Auto Accident Injuries

Our physicians have extensive experience in evaluating and caring for auto accident injuries. Dr. Jonas Skardis is certified in vehicle crash dynamics and crash injury biomechanics by the Personal Injury Training Institute. Not every pain clinic is oriented to the unique needs of auto injury patients, and we believe we have the resources and orientation to provide uniquely effective medical care in this specialized area of auto accident care. Most importantly, we have a treatment approach that actually repairs deep tissues damaged in car crash injury, while most other treatment approaches just work around those deepest, unseen injuries from an auto accident.

Click on the above triangle to listen to Dr. Jonas Skardis of New Mexico Pain Management, interviewed on KSFR-FM radio speak briefly on just the subject of automobile accident care (duration: 1 minute, 33 seconds).

Click on the above triangle to listen to Dr. Jonas Skardis of New Mexico Pain Management, interviewed on KSFR-FM radio on the subject of interventional pain management, prolotherapy, PRP therapy, and automobile accident care (duration: 14 minutes, 54 seconds).

A Lifetime of Pain?

Research has shown that for a large percentage of patients, their auto accident injuries can leave them in pain for many years or for a lifetime. We believe there are at least three reasons for this.

1. Such auto accident injuries are often poorly evaluated. A bad habit has crept into the practice of medicine in many overburdened organizations – orthopedic/musculoskeletal physical exam has gradually become under utilized or ignored.

CASE: Years ago, a quiet Santa Fe woman in her 40’s had suffered extremely severe radiating lower neck pain from an auto accident for a year and a half before she got to us. Over that year and a half she was nominally under the care of a local HMO. She was given drugs and sent to a few physical therapy sessions which hurt and did not help. There was no MRI and no one from the HMO performed any bit of physical examination, no doctor even touched her! Our physical exam found evidence of significant disc damage, and an MRI that we ordered confirmed a severely herniated lower cervical disc.

It is clear to us that musculoskeletal physical examination skills, and diagnostic efforts in general, have been casualties of fast paced changes in the medical/insurance system. Emergency room physicians often do a good job of screening for fractures and other more catastrophic damage, but after the ER many auto accident patients become marginalized, with inadequate ongoing examination and evaluation. Low standards of evaluation lead to neglect, poor healing, and symptoms that go on and on, or symptoms that recur over time.

2. Such auto accident injuries are often beneath the skin, unseen, and therefore ignored or marginalized. If a patient has a cut or scrape after an auto accident, those visible injuries may get more attention than more significant invisible injuries deep in the patient’s neck, back or other joints.

CASE: A substantially injured auto accident patient recently reported to us that her primary care provider told her there is no such thing as whiplash!

As ridiculous as this seems, there is some fringe of doctors out there who look at auto accident patients suffering from an auto accident with contempt. We can only guess that they marginalize such patients because they don’t have the tools to help, and must therefore deny any presence of injury. Of course there is also an industry of physicians who make their living from denying injury in auto accident cases. However, short of such obvious economic conflict of interest, auto accident injuries are in many cases unseen and therefore too often underappreciated.

3. Even some of the better treatment programs for auto accident injuries are missing key methods for permanently healing such injuries at the deepest level of ligament and tendon damage. To understand this better, we need to discuss what is injured in an automobile accident, and how different types of auto accident medial care address those injuries.

Sprain/Strain

The diagnosis of sprain and strain sounds so innocent and mild. Perhaps it makes one think of a slightly pulled muscle or a turned ankle that doesn’t keep you out long. However, let’s study the two terms.

STRAIN refers to muscle, so it is an injury from too great a pull on a muscle. That may be minor injury that can heal itself in a fairly short time. But there are a few complications. Trigger points might develop in the muscle. Trigger points might resolve quickly with treatment, or may persist and cause chronic pain. Worse muscle strains may involve different degrees of injury to the tendons that attach the muscle to bone. Short of full tears, most tendon injuries go undiagnosed, potentially leading to a lifetime of pain generation in that muscle and in the related region. And, finally, muscle strains often mean that some amount of sprain also occurred.

SPRAIN is a worse injury, because it is a pull or injury to ligaments. Ligaments are deeper, more foundational tissues that act like passive belts connecting bones to one another, and keeping the bones from going too far in one direction or another. If ligaments are stretched, bones press on nerves, bones rub on each other and on cartilage, and muscles in the region complain about the unstable, misaligning bones. Such inappropriate movement and rubbing of bone on bone is the beginning of osteoarthritis. While strain injuries need to be followed-up, sprain injuries are deeper and more serious. Auto accident sprains damage ligaments in the spine (whiplash), as well as knees, shoulders, wrists and other joints.

So, What Kind of Medical Solutions Are Out There?

