Long term neck and back pain after a car crash.

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Welcome back to the Forensic Chiropractor podcast.

I am a large advocate of assessing and treat every patient according to their injuries.  I am not typically a big fan of research that shows someone can or cannot be injured in a MVC.  I want to focus on showing what did or did not happen to the patient compared to what could or could not have happened to them.  Today’s studies are a little different for me, but I think it can still be useful. 

Today I have 2 studies I want to go over.  The first is Exposure to a Motor Vehicle Collision and the Risk of Future Neck Pain: A Systematic Review and Meta-Analysis by Paul Nolet et al and published in the PM&R Journal in 2019. 

The second study is Exposure to a motor vehicle collision and the risk of future back pain: A

systematic review and meta-analysis by Paul Nolet et al and published in the Accident analysis and prevention Journal in 2020.

These 2 studies were done by the same 6 authors and are essentially the same study, but the first is looking at neck pain and the second is looking into low back pain.  They reported that neck pain is a common finding in the general population and seen in 4.9% of all people.  They reported that low back pain is also common in the general population and is seen in 18.6% of people. 

These studies want to look at the risk of having persistent neck and low back pain following a MVC.  They reported that this can be difficult to study since so many people already have neck and low back pain.  They reported that it is common to hear that people with low back and neck pain that is persistent would have likely happened without the MVC. 

I know I have seen a lot of persistent low back and neck pain in my patients who have been in MVCs.  These studies got me curious what the literature can teach us regarding risk of persistent low back or neck pain following a MVC compared to persistent low back or neck pain without a MVC. 

Both of these studies looked at population of people 16 year and older.  They looked up studies as far back as 1998 to assess what the literature says about persistent low back and neck pain following a MVC.  To be included these studies had to be in English, published after 1998 in a peer reviewed journal, used a case control or cohort design with a mixed population. 

They had a multi stage study selection process with 2 independent reviewers and a third reviewer to help with any disputes.  The database search came up with 9,667 studies regarding cervical spine and 1,136 articles regarding low back pain.  After reviewing all of these studies for bias and other exclusion criteria they narrowed the cervical spine articles down to 8 and the lumbar spine studies down to 3 studies. 

The included studies all showed how likely someone is to have neck or low back pain that is persistent after a MVC compared to people who were not in MVCs.  They showed that patients in MVCs are 57% more likely to have persistent cervical spine pain than people without MVCs.  This is very significant showing that you have more than double the risk of having persistent neck pain in after a MVC compared to someone never in a MVC. 

They showed that with patients in MVCs are 63% more likely to have persistent lumbar spine pain than people without MVCs.  This is very significant showing that you have more than double the risk of persistent low back pain after a MVC compared to someone who has never been in a MVC. 

This study doesn’t say that just because one of my patients was in a MVC they will have persistent low back or neck pain.  It also doesn’t say that they won’t have persistent low back or neck pain after being in a MVC.  It does show that not only are neck and low back pain common in the general population, but much more or 57-63% more common in people who have been in a MVC. 

This study can be helpful when attempting to understand future care and needs a patient may have following a MVC.  It is clearly much more likely that future care in the low back and neck is related to the MVC than normal day to day life after the MVC.

Real World

I have had many patients with no prior traumas or treatments.  These are all patients that have no medical records for low back or neck pain.  I have heard the arguments from insurance companies that the general population will have high percentages of low back and neck pain.  The insurance company will go on to say that my patient’s spinal pain is normal for people and not related to the MVC. 

I have patients with future care letters that state they will need management of their ongoing spinal injuries.  In my reports I will now include a reference to these articles showing that the future care is much more likely due to the MVC than normal life.  According to the literature it is 57-63% more likely related to the MVC than normal life. 

This is just one more part of the large picture that can help patients get the care they need.  We still need a mechanism of injury; objective evidence of an injury and evidence of the injury being causally related to the mechanism of injury.  Then we need to show persistent problems with impact on daily life. 

I feel like these 2 studies are a small but important part of person injury work.  Every little aspect needs to be considered to take the best care we can of patients.