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Did the Accident Cause the Disk Herniation?

That is a frequent question asked by many patients.The answer is, a definite maybe the accident caused the disk herniation.

As a practicing orthopaedic spine surgeon,  I have seen many patients with complaints of pain after an auto accident.  In my community,  I have also been asked to evaluate patients in Auto accidents by attorney representatives of  insurance companies. The question is,  Did the Accident Cause the Disk Herniation?  If so,  are the treatments appropriate?  A corollary, which is also common, is did my work injury cause the disk herniation?

Everyone involved in the situation would like a definitive answer to that question.  Unfortunately,  often times the answer is not so simple.  To  answer, I usually need to ask other questions of the patient, and confirm that the medical records support that answer.

How old is the patient?  After the age of 40,  there is a 50/50 chance that the patient already has a disk herniation.  The disk herniation may have occurred long ago, and may have been completely pain free for a long time.  MRI’s will demonstrate the disk herniation but it is rare that signs of acute disk herniation will be present.   Those signs such as edema around the disk herniation,  or hemorrhage by the nearby tissue require such a force, that usually, there are also other associated injuries or complaints.  With those findings, it is easier to say the disk herniation is new and associated with the recent injury.  Unfortunately,  Most MRI’s will not show those findings, therefore, at a certain age, the disk findings by themselves are common, and therefore not conclusive of a newly formed disk herniation.

What findings are on the MRI? Can the findings determine Did the Accident Cause the Disk Herniation?  Regarding disk findings on MRI,  disk bulges secondary to disk dehydration is usually not  an acute finding.  Neither is evidence of osteophytes, which are bone spurs associated with degeneration.  At one time,  physicians put alot of weight on the so call High Intensity Zone, which usually indicated the presence of a tear in the outer part of the disk,  which is called the annulus.  Now we know that these High Intensity Zone lesions can be present for years,  and therefore do not necessarily mean a new disk injury or herniation.  As stated above,  findings of edema and hemorrhage are rare, but if found, do indicate an acute event.  If not found,  you still cannot say the disk herniation is not acute,  but you cannot say by image it is acute either.

When did the pain start? Can the timing determine Did the Accident Cause the Disk Herniation?  I find this to be a very important question.  After the accident,  in my opinion, a person that had an immediate, or within a few hours development of neck or back pain, with developing arm or leg pain is more likely to have a disk herniation associated with the accident.  There are disk herniations associated with just back and neck pain only,  but usually, for a disk herniation to become symptomatic, there is an association with nerve irritation, or as we physicians call it,  radiculopathy.  Once in a while,  I will see a person involved in an accident, but with no real complaints of back or neck pain.  After some time,  usually greater than a few weeks,  they may develop some neck or back pain. For what ever reason,  they get a MRI, and since they may be in the over 40 population,  the MRI does demonstrate a disk herniation.  While this person is convinced the disk herniation was caused by the accident,  in my opinion, it is difficult to relate the disk herniation finding to the accident after such a time delay.  In addition,  the person usually does not have the corresponding radiculopathy findings consistent with that particular disk herniation.  The timing is very important.  There is no dispute that there is a disk herniation.  The question however, is not that there is a disk herniation, but did the Accident Cause the Disk Herniation?

Has the person ever had similar complaints in the past? Can prior complaints determine if the Accident Caused the Disk Herniation?  The answer is maybe.  Back and neck pain is a part of life.  Most people  have had a pulled neck or back muscle with activities of life.  That is why there are so many terms for a back ache.  Lumbago,  sciatica, pulled back,  wry neck, crick in the neck,  kink in the back, etc.  Minor neck pains and back pains are common and expected.   In my opinion,  there is a difference between a minor neck or back ache experienced rarely, and a constant chronic neck or back condition that required constant treatments by a physician, chiropractor or therapist.  If you  have an accident, but have recurrence of the similar prior chronic condition,  it is likely that the accident flared up a pre-existing problem.  But,  if the accident caused a new set of complaints shortly after the accident, and even though you may have had a pre-existing condition, there is a definite change of complaints,  the accident may cause a new change to the disk, the accident may have caused the new disk herniation.

