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Looking Through the MIST – Minor Impact Soft Tissue Injury

As a personal injury attorney in California I, or an attorney anywhere else for that matter can tell you, low impact cases resulting in soft tissue types of injuries, including whiplash, are specifically “red flagged” by the insurance industry as cases meriting special attention. Such cases have been labeled by the code word “MIST”, short for Minor Impact Soft Tissue injury. The idea behind the “MIST” injury originated with insurance companies to allow for lower pay outs for claims resulting in little or no damage to the vehicles involved in an auto accident, and to also permit the insurance companies to pay less for injury claims that cannot be easily seen by the naked eye.

MIST cases are typically denied in their entirety by the defendant’s insurance company. If the MIST claims are not denied categorically, the defendant’s insurance company will often make an extremely low offer to settle, often not enough to even cover all the related injury expenses. This holds true even in cases where the defendant is clearly at fault in the accident. What can be even more frustrating is the fact that often, fault is admitted by the defendant in the accident. The insurance companies simply state that these “low ball” settlement offers are in keeping with what they see jury verdicts rendering in these kinds of related personal injury cases. As a result of the difficulty in litigating MIST injuries, many personal injury attorneys will no longer accept auto accident cases involving low property damage to a vehicle when the injury involved is a soft tissue injury.

The difficulty of litigating soft tissue injuries creates a quandary, leaving an auto accident victim with only two options: accepting the insurance company settlement offer or proceeding to take the defendant to court. Although one does not have to accept an insurance company settlement offer, there are a several facts to keep in mind during the decision making process. The first thing to remember is that going to court involves a substantial commitment of time for both the representing attorney and the recovering client. The second idea to consider is that bringing a case to trial and ultimately through to a verdict is often costly in terms of the expenses required to so, including but not limited to the costs of specialists, medical experts, and accident re-constructionists. Thirdly, it must also be noted that litigation can be risky and that there are absolutely no guarantees as to a successful result. It is up to the client to request their personal injury attorney to proceed through a cost-benefit analysis to determine if the case can be successfully litigated in a cost effective manner.

For victims of MIST injuries, it is important to engage in an active discussion about the possible outcomes of the options comprising soft tissue litigation. It is also important that one question their attorney about the bottom line when obtaining advice for an appropriate course of action to best resolve the soft tissue injury case.



Source by Jeffrey Frank

Assured Health Physiotherapy clinic is an Interdisciplinary medical clinic located in New Westminster which offers several premedical services such as RMT, physiotherapy, chiropractic, RMT, Acup, etc.

Assured Health Physiotherapy is also offering medical products such as Custom-made orthotics, Compression Stockings, braces, and TENS machines.

To find out more, please Contact Assured Health Physiotherapy in New Westminster at 604-526-2671

Neuromuscular Physical Therapy – Megan’s Case Study

In studying Megan’s case history and symptoms, key moments and events stand out in her time line of pain and dysfunction. Nine years ago, after the birth of her second child, was the first time that Megan noticed that her left foot was slightly wider and longer than her right foot. The timing of this is relevant as during the course of her pregnancy a hormone called relaxin would have been released into her system to loosen the ligaments of her pelvis in anticipation of childbirth. However, relaxin can also loosen ligaments elsewhere in the body and a longer and wider left foot would indicate the collapse of the main arches of the foot due to ligament laxity. This is one of the turning points in Megan’s history that has had a detrimental effect on her health ever since. The relaxed ligaments may never have fully recovered their full stabilizing strength and when she developed a tired aching sensation in her left medial arch a few years later it was probably as a result of this. A fallen arch will lead to over pronation and this will in turn put the tibialis anterior and possibly tibialis posterior muscles under undue stress as they try to stabilize and counteract over pronation. Stressed or overwhelmed muscles will form trigger points (TPs) within them and for tibialis anterior this can refer pain anteromedially as it passes the retinaculum. TPs in the tibialis posterior will refer pain into the sole/arch of the foot. Over pronation will lead to shortened peroneus longus which will further inhibit the tibialis muscles which will further exacerbate the problem in a continuous vicious circle.

