Car accidents can cause a variety of different injuries to a person: back pain and whiplash (neck-to-back damage) are just a few examples. When feeling these adverse effects, it’s common for people to wonder just how serious their injuries are. Something important to understand about car accidents is that it is entirely possible to receive an injury that you wouldn’t expect! For example, many people have been diagnosed with Sciatica (damage to the sciatic nerve, causing pain down the back of the leg or through a buttock), which when untreated, can lead to a life of pain. On top of Sciatica, did you know it’s even possible to get Carpal Tunnel Syndrome from a car accident? Most people wouldn’t expect this, since the majority of the world only knows of Carpal Tunnel Syndrome being the consequence of typing at a computer too often. So how is it possible to receive a syndrome more commonly received from typing, while driving?
Imagine you’re in a car accident- depending on the severity of the collision, it is incredibly possible for your wrist to be damaged; Whether from gripping the steering wheel too hard or it being crushed as the car flips. Carpal Tunnel Syndrome is defined as the compression of a nerve in the Carpal Tunnel (hence the name). With that definition in mind, it’s easy to see that car accidents can cause Carpal Tunnel! With this in mind, how does one go about treating the pain accrued from the injury? It’s important to note that with neurologic symptoms, the location of the pain doesn’t necessarily pinpoint the location of the damage, however, we will get into more of that later. Pain doesn’t just exist to annoy and hurt, it has a purpose! Bodily pain is evidence of damage to the cells and tissues surrounding said pain. The body is really good at healing and putting itself back together, but more often than not, large injuries require outside help. Lots of drugs and pain-relievers can help alleviate the pain from Carpal Tunnel Syndrome, but it is important to understand that pain relief via drugs does NOT imply that the problem is solved.
Pain-relievers are generally just designed to hide or mask the pain. They do not promote healing. A person who is using pain relievers to mask the pain may even be at risk to injure themselves further since they will be allowed to do things they otherwise wouldn’t because of the pain. The cells and tissues will continue to injure further as the person tries to push themselves! A person working a desk job at a computer all the time may be very tempted to just take some Ibuprofen to hide the pain of their Carpal Tunnel, and then keep on typing with incorrect form, thus worsening the compression of their nerves. I personally have treated many people whose condition worsened by overusing a damaged limb, low back, or neck after a car accident, since they were using heavy narcotics. They would go to work, play sports, and do
recreational activities, with no idea that these things were damaging their body significantly
further. After all, they felt fine…for a time!
So what does Carpal Tunnel feel like? In most cases, people will describe it as a kind of pain,
numbness, or tingling in the wrist. To an extent, this is what most nerve damage will feel like.
Now here’s the real kicker- earlier it was stated that with nerve damage, the location of the pain
doesn’t always pinpoint the location of the damage. Imagine once again that you are in a car
accident. You’re gripping the steering wheel tightly and colliding with an object in front of you.
Right before you feel the pain in your wrist, you feel your neck and head whip forward from the
force of the collision. Something important to note is that many neurologic symptoms will mimic the symptoms of other conditions! Until the nerve damage is found, it could actually be a pinched nerve in your neck that is causing the pain in your wrist! It may not be Carpal Tunnel Syndrome at all, but another condition such as Thoracic Outlet Syndrome (compression of the thoracic nerves). This is why it is so important to get treated as soon as possible following a car accident- the issue of having nerve damage in a different location than you think can cause a cascade of other problems.
Going to see a chiropractor who specializes in nerve damage and auto accidents is a great
place to start after an accident. A good chiropractor who specializes in these types of auto
accident cases will look for the origin of the nerve damage, and try to promote healing the direct
cause, not just the location. Because of the powerful forces with the contrasting directions
involved in a car accident, a person without a seatbelt can find their body thrown in a whiplash
motion, which can overstretch and tear tendons, muscles, and ligaments. It can also put a great
strain on certain nerves, therefore damaging them. Sometimes that’s the root cause of Thoracic
Outlet Syndrome or other conditions mimicking Carpal Tunnel Syndrome- overstretch on the
Overstretched nerves can take a long time to heal, and need to be protected with bracing or support. Rest is also important, along with controlling the inflammation around the injury. Oftentimes the surrounding regions are injured at the same time, so it’s important not to stop looking for damage prematurely. Nerves in your neck pass through many tissues throughout the body as it runs down the upper appendages. Inflammation around the wrists or forearms can be a direct contributor to Carpal Tunnel symptoms as well! In the case of a car accident, when damaged, these same muscles create adhesions to the nerve and may leave a person with ongoing pain and symptoms…even after these tissues have “healed”.
