In many cases, lower back pain caused by a car accident will go away in a couple of days. As a result, many people take a wait and see attitude when it comes to getting medical treatment. However, this is not the best approach, as you should get your injuries checked out right away. If your symptoms are severe, go right to the hospital emergency room. If you don’t experience severe back pain immediately after the accident, you should still get them checked out by your doctor or an urgent care center the same day as the crash. It’s better to be safe than sorry.

In addition, if your injuries are serious and they were caused by someone else’s negligence, you should consult with an auto accident lawyer.

What Is the Lower Back?

Before you can understand the cause of lower back pain, you must first understand what makes up the lower back.  
The lower back is the part of the spine between the rib cage and the pelvis. It includes the lumbar spine, the sacral spine, and the sacrum. Within the lower back, there are five bones in the lumbar spine and five bones in the sacral spine. These bones are called vertebrae. Each vertebra has bones that protrude off of them called facets. The facets hook together to form facet joints.
The spinal cord runs through the center of the vertebra. Nerve roots run off the spinal cord to all parts of the body. There are five nerve pairs that branch off from the lumbar spine and five nerve pairs that branch off from the sacral spine. 

In between each vertebra are soft gel-filled cushions that are called discs. The discs absorb shock from everyday movement and from trauma. The discs are held in place by thick ligaments that are attached to each vertebra. There are also many muscles and tendons in the lower back. The combination of the vertebrae, discs, ligaments, muscles, and tendons allows the lumbar spine to move effortlessly and flex in multiple directions.

Lower back pain after a car accident can be caused by injuries to the vertebra, nerves, facets, discs, ligaments, tendons or muscles of the spine.  

What Causes Low Back Pain from a Car Accident?

When a car is moving, the human body inside is moving at the same speed. A car accident will cause the car to stop very rapidly. However, the human body inside the car continues to move at a high rate of speed until it comes in contact with the seat belt or part of the car. 
The body not only experiences this impact, but it also experiences a sudden deceleration followed by rapid movement in the opposite direction, as it bounces off whatever it hit inside the vehicle. This rapid movement back and forth is called whiplash, which can cause pain in many areas of the lower back.

Lumbar Sprain Strain After a Car Accident

The extreme forces of a car accident can cause ligaments, muscles, and tendons of the low back to overstretch or tear. When this happens to ligaments, it’s called a sprain. When this happens to muscles or tendons,  it’s called a strain.  

How Long Do Lumber Sprain Strain Injuries Last?

The initial pain after a car accident is called acute pain. Ligament strains and muscle sprains can remain acute for up to eight to 12 weeks. Most of them resolve during this period of time. In fact, doctors hired by insurance companies routinely get paid lots of money to testify that sprains and strains always resolve in eight to 12 weeks.  
However, a significant number of people have chronic low back pain after a car accident that never seems to go away. Doctors that treat car accident patients believe ligaments, muscles, and tendons can overstretch so much that they never fully heal.

Diagnosing Lower Back Sprain/Strain

X-rays, MRIs, and CT scans do not show sprains or strains. In fact, there is no reliable imaging study that will show them. Instead, doctors diagnose these injuries using your medical history and a physical exam. If you are complaining of lower back pain and the doctor can’t find another reason for it, then you will usually be diagnosed with a lower back sprain or strain. 

Treatment for Lower Back Sprain/Strain

Treatment for a lower back sprain or strain includes rest and ice for the first couple of days. After that, chiropractic adjustments, physical therapy, and massage may help. In most cases, the best treatment is letting time pass, as the body will usually heal itself.

Degenerative Lumbar Spine Disease and Car Accidents  

As we age, the lumbar spine begins to show signs of wear and tear. The discs lose water content and may begin to bulge or herniate. Bone spurs develop. The space between the facet joints where the nerves run begins to narrow. This is called degenerative spine disease.
Some people experience low back pain from degenerative spine disease without any type of trauma. However, many people have degenerative changes without any pain.  
The trauma from a car accident can cause degenerative spine disease to become painful. Worn ligaments in the lower back can overstretch or tear. Degenerative bulging discs in the lumbar spine can herniate. Herniated discs can progress to begin pressing against nerves. Swelling in the facet joint spaces can cause already narrowed spaces to impinge on nerve roots.

