Chiropractic Causing Stroke Myth
Dec 2nd
Dr. Ferris’s comments:
There has long been a myth or scare tactic used to deter people from utilizing chiropractic care, which is actually one of the most conservative and least invasive/dangerous options for an individual. I have been to numerous med-legal seminars and not once has there been reported a peer-reviewed study that can scientifically link chiropractic with stroke, yet I still occasionally hear the comment being made. Below is a recent article that puts this debate again into perspective.
In 2008, a peer reviewed study out of Spine journal studied the correlation of stroke and a previous visit with a chiropractor or medical doctor in the province of Ontario over a nine year period with a database representing almost 110 million person-years (12.2 million people, studied over 9 years equals 110 million person-years).
The purpose of this study was to investigate if an association between chiropractic care and vertebral basilar artery stroke exceeded the association between medical primary care providers and vertebral basilar artery stroke.
The premise was that if there was a greater association between chiropractic care and this stroke then one could logically say there was a cause and effect relationship between chiropractic care and this problem.
The results were conclusive that there was substantially less likelihood of a patient experiencing a stroke following a visit to his/her chiropractor than there was after a visit to his/her primary care physician.
The research did conclude that overall, 4% of stroke victims had visited a chiropractor within 30 days of their strokes, while 53% of the stroke cases had visited their medical primary care providers within the same time frame. The authors offer the perspective that because neck pain is associated with some stroke, patients visit their doctors prior to the development of a full-blown stroke scenario.
Cassidy, J. D., Boyle, E., Côté, P., He, Y., Hogg-Johnson, S., Silver, F. L., & Bondy, S. J. (2008). Risk of vertebrobasilar stroke and chiropractic care: Results of a population-based case-control and case-crossover study. Spine, 33(45), S176-S183.
Headaches and Chiropractic Care
Oct 16th
Dr. Ferris comments: There are numerous sutdies that report the effectiveness of chiropractic care in the treatment headaches. Clinically, it is rare for me to treat a patient with headaches and not see some improvement. As in many conditions, there are many different factors that can contribute to imbalance and the subsequent symptoms. In the case of headaches, one can have contributions from sinuses, hormones, chemical imbalances, nutritional (red wine, chocolate), and structural imbalances. I often educate my patients that chiropractic care is uniquely effective in reducing the structural imbalances (misaligned spinal joints that irritate the nerves that go to the head) that lead to headaches and thus decrease the frequency or intensity of the headaches that may still occur if the other factors that I mentioned are present. What many people don’t realize is that there are many different techniques and post graduate education that a chiropractor can study. Some may choose to focus on pediatrics, pre/post pregnancy, sports injury, and in the case of headaches upper neck care. I have found much more success in treating my patients with headaches and neck issues when I utilize the upper cervical (NUCCA) training I have learned. One such recent patient comes to mind… click here to see his story.
It was reported in October of 2010 that 1 in 6 or 16.54% or approximately 45 million Americans get headaches yearly, with many people suffering daily. While the statistical numbers vary based upon your source of information, it can be agreed upon that headaches are very common and shared with Americans at an epidemic rate.
Taking into account that a single pill for many Americans can cost as much as $43, the overall cost to our economy totals billions of dollars and we need to focus on not the treatment of the effects, but the root of the cause.
While there are many types of headaches ranging from common headaches, migraine headaches, cluster headaches, tension headaches and many more, the one thing to keep in mind that there is no such thing as a “Normal Headache.” You are not supposed to get headaches as pain is an indicator of a problem and you body’s mechanism of letting you know something is wrong, go fix it.
One of the most common and less understood headaches is the “cervicogenic headache.” This is a syndrome characterized by chronic pain around the head that is associated with either the bony structures of the head or the muscles of the neck. This has also been associated with migraine headaches as 64% of migraine sufferers have reported associated neck pain/stiffness with their migraine attack; 31% experienced neck symptoms before and 93% during the headache phase and 31% during the recovery phase.
Therefore cervicogenic headaches are also a component of the migraine headaches and can be treated.
One of the hallmarks of determining if there is a cervicogenic component of any headache is to change the position of your head and if you increase, activate or alter the pain pattern, there is a component.
