DR. KEITH’S BLOG

The following article is one that seems quite applicable to the Woodinville Pain Relief Clinic’s mission due to the emphasis we put on long term health and quality of life. As a Neuromusculoskeletal specialist, I want to make sure that not only the muscles and bones are doing well, but also the nervous system which controls the function of our bodies. In that vein, I provide counseling on supplements to help our systems function optimally and the B-vitamins are certainly at the top of the list of ones I take as well as recommend for patients. If you have any questions about your health care needs please call my office. (425) 368 2003

B Vitamins Slow Brain Atrophy in People With Memory Problems
ScienceDaily (Sep. 14, 2010) — Daily tablets of certain B vitamins can halve the rate of brain shrinkage in elderly people who suffer from mild memory problems, an Oxford University study has shown.
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The two-year randomised clinical trial is the largest to study the effect of B vitamins on mild cognitive impairment, and one of the first disease-modifying trials in the Alzheimer’s field to show positive results in people.
Around 1 in 6 elderly people over the age of 70 has mild cognitive impairment, experiencing problems with memory, language, or other mental functions, but not to a degree that interferes with daily life. Around half of people with mild cognitive impairment go on to develop dementia — mainly Alzheimer’s disease — within five years of diagnosis.
Certain B vitamins — folic acid, vitamin B6 and vitamin B12 — are known to control levels of the amino acid homocysteine in the blood, and high levels of homocysteine are associated with an increased risk of Alzheimer’s.
So the Oxford team set out to see whether supplements of the B vitamins that lower homocysteine could slow the higher rate of brain shrinkage, or atrophy, observed in mild cognitive impairment or Alzheimer’s.
The study followed 168 volunteers aged 70 or over with mild memory problems, half of whom took high dose B vitamin tablets for two years and the other half a placebo tablet. The researchers assessed disease progression in this group by using MRI scans to measure the brain atrophy rate over a two-year period. The findings are published in the journal PLoS ONE.
The team found that on average the brains of those taking the folic acid, vitamin B6 and B12 treatment shrank at a rate of 0.76% a year, while those in the placebo group had a mean brain shrinkage rate of 1.08%. People with the highest levels of homocysteine benefited most, showing atrophy rates on treatment that were half of those on placebo.
Along with rate of brain shrinkage, the team from the Oxford Project to Investigate Memory and Ageing (OPTIMA) also monitored cognitive test scores, revealing that those with the slowest rate of shrinkage scored more strongly.
The team suggests that, since the rate of brain atrophy is known to be more rapid in those with mild cognitive impairment who go on to develop Alzheimer’s, it is possible that the vitamin treatment could slow down the development of the disease. Clinical trials to test this should now be carried out, they add.
‘It is our hope that this simple and safe treatment will delay the development of Alzheimer’s disease in many people who suffer from mild memory problems,’ said Professor David Smith of the Department of Pharmacology at Oxford University, a co-leader of the trial. ‘Today there are about 1.5 million elderly in UK, 5 million in USA and 14 million in Europe with such memory problems.
‘These are immensely promising results but we do need to do more trials to conclude whether these particular B vitamins can slow or prevent development of Alzheimer’s. So I wouldn’t yet recommend that anyone getting a bit older and beginning to be worried about memory lapses should rush out and buy vitamin B supplements without seeing a doctor,’ he said.
Rebecca Wood, Chief Executive of the Alzheimer’s Research Trust, which co-funded the study, said: ‘These are very important results, with B vitamins now showing a prospect of protecting some people from Alzheimer’s in old age. The strong findings must inspire an expanded trial to follow people expected to develop Alzheimer’s, and we hope for further success.
‘We desperately need to support research into dementia, to help avoid the massive increases of people living with the condition as the population ages. Research is the only answer to what remains the greatest medical challenge of our time.’
Professor Chris Kennard, chair of the Medical Research Council’s Neurosciences and Mental Health Board which co-funded the study, said: ‘This MRC-funded trial brings us a step closer to unravelling the complex neurobiology of ageing and cognitive decline, which holds the key to the development of future treatments for conditions like Alzheimer’s disease. The findings are very encouraging and we look forward to further research that is needed in order to test whether B vitamins can be recommended as a suitable treatment.’

