Oh, Don’t Worry, It Is Only a Sprain of Your Neck.

You may have heard this phrase after injuries, particularly automobile accidents. You went to your doctor, complaining of pain and stiffness and he said “Don’t worry, it’s only a sprain in the neck and it should get better after a while.  Just take some anti-inflammatories, use of heat and you will be okay.”

Time goes on, you do the things you were told to do but the pain continues to persist and over time grows worse.  You may get massages, he may take over-the-counter pain medications and anti-inflammatories but the pain continues to get worse.

Out of desperation, you seek care with an orthopedic specialist, neurosurgeon or a pain management specialist.  The medical physician takes x-rays, maybe orders an MRI or a CAT scan and they say that things are normal.  He says,” Don’t worry its only strain of neck, it should get better.”

You may have even tried a local chiropractor who did give you some relief but the pain continues.  You keep hoping that the pain will get better.


But It Doesn’t.

Sprain is defined as: A stretching or tearing of ligaments, the fibrous tissue that connects bones and joints. Ligaments are the fibrous tissue that hold bones together allowing the joint to maintain its normal position when moving under normal activity and at rest.  During normal activity, even with moderate stress and strain these ligaments remain intact.  They mildly stretch and then recoil to its original length when the load is removed.

When the injury forces are greater than the ligament can withstand, the ligament tears and is unable to return to its normal length.  This then results in instability of the joint in the spine.  This results in continued pain and a higher probability of future disability.

According to the American Academy of Orthopedic Surgery, there are 3 types of sprains, which are classified by how severe they are.

Grade I – (Mild) Slight stretching and some damage to the fibers of the ligament.

Grade 2–(moderate) Partial tearing of the ligament.  There is abnormal looseness (laxity) in the joint when it moves in certain ways.

Grade 3–(severe) Complete tear of the ligament.  This causes significant instability and the joint nonfunctional.


If the load or injury is too great, the ligaments begin to yield.  They go past their elastic limit and can stretch and tear and will not return to the original shape.  The ligament then loses its ability to hold the joint in its normal position and excessive motion in the joint will occur.  This commonly occurs in automobile accidents, even if the damage to the vehicles is not real great.

According to the National Institute of Health,” connective tissue is material inside your body that supports many of its parts.  It is the “cellular glue” that gives your tissues their shape and helps keep them strong.  Unlike fracture repair where the bone is replaced with bone and usually heals properly, connective tissue (ligaments) undergo a different type of repair that has abnormal tissue replacement, which then has abnormal function.

About 50% of the injuries to the neck, particularly in low speed rear end impacts in automobile collisions will result in a Type II ligament injury to the ligaments in the neck.  These types of injuries do not normally show up in standard x-rays or even in MRI studies.  Most of these injuries go undiagnosed and therefore are not treated.  The ligaments heal poorly resulting in continued abnormal motion of the individual neck vertebra.  This predisposes the joint to inflammation and partial instability which then increases the possibility of osteoarthritic changes of the neck and the lower back.

In the spine, this abnormal stretch and tearing of the ligaments between the bones of the spine can result in a condition called Alteration of Motion Segment Integrity (AOMSI).  This is a condition where the ligaments that hold the bones together have been damaged and torn resulting in too much movement between the individual segments.

Spinal ligament injury is one of the most common injuries in automobile collision trauma and can take up to 2 years to heal and require different treatments than other less serious injuries.  While some patients recover uneventfully from this spinal injury, significant number of patients have pain which may last indefinitely.  The risk of developing chronic pain is increased if a physician is unable to find a physical cause of the pain in these patients.  X-rays, CT scans and MRI scans are routinely ordered by the doctors in evaluating the patient, but some imaging techniques are often unable to clearly show the real source of pain adding uncertainty to what the correct diagnosis and ultimately the proper course of treatment is.

If these injuries are not properly identified and the patient is involved a law suit to get compensated for his injuries, they may be short changed in the end.

This injury is such a big deal that The AMA Guides to the Evaluation of Permanent Impairment, Fifth and Sixth Edition states that this injury is permanent and can result in a 25% whole man impairment.  The AMA Guides to Evaluation of Permanent Impairment is published by The AMA Press and is considered the Bible by the medical profession in determining impairment and disability.

So Why Hasn’t My Doctor Found This Condition?

Following an injury, most doctors will perform standard diagnostic procedures including plain film x-rays, CAT scans and MRIs and physical exams.  If these findings are negative, they assume that this is a simple strain/sprain injury and should get better.

What should be happening, soon after the injury, is the need to perform Computer Radiographic Mensuration Analysis (CRMA). CRMA is a computer-based system that uses precise spinal x-ray measurements of the spine in a stressed forward bending and backward bending position to identify the severity of joint instability.  This CRMA analysis is used to rule in or rule out any spinal ligament injury by measuring the spinal X-ray abnormal movement to determine if the patient is suffering from Alteration of Motion Segment Integrity (AOMSI).  This gives the most precise image measurement procedures available to enable the physicians to most accurately diagnosis and effectively treat patients with pain from spinal ligament injuries.  As a matter of fact, it is the only method approved by the strict criteria established by The AMA Guides to Evaluation of Permanent Impairment, Fifth and Sixth Edition.

If your symptoms continue, even after appropriate treatment, you should ask your physician or your attorney to have this very important procedure performed.  It may answer the questions that you have about your persistent pain and help to formulate a treatment regimen and may improve your compensation for your injuries.

At the Paulk Clinic, we use the latest digital radiographic procedures coupled with software developed by Spine-Tech Pro. This the leading developer of radiographic mensuration software that is reliable, researched and accurate to demonstrate the presence or absence of Alteration of Motion Segment Integrity (AOMSI). 

Dr. Paulk and his staff perform this procedure on the vast majority of automobile accident cases to assist in proper management and documentation of these injuries.