Integrative and individualized holistic health practices must be considered along with chiropractic and traumatic brain injury care for both TBIs and WADs
Chiropractic and traumatic brain injuries: bringing value for TBI and concussion patients by Eric Reis for Chiropractic Economics
A blow to the head, a sudden jolt, or a motor vehicle accident are the most common causes of traumatic brain injuries (TBI) or concussions. Every year, 1.7 million people sustain a TBI, with an estimated 52,000 leading to fatality. However, persistent headaches, nausea or vomiting, fatigue, and even depression are all symptoms of serious injury that are often downplayed until they lead someone to seek professional care, including chiropractic and traumatic brain injury.
WAD and TBI
Whiplash-Associated Disorders (WAD), which frequently occur in people in motor vehicle accidents, is very similar to mild traumatic brain injuries and concussions. WAD patients often have symptoms matching TBIs; as chiropractors, we must be aware of these differences to adequately address and treat these issues.
Chiropractors frequently support ailments associated with WADs and TBIs, including sensitivities or pain in the neck and surrounding structural tissue, acute pain throughout the body, and stiffness of the joints. The profession has always treated trauma, but we must be aware of all the components that we should be responsible for regarding chiropractic and traumatic brain injury and treating patients.
Visual and vestibular components, as well as inflammatory and centrally mediated responses, often occur from traumatic injuries. It is essential to address these structural, neurological, and metabolic aspects, especially as studies have shown that suffering from WAD can lead to an increased risk of TBI, causing potential long-term damage and risks for future injuries.
Because chiropractors are specifically trained to treat these issues, it is vital to have a strong understanding of neurometabolic cascade outcomes that arise during and after impact to better support a patients’ recovery.
During sudden impacts, the brain and supporting structures quickly accelerate and decelerate, causing forces to be transferred throughout the nervous system and spine. This movement can cause structural damage such as torn ligaments, muscle strain and misalignment, along with diffuse axonal injuries to the peripheral neurons and central neuronal networks. Depending on the severity, people may experience long-term symptoms or have a life-long impact, including neck pain, memory loss and changes in personality, among many other symptoms well documented with concussions and traumatic injuries.
Traditional medicine focuses on managing concussion related symptoms through prevention (helmets, seatbelts, etc.) and prescription medicine to ease pain. We must educate providers about the vast benefits offered via chiropractic and traumatic brain injury care. Our profession has always been skilled at treating trauma and injuries, but we are beginning to gain greater insight into how we can maximize patient outcomes by understanding neuroscience and individualized rehabilitation models. And it is time we take on more patients with these injuries.
DCs via chiropractic and traumatic brain injury care are well-positioned to treat the physical and neurological ailments that often accompany these injuries. By including structural, neurological and metabolic interventions when warranted, chiropractors can aid in patients’ recovery from trauma. Providers not equipped to offer those services in-house should refer patients to a provider with experience in that area and continue to co-manage the complex case for the best possible outcomes.
As chiropractors, we know how the musculoskeletal system is interconnected and the importance of the nervous system effectively communicating with muscles. This new research further justifies and validates our outcomes via neuroscience and understanding of the brain. But a one-size-fits-all approach to treatment is no longer an option. Patients deserve to be treated as individuals. That is why in these complex cases, chiropractors should be responsible for performing an in-depth neuro-orthopedic examination to provide a comprehensive view of how the brain and body are functioning.
Chiropractic and traumatic brain injury with depression: a case study
TBIs are commonly associated with cognitive processing and memory changes, which can manifest through symptoms of irritability, depression and altered emotional responses to stimuli.
During intake and throughout treatment, it is vital to observe for signs of mental health symptoms such as depression. As professionals who create deep and meaningful connections with patients through regular hands-on treatment and continued communication, patients feel comfortable opening up and expressing their true feelings. It is our duty to listen for signs of depression and mood changes that are common with these injuries and to incorporate supportive care plans with other providers when warranted.
In 2020, Paula Walters, a domestic assault survivor made an appointment with me at the Sweere Clinic for support with a traumatic brain injury that resulted from a near-fatal strangulation in 2006. Even 14-years later, she was exhibiting symptoms and chronic ailments that severely affected her quality of life, which became amplified following an automobile accident nearly a decade later. Unfortunately, this is all too common for people with TBIs. The signs and symptoms may be subtle and are often misdiagnosed.
After her TBI, Paula described herself as being at rock bottom and that she could not drive, go to work or do activities that previously brought her joy. One provider told her she would live like that forever, and they could not further support her treatment as the injuries occurred so long ago. This left Paula with feelings of depression, which is extremely common for people experiencing TBIs. In fact, a JAMA study found that 33% of patients during the first year after sustaining a TBI experience a major depressive disorder. This is another hurdle health care professionals must address when creating treatment plans for patients and is why chiropractors must actively listen to patients.
Paula’s last hope was to visit our clinic. Thirty days prior to her in-office treatment, we conducted blood chemistry panels and assessed her metabolic profile, creating individualized nutrition and dietary plan to support future therapies and control underlying inflammatory processes occurring in the body and brain.
For one week of intensive in-office treatment, I customized a plan to address her specific needs, focusing on her underlying issues that inherently involved structural, neurological and metabolic interventions. Specifically, her treatment included visual and vestibular therapies, rehabilitative treatments utilizing the cervical spine and cervicothoracic musculature, balance exercises and supportive modalities like low-level laser therapy and non-invasive electrotherapist to increase neurological function and healing.
This intensive approach to care allows chiropractors to personalize treatment based on a patient’s evolving needs. However, the work does not end in the clinic. Home exercises, strict dietary and nutritional protocols and gradual adjustments to care are necessary for patients to continue to improve. At-home patient compliance is significant to the recovery process.
As a result of her hard work, Paula has completely changed her life. She is working 24-hour shifts as an EMT, training for half marathons, advocating on behalf of domestic violence survivors, and most importantly, functioning throughout the day. Her story is an excellent example of how impactful chiropractic care is for those who have experienced trauma and are still suffering from symptoms.
Consider all your holistic options
Integrative and individualized holistic health practices must be considered along with chiropractic and traumatic brain injury care for both TBIs and WADs. Holistic health puts patients back in the driver’s seat and makes them active participants in their health care journey.
By offering specialized treatment methods, chiropractors provide a unique value and offer long-term support for TBI patients. By understanding the complexities of the brain and body, chiropractors can provide the highest levels of care to improve outcomes.
ERIK REIS, DC, DACNB, is a chiropractic functional neurologist at Northwestern Health Sciences University’s Sweere Clinic. He specializes in concussions, brain injuries, dizziness/vertigo, post-auto whiplash, stroke, neck/face pain, visuo-vestibular dysfunction, headaches/migraines, and sports performance. Learn more at nwhealth.edu/clinicians/erik-reis.