ScienceDaily (July 24, 2010) — Chokeberry bushes have for centuries been residents of eastern deciduous forests where their bright red and dark purple fruits continue to be favorite snacks of local bird species. Native Americans have also traditionally eaten dried chokeberries and prepared teas from parts of the plant, and several domesticated varieties now grace contemporary lawns and gardens from coast to coast. However, the chokeberry (Aronia) is enjoying a new claim-to-fame as a potentially powerful antioxidant, and can now be found for sale in the dietary supplement and “health food” aisles of your local pharmacies and grocery stores.

See Also:
Health & Medicine
•Diet and Weight Loss
•Obesity
•Cholesterol
•Seeds
Reference
•Vegetable
•Cherry
•Polyphenol antioxidant
•Blood sugar
What makes the humble chokeberry so healthful? Scientists think the answer lies in their unusually high levels of substances called anthocyanins (from the Greek anthos + kyanos meaning dark blue). There are many different anthocyanins in these colorful berries, but they all function as antioxidants — originally protecting the chokeberry seed from sunshine-induced oxidative stress. And when we eat them, they also appear to protect our bodies from a variety of damaging situations, including exposure to pollution and metabolically-derived free radicals. Indeed, a growing body of scientific literature has shown promising effects of chokeberry consumption on diseases ranging from cancer to obesity. These health-promoting effects may be due to the potent anti-inflammatory properties of anthocyanins, as uncontrolled inflammation is now universally recognized as a common thread in many of our most prevalent and deadly diseases. In addition, certain anthocyanins — including those found in chokeberry — have also been shown to improve blood sugar and the function of insulin.

To better understand how chokeberries influence health, Drs. Bolin Qin and Richard Anderson from the US Department of Agriculture in Beltsville, MD studied what happens when prediabetic rats are fed chokeberry extracts for an extended period of time. The results of their research were presented on April 25 at the Experimental Biology 2010 meeting in Anaheim, CA. This presentation is part of the scientific program of the American Society for Nutrition, home of the world’s leading nutrition researchers.

The researchers first made 18 male rats “prediabetic” or insulin insensitive by feeding them a fructose-rich diet for 6 weeks. Then they randomized the animals to continue drinking either pure water or water spiked with low or high levels of chokeberry extract (CellBerry®, Integrity Nutraceuticals International). After drinking this water for 6 weeks, the groups were compared in terms of body weight, body fat, blood glucose regulation, and molecular markers for inflammation.

Qin and Anderson found that at the end of the study the rats consuming the chokeberry-spiked water weighed less than the controls; both levels of chokeberry had the same effect in this regard. Similar beneficial effects of chokeberry consumption were found for body fat (specifically, that of the lower abdominal region). They also discovered that animals that had been drinking chokeberry extract had lower blood glucose and reduced levels of plasma triglycerides, cholesterol, and low-density lipoprotein (LDL) cholesterol when compared to the control animals. These alterations would theoretically lead to lower risk for diabetes and cardiovascular disease in humans. And to add even more evidence for a healthful impact of this super-berry, the researchers documented numerous alterations in expression of genes that would likely lead to reduced chronic inflammation and perhaps even lower cancer risk. For instance, drinking chokeberry extract lowered expression of the gene coding for interleukin-6 (IL-6), a protein that normally triggers inflammation following trauma or infection. Chronic overproduction of IL-6 has been documented in many diseases such as diabetes, arthritis, and atherosclerosis and is thought to be a partial cause of these conditions.

Of course, human studies will be needed before scientists can declare whether we derive the same health benefits from the chokeberry, but Qin and Anderson believe that their study “provides evidence that the chokeberry extract inhibits weight gain in insulin-resistant animals and that it modulates multiple genes associated with adipose tissue growth, blood glucose regulation, and inflammatory pathways.” A final word to the wise: raw chokeberries are exceptionally bitter, so don’t be tempted to harvest the shrubs in your backyard. Instead, look for this unassuming berry in fruit juice blends, jellies, and sweetened syrups.

Drs. Qin and Anderson are federal researchers in the Diet, Genomics, and Immunology Laboratory at the Beltsville Human Nutrition Research Center, a component of the US Department of Agriculture. This study was supported, in part, by Integrity Nutraceuticals International (South Spring Hill, TN).

We realize that there are other areas of health to cover, and here at the WPRC, we will begin to post articles on many subjects, as well as plans on treatment of maladies, home remedies and protocols of how to take care of injuries, and home rehabilitative techniques that are utilized by our clinicians and can be useful tools and reminders for everyone.

