Thursday, May 10, 2018

Car insurance company takes a BIG LOSS with a jury verdict in Providence Superior Court

by: Dr Stephen Estner

After nearly 20 years in practice I was called to testify in live court on my first case on March 6, 2018. It involved a young couple on their way to the Wrenthem Outlets, traveling on 95 in Providence when they were rear ended by a driver of another car. The couple pulled off to the breakdown lane to assess the vehicle and found little to no visible damage. They exchanged information with the other driver and continued their shopping trip. Their young daughter was in the car and the parents had promised her a trip to the Disney store. The daughter had no injuries but the following day the parents awoke with complaints of neck, back and some head pain. They proceeded to Kent Hospital and underwent a standard evaluation, but no x-rays or CT scans were conducted. Approximately two days later they contacted my office, Estner Injury Centers to come in for evaluation because they felt their condition was worsening. By that time, they were represented by an attorney.

A general history was taken as well as a medical exam including orthopedic, neurological and chiropractic testing and it was determined they were candidates for treatment. They each had cervical sprain/strain injuries, upper back pain and some headaches likely from striking their head hitting forcefully against the headrest on impact. It was advised that they refrain from all work duties for four weeks but due to financial concerns they were unable to do so. They were sent for neck x-rays which revealed no significant findings with the exception of noted straightening of the cervical spine lordosis likely due to spasm on the wife’s report. A normal course of therapy commenced for nearly the next ninety days totaling approximately twenty visits for each. Because they only had one car, the one from the accident and on nearly all visits they attended together. Therapy consisted of a mixture of chiropractic manipulation to restore normal motion to the spinal joints, electric muscle stimulation to help relax the musculature by reducing spasm and hypertonicity (tightness), laser light therapy to reduce inflammation and pain and advised stretches and exercise to be conducted at home. They had no work restrictions, they were compliant with therapy, treating a standard 3-2-1 per week until discharge at nearly month three. They were never seen again by our facility for treatment and resumed their normal activities of daily living without limitations.

(It is my experience that people who push through the pain, try to maintain their normal daily activities are steadfast in their intent to heal conclude treatment sooner. However, those types of patients are also prone to relapse and often return at a later date, this was not the case with this couple though.)

The insurance company refused to accept a reasonable offer to settle for under $10,000 each including payment of their medical bills which totaled about $2500 each. About three years post discharge, all involved parties were deposed including myself. Within about two months the case was brought to trial in Providence Superior Court in front of a jury of 8. I was the expert witness for the plaintiff. The case seemed to hinge on whether occupants of a rear end collision can be injured if there is no visible damage to the vehicle. I clearly stated that although I am not an expert in physics or biomechanics I have taken physics courses and there is some degree of common sense involved here. I stated not all car bumpers are equal in their ability to absorb impact, the position of the occupants’ body, specifically the head position plays a role, the age of the car is also a factor. Other factors not mentioned include: position of the headrest, damage to the undercarriage of the vehicle, speed of the impacting vehicle and whether or not the car impacted with stopped, moving or hit a vehicle in front. To explain to the jury, the transfer of force, I used a simple visual experiment. I held my cup of water and asked the jury of they thought they would get wet if I was hit somehow from behind. This simple experiment indicated that regardless of bumper absorption, there is some degree of force transferred to the occupants, resulting most probably to an injury to the neck and upper back as well as likely to cause the head to impact into the head rest. It seemed as if the jury was convinced at that point (observing of their expressions). After cross examination by the defense, the case continued into the next day due to the fact that the defendant, an out of state resident elected not to attend and in lieu of live testimony his deposition was admitted into evidence. The jury deliberated for about two hours and a verdict was reached in favor of the plaintiffs. The couple was awarded nearly $8000 each with an additional $3000 interest.

In conclusion, patients present frequently to my office for a variety of accidents, work, auto or slip and falls. The common denominator is that the mechanisms of these types of injuries are multifaceted and do not necessary equate with bodily injuries. In this particular circumstance, the damage to the vehicle could not at all be considered because it was an older car and it was never inspected or appraised, Regardless, we have all seen people walk away unharmed from the worst looking accidents and of course the contrary as well. I have faith in the judicial system and will continue to stand up for the innocent victims of accidents to ensure that they can continue to receive the reasonable and necessary treatment they need to restore their health without being intimidated by insurance companies.


