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028 Whiplash and concussion

028 Whiplash and concussion

By Jurmaine Health

Do you know the difference between whiplash and concussion? Who is the Smurf, who is the Oompa Loompa at our clinic? We also share our experience in witnessing concussion in contact sports. Keep your eyes peeled during your next footy game. Also see you at Jurmaine Health at Moorabbin on 27th April 12pm! Tickets can be purchased now.

SHERMAIN [02:52]

People mistake several scenarios for whiplash and also, to get whiplash. So, the main thing like you mentioned before, is that people think that they have can only sustain whiplash from a motor vehicle accident. But that’s not true. They can sustain it from many, in many ways, actually from many approaches many ways. Like, for example, if you’re surfing and suddenly you get caught in a riff on a big wave and being thrown into a sea, you can get that. Yeah.

SHERMAIN [15:53]

That’s right and also sometimes you would go to other clinics and go out and have this. They would say, oh, it’s all in your head, because it can become chronic fatigue you know, it can turn, you know, from a whiplash case it can become a chronic fatigue case. And then it just goes into a vicious cycle. And it’s also really demoralizing to hear that, hey, it’s all in your head. Well, yes, most tissues in your head have been traumatized.

SHERMAIN [24:23]

Okay, all about headaches and also, you know, sometimes headache can present itself because a person has got low testosterone and all the neuro endocrinology that happens along with that, right.

Dr Shermain Wong is a seasoned chiropractor with particular expertise in Sports Medicine and a passion for the benefits of in ‘Active Release Technique™ (an advanced Soft Tissue Technique developed by Chiropractors). She is professionally trained in ART and has a Masters in Clinical Chiropractic from RMIT University. Dr Wong has provided chiropractic and movement rehabilitation services at international sporting competitions, and provided rehabilitation and training for professional dancers, professional football players and professional athletes.

Episode 028: Whiplash and concussion

Podcast brought to you by Jurmaine Health

JACKIE [00:00]

This is Jurmaine Health, the center to help you achieve in wellness in both your brain and body. We endeavor to encourage cross communication between health professionals for your health and well being. We'll bring you topics on functional neurological health such as neuro psychology, neuro behavior, neuro musculoskeletal, neurogastro, the Embodied Project, metabolism and microbiome, which are also some of the services that we provide. In today's podcast, we're continuing on from our head and neck series by talking about whiplash and whiplash associated disorder, as well as concussions and post concussion syndrome. And a quick disclaimer, before we start, none of what we're discussing today is to be taken as medical advice. And if you have any concerns, please seek help from your healthcare practitioner or provider since I couldn't pronounce the word, sorry, guys. We'll start off with whiplash I think. We'll start off with the mechanism of injury and I completely forgot to say that I have Dr. Shermain with me today.

SHERMAIN [01:05]

Hello, thank you.

JACKIE [01:09]

I was listening to myself speaking and I feel like I missed a little paragraph in there. Where was the introduction to Shermain? Sorry guys. Getting back, we will start with the mechanism of injury for whiplash or whiplash associated disorder. They're both stemming from the same mechanism. And in this case, what we're looking for or what the injury is, it's a flexion extension injury. So an acceleration deceleration in most cases, or what were they looking for, often it's associated or most often and what people associate it with is a motor vehicle accident. So between your head pretty much gets thrown forward, and then goes backwards, or vice versa, but the mechanism is still the same. So it's still that flexion extension, extension flexion the heads being thrown with force, leading to some most of the time, sprain or strain of the ligaments and muscles in the area to even begin with the facet joints themselves have a tendency to then suffer as a result of the mess in the muscles, of course, treadway that's the one that most people associate with whiplash so that everyone associates whiplash with motor vehicle accidents. They forget that the mechanism of injury itself is just a flexion extension situation so that it can happen in different types of situations rather than just a motor vehicle accident and it's where a good history taking on our part plays a big role in cushioning people that have had say that are coming in for like chronic neck pain, chronic headaches, I think, two biggest factors, I'd say.

SHERMAIN [02:52]

People mistake several scenarios for whiplash and also, to get whiplash. So, the main thing like you mentioned before, is that people think that they have, can only sustain whiplash from a motor vehicle accident. But that's not true. They can sustain it from many, in many ways, actually from many approaches, many ways. Like, for example, if you're surfing and suddenly you get caught in a riff on a big wave and being thrown into the sea, you can get that. Yeah.

