Sunday, March 13, 2011

Numbness after Whiplash

I find for the most part, upper back spasm and neck pain from trauma always get better faster with the same suggestions. Remember, every body type, age and sex has their idiosyncracies so treatments vary. Here is an excerpt from a recent communication with a patient:

Hello Mr S

I was contemplating S's symptoms and I have some ideas. First if the symptoms havent changed, since I saw her, great! The usual symptoms of numbness tingling or pain and dysfunction are attributed to trigger point irritability. The only reference most of the medical community will use for trigger points is with fibromyalgia so if you talk to another MD, dont be surprised they may no agree with me. If trigger points are irritated, my patients will have shooting, numbness or tingling from the neck or shoulder down to anywhere in the hand, sometimes specifically to a finger. My neurology counterparts will try to associate the distribution of the symptoms to a specific 'dermatome' to decide which level disc from the cervical spine the spinal column is suffering. This is good for mapping exactly where the etiology is if a surgeon is going to 'build up a disc' or if a pain doc/neurologist is to inject steroids to around the irritated nerve to speed up healing. In the end, S isnt that bad yet.(unless something has changed)

The two problems I see hindering quick resolution are:
1-Age of the injured. Although a healthier than normal 50 year old, healing will still be slower than an average 20 yearold. 20 year olds going through trigger point recovery sometimes 3 weeks, females usually longer than males, (not sure why but I find it is also associated with the reason why women prdominately are the ones afflicted with Fibromyalgia).
2-S's posture. This is nothing bad and I mentioned this to sensei already, sometimes we are used to a certain posture for years, kinda like flat feet. But....when injury occurs to the same person, healing can be prolonged due to the 'flat feet' or rolled forward shoulders. I typically see butterfly stroke swimmers have more problems recovering from trapezius injury or neck spasm than free style swimmers due to the forward rolled shoulders and the 'collapse' of the thoracic outlet. Any tightening to the thoracic outlet will potentially pinch the nerve plexus passing through it. When the plexus is irritated, a nerve pinching can and usually results in numbness or tingling or shooting pain and occasionally weakness. (btw, if it ever gets to weakness, time to throw in the towel and save the nerve by surgically decompressing it)

The two benefits I see are:
1- S's health level. Good diet, good supplements, good awareness of health.
2- S's training. Fairly better range of motion with the upper extremity than average female her age.

I havent done much acupuncture these days since I have a full patient schedule and an acupuncturist at the office but remember......this was an car accident so you can save all bills and give them to the offender's car insurance. I would still suggest Frank Grill at Naperville Acupuncture Center or Dr Zu at my office. The only problem is you have to pay upfront to these folks then submit and await reimbursement from car insurance. I feel this route would help and speed up recovery. I would also suggest massage therapy, deep tissue regularly to loosen and care for the trapezius spasm. (again save the bills) I have an excellent massage therapist that works out of Turner Rehab on Eola. and she may be able to help with alignment principals of yoga to help reposition the cervical/thoracic spine and scapula to help open the thoracic outlet

I would always increase levels of
-vitamin d3 to 2000IU twice a day (unless recent blood levels havenot been drawn) with a fatty meal
-make sure there is a supplemental amount of calcium to 1000 mg daily
-cut out dairy for 2-3 weeks, ok to substitute with soy (initially a total of a cup daily to accomodate for the new protein being introduced to the gut (gas) for a week)
-turmeric three times a day (I believe the most potent antiinflammatory veggie available to man) I like New Chapter Turmeric or Zyflamend - (found at most Whole Foods Market) +/- 400mg three times a day
-valerian at three times a day as long as no sleepiness is felt, it is great for sleep but in europe great as well for relaxing anxiety or muscle.
-magnesium if not checked is also helpful if there is a sense of tight musculature, but I remember sensei didnt feel she was tight, right? 400mg daily is good. I have used much higher but have to be careful with slower kidneys. Watch for diarrhea.
-topical use of tea tree oil, helicrysium, arnica, Traumeel (homeopathic) or cod liver oil before deep tissue or just three times a day
-physical therapy should be considered since it can be applied to a regular insurance card, (just need a script from me-let me know if you decide yes) and if trained correctly, the pt can reduce alot of spasm just with proper posture cues, kineseo taping or body alignment training,and scapular stability exercises -Mary Rachford at Naperville PT also has been trained with ASTYM-kinda like a modern version of gua sha or chinese skin scraping and finally use of transdermal steroid to locally bust up inflammation to trigger points with ultrasound or low intensity electricity.
-finally, do no further harm with overhead work or carrying on same side

This will help, just let me know what you need from me
always at your service-
Ric Saguil

BTW-I will be giving a lecture at the Whole Foods Market in Schaumburg on March 26th saturday on Food Choices for helping Inflammation Resolve

11 23 12 addendum: comment was sent in that numbness could be due to impingement of nerve tissue.  If I see anyone with severe pain, loss of function, unresponsiveness to standard treatment, I would get mapping (MRI and EMG) to see if the symptoms are from major structural damage.  On the other hand, if symptoms are mild, physical exam is reassuring and problem is not chronic-proceed with what was mentioned in my blog.  The majority of evaluations in all offices are muscular causes with an incidental bulging disc on MRI.  The above treatments are good for muscular causes and still helpful for impingement (other) causes.  I have great Neurosurgery collegues/friends who know when and how to surgically fix discs with minimal residual damage.  If I am the doc responsible for your health, and if I didnt consider every avenue of diagnosis, treatment and possible side effects, I wouldnt be doing my job.  So good point Mr T. 

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