Can a prior identified disk herniation become symptomatic after an accident? In my opinion,  there is that possibility.  I have seen circumstances by which a person has had a test long ago demonstrating a disk herniation.  Then for a long period,  there is no pain associated with that disk herniation.  But, after an accident, there is a quick development of significant pain with corresponding radiculopathy.  The pain does not improve or go away.  In that scenario, Did the Accident Cause the Disk Herniation?  The answer would be no.  But,  the accident did cause a permanent aggravation of a pre-existing condition.  So in that circumstance,  the accident did cause a pre-existing condition to become a permanent injury.

Can the Energy of the accident determine if the Accident Caused the Disk Herniation?  I am not a biomechanics expert,  so I am told that a low energy fender bender will not likely cause a disk herniation.  While I think that is the general case,  in the end,  it comes down to history of the development of the pain and the nature of the pain.  Some patients are very frail, and some are predisposed to getting injured with minor forces.  In some instances,  It is my opinion that a low damage, low energy impact can still cause disk problems.  It comes down to the history and clinical presentation.

In the end, as a practicing orthopaedic surgeon,  after reviewing all the history, and all the records, and after looking at the MRI’s and other images,  my conclusions are based on the entirety of the information.  And I can say I have been wrong when trying to answer Did the Accident Cause the Disk Herniation?  It does come down to the credibility of the history when the records do not match.  I know there are some people who just cannot explain their pains properly, or did not go to the hospital immediately after the accident because they hoped the pain would go away, or was afraid of the costs.  Unfortunately,  their recollections may not match the evidence, and because of that,  the history is wrongly discounted.  I can say I may have been wrong with my conclusions in that scenario.  In another scenario,  I believed the history, and the records were also consistent with an accident related disk herniation.  But,  to my chagrin,  that person also had surveillance video’s showing the person performing exceptional physical feats immediately after the accident, or after my evaluation.  My opinion about the significance of the disk herniation was likely wrong.

The bottom line is the answer to that question is not always straightforward.  Did the Accident Cause the Disk Herniation?  It depends on the factors discussed above.  It also depends on the credibility of the historian, and the otherside would argue, the bias of the person answering the question.

Last modified: March 18, 2019

31 thoughts on “Did the Accident Cause the Disk Herniation?

  1. Please answer this question.
    I was 57 at the time of the injury. However, I was the hardest worker in the crew. We lift machine parts that weigh between 15-75 pds, and meat that weigh from 7 1/2 – 55 pds. I turned and pulled meat racks that weighed 125-1,400 pounds of rapped meat fully rack by myself for 5/months and never complain of my back hurting . Moreover, squating lifting, pulling and twisting was all apart of my work ethics. Not once did my back hurt me. I received $500 two months In a row for working hard and not missing a day of work.
    Now work Comp, and associated doctors I see monthly and paid by work Comp is suggesting that due to my age the 2/herniated disk in my lower back and vertical stenosis in my upper back is subacute and not related to my slip and fall.
    If this had merit then how was it possible for me to work the way I did from January to October without complaining of pain? According to my research it’s impossible for anyone to have these type of back injuries and not complain or continue. The type of work I was doing. What is your take. Please be honest.

    1. I have sympathy for you. As We age, it does get harder and harder to do the things we once did. It is a gradual “straw that broke the camel’s back” scenario. At 57, if possible, you should find a position that no longer requires you to pull 400 lb meat racks. I know that is easy for a doctor to say. It is also a truth. If you had the option, you should take it. As far as the cause of your herniated discs, the truth is also difficult to accept. After 40, more than 50% of people will have some sort of disc problem in their back, even if they do not feel pain. I hope you get better. I hope you find a solution to your situation.

  2. I am a Home Health Aide and was assisting my elderly client to his camode and he started to slip and fall so I just reacted to prevent his fall. In doing so I fell with him we landed on our buttocks, he landed slightly on my left leg. I felt a little soreness in my lower back and a weird slightly painful l sensation between my shoulders but assumed it was a pulled muscle or something. long story short the pain intensified and never got better. Two weeks later my boss and I decided I should go to the Dr. I went and have a few herniated discs, I am being questioned on the cervical herniation, I have never injured my neck and don’t know how to explain. It is possible to sustain thistype of injury during this fall right???I am an overthinker and am beginningto wonder myself….

    1. It is possible to herniate a disc with a sneeze. It can also happen with a twisting fall. Please look after yourself and work on proper body mechanics to avoid future falls.

