shoulder blades) pain. It is important to know that whiplash can occur from even low velocity collisions. The reason is that the kinetic energy (force) of a car is very high, even at five miles per hour, due to the large mass of the car. This energy is transferred to the occupants (passengers) of the vehicle and is actually more violent if the cars do not deform (dent), which is often the case in low impact collisions. Therefore, even if you were in a low-impact accident that was enough to cause a whiplash effect, It is advisable to get checked to make sure problems don’t develop later on.
As stated previously, whiplash can effect the cervical spine (vertebrae) causing injury to the intervertebral discs which can cause radiating pain, tingling, numbness or pins and needles into the arm, hand or fingers, facet and uncinate joints causing local neck or shoulder pain, the muscles attaching to the neck and midback such as the: trapezius, scalenes, sternocleidomastoid, levator scapulae, interscapular, rhomboid or paravertebral causing trigger points or referred symptoms into the arms. Damage to the Scalene muscles, presence of a "first rib" in the cervical spine or irritation of the collar bone can cause a condition called Thoracic Outlet Syndrome (TOS). Symptoms of TOS can be surprisingly similar to other conditions such as: cervical nerve irritation, cervical disc bulging or herniation. It is important to correctly diagnose the cause of the symptoms because the treatment options may be vastly different.
Other Whiplash Symptoms:
 • Blurred vision
• Difficulty swallowing
• Irritability
• Fatigue
• Dizziness
• Pain between the shoulder blades
• Pain in the arms or legs, feet and hands
• Low back pain and/or stiffness
• Shoulder pain
• Nausea
• Ringing in the ears
• Vertigo
• Numbness and tingling
• Pain in the jaw or face
• Headaches
Although the majority of Whiplash injuries occur as a result of motor vehicle, auto or car accidents, it is still possible to get "whiplash" from sports injuries or any injuries in which your body was suddenly "jerked" forward. Whiplash can been given the unfortunate term due to its similarity with the action of a bull whip. Any trauma which causes a rapid acceleration-deceleration of the neck can be diagnosed as whiplash.
Dr. Rommel Hindocha, D.C., located in San Mateo treats whiplash by first diagnosing the cause of the symptoms. Typically, patients with Whiplash Disorder are treated by gentle spinal manipulation or mobilization in the neck or mid back. Physiotherapy modalities such as: massage, trigger point therapy, myofascial release, therapeutic ultrasound, electrical muscle stimulation, spinal traction, VAX-D Spinal Decompression, therapeutic exercises and stretches can help in different stages of the healing process. Patients that exhibit neurological symptoms are advised to seek a Neurological consultation
Headaches
 Post traumatic headaches, next to Whiplash injuries, are the second most common injuries following a car or auto accident. These are usually due to rear end collisions in which the neck is often injured (sometimes referred to as whiplash). Many cases of post traumatic headache will resolve within days to weeks but there are cases in which patients suffer from the symptoms for months, years or even their lifetime (in extreme cases). Headache symptoms can be due to: whiplash or neck problems, facet joint irritation, muscle related, disc related or may be more insidiously related to traumatic brain injury or post-concussion syndrome in which case a qualified Neurologist should be consulted. Since many post traumatic headaches are related to neck, or Cervical Spine, injury, a thorough evaluation of the neck should always be performed. These headaches can feel either like "Tension" type headaches or more severe "Migraine" type headaches. They can originate from under the base of the skull (sub-occipital) and involve the the front (frontal) and sides (temporal) of the head sometimes affecting the jaw (tempromandibular) and eye sockets (orbital). Patients with whiplash related headache often also get shoulder pain and touching the big trapezius muscles over the back of the neck and shoulders often provokes pain or headache. There are often tender spots or trigger points in these muscles.
Dr. Rommel Hindocha, D.C., located in San Mateo treats post traumatic headaches by first diagnosing the cause of the headaches. Headaches caused by whiplash disorder are treated by gentle spinal manipulation or mobilization in the neck or mid back. Physiotherapy modalities such as: massage, trigger point therapy, myofascial release, therapeutic ultrasound, electrical muscle stimulation, spinal traction, VAX-D Spinal Decompression, therapeutic exercises and stretches can help in different stages of the healing process.
