Accident Injuries

Motor vehicle accident injuries are unique. To fully explain this, one must look at the architecture of ligaments and tendons. First of all, ligaments are like steel cables and they hold bones together; tendons are like ropes and they attach muscles to bones. If you look closely at both ligaments and tendons, you see that they are composed of long (hair-like) strands called collagen. It is in these very specialized collagen strands that we find a puzzling thing. When these strands are pulled on slowly they show elastic properties - in other words they stretch some without breaking - but when the strands are pulled very quickly they break. This odd characteristic is called viscoelasticity. Remember Silly Putty? It too has viscoelasticity - if pulled on quickly it snaps, but pull it slowly and it will stretch around the block before it breaks.

When a person’s body is twisted, relatively slowly, as in an ankle strain or sprain, the primary injury is to the blood vessels on the outer surface of the tendons and ligaments. This causes a lot of swelling and discoloration, but usually heals within a couple of months. In contrast, when a person is a passenger in a motor vehicle collision, their ligaments and tendons are pulled on in a very rapid manner - studies show accelerations of 100,000 degrees per second in the first milliseconds after the impact - even in urban-speed accidents! If one could look at the tendons and ligaments closely, after the collision, one would see that the tendons and ligaments have areas where the collagen strands have been broken, often along the full length of the ligament or tendon. In other words the “ropes” and “cables” are frayed.

From years of clinical experience I have noticed that patients, who have been in a motor vehicle accident, often report that they initially had very little pain and stiffness, but over the days and weeks that followed, they noticed it more and more. This is due to the fact that the fractures in the tendon and ligament fibers (many of them deeply imbedded in the core of the tendon and ligament) cause the production of swelling more slowly than injuries that primarily break blood vessels near the outer portions of these same structures - as explained above.

As more swelling develops, more pain and stiffness becomes evident. Patients are often told to just take anti-inflammatory drugs to stop this pain. Although this may sound like a reasonable approach, studies have shown that these drugs have some very serious side effects. Also, and just as importantly, the fluids that bathe the injured tendons and ligaments are there for good reason. These fluids allow for the easy migration of cells that provide the necessary enzymes for the cleanup stage of healing. Many researchers and doctors believe that without this normal fluid bath, the ligaments and tendons will be repaired with fibers of inferior strength and poor architecture.

Lastly, one must consider the course of healing, from these types of injuries, if nothing is done and the injured person just goes about their daily life. First, because these injuries do not seem like much, in the early days or weeks, the person continues to put stress on the tendons and ligaments. This repeated stress (like carrying groceries, for instance) aggravates the torn fibers and may disrupt a newly formed and incomplete repair. These “secondary injuries” then will often promote scar tissue development instead of normal tissue repair. With successive injuries the scar tissue becomes more prevalent and layered. Eventually, the scar tissue forms masses that were previously not present and these masses constrict the blood and lymph vessels. This decreased flow of blood and lymph, slows the delivery of nutrients to the muscles that stabilize the joints in the area, causing them to tighten. One of the best examples of this is seen in a collision where neck ligaments are damaged. If the injury is not treated properly, the scar tissue causes the neck muscles to have periods of deficient nutrient supplies (due to poor nutrient delivery) and the muscles tighten. In the case of the neck - let’s say on the right side - these tight muscles pull the bones of the neck out of alignment (to the right) and put a great deal of stress on the joints between these bones and also the discs between them. This is like driving with your wheels out of alignment in your car; something is going to wear out! In my example of the neck, it is the beginnings of osteoarthritis and possibly disc herniations. Not good.

What can be done to Promote the healing process for these types of injuries?
One of the most important interventions is massage. Massage contributes to the rapid movement of fluids through the injured area. This is important because these fluids carry nutrients to the healing tissues and carry away the “toxins”. This quicker turn over in fluids ensures a high metabolic rate for the energy of healing. Massage also helps to prevent the accumulation of proteins that cause scar tissue. A special kind of massage called myofascial release, stimulates the laying down of new replacement collagen so that it is of adequate strength. Lastly, massage helps to control pain and prevent muscle spasms.

After the muscles have regained their normal resting tone, any damage to the joints must be addressed. Chiropractic manipulations are a crucial part of this process. To understand this, remember (if you ever have worn a brace) that joints become very stiff if they are held immobile for any prolonged period - the longer they are immobile the stiffer they become. As described above, the tight muscles will often cause this sort of bracing to occur and it is therefore important to free these joints up again. Also, a joint that does not move will degenerate. This is because the fluids in a joint are sealed off from the rest of the body and only circulate - and therefore carry nutrients to the living cartilage cells - when the joint moves.

Other important ways to stimulate the proper healing of these injuries include microcurrent and specific supplementation, and exercises - to name but a few. For more information on supplements, exercises and microcurrent, please see related links on this web site.