According to M. Haas, ET. Al. in 2010, spinal manipulative care (chiropractic adjustments) showed significant reduction in cervicogenic headaches of over 50% of the research group that lasted for 24 weeks, or the length of the study. The researchers used the 50% mark to determine validity and they reached their milestone and it lasted for 24 weeks, the length of the study. They also noted a decrease in over the counter medication during the 24 weeks of the study.
Haas also reported in 2010 that at 12 weeks 85% showed improvement with varying degrees of improvement ranging from 25% to 100% with similar findings at 24 weeks.
Chiropractic has been proven to reduce and in many instances totally eradicate headaches. The financial cost to headache sufferers for drugs is staggering along with loss of paychecks when unable to work, the disability costs to insurers and loss of production of workers to industry when their employees cannot perform their jobs on a daily, weekly or monthly basis.
“Reprinted with permission from the US Chiropractic Directory (www.USChiroDirectory.com.)
Simple action steps to prevent auto accident injury
Oct 6th
Many factors are beyond our control, but I like to educate my patients on the ones that they can control, which include:
- Head Restraint Position- the top of the restraint should be level with the top of the head and within 3 inches of the back of the head. Many physicians, including myself, would agree that this is one of the most important and most neglected preventative thing one can control.
- Seat belt- Using the lap and shoulder belt is still the most effective means of reducing serious injury
- If you notice you are about to have a collision…
- Sit fully back against seat and head restraint
- Shrug shoulders and contract neck muscles firmly to limit neck motion
- Look straight ahead with head back slightly
- Apply brake firmly (if already stopped)
- Place hands flat on steering wheel
If you have any questions, visit our website and send us email or give us a call at 317-585-9111. We would be happy to answer your questions or setup a complimentary consultation with one of our doctors to assess your conditions.
How whiplash injures the neck
Oct 6th
Dr. Ferris comments:
The information below is very analytical in nature. I have bolded and underlined the key highlights of the below literature. The studies sited below confirm what I continually discuss with my patient’s and what I see clinically…that there is little to no correlation of car damage and actual patient injury. As discussed below, there are so many different factors that can affect the amount of potential injury, such as position of head at impact, head restraint position, car impact point (rear-end, front-end, corner, etc.), gender, pre-existing joint degeneration, and many others. Many factors are beyond our control, but I like to educate my patients on the ones that they can control, which include:
- Head Restraint Position- the top of the restraint should be level with the top of the head and within 3 inches of the back of the head
- Seat belt- Using the lap and shoulder belt is still the most effective means of reducing serious injury
- If you notice you are about to have a collision…
- Sit fully back against seat and head restraint
- Shrug shoulders and contract neck muscles firmly to limit neck motion
- Look straight ahead with head back slightly
- Apply brake firmly (if already stopped)
- Place hands flat on steering wheel
If you have any questions, visit our website and send us email or give us a call at 317-585-9111. We would be happy to answer your questions or setup a complimentary consultation with one of our doctors to assess your conditions.
Cervical Spine Injury Mechanism of Whiplash
A great deal of information has been published about low speed rear-end collisions and potential mechanisms of injury. Lord et al1 have shown that the neck/facet joints are at particular risk of injury during whiplash-type accidents, and that treatment of these lesions has a positive effect on pain and psychological symptoms.
Yang et al2reported that compression of the cervical spine temporarily weakens the cervical ligaments, making them susceptible to injury from extension during whiplash.
And Grauer et al3 recently published a study that showed that the cervical spine undergoes a “S-shaped curve” during whiplash motion that results in excessive hyperextension of the lower cervical spine.
Now a new study has just been published that supports these studies and provides additional insights into the complexity of whiplash kinematics. In this study, researchers examined the mechanics of simulated rear-end collisions with high-speed video and cineradiography—a technique that permits analysis of the motion of each vertebral segment. The test collisions were at very low speeds—4 to 8 km/hr (2.5 to 5 mph). The researchers compared the test collision movements with the normal extension motion of the subjects.
Cervical Spine Compression
This study confirmed what other studies have shown about compression—that during the early phases of the collision, the axial forces on the cervical spine are in the range of 33 pounds. According to Yang et al, a compressive force of 40 pounds results in a 73% reduction in ligament stiffness at C5-6. This loss of strength increases the potential for injury.
