Head to Toe After a Frontal Crash: Neck, Back, Hip, Knee and Foot Injuries in an Integrated Chiropractic and Medical Case

This is the story of a woman in her mid-50s who walked into our office eleven days after a frontal collision, hurting from the base of her skull to the soles of her feet. Dr. Alexander Jimenez, DC, APRN, FNP-BC, cared for her and holds two licenses: doctor of chiropractic and board-certified family nurse practitioner, working on a multidisciplinary team that includes an internal medicine physician, rehabilitation staff, and nutrition, naturopathic, and acupuncture providers. Over about twenty weeks, her pain went from 10 out of 10 everywhere to a 1 out of 10 in her back, with her feet as the main remaining problem. This page explains what happened, what we found, what we did and why, what the research says, and what we learned.

Mechanism: Belted driver of a midsize car, frontal collision with a faster, larger SUV; airbag deployed; vehicle a total loss

Time to first visit11 days after the collision, after emergency care and a primary care visit

Course of care: 21 treatment visits over about 20 weeks, plus a final evaluation

Pain at intake10 out of 10, constant, from the neck to the feet

Last rating: low back 1 out of 10, knees 1 out of 10, mid back 1 out of 10; feet now the main complaint

OutcomeMuch improved, no pain medication needed; mild residual disability (Oswestry about 16%); released to self-care with referrals

 

Who treated the patient

Most people who are hurt in a car crash end up seeing several different offices. An emergency department checks them first. A family doctor may prescribe medication. A chiropractor or physical therapist works on the muscles and joints. If something does not improve, there is a referral to a specialist, a wait, and another set of forms. Each office sees one slice of the person, and the patient becomes the messenger who carries information from one place to the next. That works for many people, but it can leave gaps, especially when an injury involves many body regions at once, as this one did.

Our patient was treated in the office of Dr. Alexander Jimenez, who practices as both a doctor of chiropractic and a board-certified family nurse practitioner. In practical terms, that means one provider could examine her spine and extremities the way a chiropractor does, deliver hands-on care, and also take a medical history the way a primary care clinician does, recognize warning signs that need medical testing, order or coordinate that testing, think about medications and their side effects, and refer to medical specialists when the picture called for it. He does this within a larger practice, ChiroMed and Injury Medical Clinic, that also includes medical providers, including an internal medicine physician, and offers family practice and internal medicine services alongside chiropractic care, rehabilitation, nutrition, naturopathic medicine, and acupuncture.

Holistic and allopathic, not one or the other

We describe our practice as both holistic and allopathic, and we mean both words. “Holistic” means we look at the whole person: how she sleeps, what she eats and drinks, how she moves at work, how she feels emotionally, her body composition and fluid balance, and what she can and cannot do in daily life. “Allopathic” refers to conventional medicine: physical examination, medical screening for dangerous conditions, laboratory tests, imaging when it is warranted, medication when it helps, and referral to medical specialists. Many offices practice one model or the other. A purely holistic office may not be set up to recognize when leg swelling needs blood work to rule out a clot. A purely medical office may not be set up to deliver hands-on spinal and extremity care several times a week or to coach a patient through a home exercise program. We set ourselves apart because we do both under one roof, and this case shows why that matters.

In this patient’s care, that combination showed up again and again. It showed up when persistent swelling of both lower legs and an episode of chest pressure prompted a medical work-up for a possible blood clot rather than another session of soft-tissue work. It showed up in the way medication was handled: she preferred not to take pain pills, and the plan respected that while still giving her a topical option and keeping an eye on whether stronger measures were needed. It showed up in the imaging decisions, where we ordered X-rays of the regions that needed them, offered knee films, and deferred an MRI because her course did not call for one. It showed up in body composition testing that let us track fluid in her legs. And it showed up at discharge, when new or persistent findings, namely anxiety, sadness and fear of driving, led to a referral for a behavioral health evaluation rather than being written off as outside our lane.