ScienceDaily (July 19, 2010) — Vitamin D surfaces as a news topic every few months. How much daily vitamin D should a person get? Is it possible to have too much of it? Is exposure to the sun, which is the body’s natural way of producing vitamin D, the best option? Or do supplements suffice?

In the July 2010 issue of Endocrine Today, a monthly newspaper published by SLACK, Inc., to disseminate information about diabetes and endocrine disorders, Anthony Norman, a distinguished professor emeritus of biochemistry and biomedical sciences and an international expert on vitamin D, notes that half the people in North America and Western Europe get insufficient amounts of vitamin D.

“Elsewhere, it is worse,” he says, “given that two-thirds of the people are vitamin D-insufficient or deficient. It is clear that merely eating vitamin D-rich foods is not adequate to solve the problem for most adults.”

Currently, the recommended daily intake of vitamin D is 200 international units (IU) for people up to 50 years old; 400 IU for people 51 to 70 years old; and 600 IU for people over 70 years old.

“There is a wide consensus among scientists that the relative daily intake of vitamin D should be increased to 2,000 to 4,000 IU for most adults,” Norman says. “A 2000 IU daily intake can be achieved by a combination of sunshine, food, supplements, and possibly even limited tanning exposure.”

While there is now abundant data on vitamin D and its benefits, Norman believes there is room for more study.

“The benefits of more research on the topic justifies why this field of research deserves additional governmental funding,” he says. “Already, several studies have reported substantial reductions in incidence of breast cancer, colon cancer and type 1 diabetes in association with adequate intake of vitamin D, the positive effect generally occurring within five years of initiation of adequate vitamin D intake.”

Because vitamin D is found in very few foods naturally (e.g. fish, eggs and cod liver oil) other foods such as milk, orange juice, some yogurts and some breakfast foods are fortified with it. The fortification levels aim at about 400 IU per day.

Norman, who holds the title of Presidential Chair in Biochemistry-Emeritus, has been researching vitamin D for nearly 50 years. In 1967, his laboratory discovered that the vitamin is converted into a steroid hormone by the body. Two years later, his laboratory discovered the vitamin D receptor (or VDR), an essential receptor for the steroid hormone form of vitamin D that is present in more than 37 target organs of the body that respond biologically to the vitamin.

“There is now irrevocable evidence that receptors in the immune, pancreas, heart-cardiovascular, muscle and brain systems in the body generate biological responses to the steroid hormone form of vitamin D,” he says.

The hottest topic in medicine isn’t the newest drug or the latest surgical device: It’s vitamin D.
Now, before we get into the bulk of the article, there are a few disclaimers which affect how vitamin D should be viewed especially here in the Northwest. We do have the ability to activate vitamin D through sulight exposure. But, during the winter months in Seattle the sunlight is not intense enough to cause this activation. So, you either have to supplement with vitamin D, or migrate like a bird for the winter.

What brought the simmering debate to a boil was a 2007 study showing that people taking normal vitamin D supplements were 7% less likely to die than those who didn’t take the daily supplements.
A year later, a major study found that when women with low vitamin D levels get breast cancer, they have a much higher chance of dying from their cancer than women with normal vitamin D levels.

That was surprising news. But just as surprising is the fact that many men, women, and children have insufficient blood levels of this important vitamin. How many? Data suggest many of us don’t get the vitamin D we need. For example, a 2007 study of childbearing women in the Northern U.S. found insufficient vitamin D levels in 54% of black women and in 42% of white women. These findings led the American Academy of Pediatrics to double the recommended amount of vitamin D a child should take — and have led many doctors to advise their adult patients to up their vitamin D intake.

Your health may depend on knowing the answers to these important questions:

Why do I need vitamin D?
How can I get enough vitamin D?
Will a vitamin D test tell me if I need more vitamin D?
Which foods contain vitamin D?
How much vitamin D do my children and I need?
Can I get too much vitamin D?
What kind of vitamin D is best?
Does vitamin D interact with other medications?

Why do I need vitamin D?
Your body must have vitamin D to absorb calcium and promote bone growth. Too little vitamin D results in soft bones in children (rickets) and fragile, misshapen bones in adults (osteomalacia). You also need vitamin D for other important body functions.

Vitamin D deficiency has now been linked to breast cancer, colon cancer, prostate cancer, heart disease, depression, weight gain, and other maladies. These studies show that people with higher levels of vitamin D have a lower risk of disease, although they do not definitively prove that lack of vitamin D causes disease — or that vitamin D supplements would lower risk.