JACKIE [03:36]

I've had that. Not from the surf board, but from boogie board. All right, when a massive wave, the board has gone over, board gone over me and pretty much just continuously whacking me under that water.

SHERMAIN [03:49]

Oh my god

JACKIE [03:51]

The amount of times that I've could not remove my neck, like talking. I once was so paranoid, I went into the water, I walked down and I went I can't move my neck.

Oh it's bad yeah I certainly have one

SHERMAIN [04:04]

And Judy was caught in I was doing you know, the artificial surf wave and then she was like oh my god my neck and my body. I'm having a stroke because Judy is a neuropsychologist everything that happens to her head is a stroke.

We go like well, I think that you've got whiplash right she's built Judy is robust you know she's built like

JACKIE [04:30]


SHERMAIN [04:32]

She's been like a wombat like it really tough right?

And she still manages to sustain a whiplash.

Yeah, I say that with a lot of love.


So with that description, are you trying to imply that rugby players with a short little necks, would get whiplash injury.

SHERMAIN [04:57]

Well, it's not that that's the case but what they can do is to strengthen their necks a lot more.

JACKIE [05:03]

Pivot, your injury the whiplash injury would just be on that pivot point.

SHERMAIN [05:04]

That's right. Exactly. And also, the last I'm not sure which episode it was that we spoke about shoulder injuries for burners and stingers or cervical spine for burner stingers, into the brachial plexus and pain that way, you know, for whiplash that can happen to, you know, easily. And if you're caught in a car accident, then what can happen is that the, depends on the speed of that accident that happened. It will that very, reverberations will continue to reverberate for at least about two hours after the accident. So then we start developing a huge range of dysfunction. Both physical dysfunction and neurological interference and also from that, you definitely will have a behavioral difference because your entire nervous system is impacted. So, your parasympathetic nervous system will be impacted, your sympathetic nervous system will be impacted, your autonomic nervous system will be impacted, your peripheral nervous system will be impacted. So the entire neurological health will be impacted; it is quite circular in that sense. So when a person goes to, as a result of that and that can be quite persistent as well. What that means is that people will have things like brain fog and dizziness and random anxiety happening �

JACKIE [06:51]

Chronic headache

SHERMAIN [06:52]

Chronic headaches, they feel fatigue suddenly or they can't you know, they can't concentrate which comes along in the territory of foggy brain thinking and they wonder why that is the case. Well, the thing is that there are many different functions apart from not just the tissues that really, interior into these cervical neck or tissues within the brain cranium that is going to give off that impact. So things like the breath will be interfered with the pelvic floor. So for example, I especially, especially with the pelvic floor, people keep thinking that, oh, it's a neurological Yes, you will have a neurological impact you will have neurological inflammation or inflammation of the brain tissues to be precise. And when that happens, does inflammations need to calm, settle? So for example, when a person has that then, and has too many motor vehicles accidents or falls, or stuff happening, who love surfing, horse riding, climbing and loves, you know, I don't know climbing up a tree or something like that and they will fall and then they will fall in the waves and hope happen to do judo as well or jits and then they will fall get choked. You know, you suffer from chronic traumatic encephalopathy, which is a progressive degenerative disease, really, for people who has a history of repetitive brain trauma. When that happens, you have several whiplashes or several injuries to the brain. Then you wonder why you can't resolve this quickly. Before we delve into concussion and the brain thing, we'll just keep it, just staying with the whiplash itself. Some people can get whiplash just because they are lifting, they keep whipping their lift and it's a technical issue. And I've seen it happen all the time.

JACKIE [08:55]

I know you just told me last time as well as asked me once what's where am I getting my whiplash from, and I got like nothing. And then I message you saying, I know where my whiplash is coming from and it was dad's driving. Not that Dad was actually hitting anything it was literally be like, dad be like, yep, my �

So what does it mean? It was a break just before stopping.


So he kept stopping

JACKIE [09:21]

He keeps stopping, like he stops and fast pace rather than slowly pacing down and then you settle, that would be the 60 60 60 0.

