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11 RISK FACTORS OF WHIPLASH – PART FOUR

WHIPLASH BASICS

Whiplash is a neck injury caused by forceful, uncontrolled neck movements. This type of injury is commonly experienced during a motor vehicle collision,
but may also result from other trauma.

Some Common Signs and Symptoms

  • Neck pain, stiffness and soreness
  • Decreased range of motion in the neck
  • Headaches
  • Sharp or shooting pain in the shoulders, upper back, arms, or hands
  • Numbness or tingling sensations in the shoulders, upper back, arms, or hands
  • Fatigue
  • Dizziness

This series will identify 11 commonly seen risk factors that contribute to whiplash injuries. We have divided the risk factors into “human (part one and part two),”
vehicular,” and “collision”
categories.

COLLISION FACTORS (Part Four)

REAR-END VS. OTHER POINTS OF IMPACT

The point of impact is a factor in risk assessment of collisions. While large proportions of collisions involve frontal crashes, the risk of whiplash injuries
is higher in rear-impact collisions.

One study found that individuals in rear-impact crashes are exposed to a more complex and unnatural neck movement upon being hit. They may experience a
rapid change in direction of the head within a fraction of a second. Additionally, rear end collisions often cause the head to strike the head restraint,
which may lead to further injury.

IMPACT BY VEHICLE OF GREATER MASS

The likelihood of experiencing whiplash may increase when a person has a collision with a vehicle larger than his or her own vehicle. In general, the relative
mass between two colliding vehicles is an important determinant of the outcome of a crash. Since a vehicle with a larger mass transfers more energy
to a smaller vehicle, injuries, including whiplash, may be more likely and more significant to occupants in the smaller vehicle.

This concludes the 11 Whiplash Risk Factors series.


  • Berglund A., Alfredsson L., Jensen I., Bodin L., Nygren A. (Jan. 2003) Occupant- and Crash-Related Factors Associated with the Risk of Whiplash Injury. Ann Epidemiol.
  • Croft, Arthur C., (2009), Whiplash and Mild Traumatic Brain Injuries. SRISD Press.
  • Spine Research Institute of San Diego


Disclaimer

This blog pro­vides gen­eral infor­ma­tion and dis­cus­sion about med­i­cine, health, wellness and related sub­jects. The words and other con­tent pro­vided in this blog, and in any linked mate­ri­als, are not intended and should not be con­strued as med­ical advice. If you or any other per­son has a med­ical con­cern, it is recommended that you con­sult with an appropriately licensed physi­cian or other health care worker.

11 RISK FACTORS OF WHIPLASH – PART THREE

WHIPLASH BASICS

Whiplash is a neck injury caused by forceful, uncontrolled neck movements. This type of injury is commonly experienced during a motor vehicle collision, but may also result from other trauma.

SOME COMMON SIGNS AND SYMPTOMS

  • Neck pain, stiffness and soreness
  • Decreased range of motion in the neck
  • Headaches
  • Sharp or shooting pain in the shoulders, upper back, arms, or hands
  • Numbness or tingling sensations in the shoulders, upper back, arms, or hands
  • Fatigue
  • Dizziness

This series will identify 11 commonly seen risk factors that contribute to whiplash injuries. We have divided the risk factors into “human (part one and part two),” “vehicular,” and “collision” categories.

VEHICULAR FACTORS (PART THREE)

FRONT VS. REAR SEATING

Different seating locations within a vehicle may contribute to the likelihood of experiencing whiplash during a crash. A person occupying the front seat of an automobile has a higher risk of neck injury than passengers in the rear, possibly due to mechanical or head restraint differences.

SEAT BELT AND SHOULDER HARNESS

Safety features such as the seat belt and shoulder harness should always be worn. Correct use can prevent serious injury, or death. Unfortunately, wearing a seatbelt and shoulder harness may increase the likelihood of experiencing whiplash.

POSITIONING OF HEAD RESTRAINT

For a head restraint to properly protect passengers, it should be a placed at the center of gravity of the occupant’s head, which is located approximately at the level of the top of a person’s ears. If positioned lower, risk of neck injury may be greater.

Depending on an occupant’s height, head restraint position and design may increase the likelihood of a whiplash injury, as some head restraints don’t adequately protect tall occupants.

The 11 Whiplash Risk Factors series concludes in part four with two risk factors in the “collision” category.



Disclaimer
This blog pro­vides gen­eral infor­ma­tion and dis­cus­sion about med­i­cine, health, wellness and related sub­jects. The words and other con­tent pro­vided in this blog, and in any linked mate­ri­als, are not intended and should not be con­strued as med­ical advice. If you or any other per­son has a med­ical con­cern, it is recommended that you con­sult with an appropriately licensed physi­cian or other health care worker.

11 RISK FACTORS OF WHIPLASH – PART TWO

WHIPLASH BASICS

Whiplash is a neck injury caused by forceful, uncontrolled neck movements. This type of injury is commonly experienced during a motor vehicle collision, but may also result from other trauma.