Why integration matters after a crash

A motor vehicle collision is not a single injury. It is a sudden, violent event that loads the whole body at once. The neck is whipped, the chest is restrained by the belt, the knees can strike the dashboard, the feet are braced on the pedals or the floor, and the brain experiences both a physical jolt and a psychological shock. The injuries that follow are partly mechanical (sprained ligaments, strained muscles, irritated joints), partly neurological (a nervous system that becomes more sensitive to pain), partly circulatory (bruising, swelling, and in some cases risk of clots), and partly emotional (fear, poor sleep, low mood). Good care must address all of these at the same time, because each affects the others. Poor sleep makes pain worse. Pain makes movement harder. Less movement slows healing and can worsen swelling. Fear of driving keeps a person from getting to appointments.

Clinical guidelines for neck and back pain after injury now recommend multimodal care, a combination of manual therapy, exercise, education, and self-management advice, rather than a single treatment.^[1,2] An integrated team is well suited to deliver that combination and to watch for the uncommon but important problems that need medical attention. You can read more about our approach to personal injury care and auto injuries on our main site.

The integrated team’s roles in this case

Different members of the team contributed different pieces of her care. The table below describes those roles in plain language. Not every service listed was used intensively in this case, but each was available, and knowing that they were available shaped decisions throughout her recovery.

How integrated care compares with the usual path

We do not think other models of care are wrong, and many patients do very well with them. But it helps to see the differences side by side. The comparison below reflects general patterns, not any particular office.

None of this guarantees a better result for any single patient. What it does is reduce the chance that something important falls between the cracks, and it lets the treatment plan change quickly when new information appears.

The collision and why the mechanism injures

Our patient was the driver of a midsize car, wearing her seat belt, when her car and a larger SUV collided front to front. The other vehicle was moving faster than hers. Her car was damaged badly enough that it was declared a total loss. The airbag deployed. In the moments of impact she struck the airbag, the steering wheel and the dashboard, and her head was thrown back against a head restraint that was set low. She hit her head but did not lose consciousness. An ambulance took her to an emergency department the same day, where she was examined and had X-rays. In the days that followed, she had an ultrasound of her legs at another facility and received medication from her primary care doctor. Eleven days after the crash she came to our office for the first time.

To understand why a crash like this can injure a person from head to toe, it helps to walk through what the body experiences in the fraction of a second that a frontal collision lasts. Our main site has a whole section on collision and injury dynamics for readers who want more depth.

What happens in a frontal collision

In a frontal crash the car decelerates abruptly. The occupant’s body keeps moving forward at the speed the car was traveling until something stops it. The seat belt catches the pelvis and chest. The airbag inflates in a few hundredths of a second to cushion the head and upper body. But the belt and airbag do not stop every part of the body at the same instant. The pelvis is held by the lap belt, the chest is held by the shoulder belt, and the head, which sits on top of a flexible neck, keeps moving. The head moves forward and down into flexion, then rebounds backward into extension, often striking the head restraint. That forward-then-back motion is the classic whiplash pattern, and it does not require a rear-end crash to happen.

When the two vehicles are mismatched in size, the smaller car usually experiences the greater change in speed. A larger SUV has more mass and typically rides higher, so in a head-on impact the smaller car is pushed back harder and decelerates more sharply. When the larger vehicle is also the faster one, the forces on the occupants of the smaller car are higher still. A vehicle that is a total loss is a rough indicator that a large amount of energy was absorbed by the car’s structure, though vehicle damage alone does not tell us how badly any person was hurt. Some people walk away from heavy damage with little injury, and some are significantly hurt in crashes with modest damage. We consider the vehicle information as one piece of the history, alongside the person’s symptoms and examination.

Head position and the low head restraint

A head restraint works best when its top is at least level with the top of the head and it sits close behind the head. When it is set low, it can act as a fulcrum: on rebound, the head pivots backward over the top of the restraint rather than being supported by it, which increases the bending at the neck. Our patient described her head restraint as set low and recalled striking it. Combined with her forward motion into the airbag, that history fits the neck and upper back pain, the muscle guarding later seen on her neck X-ray, and her headaches. Interestingly, large reviews have found that collision details such as crash direction and head restraint type are only weak predictors of how quickly a person recovers; the person’s own symptoms and psychological response tend to matter more.^[7] So we use the crash details to understand the injury, not to predict the outcome.

