What You Should Do First
Most people take a wait and see approach when they are in a car accident and experience neck pain. This is definitely not the best thing to do. If your pain is severe, go to the emergency room right away. Even if you believe your neck symptoms are minor, you should still have your doctor or a walk-in clinic document your injuries on the same day as the accident.
If your neck pain does not go away in a couple of days, you should also call an auto accident lawyer.
What Is the Neck?
The neck is the part of the body between the head and shoulders. Also called the cervical spine, the neck is made up of bones, muscles, ligaments, tendons, and nerves. The seven bones in the neck are called vertebrae. Each vertebra is stacked on top of the other. They are named C1 starting at the top all the way to C7 at the bottom. They are connected to each other by protruding bones called facets. The facets come together to form the facet joints.
There are soft gel-filled cushions in between each vertebra. These cushions are called discs. The discs act as shock absorbers to help prevent injury to the spinal cord during movement and from trauma. Thick ligaments attached to each vertebra hold the discs in place.
There are also many muscles and tendons in the neck. The combination of the vertebrae, discs, ligaments, muscles, and tendons work together to allow the cervical spine to move and flex in many different directions.
Neck pain after a car accident is a symptom and not an injury. It can be caused by injuries to the vertebra, facets, discs, ligaments, muscles, tendons or the spinal cord.
Whiplash Is the Main Cause of Injury in a Car Accident
A person inside a moving car moves at the same speed as the car itself. When a car accident happens, the car stops very quickly but the person doesn’t stop. Usually, the first thing to stop the person from moving is the seat belt, which doesn’t stop the head and neck from continuing to move forward.
As a result, the body stops suddenly but the head keeps moving forward for a short time until the neck is fully extended. Then the neck whips backward rapidly in the opposite direction. This rapid back and forth movement is called whiplash because of how similar it is to a whip moving through the air. Whiplash in the neck can cause injury and neck pain in many areas of the cervical spine.
Cervical Sprain Strain
The whiplash movement often causes muscles, tendons, and/or ligaments of the cervical spine to stretch or tear. When a muscle or tendon stretches or tears it’s called a strain. When this happens to ligaments, it’s called a sprain.
How Long Do Cervical Sprain and Strain Injuries Last?
When pain first starts, it is called acute pain. Sprains and strains can be acute for up to eight to 12 weeks, as most of these injuries go away in this time period. Cynical defense doctors hired by insurance companies get paid lots of money to testify that sprains and strains always resolve in eight to 12 weeks. This is simply not true.
A large number of people have neck sprain or strain injuries that never seem to get better after a car accident. Doctors that treat car accident patients believe ligaments, muscles, and tendons can overstretch so much that they never fully heal. This type of permanent neck pain is called chronic pain.
Diagnosing Neck Sprain and Strain
Sprains and strains do not show up on CT scans, MRIs or X-rays. There simply isn’t a reliable imaging study that can be used to see them. As a result, they are diagnosed based on a doctor ruling out all other causes.
First, your doctor takes a medical history from you and performs a physical exam. Then your doctor performs tests to figure out why you’re in pain. If none of the tests reveal the problem and you are complaining of neck pain for more than 12 weeks, then you will usually be diagnosed with chronic neck pain.
Neck Sprain/Strain Treatment
Treatment starts with rest and ice for the first couple of days. If the pain does not go away, chiropractic adjustments, massage, and physical therapy are often ordered. Over time, these treatments will help the body heal itself.
Car Accidents and Degenerative Cervical Spine Disease
The cervical spine is not immune to the aging process. As we get older, the cervical spine shows signs of wear and tear. The water content inside the discs dries up. This can cause the disc to bulge or herniate. The vertebrae hit each other during movement and cause bone spurs. A lifetime of movement causes facet joints to show signs of arthritis. The combination of conditions is called degenerative cervical spine disease.
It is possible to experience neck pain from degenerative cervical spine disease even without trauma. Many people have these degenerative changes in their spine and experience absolutely no neck pain. However, the whiplash trauma from a car accident can cause degenerative cervical spine disease to become painful. Aging ligaments in the neck can overstretch or tear during the whiplash movement. Degenerative bulging discs in the cervical spine that are prone to an injury can herniate. The trauma can cause herniated discs to progress and start pressing against the spinal cord. Already worn facet joint spaces can stretch to the point they become painful.
Discogenic Neck Pain After a Car Accident
Cervical discs that are normal and healthy do not cause pain. As a disc degenerates, it may bulge or herniate but still not cause pain. This process can cause an increase in nerve fibers within the disc.
Doctors that treat patients after car accidents think whiplash trauma from a car accident can cause these nerve fibers within a bulging disc or herniated disc to inflame and get irritated. As a result, the neck becomes painful. This pain is called cervical discogenic pain because it comes from the disc itself within the neck.
On the other hand, doctors paid by insurance companies routinely testify in jury trials that trauma from a car accident cannot cause a bulging disc to become painful. These defense medical doctors get paid lots of money to make this claim. Cross-examination from a skilled auto accident lawyer can overcome the opinions of these defense medical doctors.
Diagnosing and Treating Discogenic Pain
Diagnosing and treating discogenic neck pain can be difficult. A cervical MRI can show bulging or herniated discs in the neck. However, no imaging study, including an MRI, can tell if the disc is painful. A large number of people that have a bulging or herniated discs do not experience any pain.
This means that the only way to know if whiplash from a person’s car accident caused discogenic neck pain is to take a history of the patient and then rule out other causes. If the person did not have neck pain before the car accident, the person did have neck pain after the car accident, and there is no other reason for the pain, discogenic neck pain could be the cause.
