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Low Impact

Through the years, we’ve either been involved in one or seen one occur…the low impact collision, the “fender-bender”.  Injuries from these “minor” impacts have been reported by patients, duly noted by doctors, and advocated by lawyers.  Patients and in some cases even doctors have been suspected of fraud, since the injury can’t simply be due to a bump on the fender…or can it?

When vehicles collide, G forces are created.  One G force (refers to the force of Earth’s Gravity) equals 32 feet per second.  Based on research, an eight mph collision can create forces measured up to 2 G forces.  Car collisions occur in fractions of a second. (1).  The human frame is not designed to withstand these massive forces in such a brief period of time.  The elasticity of muscles, tendons and ligaments are time dependant.

Research has also shown that acceleration of the vehicle and the occupants are significantly affected in vehicles that are equipped with tow-bars (2).  A tow bar can absorb the forces of the collision, not allowing the vehicle to crush.

Croft (3) did a study in 2005 regarding correlation of crash severity and occupant injury.  He stated that predicting injury risk in low impact crashes based on property damage is unreliable.  Minor Impact Soft Tissue (MIST) strategy was created by the auto insurers to minimize loss in collisions producing less than $1000.  Based on his findings, the MIST protocol for prediction of injury does not appear to be valid.

Kaneoka (4) stated that the human threshold for injury in an automobile accident was found to be at 2.5 mph.

If a direct relationship between damage to vehicles and injury existed, wouldn’t a NASCAR race have serious injuries or fatalities at every event?

Factors that should be taken into consideration after an impact are gender, position of the head, direction of impact, previous injury, and degenerated/arthritic spine.  For further information about these factors, please visit our website.

If you have suffered an injury from an auto accident, your best reliable indicator of the extent of your injury is not how your vehicle looks after a collision, but a comprehensive history and physical examination performed by our Doctors at one of our locations.

Yours in Health,

Ashkan Aazami, DC
Total Health Family Clinic, Chiropractic care and physical therapy, offices in Landover Hills, District Heights, Rockville

1.  Dynamic Chiropractic – May 22, 1995, Vol. 13, Issue 11By Jeffrey Tucker, DC, DACRB

2.  Krafft et al (2)  ( M. Krafft, A. Kullgren, C. Tingvall, O. Bostom, R. Fredriksson; Accident Analysis & Prevention, March 2000)

3.  Arthur Croft; Med Sci Monit, 2005

4.  Koji Kaneoka, Koshiro Ono, Satoshi Inami and Koichiro Hayashi (99-04-15). "Motion analysis of cervical vertebrae during whiplash loading." Spine 24(8): 763-770



Concussion has been receiving a lot of overdue media coverage due to recent events in professional sports.  But even with the amount attention, this entity continues to be mis-understood.

WebMD defines Concussion as a type of traumatic brain injury that is caused by a blow to the head or body, a fall, or another injury that jars or shakes the brain inside the skull.  Some symptoms of concussion are headaches, forgetfulness, irritability, sleep disturbances or dysfunction, crying spells, dazed look, inability to focus, confusion, and dizziness.  It can become quite frustrating when the individual is unable in performing their usual daily tasks.  Sometimes, it is family members, friends, and co-workers that alert the individual who is “not behaving as themselves” to seek medical care.  It should be important to note that you don’t need to pass out to have a concussion. 

Auto accidents are the single most important agent in both fatal and mild brain injuries, causing from 60% (1) to 67% (2) of the cases.  Most of these auto accident related cases are as a result of blunt head injury (soft head injury, as when the head strikes an object without penetration of the skull.

Parents of a child who is involved in contact sports should understand that it is extremely crucial to know that signs and symptoms of concussion (some of which are noted above) can last days or weeks after initial injury.  If you ever suspect your child has sustained a head injury and is expressing any of the above symptoms, err on the side of caution.  When in doubt, sit them out, and seek professional help immediately.

Yours in Health,

Ashkan Aazami, DC

Total Health Family Clinic (Chiropractic and Physical Therapy, Offices in Landover Hills, MD, District Heights, MD, and Rockville, MD)


How do I know if I need a Chiropractor

Some people think chiropractors only treat back pain, but actually we are specialists in the entire musculoskeletal system. We do focus primarily on the spine and surrounding tissues, but the spine is intimately related to good functioning of the whole body. Chiropractors may treat back pain and spasms, sports injuries, headaches, and pregnancy pain. We are trained in a variety of non-invasive techniques and believe in the most natural healing possible.

