Croft Guidelines

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Croft Guidelines for Diagnosis and Treatment of Whiplash Injuries in Lakewood

The Croft Guidelines (CG) are specifically for whiplash or better defined as Cervical Acceleration Deceleration (CAD) injuries in Personal Injury (PI) cases. CG are to be used by chiropractors in diagnosing and treating motor vehicle collision occupant injuries (MVCOI) with CAD’s.

The CG grading system is specifically for the diagnosis and Chiropractic treatment of whiplash or CAD injuries. Treatment protocols for cases involving whiplash injuries are included with these guidelines following grading. Dr. Art Croft, an internationally known chiropractic physician, whiplash researcher, lecturer and author, developed this CAD guideline. Croft published his first work in 1993 in American Chiropractic Association Journal and later in 1995 in the text Whiplash Injuries. Foreman & Croft published more current information in Whiplash Injuries 2001 third edition on page 61 Table 1-14.

Utah Chiropractic Physicians Association was the first chiropractic association in the nation to approve the CGs. This move followed the Oklahoma Board of Chiropractic Examiners approval. Now many states and at least one Canadian providence have adopted these CG’s. Currently the CG’s are the most used United States national standards for CAD care by doctors of chiropractic. Since 1993 many Utah chiropractic physicians have used the CGs in CAD cases. Further, since the early 90’s doctors have been submitting these standards with their reports to automobile insurance companies for motor vehicle collision occupant injuries (MVCOI) cases involving whiplash injuries.

The bottom line is with these standards; individuals with CAD injuries due to motor vehicle collisions (MVC) can receive better care attempting to return to pre-crash physical state. Automobile insurance companies (including workers compensation carriers) using unacceptable standards can be challenged since they are not adhering to accepted national researched protocols.

States adopting the Croft standards take a major step forward in diagnostic and care guidelines for CAD victims. These standards and grading systems have been taught across the nation for years. It is the responsibility of every chiropractor caring for individuals with whiplash to intimately know and understand how to properly grade CAD cases in accordance with these treatment standards.

Croft Guidelines

Croft Guidelines (CG) are standards that take a major step forward in diagnostic and care for whiplash or Cervical Acceleration/Deceleration (CAD) victims treated by chiropractors.

CROFT GUIDELINES – Classifications of Cervical Acceleration/Deceleration (CAD) Trauma

Types of Collisions: (Occupant maybe driver or passenger. Criteria does not consider loss of consciousness, the use of seat belts, shoulder harnesses or other factors).

Type I** Primary rear impact (struck car moving or stationary)
Type II** Primary side impact
Type III** Primary frontal impact
Other: Multiple Impacts, Rollover, Spinout etc.

CAD Grades of Severity of Injury**:

Grade I: Minimal; No limitations of motion or ligamenetous injury, No neurological findings
Grade II: Slight; Limitations of motion no ligamenetous injury, no neurological findings
Grade III: Moderate; Limitations of motion; some ligamenetous injury, neurological findings may be present.
Grade IV: Mod/severe; Limitations of motion; ligamenetous instability; neurological findings present. Fracture or disc derangement
Grade V: Severe; requires surgical management/stabilization

Stages of Injury:**

Stage I: acute; inflammatory phase; 0 – 72 hours
Stage II: sub-acute; repair phase; 72 hours – 14 weeks post MVCOI
Stage III: remodeling phase; 14 weeks – 12 months or more post MVCOI
Stage IV: chronic; permanent injury

Protocol Frequency and Duration of Care in CAD Traumatology**

5x/w 3x/w 2x/w 1x/w 1x/mos. TD TN

Grade I 1w 1-2w 2-3w <4w * <11w <21
Grade II 1w <4w <4w <4w <4mo. <29w <33
Grade III 1-2w <10w <10w <10w <6mos. <56w <76
Grade IV 2-3w <16w <12w <20w prn prn prn
Grade V Surgical stabilization necessary–chiropractic care post-surgical

TD = treatment duration * Possible follow-up at one month
TN = treatment total number prn May require permanent monthly or prn (as needed) treatment

Factors potentially complicating CAD trauma management & medical treatment duration:

1. Advanced age**
2. Metabolic disorders**
3. Congenital anomalies of the spine**
4. Developmental anomalies of the spine**
5. Degenerative disc disease**
6. Disc protrusion (HNP)**
7. Spondylosis**
8. Facet arthrosis**
9. Rheumatoid arthritis or other spinal arthritides**
10. Ankylosing spondylitis or other spondylarthropathy**
11. Scoliosis**
12. Prior spinal surgery**
13. Osteoporosis**
14. Prior vertebral fracture**
15. Paget’s disease or other bone disease**
16. Spinal or foraminal stenosis**
17. Prior spinal injury**
18. Paraplegia or quadriplegia**
19. Fibromyalgia
20. MVC known injury risk factors

**SRISD = Spine & Research Institute of San Diego ¤ **Whiplash Injuries Foreman & Croft 1995, 2001 ¤ **Am Chiro Assoc. J © 1999-2011 Personal Injury Training All Rights Reserved Permission is granted to use.

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