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Category Archives: Other Physical Injuries

Traumatic Spinal Cord Injuries Increasing in the U.S.

Categories: Other Physical Injuries

By Steven J. Angles. Posted on .

I very recently received news from a family member across the country that she had been injured as a result of a fall.  While performing some online research to try and determine the best possible resources in her area to help her cope with this difficult time in her life, I came across an interesting news item that was released by the Johns Hopkins University School of Medicine on January 27, 2014.  According to a study published in the Journal of Neurotrauma and conducted by Shalini Selvarajah, M.D., postdoctoral research fellow at Johns Hopkins, the single largest cause for the rise in traumatic spinal cord injuries in the United States is no longer the motor vehicle crash.[1]  Instead, the blame rests with the increasing number of falls that occur yearly, and in particular, among the elderly.

The study tracked 43,137 adults treated in hospital emergency rooms for spinal cord injuries between 2007 and 2009.   Over the course of the three-year study, falls accounted for 41.5% of traumatic spinal cord injuries, followed by motor vehicle collisions at 35.5%.  The average age of a patient with a traumatic spinal cord injury increased from 41 years old (during a 2000-2005 study), to 51 years old. 

The big question for me was: “Why the sudden large-scale shift from car crashes to falls?”  While the study did not provide a specific response, the researchers noted that we as Americans are living longer, more active lives, leading to more opportunities to be subject to injuries of this type.  In addition, advances in vehicle safety are making it increasingly possible to reduce serious injury in motor vehicle collisions, while individuals injured during a fall have little to no way of protecting themselves from some degree of injury. 

In the end, this study makes me recall the words of my snowboarding instructor, who always taught me to “hug myself” if I ever felt like I would fall (instead of instinctively bracing myself with my hands). Unfortunately, as in cases where someone unexpectedly falls due to the negligence of another, it is never quite that simple.

 



[1]http://www.hopkinsmedicine.org/news/media/releases/johns_hopkins_study_traumatic_spinal_cord_injuries_on_the_rise_in_us

 

Rolfing: What is it, and can it help with chronic back pain?

Categories: Other Physical Injuries

By Melissa D. Carter. Posted on .

“Rolfing” is a massage therapy that involves manipulation of the body and movement education.  Founded by Ida Rolf, a biochemist over 70 years ago in New York City, the Rolfing Institute explains that Rolfing is a “holistic system of soft tissue manipulation and movement education that organizes the whole body in gravity.”   Rolf theorized that, while skeletal muscles often work in opposing pairs in concert, with one contracting and the other relaxing, the fascia, or connective tissue, often get bound up and restrict opposing muscles from functioning.  When an injury occurs, Rolf theorized, the fascia tightens around that injury, somewhat like a cast or band-aid. Even after the injury heals, the fascia stays in that rigid position, often causing chronic pain and discomfort. Rolf sought to separate the fibers of the jumbled fascia manually, to loosen them and allow effective movement.

The theory was born out of many modalities, including osteopathic medicine, chiropractic medicine and yoga.  The main premise is that the body must be secure so that it can use gravity for support, to then allow each segment of the body to relate properly to the other. 

 The Rolfing massage technique involves an attempt to reposition tissues under the skin by manipulating connective tissue, keeping in mind the body’s relationship to gravity.   Balancing the entire body and increasing movement, Rolfing is intended to resolve chronic problems, such as pain and tightness, by releasing tension patterns and realigning the legs, torso, shoulders, arms and head.

The “Rolfer” and the patient must work together to change the body’s form, balance and function.  The Rolfer slowly lengthens the body’s fascia and repositions it by manipulating the connective tissue.  Many patients praise Rolfing for restoring mobility where years of tension and holding once hindered joints.

Long ignored as a fringe therapy, Rolfing has recently been getting serious attention from researchers. The National Institutes of Health provided a grant for the First International Fascia Research Congress in 2007, which brought together therapists, scientists, and doctors.

More recently, Eric Jacobson, a research associate at Spaulding Rehabilitation Hospital in Boston and a lecturer at Harvard Medical School’s department of global health and social medicine, received an NIH grant to study the therapy’s effect on chronic low back pain, which affects 16 million American adults. Other research has shown the therapy reduces the pain of fibromyalgia.