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Dr. Stephen Estner is a Chiropractor in Rhode Island with office locations in Pawtucket and Cranston, Rhode Island. His offices offer chiropractic rehabilitation through acupuncture, massage therapy, and manipulation of the spine, joints, and muscles. Dr. Estner treats all spinal injuries, back pain, and symptoms including those due to automobile accidents, workplace and sports injuries, pregnancy, and provides general care and maintenance of the spine.
For more information or to schedule an appointment please visit: http://www.DrEstner.com.

Monday, December 11, 2017

Misconceptions about the Chiropractic Profession

There are many misconceptions about the chiropractic profession and the scope of practice, particularly in Rhode Island.  It is important for the legal community to have a clear understanding of this topic as questions will arise during statements, deposition, and even a trial. 

To begin, chiropractors in Rhode Island are considered physicians and are allowed to perform all medical procedures with the exception of prescribing medications and major surgery.  As a chiropractic physician, I can order any tests such as MRI, CT scan, and x-rays without primary care involvement.  When there are procedures that may be questionable whether or not the chiropractor should perform, if it is not typically taught in an accredited college, often the question will be presented to the Board of Chiropractic Examiners.  The Board of Chiropractic Examiners is comprised of three chiropractic physicians, on which I currently serve as Chairman, two public members, all of whom act as an advisory board to the Department of Health.  The Board handles all disciplinary actions and decisions on licensure as well as public complaints.  Chiropractors are held to the same record-keeping and HIPAA requirements as medical doctors.  All records must contain a proper history and physical examination including orthopedic and neurological testing, and the diagnosis and prognosis should be stated.  All subsequent visits are usually in a SOAP note format:  Subjective or is what the patient is stating to be the chief complaint, Objective or the physical findings for that day, Assessment or how the patient is doing since last visit, and Plan/Treatment or the details of the treatment from that day, future treatment advised, and even a comment regarding the patient's disability status.  Records should be available to the patient in a reasonable amount of time and made available to the attorney with signed consent from the patient. 

Another topic that is commonly directed towards chiropractic therapy is “overtreatment.”  In most cases, we are typically treating sprain/strain injuries and according to the American Medical Association, sprain/strain injury can take between three and six months to heal.  Typical treatment involves three phases of care—acute, subacute, and rehabilitative.  In the acute phase, the goal is to reduce inflammation and muscle spasms, which in turn will consequently increase range of motion.  The subacute phase deals with restoring movement to the injured area and usually involves stretching, massage, manipulation, and light exercises.  This phase is usually one to two months of treatment.  Finally, the rehabilitative phase is intended to elongate and stretch the damaged muscles which usually involves exercise therapy and will reduce the chance for relapse and allow the patient to sustain the treatment that has been performed thus far and insure long-term success.  The response time to these phases of treatment can depend on a variety of factors such as the patient's age, underlying spinal or extremity conditions such as degenerative arthritis which will prolong the treatment time, and general health issues such as diabetes or rheumatoid arthritis which will certainly impede progress.  Furthermore, the patient is often under the care of another physician and/or still following recommendations given to them by a hospital, and whether or not they are using medications such as ibuprofen and muscle relaxers will also dictate their response to treatment time.  There are situations where chiropractic overtreatment does occur and in my opinion, chiropractors who only perform manipulation, use heat and modalities such as electric muscle stimulation throughout the entire length of treatment, and exceed approximately three to four months would be considered to be overtreating, and this is usually not a format that will provide a positive long-term outlook for the patient.  It should be noted that Estner Injury Centers follows a three-phase protocol strictly and over the course of the past 17 years of practice in Rhode Island has rarely encountered the question of overtreatment by insurance companies or other physicians and has rarely experienced patients returning due to relapse. 

 This post was proudly written for Lawyers Weekly Rhode Island publication. 




