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Spine & Injury Clinic of Laramie, PC
3905 E Grand Ave Ste 200
Laramie, WY 82070
Uber
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Physical Therapy - Chiropractic - Massage Therapy
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At the Spine & Injury Clinic of Laramie, we are a highly results-driven facility specializing in the diagnosis, treatment and rehabilitation of injuries and other musculoskeletal disorders. Because no two patients and no two injuries are the same, we are committed to providing a variety of treatment options. We develop customized treatment programs created specifically for each patient's individual needs and requirements. We place considerable emphasis on the ever-evolving health sciences by staying current with the most relevant clinical research and treatment techniques available to date. This provides the most effective treatments, sensible rehabilitation and prevention regimens available. Our goal is to return our patients to their active lifestyles as quickly as possible. We have an excellent relationship with local and regional orthopedic providers and other specialists and can steer you in the right direction if you do not respond to conservative management or we feel your injury warrants such referral. If a recent or recurring injury is hampering your lifestyle, contact us today for an appointment.
Physical Therapy
Customized treatment plans are designed to increase strength, restore range of motion and alleviate pain. Physical therapy and rehabilitation programs are developed using the most effective treatment methods available, including: Post-operative rehabilitation Therapeutic exercises Manual therapy techniques Joint mobilization Trigger point therapy and myofascial release Trigger point dry needling (TDN) Muscle energy techniques Postural training Strengthening, flexibility and mobility training Balance/proprioception training Modalities (mild electrical stimulation and ultrasound) Traction Exercise & Fitness program design Home exercise programs Post-surgery management Sports injuries Running injuries Low Back Pain Neck Pain and Headaches Car Accidents, Work injuries Repetitive stress injuries Shoulder/rotator cuff injuries Knee, hip and foot pain and pathology Tendonitis and bursitis Arthritis
Chiropractic
The treatment techniques that we select are tailored to the needs of each individual patient's needs. We select the treatments that we offer based upon the most recent scientific investigations and literature. Spinal Manipulation The chiropractic adjustment is also referred to as a spinal "manipulation". During this procedure, the doctor applies his / her hands to the area of the spine to be treated in such a way as to mobilize the joints. Most commonly, the doctor will administer a quick, short hands-on movement to the joint. The joint usually elicits a "pop" or "crack," similar to when "cracking" one's knuckles. Patients usually sense movement of the joint. The goal of the chiropractic spinal manipulation is to: Increase the joint mobility / range of motion Relieve pain Reduce muscle spasm Restore optimal joint function Joint mobilization Mobilization is a form of stretching that is applied to stiff joints in order to optimize and restore range of motion, relieve pain and reduce muscle tension. These procedures consist of small passive movements, usually applied as a series of gentle stretches in a smooth, rhythmic fashion to the individual's joints. Mobilizations may be administered in various gradations or degrees of pressure, depending upon the sensitivity and stiffness of an individual's joints.
Massage Therapy
Therapeutic massage therapy is part of the hands-on manual approach at SICL. As with all manual therapies, massage therapy which deals specifically with the muscular and other soft tissues of the body promotes balance and direct healing to the neuro-musculoskeletal systems. The therapeutic effects include: Medical Massage Therapy is a covered expense under some major medical insurance plans. Reduced pain and the accompanying stress response Increased circulation and metabolism Detoxification Improved lymphatic drainage Increased range of motion (joints) Increased elasticity of muscles Decreased muscle spasm Less fatigue Maintenance of healthy skin function In addition to effectively treating many health conditions and injuries, massage therapy is used as a restorative to promote general wellness. Patients are welcome indeed, encouraged to continue to receive massage therapy after rehabilitative services are complete. Our certified and licensed Massage Therapists offer: Therapeutic clinical massage - traditional Swedish, deep tissue, myofascial release and trigger point therapy. Sports massage - tailored for athletes emphasizing stretch and neuromuscular work Pre/post-natal massage - treats symptoms associated with pregnancy such as sacroiliac pain, low back pain Manual lymphatic drainage Structural integration Myofacial Release
Spinal Manipulation
The chiropractic adjustment is also referred to as a spinal "manipulation". During this procedure, the doctor applies his / her hands to the area of the spine to be treated in such a way as to mobilize the joints. Most commonly, the doctor will administer a quick, short hands-on movement to the joint. The joint usually elicits a "pop" or "crack," similar to when "cracking" one's knuckles. Patients usually sense movement of the joint. Mobilization is a form of stretching that is applied to stiff joints in order to optimize and restore range of motion, relieve pain and reduce muscle tension. These procedures consist of small passive movements, usually applied as a series of gentle stretches in a smooth, rhythmic fashion to the individual's joints. Mobilizations may be administered in various gradations or degrees of pressure, depending upon the sensitivity and stiffness of an individual's joints. The goal of the chiropractic spinal manipulation is to:
Increase the joint mobility / range of motion
Relieve pain
Reduce muscle spasm
Restore optimal joint function
Joint mobilization
Soft Tissue Therapies
Trigger Point Therapy
During this procedure, deep manual pressure is applied to and held on sensitive pressure points within muscles. This procedure usually reproduces discomfort in the area of a patient's complaint, as well as under the point or pressure. Trigger point therapy is used to relieve painful trigger points and their characteristic referred symptoms.
Active Release Techniques
ART is a patented, state of the art soft tissue system/movement based massage technique that treats problems with muscles, tendons, ligaments, fascia and nerves. Headaches, back pain, carpal tunnel syndrome, shin splints, shoulder pain, sciatica, plantar fasciitis, knee problems, and tennis elbow are just a few of the many conditions that can be resolved quickly and permanently with ART. These conditions all have one important thing in common: they are often a result of overused muscles. What is an ART treatment like? Every ART session is actually a combination of examination and treatment. The ART provider uses his or her hands to evaluate the texture, tightness and movement of muscles, fascia, tendons, ligaments and nerves. Abnormal tissues are treated by combining precisely directed tension with very specific patient movements. These treatment protocols - over 500 specific moves - are unique to ART. They allow providers to identify and correct the specific problems that are affecting each individual patient. ART is not a cookie-cutter approach. Please visit the following link for more ART info: http://www.activerelease.com
Myofacial Release
Soft tissue is defined as muscles, ligaments, fascia, tendons and nerves. These tissues are the structures that hold your skeletal system intact and allow it to move and function. When these structures become injured or inflamed due to direct trauma, repetitive stress, overuse, and nutritional deficiencies, they become scarred and sticky. These structures stick to surrounding structures which prevents full movement, causes pain, weakens the muscles and leads to chronic problems. The analogy is muscle should be like a rubber band and soft tissue injury causes them to become a rope. We feel that that these structures MUST be evaluated and treated.
