Common Car Accident Injuries with Dr. Fred Williams

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Matt Dolman:

Welcome to Dolman Law Group podcast. I'm here with Fred Williams, Dr. Fred Williams from Kingdom Chiropractic. Fred, say hello.

Fred Williams:

Hello everyone. Thank for having me today.

Matt Dolman:

Today we're going to talk about common car accident injuries. What are you commonly seeing in your all office, as a practicing physician, when an individual is coming for a car accident?

Fred Williams:

Sure. That's a really good question. Most common will see whiplash type of injuries in the neck.

Matt Dolman:

And that's from a rear end accident.

Fred Williams:

Correct.

Matt Dolman:

It sounds weird, but you're getting hit in the rear and your head snaps forward quickly. Explain what is whiplash.

Fred Williams:

Correct. So you can have that from front to back, or actually can get hit from the side. It's just jarring and stretching over the muscles and ligaments, which is causing pain in the neck area.

Matt Dolman:

Could that be as bad as a disc injury?

Fred Williams:

It could be. It could be more symptomatic, actually.

Matt Dolman:

Why is that? Because there's no surgical solution to a ligament injury?

Fred Williams:

Correct. It's a soft tissue injury.

Matt Dolman:

How long does a ligament take to heal?

Fred Williams:

Everyone's different, everybody heals differently. So it depends totally on the person.

Matt Dolman:

So in a lot of cases that I've handled myself as a trial lawyer, the insurance company will take the defense that a sprained strain injury, which is basically a soft tissue injury, should alleviate within 46 weeks. They'll place a time limit on there for the purpose of cutting off the patient's benefits, at least from their own insurance carrier, or on the other side, to minimize the value of the case.

Fred Williams:

Correct.

Matt Dolman:

What's to it? If the ligament injury can last for an extended period of time or prolonged period of time, why are they limiting it to four to six weeks? What's the science behind that?

Fred Williams:

Well, I think less of the science, more so financially because they want to limit how much they're paying out on these cases. Sometimes they do fall into that range. So there's probably some studies they looked to substantiate that claim. But most folks will take a little bit longer to heal. It all depends on how they were before they had this accident. Were they in good shape? Were they in good health? Did they have previous damage to those areas? So all those things play a part in it.

Matt Dolman:

So if had any preexisting injuries, let's say it's a 20 year old individual that gets no car accident, rear end collision. So the force obviously translates to neck, the flexion extension. They come back, that rapid movement. Does that tear the fibers? Does it tear the muscles? Does it tear the ligaments?

Fred Williams:

That's another good question, there. Actually, if it's enough force there, we can see some damage in the ligaments, which would be the ALL or the PLL. And how this is noted first from the plain film x-rays, if we see this anterolisthesis or retrolisthesis, that's going to lead us to the thought of the ligaments being strained or stretched out of bit.

Matt Dolman:

What is anterolisthesis and retrolisthesis?

Fred Williams:

Okay, good thing, good question. There that's the ligament on the front of the spine, the anterior longitudinal ligament. And then the PLL is posterior longitudinal ligament, which keeps the spine, the vertebral bodies in place when you flex and extend, bend your head. Keeps everything in place. So if it's enough force there, those ligaments get stretched. And then what happens, the vertebrae slides forward or slides back on the vertebrae below it.

Matt Dolman:

Okay. That's angular translation?

Fred Williams:

Correct.

Matt Dolman:

Of the spine. So when there's a tear to a ligament, what do you do? How do you treat that?

Fred Williams:

Well, if it's a tear, those are those internal, so it's going to heal with time. But the way we document-

Matt Dolman:

With the stretching rather.

Fred Williams:

Yeah. It's going to heal. The body's going to heal, just with some time. We have some therapies we can do to help with those issues. When we look at the radiology to determine if there is a permanent injury, we can do looking at the stress films of the x-rays, we have them bend their head forward and been their head back. And then we look to see if there's any translation of the vertebrae on top of the other. If it's more than the width of a quarter, then it puts them at a 45% Whole Person impairment.