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Dr. Stephen Estner is a Chiropractor in Rhode Island with office locations in Providence, Pawtucket, Warwick and Cranston, Rhode Island. His offices offer chiropractic rehabilitation through acupuncture, massage therapy, and manipulation of the spine, joints, and muscles. Dr. Estner treats all spinal injuries, back pain, and symptoms including those due to automobile accidents, workplace and sports injuries, pregnancy, and provides general care and maintenance of the spine.
For more information or to schedule an appointment please visit: http://www.DrEstner.com.

Tuesday, January 3, 2017

Scoliosis

by: Dr. Frankie Rodriguez
Scoliosis is known as a sideways curvature of the spine. It occurs most often just before puberty. Certain conditions such as cerebral palsy and muscular dystrophy can lead to scoliosis, even though most of the causes are not yet known.
There are several risk factors for this condition and they are;
1.    Age – Signs and symptoms appear at the beginning of puberty.
2.    Sex – Girls have a higher risk of the curve worsening.
3.    Family history – Scoliosis can run in families.
Scoliosis is mild most of the time, but sometimes, it the deformities becomes more severe as children grow. Severe scoliosis can be serious as disabling a person. Especially a severe spinal curve can reduce the thoracic (chest) cavity volume, making it difficult for the lungs to move while breathing and will disturb its functions.
Mostly, scoliosis and the body shape changes are noted by the parents or child itself. The main signs and symptoms of scoliosis include uneven shoulders, the appearance of one shoulder blade more prominent than the other, uneven waist or one hip higher than the other. In the case of severe scoliosis, the spine will also rotate or twist, additionally to curving sideways. This leads to increased intercostal spaces (space between the ribs) on one side than the other.
Your Chiropractor will take a detailed medical history first and during the physical examination, the Chiropractor will check the child while standing and then while bending forward from the waist, to see if one side of the rib cage is more prominent than the other. In certain cases, the doctor may also do a neurological exam to check for muscular weakness, numbness, and abnormal reflexes.
A chest and a lumbar X-rays of the spine can confirm the diagnosis of scoliosis and reveal the severity of the condition by imaging the abnormal curves and some complications. In the case of a doubt, whether a tumor is causing scoliosis, additional imaging tests, such as an MRI would be needed further.
Most of the children with scoliosis who have mild curves do not need a treatment with a brace or a surgery. But, they will need checkups with their Chiropractor once every four to six months to see if the abnormal curvature increases. In moderate or severe cases, treatment will be needed and studies show that chiropractic treatments, electrical stimulation treatments, and dietary supplements are very effective.
Know that your problem is understood and will be resolved with Estner Injury Centers.
“Your pain and suffering stops at Estner Injury Centers!

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Dr. Stephen Estner is a Chiropractor in Rhode Island with office locations in Pawtucket and Cranston, Rhode Island. His offices offer chiropractic rehabilitation through acupuncture, massage therapy, and manipulation of the spine, joints, and muscles. Dr. Estner treats all spinal injuries, back pain, and symptoms including those due to automobile accidents, workplace and sports injuries, pregnancy, and provides general care and maintenance of the spine.
For more information or to schedule an appointment please visit: http://www.DrEstner.com.

Tuesday, August 23, 2016

What does Chiropractic Heals

by: Dr. Frankie Rodriguez
• Neck pain
• Joint pain
• Arthritis
• Back pain
• Headaches
• Asthma
• Healthy pregnancy
• Blood pressure
• Scoliosis
• Surgery prevention
Chiropractors can heal the musculoskeletal system specially the spine without surgery or drugs. We use hands on spinal manipulation and various techniques and treatments for the proper alignment of the body. Manipulation is used for curing the injuries caused by traumatic events such as falling from the stairs, sitting without a back support or repetitive stress.

Chiropractors seek to care for the general wellness of a person as well as prevention from diseases. We check every patient thoroughly to know the status of their health. Other tests and examinations like x-rays might also be conducted to know what exactly the issue is. Once the chiropractor diagnoses, he develops a treatment plan for the patient. We provide exercise recommendations, nutrition advice, and lifestyle counseling and so on. We combine the manual therapies along with the use of spinal adjustments for the treatments. Such approaches include; relaxation techniques, heat and ice, dietary supplements and electric stimulation. Our goal is to increase movement and motion in the area that the patient is complaining about and restoring optimal health.