Ride Safely Out There

Categories: Other Physical Injuries, Practical Tips You Can Use

By Steven J. Angles. Posted on .

Living in the Pacific Northwest means being surrounded by miles of natural beauty that can sometimes be best experienced on the back of a motorcycle or scooter.   However, it’s also no secret that a motorcyclist’s (or scooter operator’s) best defense against sustaining traumatic injury is proper training, constant awareness, reliable equipment, and taking appropriate safety precautions.  For those who prefer this two-wheeled mode of transportation, or are thinking about the transition from driving to riding, here is a quick safety review of Washington State’s “on-road” motorcycle laws:

Are safety helmets required by law?

A: Yes, as of January 1, 2007.  Following the letter of the law also means that your helmet must be certified by the manufacturer as meeting the United States Department of Transportation (DOT) standards listed under 49 CFR 571.218.  The Washington law itself can be found at RCW.37.530

Is eye protection required by law?

A: Yes.  Unless your motorcycle is equipped with a windshield, you are required to wear glasses, goggles, or a helmet with a face shield. RCW.37.530

Does Washington require the daytime use of a headlight?

A: Yes, pursuant to RCW 46.37.522.  As an extra safety precaution, the Code of Federal Regulations, Title 49, 571.108, permits modulating headlights (which flicker quickly between high and low beams in order to make an approaching motorcycle more visible).

How loud can your motorcycle be?

A: This is a tricky one since plenty of riders believe that a louder exhaust note means higher visibility, and therefore, increased awareness from those around them.  However, the letter of the law can be found at section 173-62-030 of the Washington Administrative Code.  It specifies that exhaust systems or mufflers causing “excessive or unusual noise” are prohibited.  The code section also specifies the decibel levels that are legally acceptable when measured at a distance of 50 feet.

Is lane –splitting allowed in Washington?

A: Unlike states such as California, Washington does not allow lane-splitting (riding between lanes of stopped or slower moving traffic, or moving between lanes to the front of the traffic stopped at a traffic light). RCW 46.61.608

What are the Washington State insurance requirements for motorcycles, scooters, or mopeds?

A: Believe it or not, Washington State does not require motorcycles, scooters, or mopeds to be insured under a motor vehicle liability policy, according to RCW 46.30.020.  All other forms of insurance, including “first-party” coverage (i.e. PIP or MedPay), uninsured motorist coverage (UM), or underinsured motorist coverage (UIM) are similarly “optional.”

However, it is always advisable to insure your motorcycle or other 2-wheeled vehicle to the extent possible.  Most attorneys or medical providers that handle personal injury situations will tell you that at some point, they have come across a situation where a motorcyclist has caused serious injury to another person, possibly a pedestrian, or a passenger.  These same attorneys and providers can also share stories of terrible situations where even a fully helmeted and armored motorcyclist or scooter operator has sustained life-altering traumatic injuries, only later to discover that the vehicle causing the collision was uninsured, or woefully underinsured.   Other situations are simply a matter of gravel in the wrong curve causing a motorcyclist to lay down their bike.  When you consider the fact that motorcycle insurance policies in Washington can be less expensive than similar policies for cars, and can offer very similar coverage amounts, it becomes clear why it’s important to invest in coverage regardless of the legal requirements, especially when you’re not protected by the “cage” of your automobile.

Meditation and Chronic Pain

Categories: Other Physical Injuries

By Melissa D. Carter. Posted on .

A recent Brown University study proposed that meditation can help patients manage their chronic pain.[1]  The study analyzed the intimate connection in mindfulness between mind and body, as meditation training begins with a highly localized focus on body and breath sensations.

Meditation and Chronic Pain

The study’s researchers state that the repeated concentrated sensory focus enhances control over localized alpha rhythms in the primary somatosensory cortex, where sensations from different parts of the body are mapped by the brain.  By learning to control their focus on the present somatic moment, researchers say, meditators develop a more sensitive “volume knob” for controlling spatially specific, localized sensory cortical alpha rhythms, thus enabling optimal filtering of sensory information.  Meditators learn to control which body sensations they listen to, and also how to regular attention so that it does not lean toward negative physical sensations, like chronic pain.