Transverse Friction Massage (TFM)
Scar tissue forms when inflammation is present after an injury. The presence of scar tissue often leads to a significant loss of function. Transverse friction massage (TFM) involves deep pressure with specifically directed movement in order to remodel scar tissue allowing the soft tissue to become more flexible, pliable, and more functional.
Kinesio Taping and Kinesio Tex Tape
The Kinesio Taping® Method is applied over muscles
to reduce pain and inflammation, relax overused or tired muscles, and support muscles in movement on a 24-hour-a-day basis. The taping is non-restrictive and allows for full range of motion. In contrast, more traditional sports tape is wrapped around a joint strictly for stabilization and support during an athletic event. Kinesio® Tex Tape is used to treat anything from headaches to foot problems and everything in between. Just a few examples include rehabilitation from sports injuries, carpal tunnel syndrome, lower back strain/pain (subluxation, herniated disc), knee and shoulder conditions. There are many more.
The Kinesio Taping® Method is applied over muscles
that is designed to facilitate the body's natural healing process while providing support and stability to muscles and joints without restricting the body's range of motion as well as providing extended soft tissue manipulation to prolong the benefits of manual therapy administered within the clinical setting. Latex-free and wearable for days at a time, Kinesio® Tex Tape is safe for populations ranging from pediatric to geriatric, and successfully treats a variety of orthopedic, neuromuscular, neurological and other medical conditions. The Kinesio® Taping Method is a therapeutic taping technique not only offering your patient the support they are looking for, but also rehabilitating the affected condition as well. By targeting different receptors within the somatosensory system, Kinesio® Tex Tape alleviates pain and facilitates lymphatic drainage by microscopically lifting the skin. This lifting affect forms convolutions in the skin thus increasing interstitial space and allowing for a decrease in inflammation of the affected areas.
McKenzie Technique
The McKenzie© Method was developed in the 1960's by Robin McKenzie, a New Zealand physical therapist.
During the course of his practice, he discovered that extending the spine (backward bending) could provide significant relief from low back and lower extremity pain for certain patients. This represented a significant shift in thinking for spine care practitioners, as much of the focus of spine care previously was on flexing (forward bending) the spine.
With the McKenzie approach, a step-by-step examination identifies the movements and postures that best relieve a spine pain sufferer's complaints.
The focus of the examination is on identifying which movements and postures "centralize" the patient's pain. That is, which positions and activities reduce any extremity (or "perhiperal") symptoms. The theory of the approach is that centralizing the pain allows the source of the pain to be treated rather than the symptoms.
A central tenent and goal
of the McKenzie Method is to teach neck pain and/or back pain sufferers how to treat themselves and manage their own pain for life using exercise and other strategies.
Flexion-Distraction
Flexion-Distraction
Flexion/distraction manipulation is used to decompress the spinal joints by applying a gentle stretch, or traction, to the lower spine. It is usually applied in a series of repetitive slow movements without dynamic thrusts. The procedure is often used for people with disc problems, lumbar stenosis and facet syndrome, and may also be used in other ways, such as to gently mobilize joints.
Stretches and Exercises
Our patients learn to perform home stretches and exercises to improve their overall fitness and health. Condition specific exercises and stretches are customized to each patient's physical needs. Descriptive handouts are provided to facilitate ease of implementation.
Proprioceptive Neuromuscular Facilitation (PNF)
PNF stretching is an advanced form of flexibility training and is considered to be the fastest and most effective way to increase static flexibility. Overall, PNF flexibility training reduces post workout soreness, decreases musculoskeletal injury, increases range of motion, and improves muscular strength and coordination.
Therapeutic Modalities
Short courses of some therapy modalities may facilitate pain relief and muscle relaxation. We provide the following therapy modalities very conservatively, in order to facilitate exercise-based treatments.
Electrical Muscle Stimulation
Often referred to as "muscle stim," the therapy involves low levels of electrical impulses delivered to the injured, painful tissues to reduce pain and speed healing. Often described by patients as a pleasant, "tingling" sensation, or "electrical massage," these impulses stimulate the body to release natural pain relievers, called endorphins. These endorphins reduce pain and inflammation, thereby promoting faster healing of the injured tissues. This therapy is often used to treat acute or chronic pain, as well as strains or sprains of the muscles, joints, and soft tissues of the spine and extremities.
Theraputic Ultrasound
Therapeutic Ultrasound is a deep heating modality that emits high-frequency acoustic vibration that is above the human audible spectrum. Therapeutic ultrasound reaches underlying tissues as deep as 1 to 5 centimeters. When electrical energy is applied to a crystal, it causes it to vibrate at a high frequency and to produce ultrasound. Ultrasound is delivered by continuous or pulsed wave and provides a high heating intensity. Therapeutic ultrasound stimulates the repair of damaged tissues, relieves pain, increases blood flow, relaxes muscle spasms, and may speed the healing process.
Interferential therapy
Interferential current therapy involves administering alternating electrical currents through electrodes placed on the skin at a painful area, or the spinal nerve root associated with a painful region. It is theorized that the low frequency of the interferential current affects the nervous system in such a way as to result in muscle relaxation, suppression of pain and acceleration of healing.
Moist Heat
Moist heat is used to heat the muscles and increase blood flow and cellular activity. It is often used prior to treatment to help relax the large muscle groups in the back. Often times it is used in simotanously with muscle stimulation.
