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Whiplash and Dural-Neural injury
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- čas přidán 7. 09. 2022
- There are two key ways that nerve tissue (and its dural fabric) get involved in whiplash disorders:
1) Excessive pressure/tension during whiplash motions can physically injure dural tube and nerves -- especially near the nerve root, and especially if there is pre-stress on the system.
2) All the dural tissues are innervated by nociceptors, and can become sensitized by the inflammatory / CNS trauma dynamics that follow whiplash injury.
Anecdotally, #2 seems way more common. But in either case, it becomes crucial to understand how neural tissues move with the cervical spine, and how you can modulate pressure/tension on the dura and nerves for more effective whiplash treatment.
In this video, I also offer an alternate model for some transverse friction techniques, which often seem useful but whose mechanism seems implausible. Maybe it's not the collagen we are re-organizing, but the inflammatory behavior of dorsal rami we are helping to re-regulate?
(This would explain why tissue specificity still seems important, but not require us to adopt counterfactual ideas of fascial plasticity.)
How do neurodynamics and nerve tissue anatomy play into your whiplash treatment?
⚡Neurofascial Approach to Whiplash Treatment
Friday May 3rd, 10:00 AM-2:00PM Pacific
4 CE hours, $75, and accessible forever. (Or as long as email/youtube exist). bit.ly/4aeVvJX ⚡
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REFERENCES:
Nerve pathology and neuropathic pain after whiplash injury: a
systematic review and meta-analysis (fundaun et al 2022)
www.ncbi.nlm.nih.gov/pmc/arti...
How can animal models inform on the transition to chronic symptoms in whiplash? (Winkelstein 2011)
pubmed.ncbi.nlm.nih.gov/22020...
Consensus practice guidelines on interventions for cervical spine (facet) joint pain from a multispecialty international working group (Hurley et al 2021)
rapm.bmj.com/content/early/20...
Chronic whiplash and whiplash-associated disorders: an evidence-based approach (Schofferman et al 2007)
pubmed.ncbi.nlm.nih.gov/17916...
The Peridural Membrane of the Spinal Canal: A Critical Review (Ansari et al 2011) onlinelibrary.wiley.com/doi/a...
High-Resolution 3T MR Neurography of the Brachial Plexus and Its Branches, with Emphasis on 3D Imaging (Chhabra et al 2013)
www.ajnr.org/content/34/3/486/...
A Review of the Clinical Utility of Therapeutic Facet Joint Injections in Whiplash Associated Cervical Spinal Pain (Eseonu et al 2021) www.jstage.jst.go.jp/article/...
Biomechanics of whiplash injury (Chen et al 2009)
pubmed.ncbi.nlm.nih.gov/19788...
The response to the slump test in a group of female whiplash patients (Yeung et al 1997)
pubmed.ncbi.nlm.nih.gov/11676...
Hi!
Very interesting video. I've been diagnosed with dural ectasia after 6 years of low back pain.
I can't find anything online to try solve the problem other than NSAIDS.
Any suggestions??
Can you please post some inhome suggestions to release this tension? Thanks
Thank you 🙏 for this talk , I had a weird bicycle accident 6 months ago that led to some very difficult months, your explanation of the sheath and nerves dura mata ♥️ helped me understand what I have been going through 🙏
I thought I might never walk again but I did get better it was slooooow and painful.
Brilliant I’m in Williamsburg Virginia I just wish I knew I could go to a doctor like you here I don’t even have a clue where to start thank you again
I had a concussion followed by a chiro aggressive manipulation to the back of my head 5 years ago. Two head impact injuries. I’m bedridden 38 therapists 23 doctors can’t help me. 8 MRIs and multiple other things. Two therapists told me my dura is twisted neither have helped me. The pull and muscle spasms are so intense I can’t function which runs midline right back to front torso to head and culminates into the right side Atlanto occipital joint. The worst is the pressure at the base of skull and at the sternum which feels like it will squeeze the life out of me. If the body heals itself mine hasn’t. If no one can help me I’m leaving this body. I can’t understand why not one person knows how to relax that dura
Did you check an upper cervical chiropractor?
@@EzequielEstrada-hw9yuyes11mths
Gosh you say "The pull and muscle spasms are so intense" you can't function, and the pull/spasms run "midline right back to front torso to head and culminates into the right side Atlanto occipital joint. The worst is the pressure at the base of skull and at the STERNUM".
