Part II: Spinal Soft Tissue Injuries – Symptoms and Treatment

This is part II in a three part series that will address spinal soft tissue injuries from a personal injury perspective.  In this issue we will cover the symptoms and treatment.  Part I was published in the August 2024 newsletter and covered the basics of soft tissue injury and how to differentiate sprain from strain. Part III will be in the November issue and will focus on points to consider during the evaluation of these claims. 

The purpose of this newsletter is to assist attorneys in understanding the challenges that these types of injuries may present and in identifying potential arguments that may be presented during negotiations.

Symptoms of Soft Tissue Injury

The most common symptoms include:

• Pain

• Swelling

• Muscle spasm

• Stiffness or loss of range of motion

With soft tissue injuries from trauma, symptoms do not always present immediately because it may take time for inflammation of the tissues to occur.  Symptoms often present or peak 24-48 hours after the injury.  When symptoms are immediate, it may suggest a more significant injury.  In some cases, additional symptoms may present such as weakness, dizziness, numbness, tingling, headache and nausea.  While these may be present in uncomplicated soft tissue injury, medical evaluation is usually warranted to make sure that complications involving the nerves or spinal cord are not present.

Treatment

The treatment provided in soft tissue cases is often a point of disagreement between the plaintiff and defense.  The defense will argue that soft tissue injuries usually heal within days to weeks with or without treatment.  In most cases, home treatment with rest (protected motion of the involved area), ice during the first 48-72 hours and then application of heat, and over the counter anti-inflammatory drugs is perfectly safe and effective.  If symptoms do not resolve in 2-3 weeks, medical evaluation and referral for therapy may be appropriate. If there are symptoms that may be suggestive of nerve involvement (such as weakness, numbness/tingling, or extremity pain) immediate medical evaluation is recommended  (Shiel, Jr., MD, 2012).

Chiropractic Care: Treatment with a chiropractor is very common in personal injury cases and may present another point of discussion due to conflicting findings in the literature.  The defense will present literature supporting their position that the efficacy of chiropractic care is unproven and it is not shown to be more effective than other treatments or sham placebo in the long run  (Ernst, MD, 2002).  The plaintiff can present literature that shows findings that chiropractic care may provide improved pain control early in the injury and results in decreased health care costs and earlier return to work  (Chiropractic Canada, 2012) (Legorreta, Metz, Nelson, Ray, Chernicoff, & Dinubile, 2004). With chiropractic therapy becoming more mainstream, settlement issues are more likely to present in cases where the treatment is perceived as being excessive.  Key to successful negotiation of these claims is appropriate medical records documentation by the provider including what therapies are being utilized, why they are being used and how effective they are (not just a checklist).  The records should indicate that the injured party is being re-evaluated to validate improvement with therapy (usually every 4-6 weeks), that therapy is being modified and treatment modalities reduced as improvement occurs or referral is being made if the patient does not maintain improvement.

Physical Therapy: When physical therapy is being utilized, the extent of treatment can vary widely.  In some cases, you see 1-2 visits for instruction in a home exercise program only.  In other cases, treatment may involve weeks to months of therapy.  As with chiropractic treatment, the medical records should document sustained improvement, modification of therapy and modalities with improvement, documentation of what therapies are being utilized, why, patient response and interim examinations to support the need for ongoing therapy.

 

Works Cited

Chiropractic Canada. (2012). Effectiveness of Chiropractic Treatment. Retrieved August 11, 2012, from Canadian Chiropractic Association: http://www.chiropracticcanada.ca/en-us/FactsFAQs/EffectivenessofTreatment.aspx#1

Ernst, MD, E. (2002, October). Chiropractic Care: Attempting a Risk-Benefit Analysis. American Journal of Public Health, 1603-1604: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447290/

Legorreta, A., Metz, R., Nelson, C., Ray, S., Chernicoff, H., & Dinubile, N. (2004). Comparative Analysis of Individuals with and without Chiropractic Coverage: Patient Characteristics, Utilization and Costs. Archives of Internal Medicine, 1985-1992: http://www.ncbi.nlm.nih.gov/pubmed/15477432

Official Disability Guidelines. (2012, June 5). Sprains and Strains of Other and Unspecified Parts of Back. Retrieved August 11, 2012, from Official Disability Guidelines: http://www.disabilitydurations.com/bp/847.htm

Olson, DC, R. E. (2000). Procedural Utilization Facts – Chiropractic Care Standards. Woodstock, GA: Data Management Ventures.

Painter, DC, F. (2010, February 20). Whiplash Care Guidelines. Retrieved August 11, 2012, from The Chiropractic Resource Organization: http://www.chiro.org/LINKS/GUIDELINES/ART_CROFT.Chap12.shtml

Shiel, Jr., MD, W. C. (2012, February 03). Neck Strain. Retrieved August 11, 2012, from eMedecinehealth: http://www.emedicinehealth.com/neck_strain/article_em.htm#neck_strain_overview

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