How do you know if a chiropractor is right for you? Here are some conditions for which chiropractic treatment has been shown to be particularly effective.

1.     Joint pain. Pain in the back and other joints is one of the most common health complaints and causes the greatest number of missed work days for health reasons. Chiropractors specialize in treating back pain and have a wide variety of techniques to treat pain anywhere from the feet and ankles up to the neck.

2.     Headaches. In particular, migraine headaches can often be effectively treated by a chiropractor. While the exact origin of migraines remains a mystery, spinal manipulation has been shown to improve symptoms as much as a common prescription drug known as amitriptyline.

3.     Athletic injuries. Injuries can range from common sprains, rotator cuff injuries, shin splints to foot and ankle problems.  Soft tissue techniques such as Graston and Active Release Technique are offered by chiropractors, and can treat long-standing injuries to muscles, ligaments, tendons, nerves and fascia.

4.     Pregnancy. A somewhat sudden addition of around 30 pounds to the average woman adds stress to the body, from the back to the ankles, knees and feet. It also results in greater spinal curvature in the lower back and changes to the pelvis. Spinal adjustments, soft tissue therapy and therapeutic exercises have been shown to be effective in reducing pain during pregnancy, particularly lower back and groin pain.

5.     Whiplash. Whiplash is a common injury sustained after a motor vehicle accident. It results in pain in several areas of the body, as well as headaches and vision problems. Chiropractic treatment has been shown to be effective in treating whiplash through the use of spinal adjustments, soft tissue therapy, and specific exercises for the affected areas.

Other things to consider when choosing the type of care you need for your injury is that chiropractors use drug-free approaches without surgery. They are a good option for many kinds of pain and won’t steer you towards drugs or operations, which should be last-resort treatments because of the risks involved. At the same time, chiropractors are not “anti-traditional medicine” and often collaborate with allopathic doctors as well as other health professionals such as acupuncturists and massage therapists in order to design the most effective treatment plan for their patients.

Our staff at Total Health Family Clinic will strive to provide the most efficient care to help our patients towards a speedy recovery, and as always, provide you with the tools for strengthening and prevention.

Yours in Health,

Ashkan Aazami, DC

Chiropractic Care and Physical Therapy, Offices in Landover Hills, District Heights, and Rockville, MD


Will Chiropractic Adjustments Hurt?

What are Chiropractic adjustments? Adjustments, or spinal manipulations, are specialized procedures used by chiropractors.  An adjustment takes the joint movement beyond its active range (what you can move by yourself), but within its normal range of motion. The purpose of chiropractic adjustment is to improve your body’s function and alleviate pain.

Adjustments can be made to any joint in the body, such as your back, neck, shoulders, knees, etc. A Chiropractor may use their hands or an instrument to “adjust” your joints.  You may be treated by a chiropractor in order to correct such conditions as:

Neck, back, shoulder, arm, hand, chest, leg, or foot pain and stiffness




Trauma, such as whiplash


Sports injuries

Repetitive strain disorders such as carpal tunnel syndrome


If you are new to chiropractic medicine, you may have a harder time relaxing during the procedure than more experienced patients. If you stiffen or resist the adjustment, you may feel some discomfort. However as you get used to the procedures you should find not only that the discomfort decreases, but that you may feel relief and a sense of well-being after the adjustment I completed.

During the procedure, you will be placed in a certain position to treat the affected areas. Usually you will be lying face down on a padded table. There may be popping or cracking noises during the adjustment, as the joint is moved. These noises are the result of the release of tiny pockets of gas during the procedure, which is completely normal. In fact, it’s the same thing that occurs when someone cracks their knuckles.

After the procedure, you may feel some soreness or aching in the muscles or spinal joints. If it occurs, this kind of discomfort usually happens within the first few hours of treatment. It should not last longer than 24 hours (and if it does, be sure to contact your chiropractor for assistance). If you like, you can place an ice pack on the affected area, which should help reduce the symptoms and help you recover more quickly.

After a thorough history and examination, our experienced staff at Total Health Family Clinic, will plan a course of treatment that will best benefit your condition.  The proper mode of adjustment will be discussed with you (manual, instrument, or both).  Our aim is to help you recover from your ailment and provide you with prevention tactics. 

