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A 30 y/o female came to see me recently regarding her neck and back pain after a motor vehicle accident (MVA). On evaluation her findings included constant neck pain with referred symptoms to left shoulder blade and localized low back pain. Neck range of motion (ROM) was limited into extension (bending backward), bending to left side and rotation in both directions. Low back ROM was limited in flexion and extension. On repeated movement testing the neck ROM decreased with repeated extension and the low back pain decreased with repeated flexion in lying (pelvic tilts and knees to chest). This indicated McKenzie diagnosis of lower cervical posterior-lateral reducible joint derangement and lumbar anterior reducible joint derangement.

On follow-up appointments the patient consistently improved her neck pain with retraction/extension and left side-bending stretches. Low back continued to improve with pelvic tilts in standing or lying and general abdominal stabilization exercises to maintain stability of anterior joint derangement during the healing process.

So what happens in a MVA that causes joint derangements? During impact in a MVA the neck is thrust in one direction and depending on the restraint the rest of the spine may follow. On the rebound from the impact the spine is thrust into the opposite direction. Since the headrest keeps the neck from hyper-extending, most neck strain occurs on the back of the neck (from the forward motion) pulling the ligaments around the disc, there-by weakening the disc on the posterior (back) side of the disc.

In the lumbar spine, the seatbelt may prevent forward bend however when the head bends back hitting the headrest the low back is thrust forward causing a strain to the front (anterior) ligaments of the lumbar discs.

The patient may not feel pain due to shock right after the accident however after the initial shock wears off and the disc starts to bulge toward the overstretched ligaments and derangement is discovered in the form of neck or back pain. If the bulge gets worse then referred pain may develop into the arm from the neck (or hip/leg from the low back). When this pain is felt, early intervention is recommended to reduce pain and teach the injured client the correct sleep postures and stretches to perform in order to improve the pain and function.

If you or someone you know could benefit from a McKenzie evaluation call Ted at (503) 445-4936.