Matt Dolman:

That's an impairment rating that it's important for both the patient from a doctor patient perspective to basically explain how severely injured the individual is. It's a rating scale. But very important to the attorney, likewise, when we submit a demand, oftentimes the impairment rating is what the adjuster will look at, determine the severity of a whiplash injury.

Fred Williams:

Correct.

Matt Dolman:

Maybe not so much for disc injuries, surgical cases. But the smaller cases, the whiplash cases, that's how the insurance company will determine the value.

Fred Williams:

Absolutely correct. And to give the folks a reference point and also, you have important ligaments of the spine and integrity spine is that 25% would be similar to if you lost your leg or lost your arm. So it's very important to keep the spinal stability.

Matt Dolman:

Is that based on the loss of bodily function?

Fred Williams:

Correct.

Matt Dolman:

Okay. What other injuries are you seeing at your clinic?

Fred Williams:

You're going to have your low back type of injuries. You can have similar injuries to ligaments. They're not as common as in the neck, but they do have the anterior longitudinal ligament and posterior longitudinal ligaments sometimes gets stretched in the lumbar spine, which is the low back. Also very common, or dis bulges or disc herniations, depending on the severity of the accident.

Matt Dolman:

Yeah, that's a question that comes up often and we can even cover that in a separate video. But real quick, I know a lot of patients and individuals in general get caught it up in the vernacular of a bulging disc versus a herniation, and they think herniation is this horrible thing that could occur, which I'm not saying it isn't, but that a bulging disc is much more minimal. Explain how you can have a herniation, but be asymptomatic, meaning you're not feeling any pain or you can have a bulging disc that is very painful. Why is that?

Fred Williams:

That's also a very good point there, you made. The bulging disc in a herniation, this is how I explain it in our office, I tell the folks, listen, think of a jelly donut. If you squeeze it enough, the jelly can show in the hole, but it doesn't come out. That'll be more of a disc bulge. If you press hard on that jelly donut, the material can squirt out, and that's a herniation. So a bulging disc can have different degrees of bulge. And also, it can either come straight to the back posterior, or it can go to your left or go to your right. So depending on the position of the person can be symptomatic or can be asymptomatic. And that's all due to the type of injury that's sustained. The herniations can be asymptomatic, meaning that the nucleus pulposus isn't touching any of the spinal nerves. So they won't feel any symptoms, but yet they still have the problem.

Matt Dolman:

Yeah. I know I have from prior auto accidents and prior workups with different physicians, I have three blown discs in my neck, meaning they're herniated. I don't feel any pain, I don't have any problem. And isn't it true when you say that as the population ages, an individual goes from 25 to 40 years of age, their spine progressively gets worse.

Fred Williams:

Correct. Because our bodies are mostly made up of water. And as we age, we do lose some of the water in our body, including inside our disc, because they're mostly made of water as well. So we shrink a little. As we get older, we also sleep a little less, require less sleep and we'll eat a little less. So those are only three things that happen as we age. Anything outside of that would be abnormal in aging.

Matt Dolman:

So how do you age a finding on a film? Like say somebody has a herniation and we can't tell if it preexists the accident or not. How do you determine what's preexisting versus what is acute and from the accident?

Fred Williams:

Sure. What you're referring to here is looking at the radiology and the findings there. In most of the facilities in town, they do a really good job. They have a radiologist that can easily note it. But it's just looking at the either is it transparent or is it white, and that will tell you the chronicity of the injuries when we're looking at the radiology.

Matt Dolman:

So does the disc have fluid or if it's lost complete fluid.

Fred Williams:

Correct.

Matt Dolman:

So if it's lost fluid, it's a black disc. That's degeneration.

Fred Williams:

Correct.

Matt Dolman:

Otherwise, you're looking at an acute injury.