Yours in Health,

Ashkan Aazami, DC

Total Health Family Clinic, Chiropractic care and Physical Therapy, Offices in Landover Hills, District Heights, and Rockville, MD


Chiropractic Adjustment: What you can Expect.

Reactions Following a Chiropractic Adjustment.


You've been in a car accident

You’ve been involved in a car accident.  Insurance company tells you that they are denying your claim because your car has very low damage and they don’t think you could’ve been hurt.  Are they right?

Nothing can be further from the truth.  Research dating as far back as 1955 has failed to prove a correlation between crash severity and occupant injury (1-4).   Further detail on this subject can be found in an earlier blog we had written.

If  the amount of damage to your car is not a predictor of injury, then what is?  Factors that should be taken into consideration instead are:

  • Awareness:  Did you know that the crash was about to happen?
  • Position of the head:  Were you looking straight or was your head turned to either direction?
  • Position of the headrest:  was it below the head’s center of gravity before impact?
  • Out of position occupant:  leaning forward, slumped
  • Position in vehicle:  Driver vs. passenger
  • Age of occupants
  • Stature of occupants

These are just some of the pertinent details that should be considered after a car accident.  At Total Health Family Clinic, we have a combined experience of 30 years in evaluation and management of auto accident injuries.  Our experienced staff will through a detailed history, be able to pinpoint important risk factors that were involved in your injury, and develop a plan of care required to get you to full recovery.

Yours in Health,

Ashkan Aazami, DC

Severy DM, Mathewson JH, Bechtol CO:  Controlled automobile rear-end collisions, an investigation of related engineering and mechanical phenomenon.  Can Services Med J 11:727-758, 1955

Croft AC, Eldridge TR:  Human subject rear passenger symptoms response to frontal car-to car low-speed crash tests.  Journal of Chiropractic Medicine, September 2011
Freeman MD, Centeno C, Croft AC, Nicodemus CN:  Significant spinal injury resulting from low-level accelerations:  a comparison with whiplash.  Proceedings, International Congress on Whiplash-Associated-Disorders, Berne, Switzerland, March 9-10, 2001
Bailey MN, Wong BC, Lawrence JM:  Data and methods for estimating the severity of minor impacts.  SAE Tech Paper Series 950352 1339-174, 1995


Social and psychological aspects of pain affecting patients post-auto accidents/work injuries

After an automobile accident, aside from the patient’s physical complaints of headaches, spinal and/or extremity pain, further questioning from the prudent clinician will reveal exactly how the injury has affected the patient in their daily lives.

Duties under duress, if present, can be manifested by a patient who continues to work despite pain.  Complaints of neck or low back pain with sitting in an office worker or a professional driver, neck or back pain while bending and lifting in a mechanic, back pain while standing in a retail worker, can be documented properly to depict symptoms that were not present prior to their injury.

Loss of enjoyment, if present, can be documented in the records as any social or physical activity that the patient used to do prior to the injury and is precluded from that activity now due to neck, back, or extremity pain.  Examples could be inability of a patient to lift/interact with kids, clean their house, wash dishes, prepare meals, performing yard work, etc.

Recent research (Hinton PM, Journal of Canadian Chiropractic Association 2010) has revealed that proper documentation of the psychosocial aspects of the patient’s post-injury complaints with proof of improvement with care, will provide a quantifiable baseline, influencing treatment decisions, eliminating any uncertainty or dispute about whether care provided was necessary, effective, and reimbursable.

At Total Health Family Clinic, we strive to paint the perfect picture of exactly how the injury at issue has affected our patient in every aspect of their lives.

Yours in Health,

Ashkan Aazami, DC
Total Health Family Clinic, Chiropractic care and physical therapy, offices in Landover Hills, District Heights, Rockville, MD


What is Sciatica?

Many people use the term sciatica incorrectly. Sciatica is pain along the path of the sciatic nerve which extends from the lower back down each leg. Sciatica is a symptom (like itching), it is not a diagnosis (like Parkinson’s disease). Sciatica can range from an occasional nuisance to excruciating pain that makes walking near impossible. There can be multiple underlying reasons for your sciatic nerve pain. Causes can range from trauma (falls, auto accidents), to disc herniations and other pathology.  We can help find the root cause of the problem with an exam and may also order some diagnostic imaging such as an x-ray, MRI or CT scan to examine the underlying structures.