S-Shaped Curve
The latest literature, however, has been able to look at each individual segment of the spine, and has found that the spine does not undergo smooth, even extension during whiplash but that the spine is subjected to an S-shaped curve during the early phase of the collision.4
This is a relatively new finding in the literature, and one that was independently documented by Grauer et al.3 Grauer reported that the whiplash motion was not simply extension, but a complex combination of compression, flexion of the upper cervical spine, and excessive extension of the lower cervical spine. Their study, however, was conducted on cadaver spines, and so there were some questions of whether these findings would also apply to living occupants.
Apparently they do, as this current study by Ono et al4 reports the same phenomena:
“A subject’s torso shows the ramping-up motion by the inclined seatback during rear-end impact. As the head remains in its original position due to inertia in the initial phase of impact, an axial compression force is apt to be applied to the cervical spine, which in turn moves upward and the flexion occurs at about the same time. The lower vertebral segments (C6, C5 and C4) are extended and rotated earlier than the upper vertebral segments. Those motions are beyond the normal physiological range of motion. It is found that by comparing the motions during crash with the normal extension motions of the same subject that the rotational angle pattern is reversed by the pattern of the normal state around 100 ms. The lower the vertebral segment, the larger the rotational angle becomes. That is, the rotational angle between the fifth and sixth vertebral segments is the largest of all. This is a non-physiological motion of the vertebral segments.”
Normally, the facets slide over each other, allowing smooth, equal movement of the motion segments. When the spine is compressed, however, the mechanics of facet movement changes dramatically. Researchers have found that the Instantaneous Axis of Rotation (IAR)—or the point that the vertebrae rotate around—actually moves.
The result of this abnormal motion? The facets of the vertebrae, rather than sliding over each other smoothly, are jammed into each other. Such abnormal motions are believed to result in joint injury—a lesion that would not be detectable with modern imaging techniques, but one that could cause chronic pain.
Effect of Muscular Tension
This current study confirms that when an occupant has advanced awareness of an impending collision, the resultant tensing of the muscles resulted in a 30-40% reduction in total head extension. The researchers, however, did not study individual motion segment movement during the tense muscle collisions.
This study also determined that involuntary muscle reflex that occurs even without advanced awareness of a collision was not significant enough to reduce neck ligament damage. “The average start time of the neck flexors discharge was measured here to be 79 ms. Since there is about 70-100 ms delay between the EMG onset and the time when muscle force can reach maximum, and the head angle reached its maximum at 200-250 ms after the start of an impact,5 we conclude that muscle effect on kinematics of the head-neck complex was insignificant when the neck muscles were relaxed before impact.”
Effect of Seat Stiffness
Which is worse: a rigid seat back or an elastic seat back?
1. Rigid seats create a sharp ramping effect on the body. In a rigid seat, the occupant’s body cannot move straight backwards, and so it must move up the seat. Every study published on low speed impacts has found that some degree of ramping occurs. The more rigid the seat, the sharper the ramping. As the authors state:
- “The interpretation of these variations in terms of neck moment, shear and axial compression forces reveal that the axial compression force applied to the cervical spine is approximately 150 N [33.8 pounds of force] with the rigid seat around 100 ms in the early phase of impact, which is about twice greater than the standard seat.”
As we saw earlier, compression can have a dramatic effect on ligament strength. In the above quote, the researchers found the compression with a stiff seat could amount to about 34 pounds of force, in a collision of just 5 mph.
2. Elastic seats allow too much bounce, causing rapid rebound of the occupant’s torso. At approximately 100 ms, the torso has compressed the elastic seat to its greatest amount, and the seat then springs forward, accelerating the torso with it. The head is moving backwards at the same instant, creating a large difference in speed between the torso and the head. This can result in very large shear forces on the spine, as the authors state:
- “The sheer force…is 241 N [54 pounds] with the standard seat around 110 ms when the rebound of the torso has occurred, which is roughly 1.6 times greater than the value of 152 N [34.2 pounds] with the rigid seat.”
In summary, then, both types of seats put occupants at risk of injury, but in different ways. If the vehicle is equipped with good head restraints that are properly positioned (i.e., top of head rest even with top of head and within 3 inches of the back of the head), the chance of injury will be dramatically reduced from such motions. Unfortunately, other studies have found that only 10% of head restraints are properly adjusted.
Effect of Posture and Head Position
Researchers have identified out of body position and posture as a potential risk factor for injuries from low speed collisions, and this study has provided some new information on this topic.