Benefits of Chiropractic Care
Other than being a treatment for your mechanical disorders, Chiropractic has various other benefits. A few of these benefits are;

1. Improvement in Posture
Due to our habit of sitting in front of a computer daily, we usually get neck and back issues. Regular Chiropractic sessions can help the alignment of the curves of your spine and help you maintain a straight posture.

2. Improves Immune System
The nervous system and immune system of the body are interrelated. Chiropractic treatments remove subluxations that prevent your nervous systems from working properly. Once the nervous system starts working efficiently, it starts keeping your immune system working better as well.

3. Decreases tension
Chiropractic manipulations help maintain alignment. With proper alignment the muscles are under less tension and can relax. This, in turn, helps decrease your tension and pain in that region.




--------------------------------------
Dr. Stephen Estner is a Chiropractor in Rhode Island with office locations in Pawtucket and Cranston, Rhode Island. His offices offer chiropractic rehabilitation through acupuncture, massage therapy, and manipulation of the spine, joints, and muscles. Dr. Estner treats all spinal injuries, back pain, and symptoms including those due to automobile accidents, workplace and sports injuries, pregnancy, and provides general care and maintenance of the spine.
For more information or to schedule an appointment please visit: http://www.DrEstner.com.

What does Chiropractic Heal

by: Dr. Frankie Rodriguez
• Neck pain
• Joint pain
• Arthritis
• Back pain
• Headaches
• Asthma
• Healthy pregnancy
• Blood pressure
• Scoliosis
• Surgery prevention
Chiropractors can heal the musculoskeletal system specially the spine without surgery or drugs. We use hands on spinal manipulation and various techniques and treatments for the proper alignment of the body. Manipulation is used for curing the injuries caused by traumatic events such as falling from the stairs, sitting without a back support or repetitive stress.

Chiropractors seek to care for the general wellness of a person as well as prevention from diseases. We check every patient thoroughly to know the status of their health. Other tests and examinations like x-rays might also be conducted to know what exactly the issue is. Once the chiropractor diagnoses, he develops a treatment plan for the patient. We provide exercise recommendations, nutrition advice, and lifestyle counseling and so on. We combine the manual therapies along with the use of spinal adjustments for the treatments. Such approaches include; relaxation techniques, heat and ice, dietary supplements and electric stimulation. Our goal is to increase movement and motion in the area that the patient is complaining about and restoring optimal health.

Benefits of Chiropractic Care
Other than being a treatment for your mechanical disorders, Chiropractic has various other benefits. A few of these benefits are;

1. Improvement in Posture
Due to our habit of sitting in front of a computer daily, we usually get neck and back issues. Regular Chiropractic sessions can help the alignment of the curves of your spine and help you maintain a straight posture.

2. Improves Immune System
The nervous system and immune system of the body are interrelated. Chiropractic treatments remove subluxations that prevent your nervous systems from working properly. Once the nervous system starts working efficiently, it starts keeping your immune system working better as well.

3. Decreases tension
Chiropractic manipulations help maintain alignment. With proper alignment the muscles are under less tension and can relax. This, in turn, helps decrease your tension and pain in that region.




--------------------------------------
Dr. Stephen Estner is a Chiropractor in Rhode Island with office locations in Pawtucket and Cranston, Rhode Island. His offices offer chiropractic rehabilitation through acupuncture, massage therapy, and manipulation of the spine, joints, and muscles. Dr. Estner treats all spinal injuries, back pain, and symptoms including those due to automobile accidents, workplace and sports injuries, pregnancy, and provides general care and maintenance of the spine.
For more information or to schedule an appointment please visit: http://www.DrEstner.com.