Custom Orthotics
Custom made orthotics are typically an investment made during some desperate phase of life that usually involves a chronic injury.
This desperation can sometimes be met with less than successful results. In spite of this fact, most people would benefit from orthotics, but the success comes when they are purchased before being injured. And here's why.
First of all, custom orthotics are not just for runners with foot problems.
The feet are the foundation of our entire structural system and are the sole or contributing cause of many structural problems. So, if you're suffering with low back, hip, hamstring, calf, sciatic or other problems, even upper body, your feet will usually be involved. If we don't balance and stabilize the feet as our primary goal, we limit the potential benefits when attempting to correct and balance our structures.
Generic orthotics that can be purchased "off the shelf" have limited benefits.
Just as you would never think of wearing some generic running shoe from "off the shelf", don't be cheap when it comes to one of the more important decisions you'll make involving body. Your foot is made up of 26 bones, 33 joints plus 126 ligaments, muscles and tendons. Your biomechanical longevity will be greatly impacted by keeping your feet happy.
Many patients of mine resort to buying orthotics only after an injury.
With a pro-active, instead of reactive, management of the structure, many of their debilitating injuries could have been prevented. Keep in mind, my goal is to help patient prevent injuries as well as resolve injuries that are present. Again, paying now is always less than paying later.
Foot Exam
The examination of the foot will be performed to access structure.
Both feet should have a similarly high arch, so that a good chunk of fingers can make it under the arch. If the feet are flat, different in arch height or have excessively high arches, custom orthotics are imperative.
A study of shoe wear will be done next looking for different wear patterns on the base of the two shoes.
Observation of the patient from behind without shoes on. If the achilles tendons bow or bend due to pronation of either foot, this adds to the urgency for orthotics. If either toe points in or out when standing, orthotics may be necessary. Finally, upon standing, the center point of the knee cap, and then the bump on the bone (tibia) just below the knee cap will be observed. They should be almost in line with each other. If the alignment between the two points is more than a 14" off, orthotics may be recommended.
Dr. Milam will then decide what type of orthotics will suit your body the best.
In most cases Dr. Milam recommends a softer orthotic which will allow the foot to move in it's full range of motion while providing shock absorption in the heel with each foot strike. Some orthotics have better shock absorption than others, and this is an important factor considered when deciding on which orthotics will best suit the patient. Softer orthotics allow shock absorption as well as necessary normal foot motion which is easier on the foot, leg and low back. If the foot is unable to move in a complete and normal manner due to the restriction of the orthotic, this can alter the normal motion relationship between the foot and the rest of the body.
The method used to get fitted for your orthotic is important too.
Some doctors use the neutral casting method, which casts the foot in a non-weight-bearing position. The preferred method at Spine & Injury Clinic of Laramie is to have the foot evaluated and scanned in a weight-bearing position so the influence of gravity can be considered.
Conclusion
Custom orthotics are the very beginning of learning more about your biomechanical system.
The foot is the foundation of your entire structure, and imbalances in the low back, neck, hips and entire muscle system can certainly originate from the feet. If attempts are made at correcting any structural condition without first considering the feet, the benefits will be limited.
So ask Dr. Milam for a complete structural foot exam in the standing position with an evaluation of the wear patterns of your shoes.
This should be done at least once a year on all athletes. Finally, in some cases standing x-rays of the low back can help make specific structural recommendations.
Pronation & Supination
These are two normal movements, which take place in many joints of the body.
In the foot the main joint where these movements occur is the sub-talar joint (or lower ankle joint). As we walk the heel hits the ground and the foot pronates, which causes it to roll inwards and the arch to lower. At the same time the leg bones twist inwards slightly. This is a shock absorbing movement and the midfoot is slightly unstable at this time.
As weight is moved on to the ball of the foot, the opposite movement (supination) should occur at the subtalar joint (lower ankle).
This makes the foot more stable, lifts the arch of the foot and creates a secure platform, which is important because the other foot is now swinging forwards to take the next step. Once this has occurred the heel can lift easily and we push ourselves forward from the ball of the foot and toes. These are normal movements; it is just that some of us have more or less of one than other people.
The cycle of pronation and supination movement occurs with every step we take.
In feet with lower arches it is often easier to see pronation because the Talus (ankle bone) tends to drop down further into the arch. In feet with high arches it is more difficult for the talus to drop and this causes the leg bones to twist inwards slightly more instead.
Patients with lower arch feet who pronate too much are left with an unstable midfoot, no secure platform and no shock absorbency left.
Patients with high arch feet who pronate too much tend to develop symptoms further up the leg. In fact, because it is so difficult for high arch feet to lower the arch they often tend to over supinate, which causes the arch to become even higher.
Massage Therapy
Medical Massage Therapy is a covered expense under some major medical insurance plans. Therapeutic massage therapy is part of the hands-on manual approach at SICL. As with all manual therapies, massage therapy which deals specifically with the muscular and other soft tissues of the body promotes balance and direct healing to the neuro-musculoskeletal systems. The therapeutic effects include:
Reduced pain and the accompanying stress response
Increased circulation and metabolism
Detoxification
Improved lymphatic drainage
Increased range of motion (joints)
Increased elasticity of muscles
Decreased muscle spasm
Less fatigue
Maintenance of healthy skin function
Info
In addition to effectively treating many health conditions and injuries, massage therapy is used as a restorative to promote general wellness. Patients are welcome indeed, encouraged to continue to receive massage therapy after rehabilitative services are complete.
Our certified and licensed Massage Therapists offer
Therapeutic clinical massage
traditional Swedish, deep tissue, myofascial release and trigger point therapy.
Sports massage
tailored for athletes emphasizing stretch and neuromuscular work
Pre/post-natal massage
treats symptoms associated with pregnancy such as sacroiliac pain, low back pain
Manual lymphatic drainage
Structural integration
Myofacial Release
Radiological Imaging & Other Tests
These radiological imaging tests help your doctor see the anatomy of your spine. There are several other kinds of diagnostic imaging tests that are available that can be ordered if indicated. Below is some basic information on these various tests.