The term “overstretched” used in the context of bodily tissues can be misleading, or at least lead one to believe it isn’t as serious as it is. It’s important to recognize that when tissues are overstretched, there is micro-tearing within the tissue which also means there is bleeding in that region to some extent. If you have ever suffered from a severe car accident injury, you may notice discoloration under the skin, much like a bruise, without ever hitting a body part on the interior of the vehicle. That bruising is an indication of torn tissues that are now trying to heal. The bleeding from torn tissues is damaging to cells and acts almost like a glue that damages nerves and muscles, this then leads to fibrotic adhesions, adhering one tissue to another. Nerves to muscles, muscles to other muscles, ligaments to tendons… A whole cascade of painful scarring can be very problematic to a person’s recovery.
When we consider car accident injuries, typically the neck is the most injured area. Disc
herniations, bulges, and protrusions can all cause conditions that will mimic Carpal Tunnel
Syndrome! This happens because a bulged disc in the spine can extend and compress the
nerves directly surrounding it. The nerve being compressed can mean that you feel pain in your
wrist, or even down into your legs. In my practice, disc herniations account for approximately
35% of all conditions that I treat. Disc herniations come on for many reasons, everything from
acute traumatic injury to poor posture. The most prevalent thing that all disc herniations have in
common is the origin of spine flexion, either sudden and sharp or slow and steady.
When you consider the anatomical makeup of a spinal disc, especially in the lower back or
lumbar spine, you come to understand that the outer lining of each disc is a tough material
referred to as the annulus. The center of the disc, or nucleus pulposus, is a very tough, viscous, gel-like material. The spinal vertebra above and below with the intervertebral disc in between, comprise a joint in the spine. These joints allow for flexion movements in various directions, in fact, all directions. In anatomical terms, flexion of the spine is referring specifically to forward bending. During forward bending, there is more pressure at the front of the annulus by the bones above and below than when standing neutral. The same goes for any motion such as side bending or extension (back bending). At the same time, more pressure on one area of the annulus will also cause a shift in pressure on the nucleus pulposus. Imagine a water balloon sitting between the two flat surfaces of the spinal bones. Now, when you flex the bones, the pressure on one side of the water balloon increases while the other side decreases. In normal movements, flexing the spine in various movements is not a problem. But now imagine very sharply flexing and extending the bones within less than 1/10 of one second. Now the risk of popping the water balloon is highly increased! This is what we notice in the case of car accident injuries… When the low back is thrown suddenly and sharply forward and backward, compression and overstretch (or overstretch and compression) may cause a rupture or herniation in the intervertebral disc.
The other way that discs are damaged is the slow and steady reasons. These types of disc
bulges or disc herniations come on over time with micro traumas such as poor posture (both
seated and standing), poor bending and lifting habits, loss of core stability, or uncorrected
movement disorders following a previous injury. These happen very often for people who work
in trades for many years such as plumbing. All of these “microtraumas” can add up to, what
seems like, a sudden event. When, in actuality, the disc(s) has been under stress for quite some
time. It then only takes a “final straw” for someone to realize and feel that there was an underlying issue, to begin with. Many times people will come into my office indicating that they “threw their back out” when bending over to pick up a pencil off the floor. What they don’t realize is that there was already a significant disc issue, but since it wasn’t manifesting as pain, they think it’s the pencil’s fault.
Initially, the rapid disc injury may only feel like stiff muscles or a simple low back injury. This can be mostly true because the initial low back whiplash injury also overstretches the muscles, tendons, and ligaments surrounding the same disc. All these areas typically will become inflamed immediately following the accident. Therefore the individual wakes up the next morning stiff and sore, calls the doctor, and is prescribed a simple muscle relaxant. These muscle relaxant drugs may give some amount of relief for the person’s lower back pain, much like what was mentioned earlier with carpal tunnel. These relaxants end up not doing the disc any favors since there is now disc damage in the form of a simple bulge, herniation, or protrusion of one or more of the discs in the spine.