The authors studied the effects of flexion, neutral, and extension head position before impact on the outcome of the collision. Not surprisingly, they report that neutral or extension pre-collision head position is safer than a flexion (kyphotic) position, for two reasons:
- The S-shaped curve phenomena becomes more pronounced in the flexion position, putting more stress on the lower segments of the cervical spine.
- The axial compression that occurs at 100 ms is worse in the flexion position.
The position of the head is so important, the authors write, “In this regard, more attention should be paid to the cervical spine alignment than any other parameter affecting the occupant’s seating position such as seat stiffness and seatback inclination angle, when considering parameters for the evaluation of neck injuries.”
Women and Whiplash
“Matsumoto et al6 in a recent study conducted on the relationship between cervical curvature and disc degeneration using 495 subjects reported that the lordosis position accounts for 35% or so of the cause of such injuries among female occupants younger than 40, while kyphosis…accounts for 65% or so…Based on our experimental study, it can be pointed out that the rotational angle of the cervical vertebrae becomes obviously larger at the kyphosis position. This may explain the higher minor impact neck injury incidence for occupants with the kyphosis position.” 4
In other words, pre-existing disc degeneration and/or kyphosis may put women at a higher risk of injury in low speed impacts.
- Lord SM, Barnsley L, Wallis BJ, et al. Percutaneous radio-frequency neurotomy for chronic cervical zygapophysial joint pain. New England Journal of Medicine 1996;335(23):1721-1726.
- Yang KH, Begeman PC, Muser M, et al. On the role of cervical facet joints in rear end impact neck injury mechanisms. Society of Automotive Engineers 1997;SAE 970497.
- Grauer JN, Panjabi MM, Cholewicki J, Nibu K, Dvorak J. Whiplash produces an s-shaped curvature of the neck with hyperextension at lower levels. Spine 1997;22:2489-2494.
- Ono K, Kaneoka K, Wittek A, Kajzer J. Cervical injury mechanism based on the analysis of human cervical vertebral motion and head-neck-torso kinematics during low speed rear impacts. Society of Automotive Engineers, 41st STAPP Car Crash Conference Proceedings 1997; SAE 973340.
- Tennyson SA, King AI. A biodynamic model of the human spinal column. Proceedings of the SAE Mathematical Modeling Biodynamic Response to Impact. Society of Automotive Engineers, 31-44, 1976.
- Matsumoto M, Fujimara Y, Suzuki N, Ono T, et al. Relationship between cervical curvature and disc degeneration in asymptomatic subjects. Journal of Eastern Japan Association of Orthopaedics and Traumatology 1977;9:1-4.
All papers from the Society of Automotive Engineers (SAE) are available directly from that organization. Visit their web site at www.sae.org.
Pain Goes Away On Its Own Myth
Jun 28th
Recent studies show that just waiting for the pain to go away is usually not the best solution. As the article and studies note (click here for full article), chiropractic care is one of the best conservative approaches to improving spinal joint dysfunction, which is the root cause of the majority of headache, neck and back pain.
If you have any complaints that have been going on for more then four weeks or consistently pop up every few months then it would be wise to have a spinal examination by a chiropractor trained to identify and correct spinal joint problems.
If you have any questions, visit our website and send us email or give us a call at 317-585-9111. We would be happy to answer your questions or setup a complimentary consultation with one of our doctors to assess your conditions.
Article: Reprinted from the US Chiropractic Directory (www.USChiroDirectory.com)
Exercise “Talk Test”
Mar 20th
Can’t Talk?… Slow Down
How do you know when you’re overdoing it while exercising? Use this simple “Talk Test”: Say the Pledge of Allegiance out loud. If it’s difficult to voice those familiar words, you’re probably pushing yourself too hard.
In a study, researchers tested this technique on 16 healthy participants using two types of exercise equipment — a treadmill and a cycle ergometer. The subjects, who were moderately active, recited the Pledge of Allegiance during progressively more difficult stages of exercise. Following the speech, researchers asked participants if they could speak comfortably and recorded their answers.
Participants’ exercise intensity levels were also measured by established markers — heart rate, perceived exertion and ventilatory threshold. This threshold is the point where breathing increases disproportionate to the increase of workload. In other words, it indicates when an exerciser is approaching his intensity limit.