The Vitamin D Council — a scientist-led group promoting vitamin D deficiency awareness — suggests vitamin D treatment might be found helpful in treating or preventing autism, autoimmune disease, cancer, chronic pain, depression, diabetes, heart disease, high bloodpressure, flu, neuromuscular diseases, and osteoporosis. However, there have been no definitive clinical trials.

The best known benefit of vitamin D is its role in helping calcium build strong bones. But that’s far from the whole story. Vitamin D helps regulate the immune system and the neuromuscular system. Vitamin D also plays major roles in the life cycle of human cells.

Vitamin D is so important that your body makes it by itself — but only after skin exposure to sufficient sunlight. This is a problem for people in northern climates. In the U.S., only people who live south of a line drawn from Los Angeles to Columbia, S.C., get enough sunlight for vitamin D production throughout the year.

Dark skin absorbs less sunlight, so people with dark skin do not get as much vitamin D from sun exposure as do light-skinned people. This is a particular problem for African-Americans in the northern U.S.

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How can I get enough vitamin D?
Thirty minutes of sun exposure to the face, legs, or back — without sunscreen — at least twice a week should give you plenty of vitamin D.

But this much direct sun exposure might also expose you to potentially dangerous levels of cancer-causing UV radiation. And unless you live in the South or Southwest, you probably won’t get enough sunlight during the winter months for your body to make enough vitamin D. The American Academy of Dermatology recommends against getting vitamin D from unprotected exposure to sunlight.

It’s probably a better idea to get vitamin D from foods or from supplements.

Will a vitamin D test tell me if I need more vitamin D?
Yes. As part of your regular blood test, your doctor should order a test for 25-hydroxyvitamin D (25-OHD).

Everyone agrees that anyone with a 25-OHD level of less than 15 ng/mL or 37.5 nmol/L (depending on the units reported by a lab) needs more vitamin D. A 2002 study found that 42% of African-American women of childbearing age had vitamin D levels below 15 ng/mL.

The U.S. National Institutes of health notes that 25-OHD levels over 30 ng/mL are optimal, and that there is “insufficient data” to support recommendations for higher levels.

The Vitamin D Council considers the ideal 25-OHD level to be between 40 ng/mL and 70 ng/mL.

Which foods contain vitamin D?
Surprisingly few foods contain vitamin D — unless it’s added to the food. That’s because your body is built to get vitamin D through your skin (from sunlight) rather than through your mouth (by food). But once your body has enough, it doesn’t matter whether you got it through your skin or through your stomach.

There are three vitamin D super foods:

Salmon (especially wild-caught)
Mackerel (especially wild-caught; eat up to 12 ounces a week of a variety of fish and shellfish that are low in mercury)
Mushrooms exposed to ultraviolet light to increase vitamin D
Other food sources of vitamin D include:

Cod liver oil (warning: cod liver oil is rich in vitamin A; too much may be bad for you)
Tuna canned in water
Sardines canned in oil
Milk or yogurt — regardless of whether it’s whole, nonfat, or reduced fat — fortified with vitamin D
Beef or calf liver
Egg yolks
Cheese
Nearly all milk in the U.S. is fortified with vitamin D. So are many brands of orange juice, yogurt, margarine, and ready-to-eat breakfast cereals.

How much vitamin D do I need?
The current recommended daily dose of vitamin D is 200 IU for people up to age 50, 400 IU for people aged 51 to 70, and 600 IU for people over age 70.

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That’s not enough, Boston University vitamin D expert , MD, PhD, tells WebMD. Holick recommends a dose of 1,000 IU a day of vitamin D for both infants and adults — unless they’re getting plenty of safe sun exposure.

In 2008, the American Academy of Pediatrics recommended that breastfed infants receive 400 IU of vitamin D every day until they are weaned. This doubled the AAP’s previous recommendation.

The AAP also recommends 400 IU/day of vitamin D for children and teens who drink less than a quart of vitamin D-fortified milk per day.

The Vitamin D Council recommends that healthy adults take 2,000 IU of vitamin D daily — more if they get little or no sun exposure.

There’s evidence that people with a lot of body fat need more vitamin D than lean people.

The Institute of Medicine’s Food and Nutrition Board is currently updating its 1997 vitamin D recommendations. A report is scheduled for May 2010.

high blood calcium level, which could result in nausea, constipation, confusion, abnormal heart rhythm, and even kidney stones.