X-rays
X-rays show problems with bones, such as infection, bone tumors, or fractures. X-rays of the spine also can give your doctor information about how much degeneration has occurred in the spine, by showing the amount of space in the neural foramina and between the discs. X-rays are usually the first test ordered before any of the more specialized tests. Special X-rays called flexion and extension X-rays may help to determine if there is instability between vertebrae. These X-rays are taken from the side as you lean as far forward and then as far backward as you can. Comparing the two X-rays allows the doctor to see how much motion occurs between each spinal segment.
MRI
The magnetic resonance imaging (MRI) scan uses magnetic waves to create pictures of the spine in slices. The MRI scan shows the spine bones, as well as the soft tissue structures such as the discs, joints, and nerves. MRI scans are painless and don't require needles or dye. The MRI scan has become the most common test to look at the spine after X-rays have been taken. MRI scans are very good tests for assessing the discs and nerve roots in the case of suspected disc herniations. Unfortunatly, MRI tests are expensive and not always covered by insurance.
CT Scan
The computed tomography (CT) scan is a special type of X-ray that lets doctors see slices of bone tissue. The machine uses a computer and X-rays to create these slices. It is used primarily when problems are suspected in the bones. To the untrained eye the apperance of a CT is similar to an MRI
Myelogram
The myelogram is a special kind of X-ray test where a special dye is injected into the spinal sac. The dye shows up on an X-ray. It helps a doctor see if there is a herniated disc, pressure on the spinal cord or spinal nerves, or a spinal tumor. Before the CT scan and the MRI scan were developed, the myelogram was the only test that doctors had to look for a herniated disc. The myelogram is still used today but not nearly as often. The myelogram is usually combined with CT scan to give more detail.
Bone Scan
A bone scan is a special test where radioactive tracers are injected into your blood stream. The tracers then show up on special X-rays of your neck. The tracers build up in areas where bone is undergoing a rapid repair process, such as a healing fracture or the area surrounding an infection or tumor. Usually the bone scan is used to locate the problem, and other tests such as the CT scan or MRI scan are then used to look at the area in detail.
Other Non-Imaging Tests
Your doctor may also ask you to have other tests done.
Electromyogram
An electromyogram (EMG) is a special test used to determine if there are problems with any of the nerves going to the upper limbs. EMGs are usually done to determine whether the nerve roots have been pinched by a herniated disc. During the test, small needles are placed into certain muscles that are supplied by each nerve root. If there has been a change in the function of the nerve, the muscle will send off different types of electrical signals. The EMG test reads these signals and can help determine which nerve root is involved.
Laboratory Tests
Not all causes of neck pain are from degenerative conditions. Doctors use blood tests to identify other conditions, such as arthritis or infection. Other tests may be needed to rule out problems that do not involve the spine.
Chiropractic Treatments for Whiplash
Because each individual case of whiplash is different, it is not possible to generalize about the chiropractic whiplash treatment. The appropriate chiropractic treatment is unique to each whiplash injury and is directed at the primary dysfunctions detected during the chiropractic exam and history which includes the mechanisms of injury and ordering of imaging (X-ray, MRI) if needed. However, we commonly employ different chiropractic treatments for whiplash, often including:
Manipulation
The primary whiplash treatment for joint dysfunction, spinal manipulation involves the chiropractor gently moving the involved joint into the direction in which it is restricted. Also known as a chiropractic adjustment, spinal manipulation may involve the application of a short thrust in that direction. In many cases, instead of a thrust, a slow mobilizing movement is used by the chiropractor.
Massage Therapy
In our clinic we often have massage therapy prescribed for treatment on a frequent basis to aid in the healing of the soft-tissue injuries. This treatment is done in our office by Certified Massage Therapists and treatment is focused on areas of injury.
Moist Heat/Ice
Muscle Stimulation
Rehabilitation Exercises
Ergonomic and lifestyle changes
These whiplash treatment suggestions stress improvements for performing everyday activities with minimal strain to the body. The chiropractic advice addresses factors in an individual's work, home or recreational activities that perpetuate the dysfunctions that result from the whiplash accident. Additionally, spine care professionals at the chiropractic clinic may teach the patient better "use of self" and, if necessary, stress reduction methods to help chiropractic problems.
Muscle Relaxation or Stimulation as Whiplash Treatments
The chiropractor's primary whiplash treatment for related muscle dysfunction, muscle relaxation and/or stimulation consist of gentle stretches to the muscle that has excessive tension or repeated contractions of the muscle that is inhibited. If the muscle is very tight, a more vigorous stretch may be applied by the chiropractor. Gentle finger pressure techniques may be applied to trigger points to relieve the pain associated with the tight muscles. Electrical Muscle Stimulation is often used to help relax the muscles involved. This therapy generally is very comfortable and helps with healing of soft tissue injuries.
McKenzie Exercises and Stabilization/Sensorimotor Activities
Chiropractors may employ different types of exercises, including McKenzie exercises and/or stabilization and sensorimotor exercises, to help treat patients with whiplash injuries. McKenzie exercises are specifically designed to reduce disc derangement related to a whiplash injury. They consist of simple movements that are initially done in the office but make for an easy transition to self-care at home. McKenzie exercises also help the patient take an active role in his or her own recovery. Stabilization and sensorimotor exercise approaches are designed to correct faulty movement patterns in routine activities and everyday life. Such whiplash treatment trains the nervous system to better coordinate and control movement patterns, and improves the ability of the neck muscles to maintain stability of the neck. These exercises are designed to help in a major trauma, such as a fall or whiplash during a motor vehicle accident, or in "micro trauma"from simple things such as being jostled in a crowd, playing sports or performing occupational or home jobs that require physical effort.
Whiplash Treatment in Chiropractic Care
The whiplash treatment plan developed by the chiropractor for each specific problem may include one or more of these approaches and may involve others as well. In addition to his or her whiplash treatment plan, the doctor of chiropractic might give a referral to another health professional, such as a medical specialist, if it is deemed appropriate.