Belt loading of the chest, abdomen and pelvis

A seat belt saves lives, but it does its job by applying a very large force across a narrow band of the body. The shoulder belt runs diagonally across the chest and the lap belt across the pelvis. In a hard frontal stop, those straps can bruise the chest wall, strain the muscles between the ribs, and compress the abdomen. People often notice chest soreness and abdominal tenderness in the first days after a crash. Our patient reported pain in her chest and abdomen at her first visit. Chest pain after a crash always deserves medical attention, because it can come from the heart or lungs as well as from the chest wall. That is one reason the medical half of our team kept a close eye on her chest symptoms, and later acted on an episode of chest pressure.

Knees, hips and feet: the lower-body load path

A driver’s lower body is in a particular position at the moment of a frontal crash. The knees are bent and sit close to the lower dashboard. The right foot is usually on the accelerator or the brake, and drivers who see a crash coming often push hard on the brake pedal, locking the leg. In the crash, the body slides forward against the belt, the knees can strike the dashboard, and the force travels up through the thigh bone to the hip. At the same time, the floor and pedals can push up into the feet and ankles. A case-series analysis of drivers in frontal crashes found that axial loading of the leg was the most common mechanism for hindfoot injuries, that ankle injuries also came from rolling in, rolling out and upward bending of the foot, and that injuries were biased toward the right side, with the pedals contributing in a meaningful number of cases.^[14]

This lower-body load path fits several features of our patient’s story: the front of her right knee was her primary complaint at intake; both hips and buttocks hurt; she had pain in her thighs, calves, ankles and feet; and for about a week after the crash she could not move her right foot up or down. She also noticed that one of her legs turned purple within hours of the crash, and her feet and ankles were swollen. That kind of rapid discoloration and swelling reflects bleeding into the tissues and fluid shifting after trauma, and it is one of the reasons swelling was tracked so carefully throughout her care.

Why some symptoms appear later

Many people are surprised that they feel worse two or three days after a crash than on the day itself. There are good reasons for that. At the scene, stress hormones such as adrenaline blunt pain. Over the next 24 to 72 hours, inflammation builds in injured tissues, muscles tighten to guard the injured areas, and swelling accumulates. Bruises that were deep under the skin rise to the surface. Sleep is often poor in those first nights, which lowers pain tolerance. By the time our patient arrived eleven days after the crash, she was in the thick of that inflammatory and guarding phase, which is why her pain was rated 10 out of 10 and present almost everywhere. Our article on how crash injuries are documented with evidence explains why early and consistent records of these symptoms are important.

Understanding the injury

This section explains the anatomy that was involved, the way clinicians grade neck injuries after a crash, what tissues are actually hurt, how soft tissue heals, and why pain can spread and linger. We also cover headache and the patient-specific factors that shaped her care.

The anatomy involved

The neck (cervical spine). The neck has seven vertebrae stacked on top of each other, separated by discs that act as shock absorbers and connected at the back by small paired joints called facet joints. Ligaments hold the bones together, and layers of muscles move and stabilize the head. Nerves leave the spinal cord between each pair of vertebrae and travel into the shoulders and arms. Our patient’s neck X-ray showed disc narrowing at the lower levels, C4 through C7. That kind of narrowing develops gradually with age and is very common in people in their 50s, many of whom have no neck pain at all; she had no neck pain before the crash.

The mid and low back (thoracic and lumbar spine). The mid back has twelve vertebrae, each connected to a pair of ribs, which makes it relatively stiff but also means rib joints can be strained. The low back has five larger vertebrae that carry most of the body’s weight. Large muscles run along both sides of the spine. In her case, the whole back hurt, and she had bruising under the skin of the back, a sign of significant soft-tissue impact.

The hips and buttocks. The hip is a ball-and-socket joint surrounded by strong ligaments and some of the largest muscles in the body: the gluteal muscles behind and the hip flexors in front. Force from the knees striking the dashboard travels up the thigh bone into the hip. Her hip X-rays were normal, which tells us the bones and joint spaces were intact; pain in this area was coming from soft tissues and joint irritation.