  3. Long story short, I have had three spinal fusion surgeries. in 2015 a C5/6/7 ACDF, in 2016 C4/5 and then in July 2017 a C4/5 Posterior due to a broken screw and failed fusion. A CT scan in June 2017, prior to surgery, showed no other degeneration in the cervical spine or disc protrusions. In Nov 2017, three months after my most recent surgery, I was in an auto accident where I hit a vehicle that entered my path while I was going 65mph. I went to the ER following the accident and had Xrays taken. They showed no damage to the most recent surgery and no fractures. I recently had another CT scan as I have been having constant headaches and nerve pain in my arms and the top and back of my head (feels like a really bad sunburn) since the accident. The latest CT showed a C3/4 focal disc protrusion and a C3/4 bilateral neural foraminal stenosis and posterior disc osteophyte complex. Could this be directly related to the accident or is it incidental to degenerative disc disease, a pre-existing condition?

    1. Darla, there is no way to actually know for sure what is caused by the accident and what is not, on anyone who has previous back/neck problems or surgery. Your best bet is to be examined, get a second opinion, and just look after your health. Sometimes the cause will never be determined. The solution is what is important in the end. Be well.

  4. Hi, I hurt my neck at work when I was assisting one of my resident. I felt the pain right a way went to doctor next day I did therapy for 2 months . MRI too. they found out I have c5-6 disk herniation I start feeling light pain on my left arm and left leg .
    I went to neurosurgeon he said I need surgery I’m kind of nervous…..

    1. Hi Saadia. I’m sorry you are going through this. Definitely get a second opinion and do as much conservative care as possible before undergoing surgery (unless there is direct pressure on your cord and you are having myelopathic symptoms).You should not be getting leg pain from your neck so the surgery will probably not help that.

  5. I am a mother of an 18 years old beautiful daughter. I don’t know where to turn to for help or if this is the right site to ask help or suggestions. I know from my experienced that if you are rear ended really hard you can get a disc herniation ( I have 3 disc herniation from my accident ). To make my story short…We were rear ended really hard with a cleaning van and it pushed me hard forward and jolted my neck when my daughter was about 3 years old and the look of her face saying ohh..ohh.. means trouble. We did not go in the hospital or emergency room since I did not see any dents on my car. Is it possible my 3 years old got hurt from that accident and had a herniated disc that I did not know of? Ever since she was young or growing up she had this terrible headache every time and to the point she wanted to end her life because the pain is unbearable and said nobody listens to her ( we taught she just need attention and wanted to be pulled out from school ). We took her to a Psychiatrist and said it’s anxiety and was given venlafaxine & sleeping pills. I don’t want my daughter to be over medicated because she was complaining why I am taking all these pills? If someone can help me explain what to do? I want to follow my gut feeling to have her neck MRI’d but my husband think I know more than the doctor in a sarcastic way. Is it possible her neck was affected during that incident? My friend told me to take her to the chiropractor and have her neck reline or something, is it advisable to do that or it might do more harm? I need help please. Thanks

    1. Lynn, I’m sorry it took so long to answer. I can totally understand your frustration with everyone having a different answer for you. My advice is to see someone such as a well respected neurosurgeon who deals with spine and headaches. Often laxity in the ligaments or disc herniations can happen after accidents. Children are harder to deal with because they are active when they feel well and they can reinjure themselves over and over. An MRI and flexion/ extention x-rays could at least ease your mind as to what you are dealing with. I would hold off on any chiropractic care until she is seen by a specialist. good luck to you both.

  6. I was rear-ended by another car 8 weeks ago no immediate pain at the time just pure shock, however, I am now experiencing chronic pain in my lower back
    I am seventy years of age and my vehicle being stationary at the time of impact bent the impact bar.

    1. You did not say when the present back pain started, whether you had it before, or what you have done. If there is no weakness, incontinence or numbness and tingling, you would probably benefit from some daily stretching exercises. Please see a physical therapist and learn how to do this most effectively. Always get these things checked by your MD if they don’t resolve. Good luck.

