Medication Use A common cause to modify treatment, or at the very least monitor it,…
1. ICBC TREATMENT
What does ‘ICBC treatment’ refer to?
When patients require ‘ICBC treatment,’ it means that they were likely very recently involved in a
motor vehicle accident, commonly referred to as simply an MVA. Though MVA’s are not
something that we generally have time to prepare for, they can leave us panicked, confused,
anxious, and very distressed. Regardless of how severe the MVA is, all people involved should
always seek medical attention as soon as possible, as well as ensure that they also adhere to
the post-motor vehicle accident and continued care for the MVA-related trauma which was
What is a motor vehicle accident (MVA)?
While some MVA’s are due to a traffic collision with another vehicle, sometimes it isn’t always
the case and the motor vehicle may also collide with a pedestrian, animal, or stationary object.
The severity of these accidents can range from physical damage to the vehicle and/or bodily
harm and injuries to the individuals involved.
A motor vehicle accident is generally classified into two main categories – human behavior and
external conditions which may be out of our control. External conditions such as poor
road/weather conditions may occur during snowy/rainy days, as well as on a dirt road covered in
debris. MVA’s which are caused by human behavior include making errors that could have
otherwise been prevented with adequate caution, care, and consideration. Some of these
causes include, but are not limited to distracted driving (leading cause), driving under the
influence, driving when fatigued, and speeding.
MVA- Related Injuries
Motor vehicle accidents can produce a wide array of injuries, conditions, and/or symptoms.
Many factors such as speed, vehicle model(s), severity, positioning, rear/end/side end collision,
and many more can affect the overall treatment plan for each patient. The most common
direction of impact in an MVA is a rear-end collision.
First identified in 1928 by H.E. Crowe, the condition he named Whiplash is known as an injury
most commonly acquired after an MVA. A vast majority of patients will experience effects of this
syndrome either directly after, or gradually over time. Whiplash can be defined as a severe
jerk/jolt to the head/neck, most commonly found after a motor vehicle accident. It is classified as
an injury to the head and neck which involves an acceleration-deceleration mechanism of injury.
Whiplash can also be found in high-contact sports and include numerous seemingly unrelated
symptoms which appear after the injury. Some of these symptoms include
headaches/migraines, dizziness, tinnitus, vertigo, and temporomandibular joint (TMJ) disorders.
Since fractures can occur as a result of blunt force trauma or a direct blow to the body, it is not
uncommon to see bone fractures in patients who have been involved in a motor vehicle
accident. They are generally classified into several different categories, including a
closed/simple fracture where the skin is intact, or an open/compound fracture where the bone
breaks through the skin (this type is more infection-prone). They can also be what is referred to
as a complete fracture, where the bone is broken into two or more pieces, or an incomplete
fracture when the periosteum remains intact but there is still a bending/cracking of the bone.
Associated soft tissue injury with an MVA-related fracture can include damage to structures
such as the associated ligaments, tendons, muscles, fascia, nerves, blood vessels, and skin.
Associated conditions to the trauma site – as well as to other affected locations – can include
strains, sprains, and dislocations.
A strain occurs when a muscle has been overstretched resulting in a tear within the muscle,
typically at the musculotendinous unit (where the muscle meets the tendon), however, it can
occur in the middle of the muscle belly as well. This painful injury has three grades of muscle
strain: Grade 1 (mild), Grade 2 (moderate), and Grade 3 (severe).
When a ligament has been overstretched to the point of joint instability and tears within the
ligament, it is called a sprain. The cause of a sprain is when a joint is moved beyond its normal
range of motion through a trauma-related sudden twist/wrench. This is another injury that can
be found in patients who have been involved in a motor vehicle accident. There are also a few
contributing factors that can increase the occurrence of a sprain, including hypermobility,
previously spraining the affected joint, altered biomechanics on the affected joint, and
connective tissue pathologies (such as rheumatoid arthritis). There are three levels of severity:
Grade 1 (Mild/First Degree), Grade 2, (Moderate/Second Degree), and Grade 3 (Severe/Third
Since this is characterized as a crush injury to a muscle from a direct blow, it can be observed
after an MVA – most commonly in the shoulders/abdomen from seatbelt use, or at the knees
from hitting the dashboard. Contusions damage muscle fibers and cause bleeding into the
subcutaneous (deep) tissues and skin, they can cause observable bruising up to the superficial
layers (intact skin), and may potentially also contuse the periosteum. A couple of secondary
complications can coincide with the contusion such as a Hematoma or Myositis Ossificans. A
Hematoma is when a pool of clotted blood following trauma develops and causes swelling/pain
to the local area, while Myositis Ossificans is a complication that follows a hematoma where the
blood within the muscle begins to calcify. Contusions are divided into three categories: Mild,
Moderate, and Severe.
