Most of us have experienced some sort of neck pain or lower back pain in our lives. As a personal injury lawyer who handles car accident cases, I see these complaints all the time. Car accidents exert extreme forces on the human body, particularly the spine.
The neck and lower back are two areas that are commonly injured in accidents because of car crash mechanics. The vertebrae in the neck are called the cervical vertebrae and those in the lower back are called the lumbar vertebrae.
As the car comes to a sudden stop, the body lurches forward and is caught by the seat belt, causing the neck to quickly whip around. This is what is commonly known as whiplash.
Additionally, the lower seat belt strap puts pressure on the lower back, exerting significant forces on that region of the spine and the surrounding tissues. While seat belts undoubtedly vastly improve automobile safety, their design does frequently result in injuries to the neck and back.
Not all neck and back pain is the same—its severity, symptoms, and treatment depend on the type and site of the injury. Neck and lower back injuries can result in chronic pain and the need for surgery. In severe cases, especially when there is damage to the spinal cord, lower back and neck injuries can be debilitating or disabling.
Some common causes of neck pain and lower back pain after an accident are sprains and strains to the soft tissue, disc injuries, pinched nerves, facet joint injuries, and fractured vertebrae. I recommend getting medical care if you have any back pain at all after an accident.
Soft Tissue Sprains and Strains
It’s very possible that you have experienced this type of neck pain or lower back pain before. You went to pick up a heavy box, lifted in the wrong way, and had a stiff, sore back for a few days afterward. Similarly, neck and back tissues can be easily sprained or strained after a car accident. This is called a soft tissue injury, a very common symptom of whiplash.
The difference between a sprain and a strain is simple. A joint sprain is when ligaments—the tissues that hold bones together at joints—are overstretched or torn. A muscle strain is when a muscle or tendon—the tissues that connect muscle to bone—is overstretched or torn.
Like their causes, the symptoms of sprains and strains are almost exactly the same. Both cause pain, swelling, and stiffness. The only difference is that sprains may cause bruising while strains may cause muscle spasms.
Why does the joint swell or seize up after a sprain or strain? This is part of the body’s response to the injury and helps with healing. Inflammation is essentially the body signaling to the immune system that it needs to take action. Blood vessels widen, allowing cells that promote healing, such as white blood cells, to flood the injured tissues. Muscle spasms, which often happen after a lower back sprain, happen because the body does not want you to move and cause further injury.
Sprains and strains will be painful until they are healed, especially when moving. Mild sprains and strains are easily treated and will go away on their own within a week or so. The most important thing is to rest. You can also apply ice or a cold pack, apply pressure by wrapping the area, and take an anti-inflammatory medication such as ibuprofen (always read the label before taking any medication).
Severe sprains may need more time to heal, sometimes affecting a person’s ability to work and carry out normal activities. In cases involving a severe tear to ligaments, tendons, or muscle, surgery or physical therapy may be needed to repair the damage.
Herniated Discs, Pinched Nerves, and Radiculopathy
In between each of the stacked bones of the vertebrae is a spinal disc, also known as an intervertebral disc. These discs, made up of a liquid interior and a hard shell, essentially act as shock absorbers for the spine, cushioning the impact of everyday movement. Car accidents may cause the spinal discs to rupture, also known as disc herniation.
A herniated disc does not always cause pain. It is possible to have a herniated disc without experiencing any symptoms. However, if the ruptured interior of the disc puts pressure on one of the many spinal nerve roots, a herniated disc becomes a problem.
The location of the pinched nerve determines where the patient will experience symptoms. This is because there are 31 pairs of spinal nerves, each of which travels from the spinal cord to a different part of the body. A pinched nerve in the spine causes not only pain but numbness, weakness, and a tingling sensation to shoot along the nerve’s path throughout the body. This is called radiculopathy.
A herniated disc in the neck, or cervical spine, may cause radiculopathy in the shoulders and arms, hands, and fingers. In the lumbar spine, a herniated disc may cause radiculopathy in the buttocks, legs, and feet. This shooting pain down the back of the legs is also known as sciatica.
Usually, herniated discs are treated conservatively at first. Rest, NSAIDs (e.g. ibuprofen), physical therapy, and steroid injections aim to relieve the pain of the herniated disc. If these treatments are unsuccessful, a discectomy can be performed to remove the parts of the ruptured disc that are putting pressure on the nerve.
Facet Joint Damage
Facet joints connect the bones of the vertebrae. Each vertebra has a pair of facet joints. The facet joints work along with the spinal discs to support the movement of the spine, allowing for certain motions and preventing the spine from hyperextending, or bending too far in one direction.
Damage to the cervical and lumbar facet joints is another common injury in auto accidents. When these joints become torn and swollen or knocked out of place, a symptom that often results is muscle spasms. With this type of injury, pain is usually sporadic, provoked when the neck is turned or the back is bent or rotated, and it may radiate to the shoulders or thighs, respectively.
Treatment options for facet joint injuries typically involve physical therapy and medications like NSAIDs and muscle relaxers to limit spasms. There are a number of surgical options available if these treatments are ineffective.
If a crash is bad enough, it is possible for the vertebrae of the spine to fracture. Violent compression, extension, rotation, or flexion (bending) of the spine may result in a variety of types of vertebral fractures. A back fracture can be minor enough that it does not even require surgery and severe enough that the auto accident victim suffers damage to their spinal cord and is paralyzed or killed.
For example, a minor compression fracture can be treated with a few weeks in a cast. A severe compression fracture, on the other hand, requires surgery followed by seeing a physical therapist. During surgery, the bones may be reconstructed and stabilized with things like bone cement, screws, and plates. If you have back pain after an accident, it is important to seek medical attention. X-rays, MRIs, and CT scans can be taken to determine the origin of your pain and ensure that the spine is not fractured.
Relevant Medical Studies
- Michael Freeman and Wendy Leith. “Estimating the number of traffic crash-related cervical spine injuries in the United States; An analysis and comparison of national crash and hospital data.” Accident Analysis and Prevention, Jul. 2020.
Just how many people injure their necks in car accidents every year in the United States? This is what the authors of this study wanted to estimate. To do so, they searched three national databases, the National Automotive Sampling System-Crashworthiness Data System (NASS-CDS), Nationwide Emergency Department Sample (NEDS), and the Nationwide Inpatient Sample (NIS). They found that there are approximately 869,000 traffic accident-related cervical spine injuries in the US annually, and further breakdown this number by injury type, from whiplash to spinal cord damage.
- Liang Tang et al. “A numerical investigation of factors affecting lumbar spine injuries in frontal crashes.” Accident Analysis and Prevention, Mar. 2020.
Knowing what factors contribute to the likelihood of a serious back injury is important for the future of vehicle design and accident prevention. To better understand what causes lumbar spine injuries in head-on accidents, researchers ran simulations with test cars and dummies. The researchers found that the most important factor in the likelihood of this injury is the seat design.
- Rami Hashish and Hasan Badday. “Frequency of acute cervical and lumbar pathology in common types of motor vehicle collisions: a retrospective record review.” BMJ Musculoskelet. Disord., Nov. 2017.
The researchers in this study were interested in the rate of cervical and lumbar spine injuries in different types of car accidents. They looked at data from 903 patients who had been in head-on, sideswipe, T-bone, and rear-end collisions. Specifically, they were searching for disc injuries and radiculopathy in the cervical and lumbar spine and any differences based on the type of accident. They found that T-bone accidents were most associated with symptomatic cervical injuries and that sideswipe and head-on accidents were most associated with lumbar injuries.