When results from specialized and accepted tests were compared with the “Talk Test,” researchers found that they were comparable. They concluded that the “Talk Test” is an acceptable form of monitoring exertion. In fact, they recommend it as a practical and easy tool to keep intensity levels in check.
Dr. Ferris’s comments:
This test can be used for any age or fitness level. The goal is to push your intensity level up to where it is difficult to carry on a conversation with someone. Once you reach this level, you should back off slightly. This is your optimum training level. With this test you do not need an expensive heart rate monitor. Don’t forget that after exercising, it is best to cool down with some general back and leg stretches. Happy exercising!
Chiropractic used by all 32 NFL teams
Mar 12th
Dr. Ferris’ comments:
I like this article because it is a good reminder that chiropractic is not just for those in pain. Most professional sports’ have a team chiropractor to keep their athletes performing at their peak. Also, many people who do see a chiropractor initially for a particular symptom often choose to return periodically to maintain spinal alignment and proper joint function even when they have little to no symptoms.
Chiropractic used by all 32 NFL teams
The Professional Football Chiropractic Society (PFCS) takes pride in announcing that all 32 teams in the National Football League offer their players and personnel chiropractic physician services as part of the triage in managing and preventing injuries. According to the Foundation for Chiropractic Progress, this distinction is a benchmark for the profession and documents the important role that chiropractic care plays in optimizing athletic performance.
“The robust need for chiropractic care in the NFL has been deeply driven by the players’ desire for peak physical conditioning and not simply for injuries,” states Spencer H. Baron, D.C., DACBSP, immediate past President of the PFCS and Miami Dolphins team chiropractor for the past 14 years. “From the earliest years of full contact football, their bodies are subject to structural stress that doctors of chiropractic (DCs) are specially trained to care for. ”
Saints 2006 first round pick, Reggie Bush, has been receiving regular chiropractic care since playing football in high school and during his collegiate years. “I look at chiropractic care as important to keeping me healthy and at the top of my game.”
In fact, many professional athletes are outspoken about their experiences with chiropractic care. Most notably, 2010 NFL Hall Of Fame inductee Jerry Rice, who is a spokesperson for the Foundation for Chiropractic Progress, a not-for-profit organization dedicated to educating the public of the many benefits associated with chiropractic care.
“I did a lot of things to stay in the game, but regular visits to my chiropractor made all the difference,” Rice asserts.
To see the full article click here… http://newsblaze.com/story/2010021607372200001.bw/topstory.html
Neck and back pain related to duration and posture when sitting
Mar 11th
The two key issues to consider in relation to sitting are duration and posture. The goal of this post would be to determine a few practical steps that can eliminate or reduce the amount of strain on one’s neck and back when sitting.
Seated Posture tips:
- Proper chair height should allow for both feet to be flat on the ground with a 90 degree angle formed between the lower legs and the thigh/pelvis. If you have to have your chair up higher to accommodate desk height then you may want to use one or more old phone books under your feet to maintain the angle described.
- If working at a computer, the middle of the monitor should be at eye-level height when one is sitting with their back straight up from pelvis.
- To reduce neck pain/strain, periodically make sure you are not leaning forward or bending your neck down toward the keyboard/mouse or forward towards the screen. Hint…if you were to look at yourself from the side, your ear should be directly over your shoulder.
- To reduce low back pain/strain, make sure you are not in a slouched position for long periods. To help out with this, make sure that you have adequate lumbar support on your chair. This means that back of the chair should have a hump just above the seat that will support the normal lumbar curve of one’s spine.
Duration of Sitting:
- Take short and frequent breaks to walk around and get some movement into joints of the hips and spine to help reduce low back pain/strain.
- To reduce neck pain/strain, periodically get some movement to the joints of the neck by slowly moving the head into full flexion (towards chest), extension (up and back), right ear to right shoulder, left ear to left shoulder, rotate/turn head all the way to right, then left. Try and hold each position at the full stretch position for at least 5 to 10 seconds.
How Chiropractic helped my child’s colic
Mar 10th
I saw the article highlighted at the bottom of this post and immediately thought of how chiropractic has benefited my own children when they were infants and thought more people might be interested in this option.