Chiropractic Treatment Approach to Whiplash Injuries
The chiropractor's general approach to managing the patient's chiropractic care is critical to the success of preventing chronic pain from whiplash injuries.
In the early stages of management
it is very important for the chiropractor to rapidly reduce the patient's neck pain, back pain and/or other symptoms.
Soon after, the chiropractor's whiplash treatment must be shifted toward restoration of the patient's function.
This means helping the patient return to work, home and recreational activities as soon as possible after sustaining the whiplash injuries. This process may involve a gradual transition to these activities, even if the patient is not sure that he or she can engage in them fully.
Preventing Chronic Pain from Whiplash
After sustaining whiplash injuries, it is fairly common for people to suffer from chronic neck pain if untreated. A chiropractor can detect certain factors in a patient's history and chiropractic exam to better determine patients who may be more susceptible to chronic pain from a whiplash injury. This process will help the doctor of chiropractic identify when aggressive preventative measures should be taken for patients who may be at a greater risk of developing chronic neck pain from whiplash injuries.Teaching the patient the nature of chronic pain (that "hurt does not necessarily mean harm") and placing focus on those activities the patient can do, rather than those he or she cannot, are major parts of chronic pain and disability prevention after whiplash injuries. Chiropractors integrate the strategies explained above to develop the most effective approach for recovering from a whiplash injury and preventing future episodes of back pain.
Restoring confidence after a whiplash injury
on the part of the patient in his or her ability to get back to normal activity levels is also important for rehabilitation.
Exercise
both for the purpose of correcting faulty movement patterns and instability, and for general fitness, is important in this effort to treat whiplash injuries.
Whiplash Injury Information
What Is Whiplash?
Whiplash is a term that describes injury to the neck that occurs as a result of a motor vehicle or car accident. The most common type of car accident is the rear impact, and most typically, the occupant in the vehicle that gets "rear-ended" (hit from behind) is at the greatest risk of injury, including whiplash.
What Is Now Known about Whiplash
Until recently, the reason for the extent of whiplash injuries was poorly understood. In addition, due to the legal and insurance issues, the veracity of complaints of neck pain and other symptoms by people who suffer from whiplash is commonly viewed as suspect. However, recent research has helped clarify why occupants struck from behind experience more extensive whiplash injuries than those in other types of crashes. This new information is important for the physician treating whiplash pain, as it impacts the physician's case management strategy.
How Does Whiplash Occur?
A whiplash accident occurs when one motor vehicle strikes another from behind, causing certain forces to be transmitted from the striking vehicle to the struck vehicle. These forces are then transmitted to the occupant(s) of the struck vehicle, where they have the potential to cause whiplash injury.
Common Misconception about Whiplash Injury
A common misconception about whiplash injury is that if the vehicle does not sustain damage in a low speed impact, then whiplash injury to the occupant does not occur. In reality, low impact collisions can produce correspondingly higher dynamic loading on the occupants because the lack of crushing metal to absorb the forces results in a greater force applied to items or occupants within the vehicle.
Related Whiplash Symptoms/Conditions
Whiplash injuries can be quite complex and may include a variety of related problems, such as:
Joint dysfunction
As a result of the whiplash, one of the joints in the spine or limbs may lose its normal resiliency and shock absorption (referred to as the joint play), possibly leading to restricted range of movement and pain.
Disc herniation
A whiplash accident may injure the discs between the vertebrae, lead to small tears and cause the inner core of the disc to extrude through its outer core. If the disc's inner core comes in contact with and irritates a nearby spinal nerve root, a herniated disc occurs, with symptoms possibly including sharp, shooting pain down the arm and even neurological symptoms like numbness, tingling and muscle weakness.
Faulty movement patterns
It is believed that the nervous system may change the way in which it controls the coordinated function of muscles as a result of a barrage of intense pain signals from the whiplash injury.
Chronic pain
While often resulting in minor muscle sprains and strains that heal with time, more severe whiplash injuries may produce neck pain and other symptoms that are persistent and long-lasting (chronic).
Cognitive and higher center dysfunction
In some instances,whiplash may affect the patient's mental functioning, possibly leading to difficulties concentrating, as just one example.
Research Findings on Whiplash Accidents
Research both in the Biomechanics Laboratory at Yale University in New Haven and in live crash tests using human volunteers has shed relatively new light on the contortions the cervical spine (neck) undergoes as a result of impact culminating in whiplash. Shortly after impact (about 150 milliseconds), the cervical spine undergoes what is called an S-shaped curve. In this configuration, the cervical spine,rather than simply being curved to the front in a normal C-shape, as it would normally be at rest, takes on an altered shape:
The lower part of the cervical spine moves into extension (bent backward)
When a whiplash accident occurs, the lower part of the cervical spine moves well beyond its normal range of motion, causing the potential for injury to the ligaments and discs in that area. The upper part of the cervical spine also moves beyond its normal range of motion, but to a lesser extent.
The upper part of the cervical spine moves into flexion (bent forward).
Cervical Spine Reactions to a Whiplash Accident
If this stabilization response is working efficiently following the whiplash accident, there is a greater likelihood of protection and less potential for whiplash injury. But if the response is inefficient, an injury is more likely, with various types of whiplash pain possibly resulting and whiplash treatment potentially necessary. There is an inherent stabilization response in the cervical spine that helps protect it from potential whiplash injury:
The nervous system detects the presence of the impact
The muscles of the cervical spine, under the direction of the nervous system, contract quickly to try to minimize the effects of the impact on the ligaments and discs.
Factors Affecting the Whiplash Injury
There are several factors that affect the efficiency of the stabilization response to whiplash injury, including:
Posture at impact
The posture in which a person is sitting at the moment of impact helps determine the efficiency of the stabilization response that will affect the severity of the whiplash injury. Sitting in a correct posture promotes an efficient stabilization response. Sitting in a poor posture, particularly a "slumped" type posture, promotes an inefficient stabilization response.