SHERMAIN [09:31]

Oh my God!

JACKIE [09:32]

Man, it would be the headwind to fly. Yes. I do.

That was the day that I like to message you you're on the way to church and I'm like, Wow, now I can recall, my head was just literally flying around. Like cool. Thanks.

By the time we get to church

SHERMAIN [09:47]

Yes, that's correct. So dog walking or dogs walking.

JACKIE [09:54]

The yanking of


The yanking of that you can have that effect on that as well.

JACKIE [09:59]

It can happen in footy or boxing and stuff, and this would continue on with the concussion part as well. But as well, the same sort of thing. It's in a collision where you've been, you're, you've got the ball, or not and somebody comes up, and says whacks you from the side or hits you from the side or hits you from the back. Maybe accidentally ,you have been or somebody jumping up onto your back, you're still being thrown, head, your head bracing in one position, and you being flung in the opposite direction, same sort of concept. It's still going into a whiplash like position. Yeah, they're all boxing yeah it is the same you're literally collecting someone in the head you're swinging it in a particular direction. Same thing, it doesn't have to be a motor vehicle accident as most people associated with both Shermain and myself, I have had to explain it many a times, with our patients where we've always said something like, I think you've got whiplash or whiplash associated disorder in that case when it's a bit later on and stuff. Or you�ve been in a car accident or, you don't have to be or you have people that will be in car accidents. And we're talking like they'll say that they'll they struck something. But they weren't say they didn't go off road or they didn't

SHERMAIN [11:12]

That's right

JACKIE [11:13]

They didn't end up having to call the cops or the cars were fine and stuff like that. They won't realize that still would have impacted on their neck and the rest of their body in a whiplash type of symptoms. They won't realize that they were like, Nah, everything's fine. And then you talk to like, oh, yeah, that's happened about four times, like maybe, had literally four cases of whiplash, and you're turning around and going. Ah nothing. Everything's fine.

SHERMAIN [11:37]

That's right

JACKIE [11:38]

So some people don't realize that because usually people just think of whiplash and just go, alright, massive car accident. That's it, you end up a lot of the time in hospital neck brace. That's pretty much the association that a lot of people have in their head with whiplash. And if you're going based on nouns, bringing for a split second, the classification I want to just so that you guys get an understanding of that similarity, when we're talking about the neck brace, you're ending up in hospital and having to have a neck brace, you're pretty much in category like 3 or 4. In that case, you're talking in the far end category where you've been hospitalized. Not the first two classifications, which is one isn't true, it's been. You've got some minor symptoms of like, say the headaches and stuff, and muscle tightness just from the guarding. And then two is a little bit more in his range of motion involved, decreased range of motion and the muscular tensions and stuff and sprains, strains. That's the ones that we're talking about. They're the ones that are more common, and they're the ones that are most people ignore and just think of oh, yeah, that's not. That is not a whiplash, I would have to end up with a cervical collar.

SHERMAIN [12:41]

That's right.

SHERMAIN [12:47]

Sometimes in effect, it's a little bit, it's a bit of a, it's a reverse advantage choice. When sometimes in a collar, they know that they have been in an accident. They know that you know, if they don't rehab well, you're going to have it for a long time. And so they do. So the people at stage one and stage two, maybe even stage two and a half, that sort of thing. It is not severe enough to wear collar. They don't do anything about it, or they don't know what to do about it.

JACKIE [13:18]

Uncertain. And they don't seem to realize about it even especially in case one majority of them don't realize this is the case. So they're just like, okay, we're fine. And then give it a couple of weeks� time a couple of months and the neck flares up.

SHERMAIN [13:33]

That's right.

JACKIE [13:34]

And then that's usually the time when we play the guessing game. All right, talk to me. Give me some more information.

SHERMAIN [13:40]

What people can what no one else will normally do is they will either one go to a�

I'm laughing because you know I theoretically classified as Asian but

basically, theoretically I don't know. I feel like Singapore is an Asian country, not theoretically. I don't know.

See just think about this DNA thing, right? And one of our clients, patients, she came in and go like and she's Italian and she says her best friend's dad is Italian and went for this DNA test and he tested and he had everything in his genetic makeup except for Italian, so she's really confused right now.