Drugs. Auto accident sprains/strains from an auto accident are not deficiencies of Ibuprofen, Tylenol or stronger drugs. Anti-inflammatory drugs actually weaken ligaments and tendons. The others have side-effects to consider. Most importantly, they cure nothing. They do not heal ligaments and tendons injured in auto accidents.

Physical therapy. We eventually refer most of our patients to exercise based physical therapy or some other form of exercise guidance. There are two stabilization systems in the body. The passive, architectural stabilization system consists of bones and the ligaments that connect them. The active, dynamic stabilization system consists of the muscles, and the nerves that control them. Though the ligaments are deeper, both stabilization systems must be competent. Therefore, we support the use of muscle strengthening and muscle balancing by physical therapists or others. However, exercise does not heal damaged ligaments – exercise only strengthens muscles. And, muscle strengthening and other exercise is often limited by pain from deeper auto accident tissue damage. Exercise may only be appropriate and fully useful after ligament and tendons are repaired.

Manipulation. We perform gentle types of spinal manipulation in caring for patients with auto accidents, or we are supportive of patients simultaneously seeing osteopaths, chiropractors, physical therapists or others for reasonably gentle forms of manipulation. It makes sense to adjust bones throughout the body that have gone out of alignment due to trauma, and the secondary laxity of ligaments. Skilled, gentle manipulation can be a valuable part of auto accident care. However, manipulation does not heal ligaments or tendons. In fact, one of the reasons why some practice guidelines call for protracted manipulation after auto accident sprain/strain is because repair of ligaments is not fully carried out, creating a need for repeated manipulation far into the future, or for a lifetime.

Acupuncture. We perform acupuncture in caring for patients with auto accidents. Whether injured patients receive acupuncture in our office or elsewhere, we are supportive. It is our experience that acupuncture can ameliorate pain, reduce muscle spasm, decrease anxiety, improve sleep, and help injured patients in many other ways. However, acupuncture itself does not normally stimulate the repair of ligaments or tendons.

But Don’t Ligaments and Tendons Heal On Their Own?

Yes, the human body has awe inspiring ability to self-heal injuries to its own tissues. The basic science of the healing of any wound or other injury is that the injured connective tissue initially has a few days of an inflammatory stage were a construction site is established for new growth, followed by a repair phase in which the human body miraculously grows new muscle, bone, tendon or ligament tissue to mend the damage. Without this amazing ability we would be in deep trouble. However, this repair phase in finished in 3-4 weeks! Laying down of new tissue stops in 3-4 weeks. There is no more significant regeneration after 3-4 weeks. Oh, there are other stages of healing – remodeling of the newly laid down tissue, restrengthening of surrounding muscles, etc. But, the regrowing of ligaments and tendons damaged in auto accidents only takes place for 3-4 weeks.

Furthermore, those first 3-4 weeks of tissue repair can be fully stopped by taking anti-inflammatory medicines – Ibuprofen, Advil, Aleive, cortisone, etc. And, even without the negating effect from such medicines, self-repair is often incomplete. It has been said that if ligaments heal to 70%, you might be able to get by some of the time. Yet, why would one want to live with ligaments that are still 30% damaged? Complicating this further is that we may heap injury upon injury, cumulatively reducing the integrity of many connective tissues.

The result is that while our bodies have the ability to repair ligaments and tendons damaged in auto accidents, there is a limited window for such repair, it can be compromised by medications, and among adults it is routinely less than a complete repair.

How to Optimize Your Body’s Own Month of Regrowing Damaged Ligaments and Tendons

Don’t take anti-inflammatory drugs – they stop the self-regeneration of those tissues. Eat well. Some nutritional supplements or natural medicines may help. Get good sleep. During each day, stay as active as you can short of grossly aggravating your injuries.

And, there are a variety of integrative medicine therapies that can optimize your own inherent regrowth and repair in that first month, and provide symptomatic benefits well after that first month.

Acupuncture. Used right away after your auto accident, this gentle therapy can balance your body to make the most of the injury’s stimulus of one month of new growth of repair tissue. During that month, and well beyond, acupuncture can balance the sympathetic and parasympathetic nervous systems, regulate blood flow, reduce anxiety, improve your sleep, and lessen pain – all functions that can help you get more out of the one automatic month of tissue regeneration. And, balancing such functions in your body can also make the many following months less symptomatic.

Manipulation. If performed gently enough, spine and joint manual manipulation can help align bones, take pressure off of nerves, reduce pull on surrounding muscles, and improve circulation, improving tissue repair that occurs automatically in the first month after the auto accident.