The whiplash injury experienced last year would also add to Megan’s problems and since then she has experienced occasional headaches and neck stiffness. The whiplash injury almost certainly would have affected her sub occipital muscles, sternocleidomastoids (SCM), scalene and other stabilizers of the neck and spine. This whiplash would lead to improper neck movement which in turn would lead to TPs in the SCM and possibly the longus colli on one side (left) possibly due to the leg length discrepancy. TPs here would leave these muscles in a shortened state resulting in rotation of the head to the right hand side. If the longus colli is involved it result in kinetic chain problems and affect the peroneals on the lateral aspect of the lower limb further exacerbating the fallen arch. With the peroneus longus muscles in such an unhealthy state it is possible that it could have an effect on the sacrotuberous ligament of the pelvis and its ability to hold the sacrum in position. Megan states that one day last year she felt a twinge in her right sacroiliac joint while assisting an obese client up from a supine position. She experienced locking/jamming and diffuse soft tissue pain in QLs, multifidis and shooting pain into her hip. The fact that she was locked into torso flexion to the right suggests that the QLs went into spasm on the right side after insult and as we find out later her sacral base is an inch high on the right and there is posterior rotation of the right ilium with resultant postural imbalance whereby 2/3rd of Megan’s weight is pressing down on her right side. This extra load and postural imbalance has led to shooting pain in the trochanteric region and referred pain on the lateral aspect of the thigh due to TPs in the weakened gluteus medius and iliotibial band issues due to the over worked tensor fasciae latae.

With all this pain getting to unbearable levels, Megan turned to prescription drugs, codeine based painkillers, antidepressants, Zoloft, anti inflammatory tablets all of which would have exacerbated her problems through time by building up toxins in her system. She was also whilst under the influence of painkillers probably injuring tissue by doing activities that she would not have done if she had her natural alarm system of pain stopping her. The elastic support belt and the taping would have made the situation worse by encouraging atrophy of supporting muscle tissue.

Megan’s right shoulder is lower than the left possibly due to shortened latissimus dorsi pulling on the humerus and inhibiting upper trapezius and hypertrophy of the pectoralis minor muscle pulling the scapula forward and down.

As we consider Megan’s problems, symptoms, and case history, we can appreciate that she is suffering abject pain and dysfunction up and down her functional kinetic chain. From the pain in the plantar fasciae, spastic peroneus longus, inhibited tibialis, medially rotated tibia, medial knee pain, lateral thigh pain, trochanteric pain, lumbo – sacral pelvic pain and dysfunction, posteriorally rotated right ilium, lower left anterior superior iliac spine, 2/3rd weight imbalance to right hand side, lower back pain with QLs and multifidis in a shortened state, latissimus dorsi, neck extensors and flexors all giving problems we have to ask the question as to which functional kinetic chain we are dealing with. In my opinion, considering all areas involved, it would be the spiral oblique chain.

Megan would have to be informed that her treatment will be extensive and prolonged because some issues have been there for a while and would involve neural retraining for the dysfunction and imbalances present.

  • Medical screening.
  • Case history.
  • Postural assessment.
  • ROM testing / neural testing.
  • All shortened and restricted muscles would have to be relaxed / lengthened with TP therapy, METs, positional release / strain- counterstrain.
  • Inhibited muscles would have to be fired and strengthened with tapotement, METs and strengthening exercises.
  • Any areas of bind would need STR, cross fiber friction etc.
  • A consideration would be referral for PCIs to address the pronating left foot initially with a plan to strengthen that area long term.
  • Megan’s nutrition was not mentioned but I would be referring her to a specialist in that field to ensure that she has no nutritional deficiencies that would hinder the healing process.



Source by Charlie J Molloy

Assured Health Physiotherapy clinic is an Interdisciplinary medical clinic located in New Westminster which offers several premedical services such as RMT, physiotherapy, chiropractic, RMT, Acup, etc.