JACKIE [14:25]

That's because going back with either the was formed by a couple of other countries.

SHERMAIN [14:32]

That's right. So that's why I'm saying theoretically

until I had given us a DNA test so I wouldn't know.

And also, to be fair, the last time I was playing around with a color palette app, I came up to be white, so some of the like, I have no idea what I am, I am white and blue.

JACKIE [14:53]

I came up orange,

SHERMAIN [14:54]

Yeah, you came up orange. Like I said to Jackie, Jackie I'm white Jackie and then Jackie is like I can see that I was like what are you talking about? I can see the blue yeah right like I could see

so I'm a smurf right yeah

We digress so that's why I'm saying theoretically Asian but anyway Asian so the massage place;s some of them are good some of them are pretty average you will be struggling most of the time to get a really good one.

JACKIE [15:48]

If you find one please let me know because I�d be happily to see them for regular massages.

SHERMAIN [15:53]

That's right and also sometimes you would go to other clinics and go out and have this. They would say, oh, it's all in your head, because it can become chronic fatigue you know, it can turn, you know, from a whiplash case it can become a chronic fatigue case. And then it just goes into a vicious cycle. And it's also really demoralizing to hear that, hey, it's all in your head. Well, yes, most tissues in your head have been traumatized. Right? So is your body, so is your gait, your thinking habits, your you know, everything.

JACKIE [16:30]

Especially when it comes to chronic situation, it will overlap, but we'll talk about the symptoms with concussion in a few minutes, but they pretty much overlap. Some of the symptomology overlap, and that's when it becomes a situation when it's all in your head, because they're not finding anything to explain

SHERMAIN [16:49]

That's right.

JACKIE [16:50]

why someone is getting so the ringing in the ears or we're getting the sleep disturbances. They are not. Docs aren't able to establish it because they're not finding an actual physical cause. Because it's something that happened a while back and wasn't either diagnosed at the time, or wasn't treated properly at the time and has become a chronic issue. Chronic issues are a lot more a lot harder to recognize.

SHERMAIN [17:14]

An acute one's simple, because of the simple fact of it is because it can become very layered, layer effect, meaning that there can be two or three things looking like one big thing. And then people will treat whatever that you are saying to them, saying to the providers, and then they will alright, and they'll just do that. And it's going to be difficult for them to tease out the relative history and how your body is performing relative to them.

JACKIE [17:44]

Yeah, concussion. Concussion is the same as well. Similar to an extent, mechanism of injury except this one more or less and direct they classified as a direct contact to the head with some relative force. So, again, same sort of things sporting injuries, where you've got I mentioned footy before, footy as especially from being knocked and you hear it consistently now. In the years with regards to AFL, especially with regards to AFL, and you hear it all over the stations and stuff where you're watching them fully, and listening to footy about potential concussions or high hit, they're getting more and more aggressive with the high hit rules to try and lower the rates of it. So for a while, not that I'm trying to attack the AFL, VFL or any of the clubs, any of the levels of sport. But for a while when we especially when we were, this was going a while back, we were still relatively fresh, because when we were still involved concussions, how do I put this. The importance of the potential repercussions of a knock to the head when not looked at very stringently or pretty much ignored.

SHERMAIN [19:05]

Turn a blind eye to.

JACKIE [19:07]

A lot of the time. Said even, you know, recent years when we were involved in a few of the clubs, it was one that I put it down to either the player wants to play, or the coaches want them to play because they wanted the best players, but trying to force someone to play or trying to continue playing, when you're seeing the knock, was difficult to watch, to say the least.

SHERMAIN [19:33]

It's even out of our hands.

JACK [19:34]

Yeah. There was a few times when it was, well should have been out of our hands. But I remember one time I saw one player, he was concussed three times in the one game. The first concussion was bad one. The first concussion was when I want to pull him off. I saw the hit. That was a bad hit. Like that was a full-blown hit where he didn't get up for a couple of seconds. Yeah, I was not happy. Then I wanted to pull him. I was not allowed. Second hit. Again he was out for even longer. Once again, I was not allowed to pull him off. Same probably slightly milder hit but he was down. The third hit believe it or not, he was down. He wasn't he didn't go down. I saw the hit to the head and I went, I'm done. I'm done watching these copping it in the head the whole time he's off. If none of you want to take the responsibility for taking this player off. I'm taking him off. He can be angry with me. Coach can be angry with me. I don't care. I'm not going to run the risk of this player ending up in hospital with a bleed on the head, bleed in the brain. Because we're waiting to play with three, three knocks Yeah. So turning a blind eye. It was definitely something that was�

SHERMAIN [20:43]

How about closing both eyes?