A dislocation is defined as a complete separation of two bones where they articulate at a joint. If
the separation is only partial, then it’s called a subluxation. The cause of dislocation is a sudden
twist/wrench of a joint beyond its normal range of motion that is trauma-related, either directly or
indirectly. Direct trauma includes direct force on the joint itself, while indirect trauma occurs in
joints that have become weakened in certain positions. A few factors which might contribute to
someone being more dislocation-prone include certain pathologies (such as rheumatoid
arthritis, paralysis, and neuromuscular diseases), joint malformation or congenital ligamentous
laxity (usually found in the hip, knee, or patella), and previous dislocation of the affected joint
(instability). A cast, joint reduction, surgery, and other therapies such as Registered Massage
Therapy can help treat compensating structures and the affected joint over time, as well as
implement a gradual home care routine.
Neurological (Central & Peripheral)
Motor-vehicle accidents can produce both central (spinal cord) and peripheral (extremities)
nerve lesions and injuries. Nerve lesions at the spinal cord can vary depending on the level that
is affected and can cause debilitating conditions such as Quadriplegia (paralysis in all four
limbs), Paraplegia (paralysis from the waist down, and sometimes abdomen), Hemiplegia
(paralysis of one side), or Monoplegia (paralysis of one limb). Since the peripheral nervous
system lies outside the brain and spinal cord, damage to this part of the neurological system will
result in injuries specific to the nerve pathway. In motor vehicle accidents neurological
conditions such as Carpal Tunnel Syndrome (median nerve compression at the wrist), Thoracic
Outlet Syndrome (compression of multiple nerves at various sides in the front
neck/collarbone/pectoral region), Piriformis Syndrome (compression of the sciatic nerve by the
Piriformis muscle), or general nerve lesions which cause symptoms in the muscles it supplies
(Radial, Ulnar, Median, and Sciatic nerves).
Other factors that need to be taken into consideration are those that we don’t normally think
about because they are crucial to the safe and proper mechanism of driving. These factors
include things such as whether or not the seat belt was worn during the impact, and did it do
any damage to the waist/groin or shoulder when it was ‘locked up’. Was the patient the driver or
passenger? Did they see the accident coming and brace for it? Was it a rear, front, or side-end
collision? Did they collide with another vehicle, stationary object, or pedestrian? How fast were
the vehicle(s) going, and what was their make/model? Did they go to the hospital immediately,
or seek medical attention soon after? What were the weather conditions on the road? What is
the patient’s normal routine pre and post-MVA, and how has the accident affected them since?
What are the limitations in their everyday activity post-MVA? There are many considerations to
take into place as every scenario will be different, and every patient will need distinctive
RMT Treatment for MVA’s
Although other injuries can arise after a motor vehicle accident, the conditions described above
are common complaints that many patients find they develop after their MVA. In most cases,
many people see a significant improvement with consistent treatment, adhering to the home
care plan, and being very patient with their recovery. As ICBC pre-approves 12 initial Registered
Massage Therapy sessions for ICBC treatment, it is beneficial to book all of the sessions at
least once a week, for the next 12 weeks. Extensions can be made on your behalf on a need-to
basis, and you are welcome to speak to your Registered Massage Therapist about whether or
not you qualify for this.
In rare cases, some of the listed injuries – along with more – may develop into more severe
conditions which can either be fatal/detrimental or require immediate medical observation.
Some of these include:
● Concussions: This must be treated as soon as possible as it is considered a serious
injury. Symptoms include: vision loss, difficulty concentrating/remembering, confusion,
speech difficulties, dilated pupils, headache/migraine, dizziness, and tinnitus. Recovery
● Facial Trauma: Injuries that are more severe than cuts/scrapes on the face, including
eye trauma (results in temporary/permanent vision loss), ear trauma (results in
temporary/permanent hearing loss), jaw fractures, and dental injuries.
● Back & Spine Trauma: Unfortunately, it is common to acquire paralysis in the limbs or
other major parts of the body, especially in severe cases. However, rest and physical
therapy are typically good for back and spine injuries which are less severe.
● Traumatic Brain Injuries (TBI): Concussions are a form of Traumatic Brain Injury and can
go away on their own with minimal to moderate care/doctor supervision. However, some
TBIs can be more difficult to recover from – such as those that alter a person’s
consciousness. In extreme cases, they can lead to serious health complications such as
coma, being in a minimally conscious state, or even brain death. Symptoms of a TBI
include concussion symptoms, loss of consciousness, coma, inability to wake up, feeling
weak/numb in extremities, seizures, persistent vomiting/diarrhea, dilation of one/both
pupils, loss of coordination, and slurred speech.
● Death: In extremely severe cases, death can be either instantaneous or inevitable due to
the very extensive trauma acquired during the motor vehicle accident.
While initial injuries or symptoms may not be instantly identifiable, you should always seek
medical attention and/or go to the hospital as soon as possible for immediate care. Although
motor vehicle accidents are typically avoidable, a few ways in which you can prevent the
occurrence of an MVA-related injury include: keeping your vehicle up to date, always wearing a
seatbelt, adjusting the steering wheel, adjusting all mirrors as needed, correctly positioning your
seat, and pay attention at all times.
Christina Sharma, RMT
(Massage Therapy Vancouver)