When my son was only a few weeks old, he had a real difficult night…and so did his parents. He was having trouble getting to sleep and then staying asleep. By 2am, my wife was completely exhausted and sleep deprived…so she tagged me and said it’s your turn. After a few hours of doing all the things that normally put him asleep, I thought to myself, “something just doesn’t seem right.” I remembered back to my grad school classes of pediatric chiropractic and the topic of colic. The instructors related their clinical experience with babies with colic to small kinks or misalignments in the baby’s neck that was causing neck discomfort and the resulting baby’s only line of defense…uneasiness and crying.
With that thought in mind…and my own sense of fatigue and passionate desire for sleep, I decided to check the joints of my son’s neck. Sure enough, one side was more restricted and seemed to be irritated when turning that direction. With an extremely gentle adjustment, the joint restriction was relieved and my son was asleep in less then five minutes…and he slept the rest of the night without waking. Needless to say, that was one instance where I was extremely thankful to be a chiropractor. As I joke with my wife, sleep is one of my favorite things to do.
Many people think that back and neck problems are only for adults, but children and even babies can have joints that get irritated and jammed up. For infants, one common cause of this joint misalignment is sustained periods of poor neck posture that commonly occurs when they sleep in their car seat with their neck twisted to one side.
With two children now, I have found out first hand that one of the most common reasons for colic is literally a “kink” in the neck.
Article Highlights:
“Research is revealing that minor disturbances to spinal alignment and function may be a factor in a number of disorders. These disturbances lead to nerve interference and can result in a host of disorders such as colic, constipation and sleep disorders” stated Dr. Sean Batte the author of the study. Other chiropractic researchers have reported on similar results and reviews of the scientific research reveal numerous other studies that have shown a similar connection.
“It makes a lot of sense when you think about it” stated Dr. Matthew McCoy a chiropractor, public health researcher and editor of the journal that published the study, “If you damage or compress the neurological structures in the spine this can have far reaching implications on the functioning of the body… correcting the misalignments or abnormal motion associated with these spinal problems reduces the nerve compression and people improve. In this study it was an infant suffering from colic, constipation, sleep disturbance and excessive crying.”
History and examination of the child revealed that he had a difficult birth, cried regularly, was not sleeping during the day, and if he wasn’t eating or sleeping, he was crying. At night, his sleep was sporadic and irregular and his parents were not able to sleep or catch up on sleep during the day as he wasn’t napping at all. The mother’s general practitioner recommended anti-depressants and tranquilizers for the child. The infant was evaluated and cared for using chiropractic protocols to reduce vertebral subluxations in the child’s spine. Within five visits his mother reported his bowel movements had started to become more regular, he was belching normally after meals, started to sleep better and the crying abated.
To read the full article, click here…
Child Car Accident Case Study
Mar 9th
A lady came to my office with many symptoms following an auto accident. During the consultation I discovered that her son was also in the vehicle with her during the collision. After her exam and x-rays I recommended that her son be examined as well. She was hesitant at first mainly because he did not have any pain. However, after explaining what I found on her x-rays, she agreed that it would be a good idea to make sure that he was not injured.
Diagnostic Results: The following link is a copy of the stress x-ray digital analysis produced by a 3rd party independent evaluation according to AMA guidelines.
MVA- 7yr old 1st page of ligament injury diagnosis report
Upon finding that the boy in fact did have ligamentous injury and spinal joint dysfunction, I began treating him with conservative chiropractic care for the subluxations or spinal misalignments that were causing the spinal joint dysfunction. Within a few treatments the mother noticed positive behavioral changes. Specifically, he was less irritable and moody and he was able to concentrate and focus more at home and with school work. As she thought back, she reported that his irritability and difficulties were not present before the accident, but that she never thought that those symptoms were the result of spinal joint injury from the accident. The mother fought back tears as she thanked me and thought of those injuries becoming permanent damages for her son.
This specific case illustrates that the nervous system is very complex and can manifest symptoms in many different ways and in differing levels of intensity for different individuals. As I tell my patients, pain is not the only indicator of injury or dysfunction. For this reason, I believe that it is so important to correct spinal subluxations or misalignments to allow for proper joint function and the least amount of nerve system interference. Not only is this one of the most conservative treatment options, but it routinely gets to the root cause of the problem so that other more invasive and costly treatments can be avoided.
– Matthew C. Ferris is a chiropractic physician and clinical accident director at Health Connections in Fishers, Indiana. Dr. Ferris has a Diplomat with the American Academy of Medical Legal Professionals and has also completed certification in Whiplash and Brain Traumatology from the Spine Research Institute of San Diego.