Low Back Discogenic Pain After a Car Accident

Normal healthy lumbar discs are not painful. Degenerative disc disease can cause a disc in the lower back to bulge or herniate without any pain.  This process can cause an increase in nerve fibers within the disc. 
Doctors that treat car accident patients believe trauma from a car accident can cause these nerve fibers within a bulging disc or herniated disc in the lumbar spine to become irritated, inflamed, and painful. This pain is called discogenic pain because it is pain coming from the disc itself.
Doctors that are advocates for their patients will testify that a bulging disc caused by the wear and tear of life over time can be pain-free before a car accident and become painful from discogenic pain as a result of the trauma from a car accident.  
On the other hand, doctors hired by insurance companies routinely testify that trauma from a car accident cannot cause a bulging disc to become painful. In fact, these defense medical doctors are paid lots of money to make this claim. A good car accident lawyer can help overcome the testimony of the defense’s medical doctors and demonstrate how the car accident caused your lower back injury.

Diagnosing and Treating Discogenic Pain

It is very difficult to diagnose and treat discogenic low back pain. While an MRI can show a bulging or herniated disc in the lower back, it cannot tell whether or not the disc is painful. In fact, a significant number of people with bulging or herniated discs do not experience any pain. As a result, doctors usually diagnose lower back discogenic pain by history and physical examination. The key to this diagnosis is that the pain is localized to the back and does not radiate into the butt or legs.
Conservative treatment includes anti-inflammatory medication, chiropractic manipulation, and physical therapy. When conservative treatment does not resolve the lower back pain, the next step is often an epidural steroid injection, which can reduce inflammation and pain. If the epidural resolves the pain, there is a very good chance it was caused by discogenic pain.

Surgery After a Car Accident for Discogenic Pain

If pain returns after an epidural injection, some doctors will consider operating. Common surgeries for lower back disc pain include:

  • Intradiscal Electrothermal Therapy
  • Percutaneous Discectomy

Herniated Disc Impinging on Nerve Roots in the Lower Back

Normal discs are made up of soft jelly-like material surrounded by a tougher outer lining. Over time, the inner material can lose water content and the outer lining begins to wear. This degenerative process can make the disc begin to bulge. A herniated disc occurs when the bulge protrudes outward. If the herniated disc does not push through the outer lining it is called a protrusion. When the outer lining tears and the inner material pushes outside of the disc, the herniation is called an extrusion.
If the herniated disc protrusion or extrusion pushes far enough, it will come in contact with the nerve roots in the low back running through the facet joints. This is called spinal stenosis. The pressure from the herniation touching the nerve root will cause pain and/or numbness to run from the lower back into the buttocks and even into the legs. 

Diagnosing Herniated Discs in the Lower Back

If back pain after a car accident continues for more than a month, a doctor will probably order a magnetic resonance imaging exam. This is commonly called an MRI for short. The MRI is the gold standard for diagnosing a herniated disc because it is the only type of imaging that shows real detail of both the vertebra, discs, and nerves of the lower back. Although the images are not perfect, the radiologist can actually see when the disc is herniated. The radiologist can also see when the disc is pushing so far out that the protrusion or extrusion from the herniation is actually touching or impinging on the nerve root.  
If the MRI shows the disc impinging on the nerve root and your symptoms include radiating pain from the lower back into the buttocks and/or one or both legs, your doctor will most likely conclude the herniated disc is causing your pain by impinging on the nerve root.

Treating Herniated Discs in the Low Back That Impinge on Nerve Roots

The first line of treatment for a herniated disc is giving it time to heal. If the pain continues more than a month, your doctor may suggest an epidural steroid injection. The steroid medication is injected into the spine to reduce swelling and inflammation, which is sometimes enough to stop the disc from touching the nerve root.  
When the treatment is successful, the pain radiating down the buttocks and into the leg goes away. Unfortunately, this treatment does not fully heal the herniated disc. As a result, swelling and inflammation can return over time, along with the radiating pain. Some people get a lifetime of relief, while others get six to eight months of pain relief and then need another injection.  