To answer the question, ‘what is sciatica’ it is helpful to explain some of the relevant anatomical structures. The sciatic nerve is both the longest and the widest nerve in your body. It begins in the lower back as five separate nerves that extend from five different vertebrae – L4, L5, S1, S2, and S3. These nerves meet up to form one large bundle, which runs through the buttocks and down the entire length of the leg. The sciatica nerve is responsible (directly or indirectly) for nearly all the sensation in your leg including the skin of the thigh and gluts.

Sciatica occurs when there is compression or irritation of the sciatic nerve. The pain is felt in the low back and leg, but the site of the pain isn’t always the site of the underlying issue. Since the sciatica nerve is so long and travels around or through the large muscles of the buttocks, it takes an expert to determine if the pain is coming from disc compression, from muscle spasms or from something else. Again, sciatica is a symptom, not a diagnosis.

While sciatica is most often associated with pain, other symptoms may be present such as tingling, numbness, or muscle weakness. The pain can be nearly constant or intermittent. If you think you are experiencing sciatic nerve pain, keep a record of the location, duration and intensity of the pain. Your specific history plays an important role in determining the cause of the pain.

Treatment for sciatica depends on the underlying cause, so there is no one recommended course of treatment for all sciatic pain sufferers.  At Total Health Family Clinic, we use a variety of non-invasive approaches that include spinal manipulation, physical therapy, targeted stretching and active muscle release.  We also discuss the role that nutrition and hydration play in reducing tissue inflammation and keeping discs healthy. The spine, discs, muscles and soft tissue all have a role to play in sciatica and should be evaluated and treated as a connected system.

The most important thing to take away from this article is that sciatica (sciatic nerve pain) is a symptom of an underlying condition. You’ll only start to get better once the underlying condition is identified and this is done through a combination of an exam, history and recommended diagnostic imaging.

Yours in Health

Ashkan Aazami, DC

Total Health Family Clinic, Landover Hills, District Heights, Rockville, MD


Faster recovery after an automobile accident with Chiropractic care

Auto accidents can have prolonged devastating effects on the health of the injured occupants.  This holds true even in cases where occupants tend to walk away from the collision, believing that they’ve dodged the bullet.  It is very common for symptoms to take days or weeks to present themselves, which will lead to delayed diagnosis and treatments.  Be sure to even mention complaints that occur occasionally.  The longer you wait to mention a complaint, the harder it will be to associate them with the collision/incident.

Be sure to address any life-threatening injuries first.  If you experience (or have reason to suspect) significant bleeding or bruising, broken bones, internal pain, difficulty breathing, loss of consciousness, or shock, you should seek immediate help from healthcare professionals who specialize in treating trauma injuries.

Following are important facts that should be communicated with your doctor on your initial visit:

  • A prior history of back, neck or shoulder problems (including previous injury).
  • Distinct numbness, tingling or pain immediately following an accident.
  • Increased muscle tension or reduced range of motion after the crash.
  • You were involved in a rear-end collision.
  • Your head was turned at the moment of impact.
  • You have symptoms that don’t resolve or that become generalized.
  • Your glasses or hat/cap was knocked off your head
  • If you were aware of the impending crash

Visit your Chiropractor as Soon as Possible After an Accident.

Do this even if you don't think you've been hurt very badly.  Research has shown that early intervention in the form of chiropractic adjustments and supervised exercise/stretching programs can make a big difference in longer-term function.

Stay Active.

Activity encourages blood flow to the injured area and promotes healing.  It also helps prevent or reduce scar tissue formation and maintain range of motion.

Strengthen the Affected Area(s) as Directed by your Chiropractor.

Exercise and stretching programs are designed to help prevent future injuries and are an important part of a balanced treatment plan.

An auto accident can affect your health (and your lifestyle) for years if you don’t receive the proper treatment.  So if you or someone you care about has been injured in a collision, please call our office and make an appointment today.  Chiropractic care can help put your recovery in the fast lane!

Yours in Health,

Ashkan Aazami, DC

Total Health Family Clinic, Chiropractic and Physical therapy, offices in Landover Hills, MD, District Heights, MD, and Rockville, MD


How To Pick Running Shoes

Running is wonderful cardiovascular exercise and a popular workout choice for men and women. Just as a carpenter requires the right tools for his trade, the right pair of running shoes is essential for both the casual and the serious runner. There are some things to consider when purchasing a running shoe.