JACKIE [20:46]

In this case, yeah. Was everyone, nobody saw anything? He's fine. Let's just continue on.

SHERMAIN [20:52]

But that happens a lot in most team sports. And that's quite a, you know, it's still very persistent today because the player wants to play and the coaches want them to play and the coaches might want, them definitely want them to play. And so who would be, well who is in question here? Now, that becomes a medical legal question in and of itself.

JACKIE [21:18]

I know I've had I was on. It must have been when I was filling in might be last year may be before was filling in at the soccer club as well. This is a player that I know family friend was housemates with my cousin at the time. And I said, I saw the hit to the head. I it was a massive hit. Not that it was soccer. So we're talking head to head clash. They went for the heads, both of them clash heads instead. This probably happened about maybe a metre and a half from me. That echo of the skull to the skull contact. It was epic. It was bad. I mean, I think the other player went down and I think he was in the ended coming off. I was looking at him, �are you sure that you�re alright?� I saw it, I heard it because in soccer, you cannot run out and you have to wait for the player, player has to call out like for red post or something like that before anything. He felt he was fine. I was actually messaging my cousin as I said, I mean he was his housemate and he's the least the things to look out for post-game. I'm like have a look at XYZ I'm not sure if he's not going to be concussed or not. This is what you've got to look out for at least the next few hours and over the next like over the next 24 hours. And here is the list of things to look out for in the next few days, the next couple of weeks for at least the things to keep an eye on so I actually sent him a list of keep an eye on this team whether he's gonna be whether there's a concussion here or not.

SHERMAIN [22:49]

We probably should put that list up for our listeners too. The thing about concussions as it doesn't have, if on game day itself presents quite differently to persistent ones before we go into you know, behavioral presentations and okay, no motor presentations and muscular presentations and gait presentations. I want to talk about how some headaches will look like, out of about, talking it out but talk about one particular case. And then we will probably talk about more about concussions in another episode. Because what happens is that I had one kid, he comes to me from really far away in country Victoria, I am in Preston, right. And he said to me, Shermain, I've got a headache. I was like, well, could you describe your headache? Oh, I have a pain in my head. I was like, you know, so I had to ask him. What does that mean a pain, a pain in the middle of your head. So you don't have a headache? No. So how about one side or 2 sides, I know, a pain in the middle my head. Okay? This is not a usual, it's not a usual headache scale. And also in order for you for people to understand headache scales, it's really important to understand what kind of headache it is and how a headache presents itself.

JACKIE [24:17]

Please refer to our previous podcast. Yep.

SHERMAIN [24:23]

Okay, all about headaches and also, you know, sometimes headache can present itself because a person has got low testosterone and all the neuro endocrinology that happens along with that, right. This kid I say he is a kid because he is young as well. You know, technically he is an adult, but he's like, you know

JACKIE [24:40]

anyone younger than us is classified as a kid.

SHERMAIN [24:42]

He had it for about two years and he had brain dopler and they couldn't find anything wrong with the arterial flow in the brain. He had brain scan couldn't find anything. He went to several people. And they couldn't find anything. That's why they thought that it was a behavioral issue. So, okay, that's true. Have you had a fall? And then I asked him, do you play footy? The thing is the thing about this is in professional level, the elite AFLs they get taken care of a lot better than the country ones. So as I say, I asked him that and he said he did. And how did it come on and he said he doesn't know he said he can't remember. This is one of the quite common responses don't know cannot remember it just suddenly come up. Comes on. Alright. So I tested him, gave him some tests. And when I think you have got a concussion had a concussion, and he's like, no, it can't be the case as well. We will test it out, if I'm correct, and we will treat for that and you get better than most likely that's what he needs. In the question, I asked him, how's your hearing, and then he was like, oh, it's good, and I was like are you sure? Is it? Yeah. Yeah. Oh, but my friend said I don't pay attention to that sometimes. That's okay. All right. Do you get black outs? And he said, I don't black out but sometimes I serve food. And if I serve too fast. I will drop all my plates. So this is a brilliant, classic sign of persistent concussion syndrome. Post concussion? Yeah, you can post concussion, you can call persistent concussion syndrome.