I have a similar WIDE spread of pull and muscle spasms, although mine is on the LEFT side, and somewhat different pattern. I've had this going on for 24 years since a neck injury, and long diagnosed with 'Cervical Dystonia', though that didn't anywhere near cover all that was going on.
Anyway, what struck me about your comment is when you said it's worst at the Atlanto occipital joint/base of skull and STERNUM. It's a long way from the atlanto-axial joint to the sternum! Not to mention one structure is at the back, the other at front. Yet it's the SAME WITH ME. I have had constant deep soreness at the base of my sternum (xiphoid region) AND at the base of my skull on the left side. There's a taut muscle band runs from occipital region to my left upper trapezius. If I try to flex my head (chin to chest) against the line of pull, it literally feels like my brain is being pulled out. If the area either side of my sternum gets accidentally pressed it triggers eyewatering burning pain that can last for 10-20 mins. I consider the sternum pain related to my neck injury as it all started at the same time, yet no doctor has made a connection.
I understand what you mean by 'leaving this body'. The urge to abandon it. I felt the same, still do some days, but I'm still here 24 years later. I'm not bedridden, but have to lie down every couple of hours. Over the years I've developed all manner of strategies, little things I do that give me a measure of relief or bring joy or capture my interest. Things that when they were first suggested made me feel like shouting 'Are you crazy? That won't begin to touch this! I'll never be the same again!'
Then I accepted that I would never be the same again.
I started to experiment with things that might give me some relief. Even transient 5-10% relief kept me going.
In the early days I juggled work and raising two children with it, but the whole time in the back of my mind was wanting to study and learn as much as I could to understand what is going on with my body.
I've seen a huge expansion of knowledge across two decades. The discovery of the myodural bridges last decade springs to mind, then last year the SCAN (Somatosensory Cognitive Action Network), which requires the rewriting of 90 year old neurology textbooks. I stay to see what happens next :-)
That dura is incredibly tough stuff - like teflon. A small piece of it can hold 50lb or more. It's also innervated. I reckon the dura is the stuff that gives us 'joy of movement', and equally so, 'despair of movement' when it's twisted, adhered, deformed, out of position. And yes I think 'yanking' on it can inflame and tear it, whilst failing to free it, which is why I don't do 'aggressive' chiro. Poor posture alone can cause havoc and well, muscle spasms pull it out of position too. For this reason I do gentle stretching every day to try to keep everything in place and gliding freely. But I can't sort my neck and upper body out once and for all, no matter what I do, and slowly it pulls me back to twisted and jerking. Vibration Therapy and Whole Body Dance therapy gives me the greatest relief at this point, but alas temporary.
The fascial system has been shamefully ignored by medical science for nearly a century, but the tide is turning.
There should be a global repository study group devoted to cases like ours - especially the atlantoaxial / sternum connection. Would speed us to the next discovery I reckon.
I will post my story here at some point as this doctor seems leaps and bounds ahead. Bit exhausted to do so right now.
Wishing you strength fellow sufferer
I can’t seem to reply without all the text going on top of each other yes to who asked if I saw an upper cervicsl Chiro I went 10 mths she made it worse
It’s crazy! Unbelievable lack of knowledge in the body work field. You’re right myodural bridge and dural torque like someone please hear us. This man seems to get it I wonder if he is my next trip in desperation. I can rub push meditate into it hold cry beg it will not let go. On my imaging there is no infolding of the dura at least not since 2023 but crap it’s adhered by scar tissue my injury was really bad and no one can release it !!!
Please talk about side shear Whiplash as in getting T-boned in a car accident what happens to the hips and the trunk and the head, neck Etc
Hi
whiplash can cause blurry vision and my question is
What are is i may call effected
What part of neck nerv system or brain is intrigued.
thanks
You are a fabulous doctor you are so informative and brilliant thank you so much for your incredible videos I was in a head on collision and they don’t hardly recognize that I have such issues with my neck and my L2 for Debria in my back I’m trying to figure out what type of doctor I need to go to about especially my neck thank you so much blessings to you and your family 🙏🏼🙏🏼🙏🏼🙏🏼😇❤️✔️