Auto Accidents FAQ

Auto Accidents FAQ

It is important to stress that guidelines are merely guides to care – not prescriptions for treatment schedules.  The patient is always the ultimate guide to the need for care.  Guidelines can alert the clinician to possibly missed or occult injuries, in the case where treatment appears outside the guidelines, or to the possibility that the approach to care needs to be re-evaluated.

 

Types of Collisions

 

Type I:                                                   Primary Rear Impact                               (struck car moving or stationary)

Type II:                                                  Side Impact

Type III:                                                 Primary Frontal Impact

Other:                                                   Multiple Impacts, Rollover, Spinout

 

The Stages Of Injury

 

Stage I                                                  Acute Inflammatory Stage                       (0-72 hours)

Stage II                                                 Repair Stage                                          (72 hours – 14 weeks)

Stage III                                                 Remodeling Stage                                  (14 weeks – 12 months, or more)

Stage IV                                                Chronic                                                 (Permanent Injury)

 

The Five Grades of Severity of CAD Trauma

 

Grade I                         minimal; no limitation of range of motion, no ligamentous injury, no neurological symptoms

Grade II                        slight; limitation of range of motion, no ligamentous injury, no neurological symptoms

Grade III                       moderate; limitation of range of motion, some ligamentous injury, neurological findings

present

Grade IV                       moderate to severe; limitation of range of motion, ligamentous instability, neurological

findings present, fracture or disc derangement present

Grade V                        severe; requires surgical treatment and stabilization, chiropractic care is post-surgical

 

 

PLACING THE GRADED PATIENT WITHIN THE FREQUENCY/DURATION TABLE

 

The table below details these treatment recommendations in tabular form.  In the two right hand columns are listed the approximate maximum treatment duration and the approximate maximum number of visits expected to be necessary over that period.  Patients not at high risk for poor outcome should not require treatment approaching these maxima.  This guideline is based on analysis of approximately 2,000 randomly selected cases from a number of treating practitioners’ files.

 

Grade Daily 3 Times

Week

2 Times

Week

1 Time

Week

1 Time

Month

Treatment

Duration

Treatment

Number

I 1 week 1-2 weeks 2-3 weeks < 4 weeks —* < 10 weeks < 21
II 1 week < 4 weeks < 4 weeks < 4 weeks < 4 months < 29 weeks < 33
III 1-2 weeks < 10 weeks < 10 weeks < 10 weeks < 6 months < 56 weeks < 76
IV 2-3 weeks < 16 weeks < 12 weeks < 20 weeks ** ** **
V surgical treatment & stabilization necessary – chiropractic care is post surgical
* possible follow-up at one month                                   ** may require permanently monthly or PRN care

 

 

POTENTIALLY COMPLICATING FACTORS THAT MAY PROLONG CARE

 

 

Advanced Age (>35 Years of Age)

Disc protrusion/herniation

Prior vertebral facture

Metabolic disorders

Spondylosis and/or facet arthrosis

Osteoporosis or bone disease

Congenital anomalies of the spine

Arthritis of the spine

Spinal or foraminal stenosis

Development anomalies of the spine

AS or other spondylarthropathy

Paraplegia/tetraplegia

Degenerative disc disease

Prior cervical or lumbar spine surgery

Prior spinal injury; scoliosis

 

 

 

Croft AC:   Treatment Paradigm for Cervical Acceleration/Deceleration Injuries (Whiplash).  Am Chiro Assoc J Chiro 30(1):  41-45, 1993.

Foreman SM, Croft AC:  Whiplash Injuries.  Am Chiro Assoc J Chiro.  1995, 2001©.

CRASH = Center for Research into Automobile Safety & Health

SRISD = Spine Research Institute of San Diego

 

Leave a Reply