Surgery for Herniated Discs impinging on Nerve Roots After a Car Accident 

If the epidural is unsuccessful, then lower back surgery could be an option. The type of back surgery offered will depend on the severity of your injury. Typical lower back surgeries performed on patients with herniated discs impinging on nerve roots include:

  • Lumbar Discectomy or Microdiscectomy
  • Anterior Lumbar Interbody Fusion
  • Lumbar Spinal Fusion
  • Decompression
  • Lumbar Laminotomy
  • Lumbar Laminectomy
  • Low Back Disc Replacement

Facet Joint Injuries in the Lumbar Spine After a Car Accident

The facets are the part of the lumbar spine bones that interlock and connect each vertebra. They help hold the spine upright. They also help the spine in combination with the discs to flex front to back and side to side. The facets come together to form a facet joint. The spinal nerves run through the facet joints. In addition, tiny nerves run along the surface of the facet joints. Over time, the facet joints can begin to show signs of wear and tear.
In a car accident, the whiplash movement can cause facet joints to bang violently against each other. This movement can cause already worn facet joints to become inflamed and painful. The movement can also cause damage to the tiny nerve endings on the joints and cause pain. Facet joint pain in the lower back is often referred to as facet joint syndrome.

Diagnosing Lower Back Facet Joint Injuries

It is often difficult for your doctor to tell whether your lower back pain is caused by the facet joints. One way to tell is to see if the facet joints are tender during physical examination. X-rays and MRIs can show wear and tear on the facet joints, but this wear and tear do not mean the facets are the cause of the pain.  
MRI technology cannot see damage to the tiny nerves than run across the facet joints. As a result, the most common way to diagnose a facet joint injury is to perform facet joint blocks. The blocks are performed by injecting local anesthetic and corticosteroid medication into the facet joint. If the facet blocks reduce the pain by 75% or more for at least 30 minutes after the procedure, most physicians will conclude the facet joints are at least part of the reason for your lower back pain.  

Surgical Treatment After a Car Accident for Facet Joint Syndrome

If the facet joint blocks provide temporary relief, surgery is one option for more permanent relief. One surgical treatment option is called Low Back Radiofrequency Ablation.  

During the procedure, the surgeon places an electrode on the nerves running across the facet joints and uses it to burn the nerves. This prevents them from sending pain signals to the brain. Unfortunately, pain relief usually only lasts for six to eight months because the nerve endings eventually grow back.

Spinal Stenosis of the Low Back After a Car Accident

Lumbar spinal stenosis means the space around the spinal cord narrows.  This space narrowing can occur because of bone spurs that develop as we age, thickened spinal ligaments, or herniated discs. In the lower back, this narrowing means there is less space for the nerves. Sometimes the space becomes so narrow that the bone spurs, thickened ligaments, or disc material pushes on the nerves and causes them to become painful.  
In a car accident, the violent movement of the lumbar spine can cause swelling in an already narrowed lamina or facet joints. This swelling can narrow the space further, causing a bone spur or disc that was not touching the nerve before the crash to touch the nerve and cause pain.  

Diagnosing Spinal Stenosis

The classic symptoms of lumbar spinal stenosis pain include back pain with numbness or tingling that extends into the leg or foot. Sometimes symptoms will include bowel or bladder dysfunction.  
Fortunately, spinal stenosis is easily diagnosed with an MRI. The narrowing of the spine can be seen on an MRI and the radiologist can even tell if the spinal stenosis is being caused by bone spurs, thickened ligaments, disc material, or all three.

Surgery for Spinal Stenosis

Lower back surgery after a car accident for spinal stenosis can include:

  • Low Back Laminotomy
  • Low Back Laminectomy
  • Lumbar Spinal Fusion

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