As a personal injury lawyer, I have worked on injury accident claims for over thirty years. I have represented chiropractic patients during that time. The understanding of the importance of Chiropractic as a healing art has grown immensely. Please indulge me to share some of my thoughts on the role of chiropractic in treating soft-tissue accident injuries.
Although manipulating the positions of bones, Chiropractic Physicians mostly treat soft tissue conditions. Soft-tissues include virtually any tissue that is not either bone or teeth. Mostly our bodies are soft-tissues. In fact, the primary element in 98% of all human tissue is water.
Soft tissue injuries are quite common in an accident and often unnoticed until a few days after an accident. Soft tissues are skin, muscles, nerves, ligaments, tendons and other non-bony parts of the body. Not surprisingly, in the event of trauma these tissues are frequently, strained, sprained, bruised, torn, or ruptured. Almost all serious soft tissue personal injuries where there is no visible bleeding are under the skin. Often, these injuries can only be felt or sensed by the person who is injured.
Injury to soft tissues is frequently not visible, even on X-ray. The repair of soft tissues can result in the accumulation of scar tissue even through the tissue cannot be observed except in surgery or autopsy. Scar tissue accumulation in tissues that are relied upon for movement and flexibility can limit range of motion in a joint and be a source of pain.
Often, bones that are broken mend with as much strength as before injury. One of the problems with soft-tissue healing is that the body attempts to fortify the area of personal injury with bone rather than with the soft-tissue that was attached to the bone before the personal injury. This is one of nature’s ways of providing structure and cohesiveness to an area of injury, which is a healing process that has been around a lot longer than doctors or either chiropractic or medicine. However, the body’s historical, unassisted ways of healing itself after personal injury are quite crude when compared with what the wonders that modern science can accomplish today.
Chiropractic was founded and blossomed with twentieth-century methods of prevention and treatment. It represented an approach to treating soft-tissue personal injury that involved more than sutures, bandages and narcotic medications. The first chiropractors adjusted the bones in the neck in order to facilitate unimpeded flow of energy in nerves. Eventually this work focused on the healthy maintenance or repair of immediately surrounding soft tissues. As the understanding of chiropractic grew, the effects on all parts of the body from adjusting the spine became better understood. In time, chiropractic began to be understood as a holistic approach to prevention, treatment and cure of the entire body.
If you have even had a broken bone, you know that the pain and discomfort is usually gone after a period of recovery of some number of weeks or months, depending on the severity and location of the fracture. However, you also know that even when there are no broken bones, there is often swelling, discoloration and pain. Many people who have had non-fracture back or neck injuries know that the pain can remain for months or years even though no bone has been broken. What this means is that although a doctor can often set a bone, there is often no historically recognized and effective way of completely healing soft-tissue personal injuries. Left to its own devices, the body usually increases the flow of blood to the area of personal injury and starts building on the bony tissue in order to give the soft tissues a structure to which to attach, much like a gardener fills soil in around an exposed and isolated tree or plant root.
Chiropractors are the master gardeners of the spine and the nerve system that emanates from it. However, instead of filling in the roots with soil, doctors of chiropractic attempt to restore the natural, intended position of the original bony structures so that the soft tissues will return and heal as nearly as possible to where they were originally found. Obviously, soft tissues are much more flexible and forgiving than bones. As the hands of a chiropractor direct the bones, the soft tissue repairs are meant to follow.
Unfortunately, when the soft tissues that are hidden below the skim are injured, these tissues are sometimes invisibly ripped or torn. Sometimes the tearing is microscopic but very plentiful. When healing occurs, the tissue below the skin that surrounds bony areas, particularly in the neck and back, are left scarred – sometimes microscopically scarred, in fact. It is small wonder that after a cleanly broken arm is set and healed, the patient is left with no pain, although the victim of a soft-tissue personal injury might continue to endure pain and discomfort for years.
Insurance companies are paid premiums to insure risk. If you are in an automobile collision in Washington or Oregon, PIP (personal injury protection) coverage from the insurance policy of the car in which you were riding will provide insurance payments for your treatment and wage loss unless the PIP coverage was waived in writing when the policy of insurance was purchased. If another driver caused your injuries, you will also have a claim against that driver’s liability insurance. If you were riding with the driver who injured you, the PIP and Liability coverages will usually both be from the coverage of the driver of the car in which you were riding.
The risk against which the PIP carrier and the liability carrier insure is the risk that they will have to pay any loss resulting from your injuries. To the extent to which people are not injured and have no loss, insurance companies get to keep the money paid as premiums for the insurance. As you can see, it is directly in an insurance company’s interests to keep as much of the money originally paid as premiums for policies of insurance as they can. The best way to do that is to avoid or minimize the amounts that must otherwise be paid to or on behalf of people whom have been injured.
A vertebral fracture can be more significant as an indication of the severity of a soft-tissue injury than as a fracture.
I once had a client with what is commonly called a “clay-shoveler’s fracture”. This fracture occurs when the spinous process of the seventh cervical vertebra (C-7) fractures and separates from the main body of the vertebrae. “Processes” are structural, bony appendages and extensions off of the main surface of the body of a vertebrae, to which ligaments, tendons and other soft tissues attach.
The C-7 spinous process causes one of the more pronounced bumps that you can feel when you reach back with your fingers (or even see) at the base of the back of your neck when you tilt your head forward, somewhat at the top of and between the shoulder blades The trapezes muscle, one of the main large muscles running laterally outward from the spine, across the top of the back, attaches to the spinous process of C-7. If the C-7 vertebrae fractures and permanently separates from the vertebral body, that point may become a source of muscle spasm in the trapezes muscle, which will no longer be anchored to the C-7 vertebrae. The treating neurologist on this personal injury case told me that the fact that the spinous process would never reconnect to the C-7 vertebrae was less significant than what the fracture revealed about the damage to the surrounding soft tissues.
It has been my experience that insurance companies will often go to great lengths to avoid paying what they should pay if they do not have to. I have over three decades of experience negotiating with insurance companies, and sometimes bringing suits to recover on my clients’ claims. It is often a struggle or an outright fight to make an insurance carrier pay what it should to compensate an injury victim for their loss.
From a layman’s point of view, I regard chiropractic care as the type of treatment most calculated to help a patient recover from the effects of a soft tissue back or neck injury. Massage, physical therapy, and acupuncture can also be quite helpful. Neither chiropractic care nor these other modalities guarantee a complete recovery, or relief from all pain. However, in absence of these “hands-on” forms of treatment, the most common other form of treatment is to prescribe muscle relaxants and pain medication, and to effectively do nothing else at all.
The prevailing view of treating these patients with prescriptive medicine and time is that the body will heal itself. Although it is true that the body does heal itself, leaving the body to its own devices in healing soft tissues injuries might sometimes be a little like letting bones set by themselves.