Initial treatment is very similar to the treatment for sprain strain. Doctors usually proscribe anti-inflammatory medication, physical therapy, and or chiropractic care. If the neck pain does not resolve with this treatment, the next step is possibly an epidural injection. The steroid reduces disc inflammation and irritation. If the neck pain disappears after the epidural, the pain was probably discogenic.
Surgery for Cervical Discogenic Pain After a Car Accident
When the neck pain resolves after an epidural injection but then returns, some doctors will recommend surgical intervention. The doctor will perform a study called a discography. If the study provides temporary relief, these doctors may operate.
Common cervical surgeries for discogenic neck pain include:
- Intradiscal Electrothermal Therapy
- Cervical Fusion
- Disc Replacement
Herniated Disc Touching the Spinal Cord in the Neck
A normal disc has a soft inside surrounded by a thick outer lining. Over time, the fluid content inside the soft inner material can decrease and the thick outer lining can wear down. As the disc degenerates, it can start to bulge or even herniate. When the herniated disc does not push through the outer lining, it is called a protrusion. When the herniated disc does push through a tear in the outer lining, it is called an extrusion.
When a bulge, protrusion, or extrusion pushes far enough, it can narrow the spinal canal or come in contact with the spinal cord running down the cervical spine. This is called spinal stenosis. The pressure from the herniation touching the spinal cord will cause pain and/or numbness to run from the neck into the shoulders and even into the arms.
Diagnosing Cervical Herniated Discs
When neck pain from a car accident continues after a month, a doctor may order an MRI to see real details of both the vertebra, discs, and spinal cord. Although the images are not as clear as looking at the discs during surgery, radiologists can tell when a disc is bulging or herniated. Radiologists can also tell if a disc is touching the spinal cord.
When a patient has pain or numbness radiating down the neck and into the shoulders and/or arms on one or both sides and the MRI shows a disc touching the spinal canal, doctors generally agree the pain and numbness stem from the disc.
Treating Herniated Discs in the Neck That Touch the Spinal Cord
If neck pain continues to radiate into the shoulders or arms, some doctors will prescribe epidural steroid injections. The hope is that the steroid will reduce swelling and inflammation. In fact, sometimes the epidural will reduce so much swelling and inflammation that the herniation stops touching the spinal cord and eliminates the radiating pain or numbness into shoulders and arms.
Unfortunately, this will not completely heal a herniated disc. If swelling and inflammation return, the radiating pain can return as well. These people may need to get epidurals every six to eight months to stay relatively pain-free.
Surgery for Herniated Discs Touching the Cord After a Car Accident
If an epidural only provides temporary relief, then neck surgery could be an option. The type of neck surgery will depend on your surgeon’s preference and the severity of symptoms. Common neck surgeries for herniated discs that touch the spinal cord are:
- Cervical Discectomy or Microdiscectomy
- Cervical Laminotomy
- Cervical Laminectomy
- Anterior Cervical Fusion
- Neck Disc Replacement
Cervical Spine Facet Joint Injuries After a Car Accident
Facets are the part of the vertebrae that connect or interlock each vertebra together. They help keep the neck upright. They also work together with the discs to let the neck move front to back and side to side. The facets from each vertebra touch each other to form a facet joint. Additionally, there are very small nerves that stretch across the surface of the facet joints.
The facets joints can hit together very hard during whiplash in a car accident. Sometimes this movement can make facet joints become swollen and painful. It can also cause damage to the small nerves running across the facet joints. This facet joint pain is often referred to as facet joint syndrome.
Diagnosing Injuries to Neck Facet Joints
It can be hard for your physician to figure out if neck pain is caused by the facet joints. X-rays and MRIs can show wear and tear on the facet joints, but this wear and tear do not necessarily mean the facets are the cause of the pain. Neither an x-ray or MRI can document damage to the facet joint nerves.
As a result, the most common way to determine if facet joints are causing pain is to push on them and see if they are tender. If they are, some physicians will perform facet joint blocks. A facet joint block is a mixture of local anesthetic and corticosteroid medication that is injected right into the joint. Most physicians will conclude the facet joints are causing the pain if the blocks reduce the pain by 75% or more for at least 30 minutes.
Facet Joint Syndrome Surgery
When there is temporary relief after a facet joint block surgery may give longer relief. The procedure is called Cervical Radiofrequency Ablation.
The surgeon touches an electrode to the nerves running across the facet joints. The electrode burns the nerve and prevents it from sending pain signals to the brain. If this procedure works, it will provide pain relief for about six to eight months. After that length of time, the nerves grow back and the pain often returns.
Neck Spinal Stenosis from a Car Accident
Cervical spinal stenosis occurs when the space around the spinal cord narrows. All kinds of things can cause spinal stenosis, including thickened spinal ligaments, bone spurs, herniated discs, or a combination. When the spinal stenosis becomes severe, neck pain can occur.
In a car accident, the whiplash of the neck can cause swelling in an already narrowed lamina or facet joints. This swelling can narrow the space and cause a disc or bone spur to begin touching the spinal cord or a nerve and cause pain.
Diagnosing Cervical Spinal Stenosis
Cervical spinal stenosis causes pain, numbness, or tingling to radiate from the neck into the shoulder, arm, or fingers. Fortunately, the spine narrowing can be seen on MRI.
Surgery for Cervical Spinal Stenosis
Spinal stenosis is a common reason to have neck surgery after a car accident. Common surgeries for spinal stenosis include:
- Neck Laminotomy
- Neck Laminectomy
- Cervical Spinal Fusion
- Cervical Disc Replacement