The knees. The kneecap sits in front of the knee joint and glides in a groove on the thigh bone. A direct blow to the front of the knee, such as against a dashboard, can bruise the kneecap and the tissues around it, irritate the joint lining, and cause swelling. The front of her right knee was her primary complaint at intake, and knee swelling was noted on examination.

The ankles and feet. Each foot has 26 bones, more than 30 joints and a network of ligaments, tendons and a thick band on the sole called the plantar fascia. The heel bone and the ankle take the load when a foot is braced on a pedal or the floor in a crash. Her foot X-rays showed small heel spurs on both feet and, on one foot, a mild bunion and mild arthritis of the big-toe joint. Those findings are common in adults who spend a lot of time on their feet and are generally long-standing, but they can make a foot more vulnerable to becoming painful after an injury that changes how a person walks.

How neck injuries after a crash are graded

Clinicians often use a grading system for whiplash-associated disorders, abbreviated WAD. Grade 0 means no neck complaints and no physical signs. Grade I means neck pain, stiffness or tenderness without physical signs on examination. Grade II means neck complaints plus musculoskeletal signs such as reduced range of motion and point tenderness. Grade III adds neurological signs such as weakness, reduced reflexes or sensory changes. Grade IV means a fracture or dislocation. Our patient’s neck findings, with pain, muscle spasm and severely reduced motion but no fracture, fit best with a Grade II pattern for the neck itself. Her leg numbness and shock-like pain were taken seriously and monitored; they were not accompanied by findings that required emergency imaging, and they settled over her course of care. The whiplash and whiplash articles on our site go into more detail about these grades.

What is actually injured

“Soft-tissue injury” can sound minor, but it covers a wide range of real damage. In a crash, the tissues most often affected are:

• Muscles and tendons, which can be stretched beyond their normal length while contracting, producing small tears, bleeding, and later spasm and tightness.
• Ligaments, the tough bands that hold bones together, which can be sprained, leaving joints painful and less stable.
• Facet joints in the spine, which can be jammed or stretched, leading to local pain and stiffness and sometimes pain referred to the head, shoulders or buttocks.
• Discs, which can be strained, particularly when they already have age-related changes.
• Joint linings and cartilage in the knees, hips and feet, which can become inflamed after a direct blow.
• Nerves, which can be irritated by swelling and muscle spasm nearby, producing numbness, tingling or electric, shock-like pain.
• Blood vessels and the tissues under the skin, which can bleed and produce bruising and swelling.

Most of these injuries do not show up on X-ray, and many do not show up clearly on MRI either. That is why the history and a careful physical examination are the backbone of diagnosis in cases like hers, and why imaging is used to answer specific questions rather than as a routine first step.

The phases of soft-tissue healing

Soft tissue heals in overlapping phases, and understanding them helps explain why treatment changes over time.

Inflammatory phase (roughly the first few days to two weeks). Blood and fluid move into the injured area. Cells that clean up damaged tissue arrive. The area is swollen, warm and painful, and muscles nearby tighten to protect it. Treatment in this phase focuses on calming pain and swelling, protecting the area, and keeping gentle movement where possible. Our patient arrived near the end of this phase, with swelling still present and pain at its peak.

Repair or proliferative phase (roughly two to six weeks, sometimes longer). The body lays down new collagen, the protein that makes up ligaments and tendons. This early repair tissue is disorganized and weaker than the original tissue. Treatment in this phase aims to restore joint motion, reduce muscle guarding, and begin guided movement so the new tissue forms along useful lines.

Remodeling phase (roughly six weeks to a year or more). The new collagen is gradually reorganized and strengthened in response to the loads placed on it. This is where exercise becomes central: tissues adapt to what we ask of them. The home exercise program she began around week 15 belongs to this phase.

These timelines are averages. Older adults, people with physically demanding jobs, people who cannot rest the injured area, and people with interruptions in care often move through the phases more slowly.