Low Back Pain
 Low Back pain is a very common injury related to auto accidents. Like the neck, or cervical spine, low back pain can come from: sprain/strain injuries of the muscles and ligaments supporting your back, facet joints, arthritis of the joints in your spine, degenerative disc disease, sciatica, spinal stenosis, herniated/bulging or "slipped" discs, sacroiliac joints, pain in the hips, bursitis. Low back pain can cause pain and/or numbess/tingling in other areas of your back, hips, groin, thighs, calves and even feet and toes. This is called referred pain (generally goes to the knees) or radiating pain (generally goes past the knees) if spinal nerves are involved. A common cause of radiating symptoms is from herniated or bulging discs. This is also known as Sciatica or has often been called "slipped discs".
Herniation of the discs occurs when the interior material of the disc is squeezed into the spinal canal, causing pressure against the nerves. Severe pain, a tingling sensation, numbness, or weakness may result. Herniated discs can be the result of a number of small injuries or of a single trauma. Bulging discs can be the result of wear on the annulus. As the annulus weakens the disc begins to lose its shape and can press on the nerve causing pain.
When this occurs, there are several treatment approaches available. Herniated discs have often been treated with Surgery, Epidural Injections, Medications, Chiropractic, Physical Therapy or Massage, each with varying degrees of success. Within the last 10 years, there have been few therapies that did not involve surgery, medication, injections or endless therapy. VAX-D Spinal Decompression, which has been a pioneer in "Disc Decompression" therapy remains this Clinics treatment of choice for these types of injuries. Please visit our VAX-D Spinal Decompression site or the informative www.vaxdusa.net site.
Dr. Rommel Hindocha, D.C., located in San Mateo treats uncomplicated post traumatic low back pain by first diagnosing the cause of the low back pain. Back pain caused by whiplash disorder is treated by gentle spinal manipulation or mobilization in the mid or low back. Physiotherapy modalities such as: massage, trigger point therapy, myofascial release, therapeutic ultrasound, electrical muscle stimulation, spinal traction, VAX-D Spinal Decompression, therapeutic exercises and stretches can help in different stages of the healing process.
 Upper Back Pain
Pain between the shoulder blades, upper back pain, or interscapular pain, can come from several areas following a car accident. Depending on the mechanism or injury, pain can can from the neck, such as facet joints in the cervical vertebrae, referred pain from a cervical disc injury, a muscle strain or from the mid back (called the Thoracic spine). Whiplash commonly include areas in the upper back just below the shoulder area. Due to the "whiplash" effect of the neck during a rear end collision, Thoracic spine and soft tissue structures can also be overlooked and misdiagnosed. The most common complaints are: shoulder blade pain which moves into the shoulder and down the arm, mid back stiffness, tension, pain while turning the head or looking down, neck stiffness and headaches.
Dr. Rommel Hindocha, D.C., located in San Mateo treats post traumatic upper back pain by first diagnosing the cause of the upper back pain. As stated above, other areas of the body can refer pain to the upper back and should always be examined as well. Back pain caused by whiplash disorder is treated by gentle spinal manipulation or mobilization in the mid or low back. Physiotherapy modalities such as: massage, trigger point therapy, myofascial release, therapeutic ultrasound, electrical muscle stimulation, spinal traction, VAX-D Spinal Decompression, therapeutic exercises and stretches can help in different stages of the healing process.
 Extremity Pain
Extremities are what we call arms and legs and involve the shoulders, elbows, wrists, fingers, hips, knees, ankles and toes. Shoulder injuries can occur by what are terms "seat belt injuries" injuring the shoulder, collar bone (clavicle), and ribcage. Shoulder pain can also be referred by other areas of the body such as: neck (cervical spine) and upper back. Thoracic spine facet joint irritation from auto accidents can referred pain, cervical spine disc herniations or disc bulges can cause shoulder blade pain in addition to arm pain, numbness, tingling or pins and needles. Shoulder, elbow and wrist injuries occur as contusions or bruising if any of your body parts hit the inside of the car during collision. Hip, ankle and knee injuries can occur if there is any contact with the dashboard. Front end collisions can also cause hip and leg injuries due to the compressive forces involved. All fractures or dislocations require immediate Emergency attention.
Dr. Rommel Hindocha, D.C., located in San Mateo treats uncomplicated extremity pain by first diagnosing the cause of the pain. As stated above, other areas of the body can refer pain to the extremities and should always be examined as well. Extremity caused by whiplash disorder is treated by gentle mobilization and manual therapy of the affected joint. Physiotherapy modalities such as: massage, trigger point therapy, myofascial release, therapeutic ultrasound, electrical muscle stimulation, VAX-D Spinal Decompression, therapeutic exercises and stretches can help in different stages of the healing process.
|