  7. Hi Dr Shim. I’m glad that I came across this blog. I’m recovering from recent accident Feb 25 , 2018. Front seat passenger on a Grehound bus. We came upon an accident as we came around a bend on a Major BC Highway driver was going 100km and literally 2_3 seconds before colliding into the other collisions. I closed my eyes dropped my head and woke up unable to move being thrown to the other side of the bus That fell a 20 or 30 ft drop on it as side. I was hurt badly with multiple fracture in T1 broken ribs and severe trauma to my left hip. The hospital ambulance put a hard collar on my neck. They took CT there as and ten days later a hospital closer to home repeated scans confirming fractures. The doctor available to me not my personal doctor from home did very little to address my complaint of lots of pain with heavy pain meds.I told him that I felt something was not right two months after accident that my neck bonne seem crooked and out of line when’s I felt under the brace. He ignore my complaints and claimed that I was redundant and dismissed me. More about his treatment and not making appts for five months with specialist has left me with the right side of my T1 He changed those to very strong anti inflamitories but never checked my neck the whole five months. Being a yoga teacher and have done many courses in massage therapy I’m unable to function my SC joint is asymmetrical and protrusion. Could this have been prevented or is it repairable without surgery? Thank you listening. So much more but too long a story. Donna

  8. I got into an accident in 2014 moved c6 and c7 .I can move my upper body but not the lower. I am currently in a wheelchair. I would like to get exercise that will help me to walk again. How ca you help?

  9. I slipped on a grape or something small at a major grocery store at the very end of April 2018. Both of my feet went up in the air but my right ankle twisted somehow so when I landed on my left side (my toenail polish on my R big toe was “erased” from the landing). They have the footage and had their insurance company call me with a claim number. I was in pain for a couple days but didn’t go to the hospital as I felt if it got worse, I would. Ever since then, my back hasn’t been the same (lower R) but I just chalked it up as maybe I slept wrong. Well the other morning, I was getting up from my bed, which is a normal bed height, and I felt like a pop in my lower R back. Again, I chalked it up as nothing. Needless to say, that pain is getting worse. It’s to the point where I have to sit or stand crooked to make it kind of go away. I can feel it from the lower R down to the back of my thigh, sharp pain (like a straight metal rod that’s crooked), if that makes any sense.. I’ve been taking anti inflammatories and Tylenol, etc., but to no avail. I’m prescribed Valium, which can work as a muscle relaxant but again, nothing. It’s constant and I have NO record of back pain, at all. I’ve only had flank pain for UTIs and my urologist said my kidney is fine. So, my question is: Is it possible after two months for an injury to come to light, per se.? Please advise, thank you.

    1. I think the “pop” in your back is probably the culprit. We have seen people herniate a disc with a sneeze. Please see a medical professional if this not resolve. Often, all you need is some physical therapy.

  10. Dr. Shim, I had my lumbar spine fused in Oct 2017. In January of this year I complained of dramatic increase in pain due to PT. I was told by surgeon to stop PT and return if issue continued. I returned in March with more pain. Sent for x-rays and the report was faxed. I was given a BLANK disk from the radiologist. The PA never mentioned the blank disk. She stated significant damage above and below fusion, hardware intact moderate to severe retrolisthesis . I was never informed of this at a different doctor, who stated report doesn’t say anything and the disk is blank. I learned my spine was fused uneven when getting recent x-rays. I have lost dramatic weight,severe pain, hip pain to right knee, trouble breathing etc. My surgeon has denied responsibility. I do not care what happened in past, I want relief from pain. How would you proceed?

    1. Jim,

      Please do not take any information as a specific comment to you or your situation. As you already know, I cannot give any patient specific recommendations online. The terms you have used to describe the disk is not ones used standardly by physicians, so I am concerned there is some interpretation issues that need explanation from a spine specialist. For anyone with continued pain after a procedure, a thorough evaluation by a spine specialist is the best way to understand your situation. Recommendations can only be made after obtaining that evaluation. When calling an office to obtain the evaluation, make sure the scheduling staff knows about your prior surgery. Some spine specialists will not be willing to evaluate you until they have had the chance to look at some of the prior records.

  11. Thanks for this great article. I was in a car accident and had no (zero) pain afterwards. The wreck was substantial and about 11 weeks later a disc in my lower back herniated. My h8sband has been upset thinking the wreck caused my back problem. The wreck was his fault, he fell asleep driving. But I had NO pain after the wreck, at all. This article helps so much, in being able to reassure him that the accident did not injure my back.

    1. So nice to hear from you Wendy and to know that one of our blogs set your mind at rest. I hope you are doing well and will continue to check out the website.

  12. Great insight, Dr. Shim. I had an accident involving my Neck but did not feel Neck pain until 11 weeks after the accident. I eventually had a cervical MRI and found disc herniations in my neck. I did have severe dizziness immediately after the accident and went to the ER. Is the dizziness suggestive of trauma causing disc herniation? I did not have Neck pain or radiculopathy until about two and half months later.