Sensitization: why pain can spread and linger

After a significant injury, the nervous system itself can change. Nerves in injured tissues become more sensitive, and the spinal cord and brain can amplify pain signals. This process is called sensitization. It can make pain feel more widespread than the original injury, make light touch or ordinary movement feel painful, and keep pain going after tissues have largely healed. Poor sleep, stress, fear and low mood all feed sensitization. Our patient’s description of her pain as burning, sharp, deep and tight in almost every region, along with her insomnia and later her anxiety and sadness, suggested that sensitization was part of her picture. That is one reason her care included not only hands-on treatment but also attention to sleep, hydration, reassurance, graded activity, and eventually a behavioral health referral. Research on whiplash shows that high initial pain and low mood are among the strongest predictors of a slower recovery.^[7,20]

Headache and the head injury

She had daily headaches after the crash and described a left-sided head pain “like a blow.” Headache after a crash can come from several sources: the neck itself (cervicogenic headache, where irritated joints and muscles in the upper neck refer pain to the head), a direct blow to the head, tension in the jaw and scalp muscles, or a concussion. She hit her head but did not lose consciousness. Loss of consciousness is not required for a concussion, so her head symptoms were screened at intake, as we describe in the concussion screening section below. Her headaches improved as her neck improved, and both had resolved within the first few months of care, which fits a predominantly neck-related source.

Patient-specific factors

Every injury happens to a particular person, and her particular circumstances shaped her recovery.

• Age. In her mid-50s, she had the kind of age-related disc narrowing in the neck and small heel spurs in the feet that are very common at that age. These were not causing pain before the crash, but they mean her tissues had less reserve to absorb a sudden load and may heal more slowly than a younger person’s.
• A job that keeps her on her feet. Standing and walking for long periods places constant demand on the feet, knees, hips and low back. It also makes it hard to rest injured lower limbs, and it explains why her feet became her most important remaining problem and why returning to full hours was difficult.
• Swelling. Her legs and feet swelled after the crash and stayed swollen for weeks. Swelling can come from injury, from standing, from fluid balance, from the veins, and, importantly, from blood clots. Swelling also makes joints stiff and painful.
• Transportation. After the first week of daily care, transportation problems limited her to about one visit a week. That is a real-world constraint that many patients face, and it shaped the plan.
• Emotional response. She remained sad, anxious and afraid to drive. Distress after a crash is common, and it influences both pain and recovery.
• Personal preferences. She preferred not to take pain medication. Respecting that preference while keeping her safe and comfortable was part of the plan.

Presentation at the first visit

Her first visit to our office took place eleven days after the collision. Before she arrived, she had already been seen in an emergency department, had X-rays there, had an ultrasound of her legs at another facility, and had been given medication by her primary care doctor. She came to us because she was still in severe pain and could not function normally. She is a Spanish speaker, and her history was taken in Spanish so that she could describe her symptoms in her own words.

History: what she told us

She described constant pain that she rated 10 out of 10. She used words like burning, sharp, deep and tight. The pain was not limited to one area. It involved:

• her neck and her entire back, from the base of the skull to the low back;
• her right arm;
• her chest and abdomen;
• both hips and buttocks;
• both thighs;
• both knees, with the front of the right knee as her main complaint;
• both calves, ankles and feet.

She also reported numbness and shock-like pain in one leg. For about a week after the crash she had been unable to move her right foot, and at her first visit she still could not bend it normally. She told us that one leg had turned purple within hours of the crash, and that her feet and ankles had been swollen since. There was bruising under the skin of her back. She had headaches every day, plus a left-sided head pain that she described as feeling “like a blow.” She was not sleeping well. Walking was hard, especially stepping up and down curbs, climbing stairs and walking on uneven ground.

That is a long list, and it would be easy to dismiss some of it as exaggeration or anxiety. We do not approach a history that way. A frontal collision with a larger, faster vehicle is a high-energy event, and it is entirely plausible for it to injure many regions at once. Our job is to take each complaint seriously, examine each region, look for anything dangerous, and build a plan that addresses the most important problems first. We map every region the patient reports, which is what Figure 1 in the outcome section shows.

