Friday, April 10, 2009
As with the mild traumatic brain injuries that we discussed last month, another issue that is often difficult to substantiate is soft tissue injuries, particularly of the spine. These injuries are often referred to as myofascial sprain and strain injuries or as whiplash injuries. Regardless, they are usually characterized by lingering pain localized to the specific region of injury without evidence of an underlying orthopedic injury such as disc disruption, fractures or arthritic changes. Although these injuries may be difficult to diagnose or prove, they can be very debilitating and can result in life-long pain and discomfort for the patient.
Although soft tissue injuries cannot be directly proved with radiological evidence (MRI, CT or X-rays) like disc herniations or fractures can be, there is often indirect evidence in the films. This is usually seen as a “straightening of the lordosis” of the spine. This means that the natural curvature of the spine has been either straightened or reversed. This straightening of the spine is often very evident in the radiological films of a patient experiencing post-traumatic pain. The straightening of the spine is an unconscious effort by the body to protect the area of injury and to alleviate pain.
The actual injury, which occurs to the muscles, ligaments, tendons and other soft tissues around the spine, can be easily explained with just a few simple soft tissue illustrations. First it is important to explain that soft tissues all have microscopic sensory nerves that run through them. Next, it can be understood that the swelling and disruption of the soft tissues immediately following an injury put pressure on these nerves resulting in the pain that we all feel for a few days after an injury. Finally, it should be shown that in these more severe cases, microscopic scar tissue can build up within the soft tissues continuing to distort the nerves, causing pain, even after the swelling of the initial injury has subsided. This scar tissue and the resulting sensory nerve disruption is the physical source of the permanent pain in most of these soft tissue cases.