IV nutrients. While oral supplementation can be useful after an accident, select IV nutrients can be dramatic in their effect. For example, oral supplementation of magnesium does not increase measurable blood levels of magnesium. However, a 5 minute IV push with magnesium can immediately increase blood magnesium levels 150% to 200%. This can have dramatic effects to reduce spasm and pain. Many other minerals and vitamins can be easily utilized intravenously to make that first month of growth more effective, and to help in many ways in the many months that follow.

Other integrative medicine therapies. There are numerous wholistic, natural methods to integrate into a program to make the key first month after injury most effective. These methods, for example counseling, homeopathy, oral supplementation, diet, exercise, and others, can also play a precious role for many months after.

Interventional Pain Management. Various pain injections described elsewhere on this website can be utilized if needed. In the case of some accident traumas, areas of severe pain can be calmed in the short run. Aggravation of the autonomic nervous system can be regulated with some of these injections. Certain headache nerves can be calmed. Some nerve compressions can be reduced with injection interventions. When you are in greater need, such brief pain management interventions can be very valuable.

All of the above therapies can help make your body’s automatic 3-4 weeks of regrowth and repair more effective. And, all of the above therapies can help make the months after that less symptomatic. However, none of the above therapies can significantly stimulate more tissue regeneration after that first key month.

Tell Me Again – What Happens After That First Month?

The basic science of human physiology is clear. Any injury is followed by one month or less of self-generated repair of injured tissues such as ligaments and tendons. After that, no significant amount of repair is carried out – you get whatever your body generates in that first repair phase, the first 3-4 weeks. There is other subtle, slow healing and normalizing that does take place after that first month. The repair tissue you managed to grow in the first month will gradually mature, cure, dry out, and fit the space it occupies more precisely – that is called the remodeling phase and it quietly takes place over the following year or more. And, the neuromuscular system (muscles and nerves) re-adapts over that year or. But, tissue repair is essentially limited to the first month.

And, the repair your body automatically mounts in that first month is stopped by anti-inflammatory drugs, and frequently limited by any imperfection in your diet and body chemistry. Repair in most adults ends up to commonly be quite incomplete. You may find a way to work around such limitations or imperfections left-over from auto accident injury, or you may have recurring pain and compromised function for years or for a lifetime.

How Can I Finish Fully Repairing the Ligaments and Tendons Hurt In My Auto Accident?

Luckily,it is possible to medically stimulate multiple subsequent months of repair, even years after the auto accident trauma. Prolotherapy, PRP therapy, and tenotomy/fasciotomy are technical variations of tissue regeneration procedures - medical methods that reinitiate the body’s natural ability to grow back more repairative collagen tissue within the ligaments and tendons damaged by your auto accident. Since your body mounted its own regeneration of such tissues for 3-4 weeks after your auto accident, each procedure with prolotherapy, PRP or tenotomy/fasciotomy will start another 3-4 weeks of new growth. See the slide show on our home page. Think of it as the growing of another “crop” of collagen. Like in gardening and farming, multiple plantings are commonly called for during a growing season, so it is routine for multiple procedures to be performed in the injured areas on a monthly basis. Younger patients with perfect health and only one injury in their history need fewer crops. Age, multiple injuries, and any compromises to health lead us to estimate a need for more crops to fill in the tissue damage. All of that is determined at the end of an initial evaluation in our office. Generally, most adults need some series of procedures – multiple plantings within the damaged tissues. These tissue regeneration procedures are a key form of medical care for car crash injuries.

Read more about these procedures at other parts of this website:

Prolotherapy

PRP Therapy

Tenotomy/Fasciotomy

You don’t need to pick one of these. The appropriateness of these different types of tissue regeneration procedures will be discussed in your initial evaluation, and more than one may be called for over time. Just understand that a large percentage of people injured in automobile accidents suffer unnecessarily for years or for a lifetime due to incomplete repair of ligaments and tendons hurt in the sprain/strain trauma of such crashes. Acupuncture, gentle manipulation, and other natural integrative medicine therapies help your body make the most of its ability to heal. And, fully healing damaged ligaments and tendons with tissue regeneration procedures is the key to avoiding pain and disability from recurring for a lifetime. This specialized approach is auto accident medical care that can resolve such personal injuries permanently, to the deepest physical level.

FOR MORE INFORMATION:

Vladimir Djuric, MD on whiplash treatment with prolotherapy

Ross Hauser, MD on whiplash treatment with prolotherapy

Prolotherapy for facet syndrome, a common syndrome after auto accidents

Headaches, Whiplash and Post-Concussion Syndrome

Rest does not heal. Get moving to the best of your ability.

Barre-Lieou syndrome from auto accident trauma can cause some combination of these symptoms: dizziness, headache, ear ringing, fatigue, disorientation, facial pain, sinus congestion, shortness of breath, poor digestion, and much more. When unusual symptoms follow auto accident trauma, this should be considered.