SOME COMMON SIGNS AND SYMPTOMS

  • Neck pain, stiffness and soreness
  • Decreased range of motion in the neck
  • Headaches
  • Sharp or shooting pain in the shoulders, upper back, arms, or hands
  • Numbness or tingling sensations in the shoulders, upper back, arms, or hands
  • Fatigue
  • Dizziness

This series will identify 11 commonly seen risk factors that contribute to whiplash injuries. We have divided the risk factors into “human (part one),” “vehicular,” and “collision” categories.

HUMAN FACTORS (PART TWO)

BODY POSITION

An occupant’s position may have an impact on the likelihood of experiencing injury. Whiplash injuries are more common when the body is twisted, turned, or if the person is leaning forward or in any other awkward position at the moment of impact.

HEAD POSITION

When the head is turned at the time of impact, asymmetric loads are placed on the spinal ligaments, facet joints, intervertebral discs, and spinal nerves. This may increase the risk of injury. Additionally, having the head turned during a collision may increase the likelihood of more significant injuries.

NON-AWARENESS

In many cases, drivers and passengers of vehicles that are struck from the rear have no warning of the impending collision. Preparedness for impact may reduce the risk of whiplash. Furthermore, since the neck is more vulnerable in the relaxed state, awareness plays a role in the severity of an injury. One study reported the risk of having chronic pain was 15 times greater when the occupant was unaware.

The 11 Whiplash Risk Factors series continues in part three with three risk factors in the “vehicular” category.


  • Croft, Arthur C., (2009), Whiplash and Mild Traumatic Brain Injuries. SRISD Press.
  • Spine Research Institute of San Diego
  • Ryan G.A., Taylor G.W., Moore V.M., Dolinis J. (1994;25(8):89-97) Neck Strain in Car
  • Winkelstein B.A., Nightingale R., Richardson W.J., Myers B.S. (May 2000), The Cervical Facet Capsule and its Role in Whiplash Injury. Spine.

Disclaimer
This blog pro­vides gen­eral infor­ma­tion and dis­cus­sion about med­i­cine, health, wellness and related sub­jects. The words and other con­tent pro­vided in this blog, and in any linked mate­ri­als, are not intended and should not be con­strued as med­ical advice. If you or any other per­son has a med­ical con­cern, it is recommended that you con­sult with an appropriately licensed physi­cian or other health care worker.

11 RISK FACTORS OF WHIPLASH – PART 1

WHIPLASH BASICS

Whiplash is a neck injury caused by forceful, uncontrolled neck movements. This type of injury is commonly experienced during a motor vehicle collision, but may also result from other trauma.

SOME COMMON SIGNS AND SYMPTOMS

  • Neck pain, stiffness and soreness
  • Decreased range of motion in the neck
  • Headaches
  • Sharp or shooting pain in the shoulders, upper back, arms, or hands
  • Numbness or tingling sensations in the shoulders, upper back, arms, or hands
  • Fatigue
  • Dizziness

This series will identify 11 commonly seen risk factors that contribute to whiplash injuries. We have divided the risk factors into “human (part one and part two),” “vehicular,” and “collision” categories.

HUMAN FACTORS (PART ONE)

GENDER

Although whiplash may occur equally between men and women, many studies show that women are twice as likely to experience a whiplash injury when involved in a crash.

AGE

Whiplash injury may occur at any age, young or old. The likelihood of experiencing whiplash following a motor vehicle collision increases with age. As we reach middle age and beyond, our fitness and strength gradually decline, the degenerative processes of the spine begin, and there is a longer history of neck injuries, all of which predispose the body to injury.

PRIOR INJURY

Individuals who have had a prior neck injury may be more likely to experience whiplash in a crash. Prior injuries may have a negative effect on the severity of the new injuries and recovery time.

The 11 Whiplash Risk Factors series will continue in the next blog article with three additional human factors that may contribute to whiplash injury.


  • Berglund A., Alfredsson L., Jensen I., Bodin L., Nygren A., (Jan. 2003), Occupant- and Crash-related Factors Associated with the Risk of Whiplash Injury, Ann Epidemiol.
  • Croft, Arthur C., (2009), Whiplash and Mild Traumatic Brain Injuries. SRISD Press.
  • Dolinis, (April 1997), Risk Factors for ‘Whiplash’ in Drivers: A Cohort Study of Rear-end Traffic Crashes, Injury.
  • Spine Research Institute of San Diego

Disclaimer
This blog pro­vides gen­eral infor­ma­tion and dis­cus­sion about med­i­cine, health, wellness and related sub­jects. The words and other con­tent pro­vided in this blog, and in any linked mate­ri­als, are not intended and should not be con­strued as med­ical advice. If you or any other per­son has a med­ical con­cern, it is recommended that you con­sult with an appropriately licensed physi­cian or other health care worker.

2016 Usual, Customary and Reasonable (UCR) Fees

Download UCR Fee Schedule

The term “Usual, Customary and Reasonable,” as it relates to any fee schedule, can be confusing. At The Neck and Back Clinics, we take the topic seriously by periodically verifying that our fees for services meet the definition of UCR and making adjustments, as necessary. The Neck & Back Clinics strives to be the leader of our industry in every way, including the determination of usual, customary and reasonable fees. We appreciate the opportunity to work with patients and provide them with high quality healthcare as they work toward recovery, and we want our patients and any referring colleagues to be confident that our patients receive high value for services that are fairly priced in the marketplace. The following bullet points explain the process of how we set our fees.