Overall physical condition
The better conditioned the body is in general, the more efficient the stabilization response will be. This particularly relates to the condition of the nervous system, as a well-functioning nervous system is essential to a proper stabilization response.
Awareness of coming impact
Gender
Women in general are more frequently and more seriously injured by whiplash than men due to the differences in muscular bulk and the female's smaller bony structures. These factors result in less protection of the cervical spine to the abnormal forces such as those that occur in a whiplash-type of injury.
Others
Awareness of Coming Impact on Whiplash Injury Severity
Perhaps the most important factor that affects the efficacy of the stabilization response in relation to whiplash injuries is awareness of the impending impact. This may help explain the findings of some studies that have shown a passenger in a struck vehicle is likely to sustain greater whiplash injury than the driver. The driver is more likely to see the vehicle coming in the rear view mirror.
Scenario 1
Aware of impending impact. This person is able to automatically prepare the stabilization system to respond quickly and efficiently.
Scenario 2
Unaware of the impending impact. This person cannot prepare the stabilization system, thus slowing the response and decreasing its efficiency. This person is likely to sustain greater whiplash injury than is the person who is aware.
Other Factors Affecting Whiplash Injury
Risk factors influencing prognosis of a whiplash injury include:
Whiplash pain /symptoms persisting beyond 6 months
Significant ligament, disc,nerve, or joint capsule injury
Delay in initiating treatment
Need to resume treatment for more than one flare-up of pain
Occupant age over 65
Head restraint more than2" away from occupant's head
Occupant in a small car
Alcohol intoxication at time of automobile accident
Pre-existing x-ray evidence of degenerative changes
Prior whiplash injury
Prior cervical spine fusion
Patient having initial radicular (arm pain, numbness, tingling) symptoms
A cervical collar used for more than 2 weeks.
Sources of Whiplash Pain
When the cervical spine (neck) is subject to whiplash, there is usually a combination of factors that contribute to whiplash pain in the neck and back, and ultimately need to be addressed individually by a chiropractor. The doctor of chiropractic maintains a "holistic" view of the patient's whiplash pain, specifically focusing on one or more of the following:
Joint dysfunction
Muscle dysfunction
When joint dysfunction develops, muscles are affected. Some muscles respond by becoming tense and overactive, while others respond by becoming inhibited and underactive. In either case, these muscles can develop trigger points that may necessitate whiplash treatment involving muscle relaxation or stimulation. Trigger points are areas of congestion within the muscle where toxins accumulate. These toxins can irritate the nerve endings within the muscle and produce pain. This whiplash pain can occur in the muscle itself or can be referred pain (perceived in other areas of the body). The muscle can also send abnormal neurological signals into the nervous system, which can then cause disruption of the ability of the nervous system to properly regulate muscles in other parts of the body, leading to the development of faulty movement patterns.
Faulty movement patterns
Disc derangement
The force of whiplash can cause injury to the discs between the vertebrae, and small tears can develop. If the gelatinous middle of the disc seeps out, it can irritate the nerve endings in this area. This is known as disc derangement. Occasionally, the gel can seep all the way out and press on a nerve root exiting the spinal cord behind the disc, known as disc herniation. A herniated disc may involve whiplash pain in the neck as well as sharp, shooting pain down the arm and possibly neurological symptoms such as numbness, tingling and muscle weakness.
Whiplash Pain Management for Joint Dysfunction
Joint dysfunction from whiplash occurs when one of the joints in the spine or limbs loses its normal joint play (resiliency and shock absorption). It is detected through motion palpation, a chiropractic technique in which the chiropractor gently moves the joint indifferent directions and assesses its joint play. When a joint develops dysfunction, its normal range of movement may be affected and it can become painful. Additionally, joint dysfunction can lead to muscle imbalance and pain,and a vicious cycle:
The loss of joint play can cause abnormal signals to the nervous system (there are an abundance of nerve receptors in the joint)
The muscles related to that joint can subsequently become tense or, conversely, underactive
The resulting muscle imbalance can place increased stress on the joint, aggravating the joint dysfunction that already exists.
Faulty Movement Patterns and Whiplash Pain
It is thought that the intense barrage of pain signals from a traumatic whiplash injury to the cervical spine can change the way the nervous system controls the coordinated function of muscles. The disruption of coordinated, stable movement is known as faulty movement patterns. Faulty movement patterns can cause increased strain in the muscles and joints, leading to neck pain and back pain. They can involve the neck itself or can arise from dysfunction in other areas of the body such as the foot or pelvis. Instability is also considered part of faulty movement patterns. There are 2 types of instability that can occur in whiplash:
Passive instability
the ligaments of the neck are loosened, making it more susceptible to whiplash pain.
Dynamic instability
the nervous system disruption causes a disturbance in the body's natural muscular response to common, everyday forces. As a result of instability, even mild, innocuous activities can be difficult to perform as they often exacerbate the whiplash pain.
Insurance
Medical Expenses & Car Insurance
Medical expenses resulting from an auto accident are covered under liability bodily injury insurance, personal injury protection (PIP), and medical payments (MedPay). Depending on your state you may be required to carry either liability or PIP/MedPay.
Know What Your Car Insurance Policy Covers
When it comes to medical coverage on your auto insurance policy, it's in your best interest to be absolute certain of what it specifically covers. We can help you with calling on your policy to determine exactly what is covered. We will always provide free consultations to answer any questions you have about insurance coverage and treatment options.
General Types of Auto Insurance Coverage
Liability Bodily Injury Protection
Currently almost every state except requires all motorists to carry varying amounts of liability protection or prove financial responsibility in some other way (generally, by posting a surety bond of some sort). However, a liability policy is the most common, and this policy covers the medical bills-up to the designated insurance limits-of motorists and/or pedestrians injured due to your driving negligence.