The study team used a brain imaging technology called magneto encephalography (MEG) to show that alpha rhythms in the cortex correlate with sensory attention and that the ability to regulate localized alpha brainwaves on a millisecond scale is more distinct in people who have had standardized mindfulness training than in those who have not.  The team also used a computer model that simulates the electrical activity of neural networks and predicts how the alpha rhythm is generated.  One prediction from this study is to explain how gaining control of alpha rhythm not only enhances sensory focus on a particular area of the body, but also helps people overcome persistent competing stimuli, such as chronic pain signals.

The study proposes that training chronic pain patients in the standardized mindfulness techniques of focusing on and then focusing away from pain, should result in MEG-measurable, testable improvements in alpha rhythm control.

“By this process of repeatedly engaging and disengaging alpha dynamics across the body map, according to our alpha theory, subjects are re-learning the process of directly modulating localized alpha rhythms,” they wrote.

 

 



[1] Frontiers in Human Neuroscience, “Mindfulness starts with the body: somatosensory attention and top-down modulation of cortical alpha rhythms in mindfulness meditation,”Catherine E. Kerr, Matthew D. Sacchet, Sara W. Lazar, Christopher I. Moore and Stephanie R. Jones.  http://www.frontiersin.org/Journal/10.3389/fnhum.2013.00012/abstract

 

CURVEBALLS AND KIDS: How Can Parents Protect Their Young Pitching Athletes From Serious Arm Injuries?

Categories: Other Physical Injuries

By Melissa D. Carter. Posted on .

With the first day of summer on our heels, most little league championships have concluded and young baseball players are done for the season.  Unless you, like I, have a TOK (totally obsessed kid) that plays post little league pitcherseason Allstars, followed by summer ball league, sprinkled with summer baseball parties and topped with pitching sessions with dad in the yard.  We are All-Baseball, All-The-Time.

At one particular little league championship this spring, an 11-year old pitching dynamite on the mound was destroying our team.  He was throwing curve ball after curve ball, striking out one batter after the next.  He was fierce.  He was feared.  The championship was on the line, and he was a Hero.  That is, until his 11-year old arm gave out on him and he collapsed on the mound, grabbing his ravaged elbow, screaming in pain.

According to the Division of Sports Medicine at Children’s Hospital Boston, the “Little League elbow” is on the up-tick, and they are seeing 12-14 year olds in droves with injuries caused by throwing curve balls.

Sports medicine physicians seem to agree that pitchers under the age of 13 are simply not physically capable of absorbing the torque and strain on the elbow caused by throwing a curveball.  The ulnar collateral ligaments that connect the lower and upper part of the arm are too underdeveloped to survive the strain.   The American Sports Medicine Institute says, “don’t throw curve balls until you can shave.”[1] ASMI Executive Director Lanier Johnson added, “The kid who throws all those curve balls in the Little League World Series is a hero. But does he ever get a change to earn a college scholarship or sign a major league contract? Do you want to take a chance on your son or daughter to get a college scholarship? Do you want to be a hero at 13 or 14 but never much else after that?”[2]

Dr. Lyle Micheli, director of the Division of Sports Medicine at Children’s Hospital Boston, believes the curveball is best not thrown until a pitcher is at least 14. He also said kids shouldn’t attempt to throw a slider, a pitch that puts even more stress on the elbow, until 16.[3]

Little League International and Little League Baseballs have tried to minimize the risk to young pitchers by mandating a pitching count limit and innings’ pitched limit per game.  They have not, to date, mandated an age requirement or restriction on curve balls.  “It doesn’t mean we’re advocating throwing breaking balls,’’ Stephen D. Keener, president and chief executive of Little League International.  “We don’t promote it. We just think it’s very difficult to regulate it out of the game, and there is no data to show that throwing breaking balls is at the root of arm injuries.’’[4]

Timothy Kremchek, an Ohio orthopedic surgeon and the Cincinnati Reds team physician, disagrees.  “They have an obligation to protect these 12-year-old kids and instead, they’re saying, ‘There’s no scientific evidence curveballs cause damage, so go ahead, kids, just keep throwing them.’’’[5]

While there is no Little League rule banning the destructive pitch, parents should remain vigilant to protect their children from serious injury, and heed the warnings by the medical profession concerning this growing trend among young pitchers.  Without Little League oversight, parental knowledge is instrumental in protecting young athletes. These injuries are totally preventable, and awareness is key.