Whenever there is significant damage in the body, all muscles surrounding that damage will contract as a means to inhibit further damage by allowing that joint, or body region, to move unrestricted. An example of this that is easy for most people to understand is fractured. When someone breaks a bone, this muscle guarding or contraction of muscles surrounding the injury will stop further motion as the body’s way to protect the area. If this did not occur, the broken limb would easily be able to flop around while the shards of bone at the fracture site would be free to cause cuts and abrasions in surrounding tissues such as blood vessels, nerves, skin, muscles, and other connective tissues. The same is true for protruding discs, herniated discs, or bulging discs. In the case of a herniated disc, once the annulus of the disc is ruptured, too much movement in that area will cause further rupturing and protrusion of the nucleus pulposus (as described above), thus leading to greater injury and potential nerve impingement which causes Sciatica, Thoracic Outlet Syndrome, and other nerve radiations depending on the spinal area in question. In the worst cases, as described above, the herniated disc may progress to a protruding disc that could be large enough to put pressure on the spinal cord and cause very serious conditions of loss of strength, muscle atrophy, bowel and bladder dysfunction, and even paralysis.
While treating muscle spasms is an important part of healing after a car accident injury, it is
vital to address the underlying cause, if any, for that muscle spasm and guarding in the
first place. In the case of muscle guarding, once a fracture heals or once a disc herniation
resolves, the treatment of the muscle spasms surrounding that area or muscle guarding
protecting the region, will many times resolve on its own. However, the resolution of the
remaining muscle spasms can be helped by a therapeutic intervention such as electrical muscle stimulation, therapeutic ultrasound, laser therapy, or trigger point injections. The longer a patient waits before getting treated, the more they risk their issues getting worse.
All of the above-mentioned problems will happen until the disc issue is solved. Spinal disc decompression is a very effective way to resolve the “carpal tunnel mimicking” pain stemming
from disc herniations, disc bulges, and disc protrusions. The research began nearly 30 years
ago, in the 90s, regarding the notion of spinal decompression therapy as a way to mitigate
discogenic pain stemming from disc bulges. In those days, a multidisciplinary team of physicians began studying and working on this new idea of fixing disc herniations without surgery. Up until this time, whenever you heard the word “disc bulge,” the word “surgery” typically followed. I am happy to say that with my learning of spinal decompression, I have been able to literally save thousands of patients from having to undergo spinal surgery.
The process of spinal decompression therapy is the act of creating a vacuum, or negative intradiscal pressure, in order to bring the disc back into its normal configuration or shape. As I described earlier in this article, disc bulges, disc herniations, and disc protrusions all include damage to either the annulus (outer lining) of the disc or the annulus and nucleus pulposus (jelly center). The act of creating this “vacuum” effect is performed during a variable weighted negative axial pressure applied to the spine. This works quite effectively for necks (cervical spine) and low backs (lumbar spine). In doing so, discs now have a better chance of healing, especially with the application of therapeutic lasers. In my clinic, we always use the laser in conjunction with spinal decompression. The net effect of these two therapies together is highly effective in nerve pain, stemming from lumbar spine disc issues.
In addressing carpal tunnel that has resulted from a car accident injury, we at Dixie Chiropractic are always careful to be sure to address all surrounding structures in order to fully restore the injured area to a state of pre-accident status. This means checking all tissues that may be involved in any way to cause nerve pain resulting from an automobile accident. After we have fixed the disc issue, we address the muscle spasms of the area with electrical muscle stimulation, ultrasound therapy, deep tissue massage, or other therapeutic intervention to give relief. Homework given to a patient may involve ”nerve flossing” or other stretching techniques of muscles, ligaments, and tendons that are potentially impeding sciatic nerve function. We want to address every issue, not just the pain itself. This way, long-lasting relief, and a pain-free life are in the cards for our patients.
With over 20 years of experience in treating car accident injuries and the resultant disc herniations and pain, I am confident in my abilities to both diagnose and treat all Thoracic Outlet Syndrome and carpal tunnel-mimicking conditions stemming from these types of injuries. Please don’t take this to mean that I can fix every single patient that comes into my office. This is not the case. When necessary, I will refer to spinal surgeons for the few cases that are unresponsive to spinal decompression. But, with 95% effectiveness in treating Carpal Tunnel Syndrome and accompanying disc protrusions, disc herniations, and disc bulges, I feel that my methods are certainly worth trying prior to going under the knife.