If you’re an insurance adjustor reading this, you KNOW that patients involved in a car accident are faking it.
Those of you out there who have actually been on the receiving end of a whiplash injury would beg to differ. Sure, maybe not at the scene of the accident, but by the next morning you’re feeling it. Owning a chiropractic office, we see patients who have been involved in car accidents all the time. Most recover on a very straightforward trajectory, especially when we apply soft tissue treatment along with manipulative therapy.
Some, however, refuse to heal at a rate that is expected. Damn patients. If only we handed out the pamphlets beforehand so these patients would know how fast they are supposed to heal. We are currently dealing with a case right now that continued FAR longer than we had thought originally (care extended beyond a year—NOT at all a usual length of treatment in our office). The insurance people who reviewed the case stated that she should’ve been all better by 12 weeks.
She definitely should’ve read the pamphlet.
The real world, however, does not always follow the guidelines we make for it. And sometimes, we later find out that the guidelines weren’t really all that representative of what happens when later research informs us. The problem here is that these guidelines change with the speed of a snail on 1,000 mg of gabapentin TID.
This particular study has so many interesting aspects to it that I’m not really sure where to begin. But, since the article really focuses on mild traumatic brain injury, maybe that’s a good place to start. For those of you unlucky ones who have never experienced MTBI follow head trauma, either in sports or in a car accident, let me enlighten you to just a few of the symptoms:
- Irritability / behavioral changes
- Inability to focus / fuzzy thinking
In a nutshell, it sucks. Worse, if you are involved in a relationship, have a job or a life, it begins to disrupt all of these by frustrating those around you.
When this happens to my patients, the best answer I usually have for them is that it just takes time to recover. In some it’s weeks, in some up to a year. When symptoms are more severe, there are certain supplements that may help protect the brain and allow it to heal faster. These can include CoQ10, vitamin E and magnesium threonate.
In this research study of 7170 adult residents injured in car accidents from Saskatchewan, Canada (for those of you who ever wondered where Bigfoot is hiding out—it’s here), 1716 met the criteria for MTBI. For those of you good with math, that’s 24%. A pretty hefty number and far higher than I would ever have expected. Here are some details of the MTBI sufferers:
- Most common in the 18- to 23-year-old group.
- Most were not hospitalized (73%).
- Loss of consciousness in 28% and 23% reported posttraumatic amnesia.
- Average time to recovery was 100 days, or a little over 3 months.
- 23% did not recover by 1 year.
Looking at what we have here, we can make a quick assessment that a very large chunk of people involved in car accidents end up with criteria for MTBI, yet a quick screen based on loss of consciousness or memory would’ve missed a huge chunk of those suffering MTBI. After seeing this information I KNOW I have missed patients over the years by not looking for MTBI because there was no overt signs of head trauma reported or a loss of consciousness or memory.
Now, before you walk away already amazed at the information in this study, there’s more (and it’s NOT free shipping). The researchers were able to identify factors associated with slower than expected recovery from MTBI:
- Age above 50 years
- Having less than a high school education
- Having poor expectations for recovery
- Depressive symptoms
- Having arm numbness
- Having hearing problems
- Having headaches (good thing no one has a headache after a car accident)
- Having low back pain
- Having thoracic back pain
- Surprisingly, loss of consciousness and posttraumatic amnesia were NOT associated with recovery.
After reading through this article and thinking back to the aforementioned patient, she absolutely, positively met many of the symptoms for MTBI as well as experienced 5 of the above factors associated with a delayed recovery. Is it possible that I could’ve done something different early on to change the outcome trajectory? It’s not exactly clear, but maybe I could’ve expected a more realistic outcome and burned the pamphlets.