Fred Williams:

Absolutely.

Matt Dolman:

What if it was preexisting and the disc was black already? How do you tell if it grew worse? Can it grow worse? I mean, a lot of my clients have preexisting injuries. I'm sure a lot of your patients do as well. So let's say they had preexisting blown disc, it's lost complete hydration over the years. It's a black disc now, at least that's how it's showing up on film. How do you determine there's new acute issue or injury that may have made this, trying to say increase the severity of their pain?

Fred Williams:

Sure.

Matt Dolman:

So we can call it-

Fred Williams:

Exacerbation.

Matt Dolman:

Exacerbation or aggravation of a preexisting latent injury.

Fred Williams:

If it's someone that was unfortunately in an accident previously and the physician's ordered the proper radiology, we'll have a reference point to compare the two. Absent of having previous radiology, you'll just have to look at the findings on the film again. Now, you can have the black disc, but you can also have other areas that may show changes in it. And it's due to the gray, the whites and the blacks when we're looking at the radiology.

Matt Dolman:

And from my experience, you're treating symptomatology or symptoms, not the pathology or the way it actually looks. Unless you have significant cord compression and to the point where you need to see a surgeon right away, it's really, you're just looking at symptoms. You're not looking at pathology, correct?

Fred Williams:

Correct. People walk in the door because they have symptoms, but we kind of address folks in a global sense, meaning that if their shoulder hurt or their knee hurts, we're not just looking at that, but we do address it. But we look at the whole system because we understand how the body functions as a whole, and just not as a piece. So we try to fix everything that may cause the new injury to be worse. So in other words, we try to get the whole system stable and on a good track for healing.

Matt Dolman:

You see a lot of numbness and tingling in the hands, which relates obviously to the neck or in the back. You'll see, not grip strength loss in the hands rather, but you'll see a strength loss in the lower extremities. You'll see individuals who feel like their feet are asleep all day long, the pins and needle feeling that extends from the back all the way down to their feet.

Fred Williams:

Correct.

Matt Dolman:

What is this relating to? What causes this?

Fred Williams:

Oh, good point there. So the neck more common than the lumbar or lower extremities. So with the spine, you have the thoracic outlet and those bundled nerves kind of looks like a pack of Twizzlers, and it goes through the shoulder area. And when you have those injuries and those muscles tighten up and you got inflammation is compressing nerves and causing irritation. And that's what happens in the neck area. In the lumbar, when the spine comes down, it bifurcates, it goes through the back and it splits into what's most commonly known as the sciatic nerve, which is the largest nerve in the body. And it's easily irritated by any imbalances of muscles and so forth or down there. So we have those injuries and all the inflammation, the muscles are tightened up. It's going to cause the irritation and cause the numbness and tingling down the legs, maybe into the feet. And that's one of the signs of nerve interference.

Matt Dolman:

Okay. Does it also happen when the disc touches, there's compression onto the nerve?

Fred Williams:

Absolutely. The nerves don't like to be touched, no matter what's touching it. So you got some sort of lesion, touch the nerve, it's going to cause the shock or pain sensations down the entire pathway of that nerve. And depending on which it goes through, the body is a map. When we look at it, certain digits on the hand, certain toes are innervated by different nerves. So if they tell you one toe, three toes or whatever the toe is, we can almost pinpoint to where the problem originates from.

Matt Dolman:

And that's called dermatomes.

Fred Williams:

That is correct. The dermatomes, yes.

Matt Dolman:

I guess the best question is what is a threshold in your practice of when a patient has done everything possible, taken every less restrictive measure and now they're a candidate for surgery? When do you make that determination? What do you like to see? What do you need to see to make that?