Either way, it's fine. Judy, our resident neuro psychologist decided to call it persistent concussion syndrome.

JACKIE [26:49]

This may not be here to find stuff.

SHERMAIN [26:52]

Because well that's different post concussion is quite immediate it can be quite immediate.

JACKIE [26:57]

Yeah but they've got it now. Now. This is all now they talk about. Yes, they can go on for years.

SHERMAIN [27:02]

So that's why Judy prefers to call it persistent. And what happened was, I said. Well, look, I'm going to do these and more things for you. And we will check.

JACKIE [27:15]

Apparently the diagnosis is made when symptoms from the concussion last for more than three months, he had to hide it for more than three months. For it to be a post concussive a persistent concussion syndrome. Cool. Yes.

SHERMAIN [27:30]

And we rectified it and he went like. I am okay, now Shermain. This is fantastic.

JACKIE [27:36]

Hasn't been here for a while. So

SHERMAIN [27:38]

No, and he has gone on to one of the armed forces. Yeah. No. So we were happy for him. Yeah. And he and it was quite amazing I thought because he was quite diligent about coming in. He didn't have to come in for many times. It was not like something, it was not something ridiculous, like, you know, 24 sessions or something like that. It was significantly less than that. Less than half of that. Yeah. And we managed to get that sorted.

And he went for his, I don't know, test

JACKIE [28:18]

They have to go through a full testing. Yeah.

SHERMAIN [28:20]

And he managed to do that. Well, so he's getting fantastic.

JACKIE [28:24]

They wouldn't have let him in. Yeah, prior to that, no chance.

SHERMAIN [28:28]

That's right. So there we go.

JACKIE [28:31]

Okay, good. Do we want to give them some symptoms. Most were here just so that they know what to look out for. I�m asking if we should be kind enough to give them some symptoms.

SHERMAIN [28:43]

We will give them the symptoms next time.

JACKIE [28:46]

And we might post it up for you guys as well. So you can actually have something to refer to, as Shermain said before about having something to refer to for if some if you see someone, especially one of your friends you see suffered a knock. Yeah. And you're concerned about it something to look out for them something to look out for as well. Mm hmm. Guys, I think we'll wrap that up from there for today. So other than that we want to remind you about is we have our upcoming workshop on the 27th of April our 2nd Embodied Recovery workshop. Will be held at Moorabbin Training Geek. So please try to get down to that one, if you can, I think, I believe it starts at 12.

SHERMAIN [29:27]

Yes, and more importantly, it's going to be a little bit different. Because we are refining and refining. And the process the program is simply because we came up as we had more information, we would put in different sets of information there. That's one. That's the first reason second reason is that even for people who come into us to get treatments within the Embodied Recovery framework, they come into us often one on one basis. So for you guys who have not had it yet or who have had it on a one on one is a good refresher for you to come in to do to have it in a group setting is cheaper, is fun, plus also breathing. And yeah, that's right and there are different approaches

JACKIE [30:19]

is more exercises too

SHERMAIN [30:20]

yes different approaches and exercises too what we are already giving you also on top of that, you will start to understand how your brain and body works better together in order to better your functional neurological health.

JACKIE [30:36]

So we'd like to see you're down there on the 27th of April guys. That's us for today guys. So if you like what we're presenting, please give us a thumbs up a like or share it with one other person who you think we may be able to help. For those of you who are coaches, dancers or athletes, and may find difficulty with expressing or executing movement patterns. Please do connect with us on our website www.JURMAINEHEALTH.com.au and JURMAINEHEALTH is spelled J U R M A I N E H E A L T H. Please socialize with us on Facebook, which is also in JURMAINEHEALTH and on Instagram which is JURMAINEHEALTH body. And last but not least, since this podcast is made for you, our clients, patients and fans, do let us know what else you might like to hear about. Guys that's us for today guys, see you bye.

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