It’s nearly impossible to get too much vitamin D from sunlight or from foods (unless you take way too much cod liver oil). Nearly all vitamin D overdoses come from supplements.

The Institute of Medicine’s Food and Nutrition Board’s 1997 recommendations — scheduled for a May 2010 update — suggest that 2,000 IU per day oCan I get too much vitamin D?
Too much of any good thing is a bad thing. Too much vitamin D can cause an abnormally f vitamin D is safe for adults and that 1,000 IU per day is safe for infants up to 12 months of age.

However, the relatively small doses of vitamin D in daily vitamin pills are not enough to correct serious vitamin D deficiency. A 2009 study suggested that the best regimen for treating vitamin D insufficiency is 50,000 IU of vitamin D3 taken three times a week for six weeks. This time-limited regimen did not result in vitamin D toxicity.

How much vitamin D is too much? That’s controversial. According to the National Institutes of Health, the maximum upper limit for vitamin D is 25 micrograms (1,000 IU) for children up to age 12 months and 50 micrograms (2,000 IU) for everyone else.

But some recent studies suggest that healthy adults can tolerate more than 10,000 IU of vitamin D per day. John Jacob Cannell, MD, executive director of The Vitamin D Council, notes that the skin makes 10,000 IU of vitamin D after 30 minutes of full-body sun exposure. He suggests that 10,000 IU of vitamin D is not toxic.

According to the National Institutes of Health, 25-OHD levels that are consistently over 200 ng/mL are “potentially toxic.”

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That’s not enough, Boston University vitamin D expert , MD, PhD, tells WebMD. Holick recommends a dose of 1,000 IU a day of vitamin D for both infants and adults — unless they’re getting plenty of safe sun exposure.

In 2008, the American Academy of Pediatrics recommended that breastfed infants receive 400 IU of vitamin D every day until they are weaned. This doubled the AAP’s previous recommendation.

The AAP also recommends 400 IU/day of vitamin D for children and teens who drink less than a quart of vitamin D-fortified milk per day.

The Vitamin D Council recommends that healthy adults take 2,000 IU of vitamin D daily — more if they get little or no sun exposure.

There’s evidence that people with a lot of body fat need more vitamin D than lean people.

The Institute of Medicine’s Food and Nutrition Board is currently updating its 1997 vitamin D recommendations. A report is scheduled for May 2010.

Can I get too much vitamin D?
Too much of any good thing is a bad thing. Too much vitamin D can cause an abnormally high blood calcium level, which could result in nausea, constipation, confusion, abnormal heart rhythm, and even kidney stones.

It’s nearly impossible to get too much vitamin D from sunlight or from foods (unless you take way too much cod liver oil). Nearly all vitamin D overdoses come from supplements.

The Institute of Medicine’s Food and Nutrition Board’s 1997 recommendations — scheduled for a May 2010 update — suggest that 2,000 IU per day of vitamin D is safe for adults and that 1,000 IU per day is safe for infants up to 12 months of age.

However, the relatively small doses of vitamin D in daily vitamin pills are not enough to correct serious vitamin D deficiency. A 2009 study suggested that the best regimen for treating vitamin D insufficiency is 50,000 IU of vitamin D3 taken three times a week for six weeks. This time-limited regimen did not result in vitamin D toxicity.

How much vitamin D is too much?
That’s controversial. According to the National Institutes of Health, the maximum upper limit for vitamin D is 25 micrograms (1,000 IU) for children up to age 12 months and 50 micrograms (2,000 IU) for everyone else.

But some recent studies suggest that healthy adults can tolerate more than 10,000 IU of vitamin D per day. John Jacob Cannell, MD, executive director of The Vitamin D Council, notes that the skin makes 10,000 IU of vitamin D after 30 minutes of full-body sun exposure. He suggests that 10,000 IU of vitamin D is not toxic.

According to the National Institutes of Health, 25-OHD levels that are consistently over 200 ng/mL are “potentially toxic.”

Top PicksEssential Screening Tests Every Woman Needs Sleep, Sex and Bladder Control Quiz: Are You at Risk for Fracture? Gotta Go? See if You Can Beat the Urge

What kind of vitamin D is best?
The recommended form of vitamin D is vitamin D3 or cholecalciferol. This is the natural form of vitamin D that your body makes from sunlight. Supplements are made from the fat of lambs’ wool.