Fred Williams:

Okay. So like how a case unfolds, they come in, do an initial exam. We'll see them for a certain amount of visits, we do a re-exam within a couple weeks to see if they're coming along as they should, based upon folks we've seen in the past. And then we move on. We order radiology soon, in the first 30 days. We give the body a chance to heal a little bit so less inflammation, we get a clean picture on the radiology. They'll treat conservatively. Usually about 15, 25 visits. And then by that time, they have the radiology done, they had an EMC exam done. And then either, depending on how the radiology comes back, we know which path they're taking, either neuro referral or ortho referral.

Matt Dolman:

Okay. So what are you seeing that would give you the inclination to send out for an ortho referral.

Fred Williams:

Ortho is anything spinal related. So disc issues, ligament type issues. Neuro, if they came in with numbness and tingling, in any of their extremities, those folks would more so go down the neuro path. Or a lot of times we see folks with mild grade concussions and then sometimes they also have to see neurologist for that.

Matt Dolman:

This is obviously, everybody's different, but if there's some numbness tingling going on, wouldn't a spine surgeon be able to correlate that? What's the purpose of the neurologist?

Fred Williams:

Well, that's good because in these type of clinics, they're specialists. So just like you won't go to a Chinese restaurant and order steak. Can they make steak? Sure. But you would probably go to steakhouse to get the best type of steak.

Matt Dolman:

So the neurologist, that's his specialty.

Fred Williams:

That's his specialty. That's what he does all day, every day.

Matt Dolman:

Understood. What other common injuries are you seeing in terms of the upper body? Are we seeing shoulder injuries?

Fred Williams:

Shoulder is very common. Usually, we'll see the injuries, if it's the driver, from the left coming down the right, basically around the seatbelt. A lot of times with the females or the folks that are skinny or less meat on them, we see the lap belt type of bruising, the injuries. But the shoulders can be very common and it can translate down the arm and cause some issues into the hand even.

Matt Dolman:

So how do you determine if the hand or the arm is related to shoulder versus the neck?

Fred Williams:

Yeah, that's good. That's when the orthopedic testing comes into play. Dermatome testing, muscle testing to kind of pinpoint where the origin of the problem is.

Matt Dolman:

That's why they check to see if you have carpal tunnel.

Fred Williams:

Correct.

Matt Dolman:

Is that common from auto accidents?

Fred Williams:

Not so much, but we do see things that come from the elbow that kind of present as carpal tunnel. And folks that's never been in accidents, I see them, they come in and they're experiencing carpal tunnel symptoms. But it actually doesn't originate in the hand and it actually comes from an elbow.

Matt Dolman:

Ulnar.

Fred Williams:

Mm-hmm (affirmative).

Matt Dolman:

So if you look at the studies of carpal tunnel surgeries, the success rates are not very good. And also, people go back for the same issue. Again, they still have the same symptoms afterwards because it's one of most misdiagnosed procedures. So a lot of it in our clinics at least, we see it comes from the elbow and this is from training we got from some orthos from Europe.

Matt Dolman:

So how do you injure your elbow in a car accident? What's the mechanism?

Fred Williams:

Sure. In an auto accident or just daily life, this happens all the time. So in the arm you have two bones, the radius and ulna. So when you flip your hand over and back, you supinate and pronate, the bone rotates. And sometimes it gets stuck somewhere in that motion pattern and it cuts off the nerve pathway to a certain percentage going downstream. And then the hand starts to get those symptoms of carpal tunnel.

Matt Dolman:

Okay. Is shoulder injuries very common?

Fred Williams:

Not as common as you think, but they are common depending on the person. Usually, smaller folks, children, females or smaller men. The more meat, the more bulk on someone, the greater chance they have of sustaining less of an injury from an auto accident.

Matt Dolman:

Really? I didn't know that. So what type of shoulder injuries are we seeing?

Fred Williams:

Usually never any tears. Just more so muscle type injuries, bruising. I have had some folks come, post surgical that tore some of the ligaments in the shoulder. Most commonly injury are the rotator cuff muscles, most common is the supraspinatus muscle. And so those are the most common type of injuries.