Assured Health Physiotherapy is also offering medical products such as Custom-made orthotics, Compression Stockings, braces, and TENS machines.

To find out more, please Contact Assured Health Physiotherapy in New Westminster at 604-526-2671

Cervicogenic Headaches – A Pain in the Neck (Part 2) – Treatment Options

OK, so in part 1 we looked at causes and effects of the cervicogenic headaches, now let us turn our attention to treatment options that can be utilized to help decrease their severity and frequency as well as postural and lifestyle changes to eliminate the underlying cause. Treatment options and expectations can be difficult to establish as the cervicogenic headache can be somewhat of a “chicken and the egg” process. The better we can tell what caused what the more accurate the recommendation and prognosis. For the purpose of this article we will divide recommendations into acute or recent onset that resulted from an injury or event and chronic or long term conditions without a history of injury. Certainly there can be a combination of both acute injury and chronic resultant conditions but for simplicity we will look at the former:

An acute injury or traumatic event is most commonly associated with a sports injury or auto accident. Remember, just because you may have not been the driver in an accident, the body goes through the same injury. As an example, studies indicate that a typical low to medium impact “whiplash” injury has the same impact as taking off in a fighter jet…about 5 to 7G’s of force. This force is absorbed by 22 cervical ligaments and tendons in the neck that attach key muscles allowed for movement and overall function. Common treatment options for an acute cervical injury with resultant cervicogenic headache include muscle relaxants, pain killers, manipulation / chiropractic, physical therapy and massage. Ideally, studies indicate that the best results may in fact be accomplished with all of the above used in combination. Pain killers should be considered as a last resort or at best a temporary option due to the potential side effects and addictive qualities. The muscle relaxants do just that, they serve to relax the muscles that are in spasm. These muscle spasms are the body’s natural defense mechanism, however left in spasm for too long they can cause on- going issues including but not limited to the cervicogenic headaches. So, from a relaxation and functional standpoint the anti-inflammatory, muscle relaxer and pain killer (preferably over the counter) provide the body a chance to rest which is important when injured. However, it does little to actually treat the underlying cause of the injuries, that being the sprain and or strain of the cervical spine muscles and ligaments as well as potentially the minor misalignment of the 7 cervical vertebrae or bones in the neck. The manipulation process addresses specifically the top three vertebrae to ensure proper nerve flow, think of it in terms of having a water hose with a kink in it and then releasing the hose to its normal position. Additionally, the muscles need to be addressed through physical therapy and massage in order to maintain the proper alignment. Like a tug of war, if the bones are manipulated to take pressure off of the nerve, yet the muscles remain in spasm then the muscles will simply pull the bone back where it was at the time of the accident or injury. Again a combination of the above treatment options appears to have the best results for acute injuries.

The treatment management of chronic or long term cervicogenic headaches can certainly utilize some or all of the above options as well, however generally speaking the results may be slower as the body has already adapted perhaps with cervical muscle scar tissue and / or cervical spine osteoarthritis depending on the events if any and the duration that led up to the headaches. The body will heal itself the best way it can to function and protect itself in the short term, however if the joint integrity and / or muscle tone is compromised for a prolong period of time then this healing process may not have been biomechanically correct if you will, resulting in chronic cervicogenic headaches. The most common cause for cervicogenic headaches appears to be resulting form postural imbalances. The head forward or flexed positions that we face through the day in front of computers, etc. coupled with poor overall posture sitting, standing and sleeping have lead to headache complaints in record numbers. Some studies indicate that over 2% of the population, translated to 18 million people have suffered cervicogenic headaches resulting in clinical outpatient visits every year! In addition to the above referenced treatment options it is very important to be aware of the potential detrimental result of poor posture of the neck and the relation to cervicogenic headaches. Options for treatment of the chronic cervicogenic headache should include adjusting any book, computer etc. to be at a position that does not require the neck to be in a flexed position for a prolonged period of time. Headsets for phone work are much better than having a phone to the ear (including cell phones). Additionally, daily stretching and range of motion exercises for the neck are very important and lastly, our sleep habits. It is important to sleep on your back or side (do not tuck chin) with the usage of a cervical pillow. The cervical pillow is designed to maintain the integrity of the neck in its proper alignment while we sleep, allowing the supporting and overstressed muscles a much needed chance to rest.