Personal Injury Protection (PIP)
Personal Injury Protection (PIP)
Personal injury protection, or what many refer to as no-fault insurance, will cover your medical costs regardless of fault. Even if you're the one who caused the accident by running a red light, you and your passengers will be covered up to the limits on your PIP policy. Currently PIP is required in some states only. If you reside in a tort state (one that requires liability insurance) you may be able to carry PIP as an option, in addition to your liability coverage. In addition to medical costs PIP also covers:
Lost wages
Funeral expenses
Child care
Household maintenance
Medical Payment (MedPay)
MedPay, like PIP, is commonly referred to as no-fault insurance. In the states requiring no-fault coverage (see listings above in PIP section) you're usually given the option of carrying either MedPay or PIP.
MedPay, compared to PIP, is more limited.
It only covers medical costs and funeral expenses, and, unlike other forms of coverage, when you file a MedPay car accident injury claim, you'll be required to pay for all medical costs up front, out of your own pocket. To be compensated you'll then need to supply your provider with your hospital and/or medical receipts.
Even if MedPay is not required in your state
it's always a wise insurance option to own, especially if you carry little or no health insurance.
Info
Direct Access now allows you to see a therapist without a doctor's prescription.
At Spine &Injury Clinic of Laramie
we provide our patients with individualized and comprehensive physical therapy and rehabilitation programs. Our approach encompasses conservative treatments that relieve pain, promote healing and prevent future injury, combined with patient education in physical therapy techniques, fitness, general wellness, and ergonomics. This comprehensive treatment strategy aims to optimize results, shorten recovery time and prevent re-injury.
Our commitment to excellence begins with a focus on personalized attention.
Our physical therapists recognize that each person has their own unique needs and desired outcomes. At the onset of care, each patient's medical and physical history is assessed along with other lifestyle factors and a personalized treatment program is developed based on the patient's injury, age, sport, and other lifestyle needs. We also take into account unique factors such as patterns of movement, body alignment, postural habits, and treatment goals in order to develop the most effective customized physical therapy and rehabilitation plans possible. Just as no two patients are exactly the same, no two treatment plans are exactly the same.
Our expert therapists work with each patient to ensure that their treatment goals are met.
Therapy programs are continually reassessed to monitor changes and improvements in a patient's condition. In addition to intensive hands-on treatment received in our offices, we integrate physical therapy into the daily lives of our patients and provide each patient with a roadmap to follow for optimal recovery. We believe that physical therapy is an active process. Therefore, each patient is provided with the tools they need, such as exercises and treatment related information, in order to continually improve and remain healthy outside of our office. This creates a results-driven attitude that accelerates healing and promotes healthy living.
When necessary, our team also works with other medical professionals
in order to help patients recover from an injury or procedure. If a patient is referred to us by a physician or surgeon, we carefully follow the doctor's recommended recovery plan and keep them regularly apprised of the patient's progress. If we feel that a patient should seek additional medical care, we can help coordinate care with some of the finest physicians in the region.
It is our philosophy, customized treatment strategy, emphasis on personalized attention, and commitment
to excellence in a private setting that distinguishes Spine & Injury Clinic of Laramie as one of the premier providers of physical therapy and rehabilitation in the region.
Physical Therapy and Rehabilitation Programs
Customized treatment plans are designed to increase strength, restore range of motion and alleviate pain. Physical therapy and rehabilitation programs are developed using the most effective treatment methods available, including:
Post-operative rehabilitation
Therapeutic exercises
Manual therapy techniques
Joint mobilization
Trigger point therapy and myofascial release
Muscle energy techniques
Postural training
Strengthening, flexibility and mobility training
Balance/proprioception training
Modalities (mild electrical stimulation and ultrasound)
Traction
Exercise & Fitness program design
Home exercise programs
Numerous Reasons
There are numerous reasons why our patients seek physical therapy. We treat people from all walks of life, at all ages, and in all physical conditions. Our expert team develops customized programs to address these common conditions, among others:
Post-surgery management
Sports injuries
Running injuries
Low Back Pain
Neck Pain and Headaches
Car Accidents, Work injuries
Repetitive stress injuries
Shoulder/rotator cuff injuries
Knee, hip and foot pain and pathology
Tendonitis and bursitis
Arthritis
Dr. Dylan N. Milam
Dr. Milam is a graduate of Western States Chiropractic College in Portland, Oregon.
After graduation in December 2005, Dr. Milam was an associate doctor at a busy practice in Portland. While working in Portland, Dr. Milam gained valuable experience treating hundreds of patients, many of which had whiplash injuries, disc injuries, and muscle injuries. Prior to graduating from WSCC, Dr. Milam earned B.S. degrees in Exercise and Sports Science from the University of Wyoming.
Dr. Milam's clinical focus
in addition to disorders of the spine and pelvis, is on conservative management of cumulative trauma disorders, sports injuries and functional progressive rehabilitation. He also encourages the integration of chiropractic care with other medical healthcare services to most efficiently and cost-effectively reach successful outcomes and to ensure patient satisfaction.
Dr. Milam is a Certified Strength & Conditioning Specialist (CSCS) through the National Strength and Conditioning Association.
He has obtained the status of a board certified sports physician - Diplomate American Chiropractic Board of Sports Physician (DACBSP) through the American Chiropractic Board of Sports Physicians (ACBSP). This credential consisted of extra training in prevention, diagnosis and treatment of sports injuries. The program also included extra training in exercise physiology, nutrition, orthopedics, and clinical biomechanics. This means the doctor must complete over 300 post-grad hours, over 100 hours of on-field experience, pass a rigorous written and practical exam, and must publish a paper in a clinical journal. Dr. Milam continues to participate in numerous post-graduate training and education seminars so that he can better himself as a practitioner and provide the latest tools and information to his patients. Dr. Milam is a contributing health columnist for the Laramie Boomerang and Wyoming Lifestyle magazine and has been named as an expert witness for legal trials regarding motor vehicle accidents to review cases for many local attorneys.
Outside the clinic
Dr. Milam enjoys being with his family. He also enjoys weightlifting, snowboarding, hiking, mountain biking, camping, fishing, playing sports, reading and being an active supporter of all of Laramie High School and UW athletic teams.