Dr. Kremcheck offered the following tips to parents and their eager, baseball loving children, on appropriate measures to minimize serious injury to pitchers:

  1. No curveballs until aged 14-16;
  2. No more than 300 pitches per week, be it games or practices; and
  3. Good coaching: ensure your child has a knowledgeable, experienced pitching coach teaching proper techniques.

If you are someone you know has suffered a traumatic, preventable, injury while participating in a sporting event, we have trained, knowledgeable and experienced attorneys in the area of sports injury law that are able to consult with you.

 



[1] http://sports.espn.go.com/espnmag/story?id=3505347

[2] http://www.cnn.com/2012/08/25/health/little-league-curveballs

[3]http://www.boston.com/sports/baseball/minors/articles/2012/04/01/curveballs_in_little_league_not_a_good_idea/

[4]http://www.boston.com/sports/baseball/minors/articles/2012/04/01/curveballs_in_little_league_not_a_good_idea/

[5] Id.

 

Tablets As An Essential Rehab Tool for TBI Survivors

Categories: Other Physical Injuries

By Melissa D. Carter. Posted on .

iPad (2)There is no doubt that smartphones have revolutionized how we work, travel, stay connected and, well, live.  More than just finding the closest Starbucks, or finding the quickest route home during rush hour traffic, the latest smartphones and tablets have also revolutionized therapy for survivors of traumatic brain injury.

For TBI patients, rehabilitating short term memory is a difficult struggle that plays a major role in rehabilitation.  Many TBI survivors cannot recall basic details to get through the day without significant assistance, and cannot retain memory beyond a few minutes in time.  TBI survivors frequently rely on copious notes with lengthy details to simply navigate a single task in a given day.  Many rely on caregivers for cues and reminders to help them with daily tasks, such as remembering to take medication, or assistance with completing the preparation of a simple meal from beginning to end.

A new study suggests that tablets, such as Apple’s immensely popular iPad, can actually assist TBI survivors with short term memory rehab.   The Royal Centre in Sydney, Australia trained 21 TBI patients to use personal digital assistants (PDAs) instead of relying upon diaries and human reminders, for help with tasks and alarms that were pre-loaded into the calendar.  The patients received multiple alarms for reminders throughout the day for medications, and other pre-arranged tasks to help the patients handle their days.  Pictures of friends and family members were loaded into the PDAs to help patients put names with faces.  At the same time, another group of patients continued on without PDAs and relied upon the traditional diary method.  At the conclusion of the two-month study, the patients using PDAs had a greater level of improved memory function over those working with diaries only.[1]

In addition to improved memory functions, devices like the iPad and their applications, commonly called “apps,” have assisted TBI victims who struggle to communicate verbally.  Here is a list of 27 life-changing apps for TBI patients for the iPhone and iPad:

http://www.brainline.org/content/2011/05/23-lifechanging-iphone-ipad-apps-for-people-with-brain-injury.html

And for the android:

http://www.brainline.org/content/2011/07/20-android-apps-for-people-with-brain-injury.html

As research develops and continues to show progress in TBI recovery, insurance companies may start treating these devices with great deference and may start to cover them for patients undergoing rehabilitation for traumatic brain injury.

 



[1] http://www.braininjuryinstitute.org/_blog/Traumatic_Brain_Injury_Blog/post/Can_the_iPad_help_with_brain_injury_rehabilitation

Common Treatment Modalities for Facet Joint Injuries

Categories: Other Physical Injuries, Personal Injury Resources

By Melissa D. Carter. Posted on .

Almost everyone is familiar with the injury term “whiplash” as a result of spinal trauma.  What, however, is a facet joint injury, and what are the common treatment methods to reduce or alleviate the pain?