    1. Hi Jarrett, The timing of the onset of symptoms makes it unlikely that the accident is the cause of your herniated discs. However, I don’t know your history, so this is something you need to discuss with your own physician. Good luck.

  13. I have a question; I was in a high speed rear ending, last July. It totaled my car, and gave me great problems in this year. I was in pain, and trauma right after making my insurance claim, and drove my self to emergency. They did their trauma evaluation, and said I was fine. But my back was hurting, and they told me it was just shock, and I was other wise fine. I tried to shake off the pain, and tried to do my new job. I ended up in extreme pain, and wasn’t able to work anymore/ lost my job. Meanwhile, I saw my chiropractor, who set up an MRI for me, the MRI said I have 3 herniated discs. He started physical therapy, but it wasn’t working for me. My toes were cramping, I was weak in my forearms, hard to bend over, major pain across my belt line, and just below my shoulder blades. and ” Sock Effect.” across my feet, legs and arms. I saw a specialist, who forwarded me to a PT center, with a script, and set me up for spine injections. They were helping. Until Allstate, my insurance cut me off, after seeing their doctor for the IME, saying it was all in my head. I am a Psychologist, its not in my head. This is the first time I have dealt with this. Now, out of work, I cant afford the PT, 250 a visit. Or the Spine Injections, at 1,500 a shot. I was pretty active before this. In fact the week before the accident, I was helping fix my parents roof.. WITH NO PAIN, and taking bundles of shingles up on my shoulder, and lifting roofing sheets- with no pain in my back at all. I am going to court soon in the lawsuit I filed. What would be a way, the “other side” could argue, that the accident didn’t cause my back problems. Thank you for your thoughts on this.

    1. Hi Adam, sorry for the delay but I am forwarding this one to Dr. Shim. Will get back to you on or before Monday with your answer.

    2. Hi again Adam. I spoke with Dr. Shim about your questions. His biggest advice was to tell your attorney everything in your history, as surprises are never welcome in a trial. The insurance company generally looks for pre-existing problems, old MRI’s proving there were problems before the accident and proof that the claimant is able to do things they say they are unable to do. Be well!

  14. I thank you for your explanation on this website. However, I will add that when medical professionals such as yourself, and as do radiologists and doctors in general, make statements such as ‘may have occurred…’ or ‘ these pre-existing conditions…’, damage is done legally by the unprovable, and indeterminate words used that add fuel to the fire of insurance provider’s efforts towards deniability of responsibility. Unless you have recently done an MRI or a complete examination before the alleged accident occurred, then factually, you have no rational reason to state that this arthritis, or any other conditions were pre-existing. That is a presumption that can be very harmful to the injured person who is seeking medical treatment. There is a preponderance of research evidence that shows the development of post traumatic arthritis and other conditions that are usually, and carelessly described as degenerative, pre-existing and/or chronic in nature are in fact caused by the trauma itself. That includes all types of trauma to muscle, bones, joints, and so on. The ‘degenerative’ changes actually begin to occur almost immediately after the trauma. In days changes in the tissue can be determine, Within a few weeks, the full blown ‘degenerative’ conditions have manifested.

    1. Intersting comment. As an orthopedic surgeon, i am asked to give my opinion on this topic. If you carefully read my blog, I will always consider the situations and fqctors leading up to the decision to get testing. The testing in isolation, can not be the only determining factor on coming to the conclusion of a very complex situation. In the perfect scenario, there will be a test seconds before the accident, immediately after the accident, then a few days afterwards. That perfect scenario can only be obtained in the lab. In real life, it comes down to a combination of history, physical examination and testing. Thanks again for your comment.

  15. I check out blog sites like this a lot. As a long time sufferer of chronic back
    pain from a car collission I have a lot of free time.
    LOL. However, I’ve never ever been compelled to publish a comment,
    till now. Fantastic post. I enjoyed reading it. I have actually bookmarked your site and shared this post
    on my Facebook wall.

    Thanks once again for your quality work!

  16. Candid Frank and Honest Commentay and analysis . Very Credible . The only way I’d take an apparent no visble damage car accident claim is if the mechanic looked under the bumper and found a damaged “bumper guard’ Thse are made of steel and can become depressed and deformed . The bumper itself may be plastic like and bend and pop back to normal so outwardly there looks to be no damage but underneath there is concealed damage indicating a forveful collision..

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