Matt Dolman:

Yeah. I've seen a few supraspinatus issues this year. Phones going off, you're always blowing up. Understood. So that pretty much concludes all my questions. I can't think of much else. I know that you probably see some lower extremity issues. I just have a few more questions and one of the issues would be headaches.

Fred Williams:

Oh, man.

Matt Dolman:

How often are they associated to a neck injury? What's the origin? I know headaches, it's a very vague term and it's a vague injury in society itself. And often, we can't figure out what caused them, whether it's cluster headaches or migraines. But after an auto accident, let's say the person who was asymptomatic beforehand, or they had no issue with the head, now they have headaches. What was the cause?

Fred Williams:

So those are very, very, actually, I'll be remiss to say that's one of the most very common symptoms that folks come in with. And everyone says, "Oh, I have a headache." So then we have to do a little bit more research. I'll say, "Okay, do you smell anything weird before the headaches come? Do you see any floaters before they come?" So if they answer yes to either of those questions, we know it's now not a headache, but it's more of a migraine, posttraumatic in nature. So those are treated a little differently than you run of the mill tension headache, cluster headaches. And those are most commonly associated with the muscles tighten up and pressing down on the nerves from the neck, up into the head. And so those are very, very common. And so in the beginning, folks are taking whatever they need to take to alleviate the pain. But once we get the spinal alignment and get the nerve pathways back open, a lot of those symptoms seem to dissipate fairly quickly.

Matt Dolman:

Okay. And that can alleviate the headache?

Fred Williams:

Correct.

Matt Dolman:

How about TMJ, the jaw?

Fred Williams:

TMJ, that's another good one. There's 14 associated symptoms of the TMJ. That's probably a whole nother podcast there, and we can address the dental industry on that. But just in the nutshell, the TMJ, if you have any misalignment, there's discs in the mouth there. So if you have any misalignment, when you open and close your mouth, you look in the mirror and the jaw goes to the left or goes to the right, forward or back, you know you have a TMJ issue and this could present itself as some of the most common headaches, neck pain, back pain, type of things, all coming from the jaw.

Matt Dolman:

Crepitus.

Fred Williams:

Crepitus.

Matt Dolman:

Yep, that popping sound.

Fred Williams:

Bruxism, grinding the teeth at night. Very common. Think about a dentist. If you do anything inside the mouth, if you don't balance out both sides, if you get a feeling or a crown or whatever the case may be, there's going to be a certain percentage that is going to be off or higher, which is going to affect how the jaw closes. So all those things can affect the TMJ.

Matt Dolman:

How do you treat the jaw?

Fred Williams:

The jaw, depending on if it's posterior disc, anterior disc in the jaw, meaning how the jaw moves when it closes. And it's just simple adjustments, it's like all the other bones, just out of alignment.

Matt Dolman:

Okay. Well, anything you else you want to talk about? I think we've covered all, it's pretty exhaustive.

Fred Williams:

Yeah. We hit over the major areas, neck pain, whiplash injury, lower back injuries, both with anterior and retrolisthesis type injuries. Fractures, not as common, really. And some folks say the radiology done, and they all look for the fractures. So those aren't as common unless it's someone that's a little bit older and the bones are a little bit more brittle. Usually women, they lose their calcium as they age. So most common with a female versus the males.

Matt Dolman:

Understood. Well that concludes our latest podcast. I thank Dr. Fred Williams from Kingdom Chiropractic for coming down. How do my listeners, how do they get in touch with you if they need a consulting, if they're injured?

Fred Williams:

Sure. So the best way you can reach us is that www.kingdomchiropractic.com, also the same handle on Instagram and also on Facebook. So you can reach us any of those ways, or we have a 1-800, 24 hour injury help line, which is 1-844-FL-SPINE. So just remember, if you're in a wreck and need a check, don't waste time, call 1-844-FL-SPINE. One call, that's all.

Matt Dolman:

Quite the jingle. Thanks for listening.

Fred Williams:

Thank you.

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