Choosing the right provider for car accident medical treatment after a motor vehicle collision is one of the most important things you will do after an accident. There are many predatory tactics that chiropractors and other individuals will employ in order to lure people injured in accidents to their offices. Needless to say these are usually not the best places to go for treatment. Many of these clinics or providers will begin lengthy treatment plans and quickly rack up expensive bills. I have seen patients scheduled daily at some offices. It is reasonable to treat more frequently initially after the accident but care should trend toward decreased dependence on passive care and move more towards an active home exercise program. Here is a list of red flags:
1. The first visit should be thorough and involve a detailed history and exam. High volume clinics will often have little to no history and a cursory exam. Improper exam and assessment lead to improper diagnoses and improper treatment plans.
2. Treatment plans should have clear, measurable, functional, and objective outcomes. This may be in the form of various questionnaires administered periodically throughout the treatment plan. This should also be assessed through common activities of daily living that have been hard to accomplish since the date of injury. These outcomes can be simply measured by time and ability to perform previously simple tasks. If there are no objective goals or outcomes there is no way to measure effectiveness of the treatment.
3. As stated earlier, treatment can initially focus on relieving painful muscles and tissues with passive modalities such as spinal manipulation, modalities such as electrical stimulation and ultrasound, and massage. As treatment progresses it is vital that there be an overall emphasis on transitioning treatment to more active goals and rehab. If your treatment plan is not changing or symptoms are not improving it is important that you address it with your health care provider, seek a second opinion, or seek treatment elsewhere.
4. Current evidence suggests that the best approach to treating whiplash and sprain/strains post accident is with a multi-modal approach. That means that the treatment plan should include a combination of spinal mobilization, manual therapy, and exercises. If you are seeing a provider and only receiving chiropractic adjustments you are short changing yourself and likely receiving low value care. Manipulation can be effective for some conditions on its own but is much more effective when manual therapy and exercises are included in the treatment plan. If you are being treated where the only intervention is frequent adjusting and an occasional massage, find a new provider that offers more options to help you through your recovery. Reliance on passive modalities (manipulation/electrical stim/ultrasound) will only run up a very expensive bill with poor outcomes.
5. If you are not improving you made need further advanced imaging such as an MRI. We commonly see various different pathologies due to the magnitude of forces that occur in accidents. Co-treatment can be very helpful in determining when imaging should be ordered. The bottom line is if you have been treating for several weeks and are not seeing improvements in your measurable outcome markers (objective questionnaires we discussed earlier) then advanced imaging is appropriate and should be considered.
6. Piggy backing off the previous point, you should seek out a health care provider that actively works with other health care professionals with your best interest in mind. Co-treating with a team of professionals such as your primary care doctor and/or a physical therapist will help provide the best possible care possible.