What does Chiropractic Heals

by: Dr. Frankie Rodriguez
• Neck pain
• Joint pain
• Arthritis
• Back pain
• Headaches
• Asthma
• Healthy pregnancy
• Blood pressure
• Scoliosis
• Surgery prevention
Chiropractors can heal the musculoskeletal system specially the spine without surgery or drugs. We use hands on spinal manipulation and various techniques and treatments for the proper alignment of the body. Manipulation is used for curing the injuries caused by traumatic events such as falling from the stairs, sitting without a back support or repetitive stress.

Chiropractors seek to care for the general wellness of a person as well as prevention from diseases. We check every patient thoroughly to know the status of their health. Other tests and examinations like x-rays might also be conducted to know what exactly the issue is. Once the chiropractor diagnoses, he develops a treatment plan for the patient. We provide exercise recommendations, nutrition advice, and lifestyle counseling and so on. We combine the manual therapies along with the use of spinal adjustments for the treatments. Such approaches include; relaxation techniques, heat and ice, dietary supplements and electric stimulation. Our goal is to increase movement and motion in the area that the patient is complaining about and restoring optimal health.

Benefits of Chiropractic Care
Other than being a treatment for your mechanical disorders, Chiropractic has various other benefits. A few of these benefits are;

1. Improvement in Posture
Due to our habit of sitting in front of a computer daily, we usually get neck and back issues. Regular Chiropractic sessions can help the alignment of the curves of your spine and help you maintain a straight posture.

2. Improves Immune System
The nervous system and immune system of the body are interrelated. Chiropractic treatments remove subluxations that prevent your nervous systems from working properly. Once the nervous system starts working efficiently, it starts keeping your immune system working better as well.

3. Decreases tension
Chiropractic manipulations help maintain alignment. With proper alignment the muscles are under less tension and can relax. This, in turn, helps decrease your tension and pain in that region.




--------------------------------------
Dr. Stephen Estner is a Chiropractor in Rhode Island with office locations in Pawtucket and Cranston, Rhode Island. His offices offer chiropractic rehabilitation through acupuncture, massage therapy, and manipulation of the spine, joints, and muscles. Dr. Estner treats all spinal injuries, back pain, and symptoms including those due to automobile accidents, workplace and sports injuries, pregnancy, and provides general care and maintenance of the spine.
For more information or to schedule an appointment please visit: http://www.DrEstner.com.

Friday, June 17, 2016

Can a chiropractor help manage spinal problems?

 By: Dr. Frankie RodrĂ­guez
The chiropractic professional has a better approach to both help make the diagnosis and manage a variety of spinal problems. The goal of chiropractic therapy is to remove the mechanical interference and restore the normal status of the joint.

One of the most common organs in the body which chiro-practitioners help regain normal function is the spine. The spine is made of many bones, ligaments, tendons and muscles. Inside the spine run important nerves that carry both motor and sensory information to the body. Anytime the spine position is altered, the nerves can be pinched or compressed. Chiropractors can help remove this mechanical interference and restore normal body health

What are “adjustments?”

An adjustment is manual procedure performed by a chiropractor using precise but robust force in a particular direction. The force is typically applied to a joint that is stuck "locked up", or not moving appropriately in order to bring back joint mobility. The adjustment increases joint mobility, restores nerve function and diminishes pain.

 How are the adjustments performed?

The rationale of adjustments is to permit the spine to mend with secure, safe and moderate joint manipulation. The adjustment may be performed manually or with specially designed instruments. Most adjustment techniques are quick, whereas other procedures demand slow constant pressure. Spine adjustment is an exact process generally done by the hand. When correctly performed, the joint regains its mobility, muscle spasms are relieved and tension disappears.





--------------------------------------
Dr. Stephen Estner is a Chiropractor in Rhode Island with office locations in Pawtucket and Cranston, Rhode Island. His offices offer chiropractic rehabilitation through acupuncture, massage therapy, and manipulation of the spine, joints, and muscles. Dr. Estner treats all spinal injuries, back pain, and symptoms including those due to automobile accidents, workplace and sports injuries, pregnancy, and provides general care and maintenance of the spine.
For more information or to schedule an appointment please visit: http://www.DrEstner.com.