The facet (zygapophyseal) joints are the articulations or connections between the vertebraes in the spine and occur in pairs at each vertebral level. The facet joints work with the corresponding disc to link the vertebrae directly above and below to form a working unit that lends stability and weight-bearing capacity while permitting flexibility and movement of the spine.  The facet joints have a synovial lining, covered with hyaline cartilage.  These joints contain nerves, the medial branches, that transmit pain back to the spinal cord.  Injuries to the spine can inflame the facet joints, or cause the cartilaginous surfaces to wear away, causing back pain in the vicinity of the inflamed joint as the friction increases within the joint space.  On occasion, the pain is located several inches away from the inflamed joint, or even into the limbs.

Treatment of facet injuries includes physical therapy, acupuncture, spinal manipulation, massage, heat and medications to reduce pain.  Anesthetic and steroidal injections under fluoroscopic (x-ray) guidance are another common diagnostic tool that can provide very good therapeutic results in combating a facet joint injury.  Immediate alleviation of pain following a facet injection confirms the pain source.  If conservative treatment modalities provide only temporary relief, radiofrequency neurotomy can provide a longer lasting result.  Under this procedure, a radiofrequency probe deadens the small nerves that supply the facet joint to reduce pain.

A less traditional modality which can have very good results, but not always covered by insurance plans, is prolotherapy.  Prolotherapy involves repeated injections of a solution of concentrated dextrose (pharmaceutical-grade sugar water) and local anesthetic into the injured facet joint.  Prolotherapy is thought to encourage the body to naturally produce connective tissues, collagen and cartilage, in the injured area to reduce pain by stimulating the immune system to bring fibroblasts and chondroblasts to the pain area and to rejuvenate it.[1]



[1] http://www.mayoclinic.com/health/prolotherapy/AN01330

Back to School Safety

Categories: Other Physical Injuries

By Jacob W. Gent. Posted on .

It’s that time of year again: summer is starting to wind down and students are returning to the classroom. Parents are inundated with information packets from schools covering an array of topics. Shopping for supplies and new clothes, completing enrollment and medical forms, registering for classes, signing up for sports and other extra-curricular activities, and coordinating the family schedules can become overwhelming. With all that’s coming at them, it’s easy for parents to overlook the critical issues of health and safety for their children.

Children need to be safe and healthy to learn at school. Talk to younger children about getting to and from school safely: walking on sidewalks, crossing at crosswalks, wearing helmets when riding bikes, and watching out for drivers who may not see them.

Talk to teenagers about safe driving. One in three teen deaths in the United States is the result of a motor vehicle collision. Teens are more likely than experienced drivers to underestimate or not recognize dangerous situations when driving.[1] Teens are more likely to speed and tailgate. The presence of male teenage passengers increases the likelihood of risky driving behavior.[2] Teenagers have the lowest rate of seat belt use compared with all other age groups. In 2005, 10% of high school students reported they rarely or never wear seat belts when riding with someone else.[3] Male high school students (12.5%) were more likely than female students (7.8%) to rarely or never wear seat belts.[4]

School playgrounds are also sources of injury. Each year, emergency departments in the United States treat more than 200,000 children ages 14 and younger for playground-related injuries. Organized sports also come with the risk for injury, sometimes very serious. Be sure to read through and discuss information about playground and sports safety provided by the Center for Disease Control in their toolkit, Heads Up: Concussion in High School Sports.

So be sure your child’s back to school list includes things like a helmet, a seatbelt, and a meaningful conversation about safety at school, on the roadway, playground and athletic field.

Source: Centers for Disease Control



[1] Jonah BA, Dawson NE. Youth and risk: age differences in risky driving, risk perception, and risk utility. Alcohol, Drugs and Driving 1987;3:13B29.

[2] Simons-Morton B, Lerner N, Singer J. The observed effects of teenage passengers on the risky driving behavior of teenage drivers. Accident Analysis and Prevention.

[3] Centers for Disease Control and Prevention. Youth Risk Behavior SurveillanceCUnited States, 2007 [Online]. (2009). National Center for Chronic Disease Prevention and Health Promotion (producer). [Cited 2009 Nov 6 ].

[4] Id.

Save Face, Wear a Helmet!

Categories: Other Physical Injuries

By Jacob W. Gent. Posted on .

