The Complexity of Back Injury
The spine (backbone) is comprised of 3 areas:
- The cervical spine is the neck
- The thoracic spine is the mid-back
- The lumbosacral spine is the lower back
One of the most common injuries is back strain or sprain, usually involving trauma to the muscles or ligaments. As a medical category, this variety of back problem is often referred to as “musculoligamentous injury.” The back can be affected severely when the victim’s head is turned to the side at the moment of impact.
In pronounced situations, back pain can result in extreme, constant misery. Beyond that, it can also result in functional loss of the legs. In the most severe situations, there can be compromise of bowel or bladder control. An orthopedist or neurologist will have to treat if the pain includes tingling or numbness of the back or neck. There may be radiating dysfunction to the legs and arms.
When the back is subjected to great trauma, there can be various injuries inflicted.
- Compression – is extreme pressure causing injury
- Corticospinal – the tracts of the cervical spinal cord are traumatized
- Bruising – when the force applied causes direct impact skin-and-muscle injury
- Lacerations – wounds resulting from the body striking against an object
If the spinal cord injury has occurred in the neck region, the legs can be as affected as well as the arms. At the thoracic or chest level, the symptoms are usually experienced in the legs. Whatever the level affected, the entire body will suffer. This is because the spinal cord involves the entire nervous system in all its massive complexity.
Back Injuries are Difficult and Slow Healing
One of the reasons back injuries are so common in vehicle collisions is that the paraspinal muscles, which support the spine, are large and vulnerable. They are charged with supporting the full weight of the upper body – while also supporting the critically important spinal column. When a person’s head is violently hurled forward, this is hyperextension. When the head is rammed backward, this is known as hyperflexion.
When damaged, inflammation of the tissues causes tremendous pain. Serious damage can result to various body parts, including the ligaments, nerves, muscles, discs and joints. Spasms can also result. Medications initially can promote some relief, but healing over months can be expected. The treatment plan may include physical therapy to include applications of heat, cold, electrical impulses, massage and home exercises.
Often, there is little that medicines can do to accelerate the healing of these soft tissue injuries. It is difficult to remain patient over weeks or months while the muscles, ligaments, and the interlocking bones slowly, frustratingly heal.
Prescription anti-inflammatory medications are often ordered, to supplement over-the-counter analgesic. If a neck collar is prescribed, this should be worn exactly according to the doctor’s instructions. As days pass from the initial accident and trauma, swelling and pain may decrease. In the meantime, most of the daily activities of life are severely restricted or halted entirely.
There are no definitive, objective diagnostic measurements to clarify the degree of injury. As a result, back injuries can be problematic claims when asserted in court. The quality of the medical charting, and the credibility of the treating physician, will be important to the strength of the damages claim. An orthopedist, who in court is an articulate advocate, can help the jury to understand what the patient has been through.
Coping with Herniated Disc
The 26 vertebrae are a series of connected bones that protect the spinal cord. They surround the spine, and signal pain when damage occurs, by way of an elaborate circuitry of nerves. The brain monitors all of this data, and instructs the muscular skeletal system as to operating instructions.
When a disc is herniated (bulging), it pinches one of the nerve roots.
Since discs hold the vertebrae together, they must act to cushion from outside forces. In turn, the vertebrae connect to each other by these discs, as well as by double-sided joints known as facets. The spine’s vertebrae are able to twist, rotate and even bend from side to side. This is allowed by the facet joints working together with the discs.
Each disc is made up of resilient connective tissues. The outer surface of each disc is comprised of annulus fibrosus, which is vital to the security of each disc. Damage to the disc can result in herniation or disc rupture. This violent re-distribution is significantly painful. A violent twisting from an accident causes the outer annulus fibrosus to tear. Then the nucleus pulposus shifts out of its position and causes severe pressure on the nerves of the spine.
Much litigation results because of the necessity of proving the nature and degree of disc herniation. A clinical examination will focus on whether there is abnormal sensation or inconsistent reflexes. Often the physician will order a CT scan or MRI to supplement the ER x-rays. If any radiating pain or numbness is present, there may also be ordered electgromyograms, discograms and even bone scans.
Distinguishing a Sprain from a Strain Injury
Many people coming out of an emergency room question the difference between a strain and a sprain. The former occurs when the fibers that make up the muscles are stretched excessively and even torn. A strain injury involves a painful injury to the muscle or tendon; both are tissues which connect the muscles to the bones.
A sprain takes place when the ligaments are actually separated from whatever they are attached to. These tissue bands are essential for maintaining the structural integrity of the skeletal system. When they are stretched or torn, the tissue damage can be extensive along with debilitating pain. This is especially true if the larger muscles of the low back are involved.
Since both strains and sprains often affect a person in similar ways, they can be difficult for medical personnel to distinguish. As a general rule it does not much affect the treatment plan, since both injuries often follow the same course.