Delayed Soreness Following Accidents or Injury
By James Beauchamp, D.C.
“How can I be hurt and yet not experience pain for several days?” This is a question I am quite frequently asked by my patients after a car accident because a large number of people feel no pain until the next day or even later. They attribute this delayed pain reaction to being “in shock” proclaiming, “I was in shock at the time and that is probably why I didn’t feel anything.” They also attribute the adrenaline surge they experience at the accident scene for blocking their pain. Generally speaking, neither of these theories is accurate. The type of emotional shock that occurs after a typical car accident won’t block true pain. It is also true that while the adrenaline reaction immediately following an accident can be powerful enough to mask even fairly intense pain, the reality is there are other factors at work. In fact, in the majority of the cases, there is no immediate pain. It does not manifest itself until the body’s healing reaction kicks in. The pain emanates from what is called the acute inflammatory reaction.
Tissue damage results in the release of chemicals, which in turn cause the body to undergo a series of physiologic reactions at the injury site. These include increased tissue permeability, vascular dilation, and the mobilizing of white blood cells to remove tissue damage and debris. As a result, the pain an accident victim incurs may be quite minimal for hours or even days after the incident. Of course, in more severe injuries the pain can be immediate and quite intense. In fact, the speed of the onset of pain is often, although not always, an indicator of injury severity. However, in general any injury is worse by the second day simply because the chemical reaction process takes a certain amount of time to occur.
The first week after an injury is a critical time because of the potential for prolonging the inflammatory reaction and prolonging the healing process. For instance, the patient may perceive the application of heat as a good idea, despite the fact that heat increases the inflammatory response as well as ultimately the pain.
Another tactic that both prolongs and/or worsens an injury is to continue with high levels of physical activity such as work or exercise. I tend to restrict a patient’s activities when initiating treatment for this very reason. Prematurely initiating in-office therapeutic exercise is another problem that I frequently encounter. Many chiropractors and physical therapists are far too aggressive with strengthening exercises during the acute phase of injury, when in reality rest, gentle active and passive motion, and inflammation control is better employed. On more than one occasion I have had a patient hail me as a ‘miracle worker’ simply because I ordered rest and the application of home-applied ice therapy.
One of the aspects I truly appreciate about Multi-Specialty HealthCare (MSHC) is working in close proximity to medical physicians. Many times, the ordinarily highly effective cures of rest and ice therapy are insufficient and medication is required. Early onset of treatment is critical. A delay of days or even weeks for patients to see their busy primary care physician is simply unacceptable. And that is assuming the doctor will even see the patient! Medical physicians often refuse to treat even their longstanding patients for accident-related injuries. That is precisely why at MSHC we have medical staff and medication dispensing in office. Not only that, but the availability of advanced diagnostic imaging within the practice is crucial during the acute stage of an injury to rule out contraindications to initiating Chiropractic or physical therapy treatment.
Dr. James Beauchamp is a Multi-Specialty HealthCare provider specializing in Chiropractic Care. He is certified in spinal trauma, manipulation under anesthesia, and as an automobile accident reconstructionist. He is also a member of the advisory board for Operation Backbone.