However, a clinical study reported in 2008 suggested that vitamin D2 works as well as vitamin D3. Many supplements contain vitamin D as vitamin D2 or calciferol. It’s derived from irradiated fungus. Because this is not the form of vitamin D naturally made by your body, WebMD nutritionist Kathleen M. Zelman, MPH, RD, recommends using the D3 form for those taking vitamin D supplements. Because of its potency, different forms of vitamin D are used in prescription medications. If you have a prescription for one of these medications, do not switch to another form of vitamin D without checking with your doctor.

Does vitamin D interact with other medications?
Yes. Steroid medications such as prednisone can interfere with vitamin D metabolism. If you take steroid drugs regularly, discuss vitamin D with your doctor. The weight loss drug orlistat — brand names include Xenical and Alli — may cut absorption of vitamin D. So does the cholesterol-lowering drug cholestyramine (sold as Questran, LoCholest, and Prevalite). People taking these drugs should discuss vitamin intake with their doctors.
The seizure drugs Phenobarbital and Dilantin (phenytoin), affect vitamin D metabolism and affect calcium absorption. So do anti-tuberculosis drugs. On the other hand, cholesterol-lowering statin drugs and thiazide diuretics increase vitamin D levels.

Cannell, J.J. and Hollis, B.W. Alternative Medicine Review, March 2008; vol 13: pp 6-20.

Holick, M.F. Journal of Clinical Endocrinology and Metabolism, March 2008; vol 93: pp 677-681.

Autier, P. and Gandini, S. Archives of Internal Medicine, Sept. 10, 2007; vol 167: pp 1730-1737.

Holick, M.F. and Chen, T.C. American Journal of Clinical Nutrition, 2008; vol 87: pp 1080S-1086S.

Bordelon, P. American Family Physician, Oct. 15, 2009; vol 80: pp 841-846.

Rovner, A.J. and O’Brien, K.O. Archives of Pediatric and Adolescent Medicine, June 2008; vol 162: pp 513-519.

Pepper, K.J. Endocrinology Practice, 2009; vol 15: pp 95-103.

MUSCLE PAIN FOLLOWING WHIPLSH INJURIES
One of the most common symptoms experienced after a motor vehicle accident, is head and neck pain especially when the occupant is struck from behind. Neck injuries associated with auto accidents have been studied for many years, recently a new study published in the prestigious medical journal Spine, was released that helped to explain the cause of this pain.
The impact experienced by an occupant in an auto accident produces a large amount of force over a very short period of time, lasting only milliseconds. A new research study explains that it is may be the short time frame that may play a larger role in neck injuries than once thought. When an occupant is struck from behind, the force travels from the back of the car through the occupant finally exiting through the front. In order to protect the body, the body muscles of the neck contract to prevent injury. The muscles have been shown to fire at 100 milliseconds post impact which is 25 milliseconds after the majority of damage has occurred to the ligaments in the neck. (1)
The conclusion of the study: The muscles of the neck fire too late in a rear end collision to prevent injury to the spine and ligaments.
Ligaments heal very slowly because they lack the blood supply that muscles have. Ligaments in the neck also do not get the rest needed due to the demands on the neck at we go about our daily activities. The muscles of the neck are required to support a greater portion of the weight of the head and therefore become tired and sore while supporting this weight.
When structures of the neck are injured, the once healthy tissue is replaced with scar tissue. This new tissue is not nearly as strong or flexible as its predecessor. Encouraging proper healing of these tissues requires maintaining the mobility through spinal manipulation and stretching. Once the injured areas become less painful, it is imperative to strengthen the supporting muscles that have been injured. These muscles will be responsible for supporting the neck and preventing exacerbations or flare ups.
Injuries in the neck can also produce symptoms of pain in areas other than the location of the injury, this is called referred pain. For example and injury that occurs in the neck from a motor vehicle collision can present at pain in the shoulder blade. Referral pain patterns have been mapped out in the neck by injecting a stimulus to a specific area in the spine with a stimulating agent and the patient is asked to identify any symptoms they are experiencing outside of the location of the injection.
Posted by Dr. Aaron Keith — Research Injuries on May 15, 2009

1. Vasavada AN, Brault JR, Siegmund GP. Musculotendon and fascicle strains in anterior and posterior neck muscles during whiplash injury. Spine 2007;32(7):756-765.