As mentioned earlier cervicogenic headaches are complex to evaluate and treat. Try these suggestions under the direction of your doctor as individual circumstances and results vary. You may just discover that those headaches you have learned to live with may not be around much anymore. Maintain good cervical posture and timely and appropriate health care for any neck injury…The quality of your life may depend on it. Best Wishes.



Source by Eric J Chartier

Assured Health Physiotherapy clinic is an Interdisciplinary medical clinic located in New Westminster which offers several premedical services such as RMT, physiotherapy, chiropractic, RMT, Acup, etc.

Assured Health Physiotherapy is also offering medical products such as Custom-made orthotics, Compression Stockings, braces, and TENS machines.

To find out more, please Contact Assured Health Physiotherapy in New Westminster at 604-526-2671

Podiatry Treatment Addresses Many Health Challenges

While many consider podiatry to be an exclusive realm of all things below the ankle, the truth is that treatment of injuries and other problems of the feet affect the whole body. When the biomechanics of walking are misaligned by damage to the feet, it can cause overarching issues in the legs, knees, hips, and back. Chronic pain can reduce the desire to exercise, leading to lethargy and depression.

Help with toe pain

Toes are made up of multiple small bones, ligaments, and muscles. When something in these complicated constructs gets out of place, injured, or torn, the pain can be debilitating. A patient suffering from bunions or hammer toe should seek treatment sooner rather than later. Addressing toe pain earlier on can reduce the need for invasive treatments, and this may make treatment more effective in the long run.

Tendonitis and heel pain

Although tendonitis can happen in several places from the ankles to the toes, it’s most commonly diagnosed in the Achilles tendon. This inflammation can cause moderate to severe pain and make even light exercise difficult. It is most often treated with physical therapy, but other treatments can become necessary if the pain is severe. The normal causes are repetitive stress or not taking enough time to stretch before working out.

Leg, knee and back pain

Most people seek out podiatry treatment only after first consulting an orthopedic surgeon about their knee, back, or hip pain. Many patients don’t realize that the pain in their lower body may be caused by problems in their feet. Balance, movement, and articulation can be affected by injury or malformation of the feet. By treating the source of the problem, these kinds of injuries can be addressed more effectively than by treating the symptoms with painkillers or antidepressants.

Treatment possibilities

Many patients seeking out the care of a podiatry specialist expect surgery to be a part of their treatment plan. While some issues must be dealt with surgically, many can be addressed through less invasive means. X-rays can help pinpoint a diagnosis, and they are often necessary in devising a long-term treatment plan. The options for treatment may range from education about appropriate footwear, to physical therapy, to specialized orthotic inserts.

Preventing podiatry problems

Many patients don’t realize that feet change in shape and size long after puberty, unlike most parts of the body. Many podiatry problems can be avoided simply by having the feet measured when buying shoes, and wearing shoes that fit properly, especially for exercise. When there are problems with the shape of the feet, or an injury that causes problems with walking, custom-created orthopedic inserts may correct balance and other issues.

Seeking out orthopedic treatment at the first sign of pain or strain often prevents further injury. Foot injuries should be treated promptly to reduce the recovery time and help ensure the fullest possible recovery. Wearing the correct shoes for activity and exercise, and taking the time to stretch and warm up before exercise help prevent injuries.



Source by Abigail Aaronson

Assured Health Physiotherapy clinic is an Interdisciplinary medical clinic located in New Westminster which offers several premedical services such as RMT, physiotherapy, chiropractic, RMT, Acup, etc.

Assured Health Physiotherapy is also offering medical products such as Custom-made orthotics, Compression Stockings, braces, and TENS machines.

To find out more, please Contact Assured Health Physiotherapy in New Westminster at 604-526-2671