How far and often will you be running? If you are a casual runner (less than ten miles per week), then a basic running shoe will be fine. If you are training for a marathon, consider making a true investment in your running shoes for optimal performance.

Consider the arch in your foot. Those with a high arch, need a running shoe with a curved shape. If you have an average arch, a semi-curved shoe might be the best fit. Those with a low arch or flat feet need a straight shape shoe.

Understand pronation, which is the rolling of the foot from heel to toe through the foot strike. A proper or neutral pronation is hitting the outside of the heel and up to ball of your foot evenly across the front. This is how your foot reduces the stress of impact. Underpronation means that the outside of your foot takes most of the shock instead of finishing in the neutral position. Overpronation is too much roll across from the outside to the inside of your foot.

To determine your level of pronation, look at the shoes you walk or run in. Most everyone will begin on the outside of the heel, the real indicator is the wear on the forefoot. If most of the shoe wear is:

  • On the medial (inside) side then you Overpronate
  • On the lateral (outside) side then you Underpronate
  • Uniform across the forefoot then you have a Neutral Stride

Where will you be running? Most people run on pavement or sidewalks, so most running shoes are designed with this in mind. However, if you are going to be running on uneven or softer surfaces (such as mountain trails or grass), look at shoes intended for those kinds of surfaces.

Shop for running shoes late in the afternoon, as feet are at their peak size at this time of day. When trying on the shoe, make sure there is a full thumb width between the end of the longest toe and the end of the shoe. In a properly fit running shoe, the toe box will allow the toes to move freely. The heel should not slip or rub against the shoe and the sole should flex with ease where the foot flexes.

Go to a store that specializes in running shoes or at least to a sporting goods store. The sales associates will be able to help you make a decision on the best shoe for you.

If you run often, consider purchasing more than one pair of running shoes. This way, you can rotate them. If you run often, your shoes should be replaced every six months or so.

Do consider price so your budget isn’t blown, but don’t sacrifice comfort and durability in the process.

Runners have a wide selection of styles, colors and levels of comfort from which to choose when looking at running shoes. Remember, whether you are a casual runner or a serious runner, comfort and excellent support are essential for the best performance!

Yours in Health,

Ashkan Aazami, DC

Total Health Family Clinic, Chiropractic and Physical Therapy, offices in Landover Hills, District Heights, Rockville, MD


Seatbelts or Car Seats replaced after an Auto Accident?

Should Seatbelts or Car Seats be replaced after an automobile accident?

Some people are not aware that their vehicle’s manual either suggests or requires their seatbelts to be checked properly and/or replaced after automobile accidents.  With the advent of new technology, car manufacturers have applied pretensioner seatbelts.  Pretensioners use a mechanism that takes the slack out of the seat belts and locks them instantly upon impact. Pretensioners also lower the risk of “submarining” after an accident, which is when a passenger slides forward under a loosely worn belt.

As in the case of airbags, pretensioner seatbelts can only be used once and should be replaced after an accident.  If seat belts worn during a crash are not replaced, they can be less effective in subsequent collisions and increase the likelihood of whiplash injuries, neck and back pain.  The chances of more serious injuries and death also increase with subsequent crashes.  Please review your car manual for further information and instructions regarding seatbelt safety and/replacement from the manufacturer.  Replacement of the seatbelts that were used during a crash should be covered under your insurance policy.

Be sure to tell the auto body repair shop to check the seat belts for replacement while they make the repairs to your vehicle.

Furthermore, if you were involved in an automobile accident (even a minor fender bender) with a child who was buckled into their car seat or booster, the seat may need to be replaced. The forces involved in these crashes may cause unseen damage to the car seat/booster. This hidden damage may keep the car seat from properly protecting the child in future crashes.  Please check your car seat/booster manufacturers manual for further information regarding replacement following a crash.  This may also serve as your best source of confirmation with the insurance company for the replacement of your car seat/booster.  You may be able to acquire the instructional booklet from the manufacturers website.

Yours in health,

Ashkan Aazami, DC
Total Health Family Clinic, Chiropractic care and physical therapy, offices in Landover Hills, District Heights, Rockville