As with the mild traumatic brain injuries that we discussed last month, another issue that is often difficult to substantiate is soft tissue injuries, particularly of the spine. These injuries are often referred to as myofascial sprain and strain injuries or as whiplash injuries. Regardless, they are usually characterized by lingering pain localized to the specific region of injury without evidence of an underlying orthopedic injury such as disc disruption, fractures or arthritic changes. Although these injuries may be difficult to diagnose or prove, they can be very debilitating and can result in life-long pain and discomfort for the patient.
Although soft tissue injuries cannot be directly proved with radiological evidence (MRI, CT or X-rays) like disc herniations or fractures can be, there is often indirect evidence in the films. This is usually seen as a “straightening of the lordosis” of the spine. This means that the natural curvature of the spine has been either straightened or reversed. This straightening of the spine is often very evident in the radiological films of a patient experiencing post-traumatic pain. The straightening of the spine is an unconscious effort by the body to protect the area of injury and to alleviate pain.
The actual injury, which occurs to the muscles, ligaments, tendons and other soft tissues around the spine, can be easily explained with just a few simple soft tissue illustrations. First it is important to explain that soft tissues all have microscopic sensory nerves that run through them. Next, it can be understood that the swelling and disruption of the soft tissues immediately following an injury put pressure on these nerves resulting in the pain that we all feel for a few days after an injury. Finally, it should be shown that in these more severe cases, microscopic scar tissue can build up within the soft tissues continuing to distort the nerves, causing pain, even after the swelling of the initial injury has subsided. This scar tissue and the resulting sensory nerve disruption is the physical source of the permanent pain in most of these soft tissue cases.
Be careful with straightening of lordosis. It all depends upon how the patient is positioned when the radiological study is performed. A chiropractor making money through a personal injury claim will position the patient to show a straightening of lordosis, while the insurance company's doctor will position the patient with lordosis preserved. It's very easy for both sides to achieve precisely the result that supports their perspective. Because it's 100% adjustable, spinal curvature is a pretty useless metric of injury.
ReplyDeleteThanks for the comment. I appreciate your insight. I'd like to hear what others have to say on this topic.
ReplyDeleteNormally, Er docs, Orthos, neuros and chiros have all deposed that the loss of lordosis was due to muscle spasms (especially if patient said that their neck hurt), which finding is therefore objective evidence of injury. Some people, like me, just have straight necks though.
ReplyDeleteThanks for the info Benjamin,
ReplyDeleteI'll think it will help many people identify the reason for lingering neck and back pain after a car collision.
www.jonpgroth.com
Most of the doctors I have dealt with find that this is evidence of muscle spasm as the neck stiffens and straightens
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That's exactly right. Evidence of soft tissue (muscle) injury.
ReplyDeletehmmm... nice article and i must say an informative article with nice comments.
ReplyDeleteVery nice and informative post.. thanks for this article.. Brilliant.
ReplyDeletenurse line
Anonymous is an idiot. I guess that's why this person did not want to be identified. When I take cervical x-rays of a trauma patient, I take the x-ray with the patient standing and I do NOT try to postition the patient to support a treatment protocol. Medical x-rays are usually taken with the patient lying down to rule out fracture. NONE of these procedure will affect the lordosis. It is either there or not. Trauma patients should also have flexion/extension pictures where we can SEE the changes to the lordosis during motion. Anonymos should finish school before prtending to have a clue!
ReplyDeleteDr. Davis Fiedler, BS, DC
I'm not suprised out of all the nice comments here that the "chiropractor" is the one doing the name calling. But, he most likely refers his patients to the same facility where there is the same rediologist reading the x-ray. I've seen hundreds of radiologists reports from a different doctors. It is very common for radiologist docs to note "loss of lordosis" could be due to posistioning of the patient during the x-ray. Be careful with those chiropractors because they would much rather you believe you are injured because it is good for business. :)
ReplyDeleteI have seen that type of injury after car accidents.
ReplyDeletehttp://www.oal-law.com
A soft tissue injury compensation claim mostly covers any injury to ligaments, tendons or muscles, but can also include compensation claims for injuries sustained to the nervous system, blood vessels or skin. Injuries caused to any of these parts of the body due to negligence or a lack of care.
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