Dr. David M. Milam
Dr. David Milam is a graduate of Western States Chiropractic College in Portland, Oregon.
Prior to graduation in September 2008, Dr. Milam worked in a multidisciplinary clinic gaining valuable experience with a variety of injuries. Prior to graduating from WSCC, Dr. Milam earned a B.S. degree in Kinesiology and Health from the University of Wyoming.
Dr. Milam's clinical focus
in addition to disorders of the spine and pelvis, is on conservative management of cumulative trauma disorders, sports injuries and functional progressive rehabilitation. Dr. Milam specializes in conservatively treating extremity injuries including shoulders, elbows, wrists, hands, hips, knees, ankles, feet, and TMJ.
Dr. Milam is a Certified Strength & Conditioning Specialist (CSCS) through the National Strength and Conditioning Association.
He has obtained the status of a board certified sports physician - Diplomate American Chiropractic Board of Sports Physician (DACBSP) through the American Chiropractic Board of Sports Physicians (ACBSP). This credential consisted of extra training in prevention, diagnosis and treatment of sports injuries. The program also included extra training in exercise physiology, nutrition, orthopedics, and clinical biomechanics. This means the doctor must complete over 300 post-grad hours, over 100 hours of on-field experience, pass a rigorous written and practical exam, and must publish a paper in a clinical journal. Dr. Milam is also certified in Active Release Technique© (ART). ART is a patented, state of the art soft tissue system/movement based massage technique that treats problems with muscles, tendons, ligaments, fascia and nerves. Headaches, back pain, carpal tunnel syndrome, shin splints, shoulder pain, sciatica, plantar fasciitis, knee problems, and tennis elbow are just a few of the many conditions that can be resolved quickly and permanently with ART. He continues to participate in numerous post-graduate training and education seminars so that he can better himself as a practitioner and provide the latest tools and information to his patients. Dr. Milam served on the sports medicine team at the Ironman Triathlon in Lake Placid, New York in 2009.
Dr. Milam also teaches Human Anatomy at Laramie County Community College
he has taught for the Kinesiology department at the University of Wyoming, and is on the City of Laramie's Board of Health. Dr. Milam is a board member on Wyoming Governer's Council of Physical Fitness and Sports. Dr. Milam is also Wyoming's state director for the National Strength & Conditioning Association.
Outside the clinic
Dr. Milam enjoys being with his friends and family. He also enjoys weightlifting, hiking, mountain & road biking, camping, fishing, playing sports, triathlons, reading, teaching, and being an active supporter of all of Laramie High School and UW athletic teams.
Dr. Jalyn Anderson
Dr. Anderson is a graduate of the University of Colorado Anschutz Medical Campus in Denver, CO.
After graduating in May 2010, Dr. Anderson worked at Ivinson Memorial Hospital, where she gained great experience treating multiple musculoskeletal and neurological diagnoses. Dr. Anderson earned a B.S. degree in Kinesiology and Health Promotion from the University of Wyoming in 2006.
Dr. Andersons clinical passions are the treatment of chronic pain, sports related injuries and preventative care.
Dr. Anderson values the importance of patient centered care with integration of multiple disciplines in order to provide the most successful outcome. Dr. Anderson is skilled to treat a wide range of orthopedic and neuromuscular injuries and has vast experience treating multiple age groups including pediatrics and geriatrics.
Dr. Anderson is certified in Trigger Point Dry Needling through the American Dry Needling Institute.
Dr. Anderson was certified in 2012 and has experienced amazing outcomes with this treatment approach.
Outside the clinic, Dr. Anderson enjoys spending time with her family and friends.
She is very dedicated to health and fitness and enjoys weightlifting, trail running, playing sports, hiking and camping.
Types of Chiropractic Care
The number of treatments required to effectively help a patient is very individual. There are many factors that may influence a person's recovery. For example, the individual's healthcare goals, overall health status, severity of the injury, how long the problem has been present, fulfillment of home/office therapies, and how many prior injuries have occurred. Some patients simply seek relief from their immediate pain and may require only a few treatments, whereas others prefer to experience optimum health and require more intensive and comprehensive care. The decision is always up to the patient. Some people make chiropractic adjustments part of their routine health maintenance, although the value of this type of care has not been scientifically investigated.
Active Care
There are four major types of chiropractic care - Acute Care, Remobilization, Reactivation and Rehabilitation.
Acute care
Acute care is provided during the first few days following an injury. It is intended to relieve pain, inflammation and muscle spasm. Therapeutic modalities such as ice, electrical muscle stimulation and ultrasound may be used to help achieve these results.
Remobilization
Remobilization is that stage of treatment directed at restoring optimal mobility and flexibility to a patient's joints and muscles. Spinal manipulation (adjustments) and muscle release techniques are often used to accomplish these goals.
Reactivation care
Reactivation care is when exercises and flexibility training are introduced into the treatment program. Scientific studies have shown that early introduction of exercise in the treatment process facilitates more rapid recovery from an injury and helps to prevent reocurrences.
Rehabilitation
Rehabilitation is the stage of care when more intensive training is necessary. This is the time when coordination, strength and endurance are emphasized. The goal of rehabilitation is to prevent recurrence of symptoms and re-injury. The ultimate objective of this treatment is to teach patients how to control their own symptoms and condition through exercise and correct posture. Depending on the patient's needs, one area may be emphasized.
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General Info
Hours
Monday:
7:00am - 7:00pm
Tuesday:
7:00am - 7:00pm
Wednesday:
7:00am - 7:00pm
Thursday:
7:00am - 7:00pm
Friday:
7:00am - 7:00pm
Saturday:
-
Sunday:
-
About Us
At the Spine & Injury Clinic of Laramie, we are a highly results-driven facility specializing in the diagnosis, treatment and rehabilitation of injuries and other musculoskeletal disorders. Because no two patients and no two injuries are the same, we are committed to providing a variety of treatment options. We develop customized treatment programs created specifically for each patient's individual needs and requirements.