THE NIGHTMARE KNOWN AS WHIPLASH
As defined by Webster’s 1913, the word “malinger” means, “to feign illness or inability.” In other words, a malingerer would be one who fakes pain or disability, usually for financial gain — something quite common here in modern America. And because it is so common, we tend to throw the baby out with the bathwater when it comes to any number of injuries that occur as the result of Motor Vehicle Accidents (MVA). The belief is that no blood, no guts, no broken bones, equals no injury. Today, as I share a small piece of Roger’s story with you, I will show you how (and to some degree, why) people with real injuries are often treated as malingerers.
Back in the winter of 2013, “Roger” was REAR-ENDED by a full-sized pickup truck, while sitting with his wife at a stoplight. A carphile, he was driving a much smaller and lighter Renault Clio (IV), which was totaled. Although Roger had dealt with periodic episodes of LOW BACK PAIN for the previous decade and had suffered through a number of SPORTS INJURIES from his days as an athlete (he also had MIGRAINE HEADACHES about three or four times a year from the time he was in grade school), these episodes had always been short-lived. They rarely caused him to miss work, bouncing back and returning to “normal” within a day or two.
The 2013 injuries were different, and rapidly became a big deal. Roger found himself missing more and more work. He could feel himself being dragged into the world of Chronic Pain via a WHIPLASH INJURY. Unfortunately, it’s a story I have seen over and over and over again in my 25 years of practice.
After the accident, Roger was the model patient. He did exactly what his doctors told him to do — namely take CERTAIN MEDICATIONS and go to the PHYSIOTHERAPIST, whose directions he followed religiously as well. Instead of getting better, he found himself getting worse. He went to several specialists who told him things like, “just lose some weight,” “it’s just one of those things that happens to people at 40,” and my all-time favorite, “I can’t really find anything wrong with you that explains why you’re having this much pain“.
And of course there was the imaging — X-RAYS, CT, MRI, with all of them showing essentially the same thing — that there was nothing really wrong (a low back MRI done a few years prior to the accident was not substantially different than a low back MRI done post-accident — even though his pain is worse by several orders of magnitude). By Memorial Day, Roger — a successful physician with a thriving 15 year practice — could no longer work. Let me take you back to the time before the accident.
Because Roger is a doctor, he was prone to go to his doctor if he had problems or questions pertaining to his health. Thus the reason he had received imaging on his lumbar spine pre-accident. And because of the work he did (surgery), he was required to sit in a very specific position and bend forward for much of the day. Certainly not anything out of the ordinary for any number of professions, but something that can certainly aggravate a low back.
Due to the FORWARD POSTURE, his neck would also get stiff and sore, which he mentioned to his doctor on a couple of occasions. Not that it was a primary concern — the main reason for the visit — or that he was asking to have anything really done about it, but was instead asking if there was anything he could be doing on his own (i.e EXERCISES / STRETCHES) to prevent future problems. Unfortunately, this made it into his doctor’s notes as ‘neck pain‘, which became part of his permanent record and is now being used against him as a pre-existing condition.
After finding our site on one of his many sleepless nights, Roger began to realize there was more going on than what his doctors were telling him and decided to contact me. Having told him that his low back problem sounded like a CLASSIC CASE OF HERNIATED DISC and that it was unlikely I could help him with his problem, he decided to come anyway. Other than the fact that he was dealing with lots of pain and his spinal RANGES OF MOTION were all in the toilet, his examination findings were fairly unremarkable for what he was going through.
His main question to me was “How can my two low back MRI’s appear almost the same even though I have vastly greater amounts of pain now?” Most of it has to do with the difference between Functional Problems -vs- Pathology. Although I have covered this topic before (HERE and HERE), it is important to grasp the difference. One of the ‘dirty little secrets’ in medicine is that a top reason people visit doctors is for something called MUPS (Medically Unexplained Physical Symptoms). Throw in the fact that the “Disc Theory” of back pain has been increasingly falling out of favor for years; probably more like decades —- at least in the SCIENTIFIC COMMUNITY — and you begin to get a sense of Roger’s frustration.
Using TISSUE REMODELING to break down the SCAR TISSUE / DENSIFICATION that was occurring in numerous places (as well as to STIMULATE FIBROBLASTIC ACTIVITY), I treated the FASCIAL ADHESIONS that were restricting normal motion of his NECK and BACK, as well as his SHOULDER. For the record, it is my opinion that Roger probably has TYPE II PAIN, without CENTRALIZATION. How much was I able to help him? Some, but certainly not completely.
I cannot leave this post without at least mentioning the neurological or “BRAIN” aspect of these sorts of injuries. Intense whiplash — NO MATTER THE CAUSE — can result in BRAIN INJURIES (MTBI). Unfortunately, every study that comes out on this subject is scarier than the one before it. Stop and think for a moment about what’s going on in the NFL right now. I would also like to mention that whether your particular problem is Functional or Pathological, one of the single most important things you can do to help your cause is to control INFLAMMATION (no, not THAT WAY). In case you are not versed as to the best way(s) to accomplish this, I created SEVERAL POSTS that will at least point you in the right direction.