✓ To ensure “Usual, Customary and Reasonable” fees, The Neck & Back Clinics continues to utilize two nationally recognized publications.

  • First, the 22nd edition of Medical Fees, published in 2016 by Practice Management Information Corpo-ration. As stated in the book’s foreword, “The UCR fees listed in this publication are derived from an analysis of over 600 million actual charges.”
  • Second, the 33rd edition of Physicians’ Fee Refer-ence, published in 2016 by Yale Wasserman, DMD Medical Publishers Ltd.

✓ Within these two publications, one will find the nationally averaged 50th, 75th, and 90th percentile fees for all CPT codes. The two publications do not list identical fees for each CPT code, but the amounts are similar. (See below for defi nition of CPT code.)

✓ Both publications list “Geographic Adjustment Factors” meant to help providers “fine tune” their fees based on work, practice, and malpractice expenses specifi c to a geographic region.

✓ The fee for each CPT code used at The Neck & Back Clinics is set at the 67th percentile, adjusted for Clark County, Nevada, and averaged between both publications.

Click here to download the actual UCR Fees document and to see an example of the formula used by The Neck & Back Clinics to determine our fees. Please feel free to contact us with any questions or for further explanation.

CPT is a registered trademark of the American Medical Association. CPT stands for “Current Procedural Terminology.” A CPT code is a five digit numeric code that is used to describe healthcare related procedures provided by physicians, hospitals, and other health care providers. Every procedure has an accompanying code.

Download UCR Fee Schedule

LACK OF RELATIONSHIP BETWEEN VEHICLE DAMAGE AND OCCUPANT INJURY

by Dr. Benjamin S. Lurie, DC


Minor Impact Soft Tissue, more commonly known as MIST, is an insurance industry concept that seeks to identify whiplash as a psychosocial phenomenon. MIST programs are typically identified by lower vehicular damage under a certain vehicle repair threshold. The medical literature in this area has not been systematically reviewed since the Quebec Task Force Review in 1995. Ironically enough, the Quebec Task Force on Whiplash stopped collecting statistical data and studies in approximately 1993. In general, the MIST program has allegedly allowed for insurance companies to examine the vehicular damage rather than the examination of the patient.

M.C. Robbins authored one of my favorite articles in 1997*. This article was published in the Society of Automotive Engineers. Using a mathematical analysis and examples from a pole-vaulter and high performance racing crashes, this article explains why it is false reasoning and a misconception to claim that vehicle crash damage offers a direct correlation to the degree of occupant injury.

Abstract: “A common misconception formulated is that the amount of vehicle crash damage due to a collision offers a direct correlation to the degree of occupant injury. The paper explores this concept and explains why it is false reasoning. Explanations with supporting data are set forth to show how minor vehicle damage can relate or even be the major contributing factor to occupant injury. Mathematical equations and models also support these findings.”

The article states “The false reasoning is often applied by the insurance adjuster, attorneys and physicians and frequently result in costly unjustified litigation. Due to this litigation process, the injured parties are often not compensated, resulting in unjustified hardship to the party who has already been injured.” velocity formulaThe amount of G force to which occupants of the vehicle are subject to is a major factor relating to occupant injury. The G force in which an occupant receives can be calculated using Galileo’s formula (see formula in graphic).

Since occupant injury is related to acceleration rate (G force), Galileo’s formula is rearranged to assess acceleration rate: a=V2/2s. Therefore, the larger the acceleration rate (G force), the greater the occupant injury, when all other factors are held equal. This is represented by “a” in the formula above. For the purposes of this article, G is defined as the acceleration of gravity, and is 9.81 m/second2. See two scenarios above.

Clearly one can see in the second scenario, which has much less vehicular damage shows significantly higher occupant G force. The results show that the greater the crush damage distance of the vehicle, the less G force may be received by the occupant. Lastly, the article states the physical condition of the occupant is relevant in assessing occupant injury.

These conditions are listed as awareness factors prior to collision as related to muscular stimulation, structural strength of the occupant, i.e., sex, age, bone mineral content and joint strength and lastly, the geometric dimensions of the occupant, i.e., height and weight.

 

CLICK HERE TO REQUEST FULL ARTICLE

 

*Malcolm C. Robbins (1997) Society of Automobile Engineers “Lack of relationship between vehicle damage and occupant injury.” 97-02-01: (#970494): 117-9


Disclaimer

This blog pro­vides gen­eral infor­ma­tion and dis­cus­sion about med­i­cine, health, wellness and related sub­jects. The words and other con­tent pro­vided in this blog, and in any linked mate­ri­als, are not intended and should not be con­strued as med­ical advice. If you or any other per­son has a med­ical con­cern, it is recommended that you con­sult with an appropriately licensed physi­cian or other health care worker.