A new study found motorcyclists are less than half as likely to break a nose or dent a jaw when wearing helmets.  Citing a rise in the number of motorcycles on the road and a rise in the number of motorcycle-related collisions, the University of California, Los Angeles conducted a study of the relationship between helmet use and facial injuries following traffic collisions.

The study, led by Dr. Joseph Cromptom and published in the Archives of Surgery, examined the records of over 46,000 bikers sent to hospitals nationwide following collisions between 2002 and 2005.  77% of bikers were wearing helmets at the time of the crash.  Overall, approximately 1,700 bikers suffered nose injuries, 2,300 had eye injuries and 800 busted their jawbones. Another 1,400 had facial bruises following the collision.  However, helmeted riders were less likely to sustain these injuries and were 60% less likely to suffer any serious face-related injury compared to helmet-free riders,

Information regarding the type of helmets worn was not available, so the researchers could not determine whether the presence of a face shield reduced the risk of injury.  Dr. Peter Layde, co-director of the Injury Research Center at the Medical College of Wisconsin in Milwaukee, who was not involved in the UCLA study, said face shields likely play some role in preventing injury, but helmets can also absorb blows to the side of the head and prevent fractures there from extending to the face.

Despite numerous studies demonstrating the safety benefits of motorcycle helmets, the debate whether state governments should require motorcyclists to wear helmets continues. The number of states with mandatory helmet laws has actually decreased in the last few decades, due to lobbying from the motorcycle community.

Nineteen states and Washington, D.C. have mandatory helmet laws for all riders, according to the Insurance Institute for Highway Safety.  Twenty-eight states only require some bikers – such as those under 21 or under 18 – to wear a helmet.  Three states, Illinois, Iowa and New Hampshire, have no motorcycle helmet laws.

“I think [the UCLA study] certainly supports the idea that there should be mandatory helmet laws,” Crompton, who rides a motorcycle, told Reuters Health.

Unintentional Injury is the Leading Cause of Death for Kids in the U.S.

Categories: Other Physical Injuries

By Arthur D. Leritz. Posted on .

The CDC recently came out with a study that found that unintentional injuries are the leading cause of death for kids aged 1-19 years. [1]  The CDC analyzed mortality data from 2000 – 2009 from the National Vital Statistics System by age group, sex, race/ethnicity, injury mechanism and state.  The study contained data that is both alarming and encouraging:

  • From 2000 to 2009, the overall annual unintentional injury death rate decreased 29%
  • The rate decreased among all age groups except newborns and infants aged <1 year; in this age group, rates increased from 23.1 to 27.7 per 100,000 primarily as a result of an increase in reported suffocations
  • The poisoning death rate among teens aged 15–19 years nearly doubled, from 1.7 to 3.3 per 100,000, in part because of an increase in prescription drug overdoses
  • Childhood motor vehicle traffic–related death rates declined 41%; however, these deaths remain the leading cause of unintentional injury death in age groups 5–19 years, accounting for 67% of unintentional injury deaths and 28% of deaths from all causes among those aged 15–19 years in 2009
  • Drowning, other transportation, fire/burn, fall, and all other unintentional injuries also showed significant linear declines, whereas both suffocation and poisoning showed significant linear increases (30% and 80%, respectively)
  • Mississippi had the highest unintentional death rate for kids aged 1-19 in 2009, with 25.1 deaths per 100,000, more than twice the national average
  • Massachusetts  had the lowest unintentional death rate for kids aged 1-19 in 2009, with 4.0 deaths per 100,000
  • Delaware had the biggest decrease – its overall unintentional injury death rate decreased 51% from 2000-2009[2]

According to the CDC, unintentional injuries occurring in 2005 that resulted in death, hospitalization, or an emergency department visit cost nearly $11.5 billion in medical expenses.[3] The study also found that these injuries are preventable and effective interventions for reducing childhood injuries are less costly than the medical expenses and productivity losses associated with those injuries.[4]



[1] http://www.cdc.gov/mmwr/preview/mmwrhtml/mm61e0416a1.htm?s_cid=rss_injury411

[2] Ibid.

[3] Ibid.

[4] Ibid.