Examination: what we found

The physical examination confirmed that her complaints matched real, measurable findings. Readers who want to know more about the individual tests can read our section on chiropractic examination and the closer look at examination tests later on this page.

• Joint restriction. Joints were restricted, meaning they did not move through their normal range and felt locked or stiff when tested by hand, from the base of the skull all the way through the low back, and also in the hips, knees, ankles, feet and right arm.
• Muscle spasm. There was widespread muscle spasm, the involuntary tightening of muscles that protect injured areas.
• Spinal range of motion. Movement of the spine was severely reduced at the first visit. This improved to moderately reduced within the first week of care and to mildly reduced by about week 4.
• Low back sensitivity. Her low back was so sore that, at first, only gentle soft-tissue work was tolerated there. Firmer techniques were added as she improved.
• Posture. In week 2, her trunk was tilted to one side, a common protective posture called an antalgic lean, where the body shifts away from a painful structure.
• Knee swelling. Swelling around the knee was noted on examination.
• Leg and foot swelling. Her lower legs and feet were swollen, which was tracked at each visit.

Baseline measures

Baseline measures are the starting line against which progress is judged. For her, the baseline included pain ratings on a 0 to 10 scale for each region, spinal range of motion, the list of restricted joints, the presence and degree of swelling, and a description of what she could and could not do: walking, stairs, curbs, sleeping, standing and working. A foot biomechanical laser scan was performed during the first week to capture the shape and loading of her feet, which matters for someone who spends her working day standing. Later in care, standardized questionnaires were used to put numbers on her function, which we describe in the outcome measures section.

Triage and medical work-up

Triage means sorting out what needs urgent attention, what needs testing, and what can be treated safely right away. This is the part of care where having a nurse practitioner’s medical training in the same room as chiropractic care made a direct difference. You can read about the nurse practitioner services in our integrated practice.

Red-flag screening

“Red flags” are signs that pain may come from something more serious than a sprain or strain: a fracture, a spinal cord or nerve problem that needs urgent care, an infection, a blood clot, a heart or lung problem, an abdominal injury, or a significant head injury. At her first visit and throughout care, she was screened for these. That screening included questions and examination for:

• signs of fracture or instability (for example, severe point tenderness over bone, inability to bear weight, or deformity);
• progressive weakness, loss of bladder or bowel control, or numbness in the saddle area, which can signal nerve compression needing emergency care;
• signs of a deep vein thrombosis, a blood clot in the leg, such as one-sided calf swelling, warmth, redness or tenderness, especially after trauma and reduced activity;
• chest pain, shortness of breath or a racing heart, which could signal a heart or lung problem, including a clot that has traveled to the lungs;
• abdominal pain that could signal internal injury;
• signs of a serious head injury, such as worsening headache, repeated vomiting, confusion, or changes in speech or vision.

At her first visit, she had already been evaluated in an emergency department and had a leg ultrasound elsewhere, and her findings in our office did not call for emergency transfer. But screening is not a one-time event. Her leg and foot swelling persisted, and that kept the possibility of a clot on our list.

The week 4 medical work-up

Around week 4, swelling of both lower legs was still present, graded +1, which means mild pitting swelling that leaves a shallow dent when pressed. At about the same time she described an episode of chest pressure that came with anxiety. Either finding alone might have been explained by her injuries and her stress. Together, in a person who had been injured, less active and in pain for a month, they deserved a medical look. The nurse practitioner side of her care sent her to her primary care doctor for blood work, including kidney function tests and clotting tests, to help exclude a blood clot and other medical causes of swelling. She was given clear instructions to go to an emergency department right away if the swelling worsened or if her leg turned purple again.

No clot or other medical cause was reported from that work-up. Her swelling eased as she recovered, although foot swelling returned mildly later in care, likely related to standing at work and her foot problems. This is a good example of why we keep medical screening active throughout care rather than only at the start. Most of the time, swelling after a crash is from the injury itself. But the uncommon exception is dangerous, and the cost of checking is small.

Imaging decisions

About four weeks into her care, she had X-rays at an outside imaging center of her neck, mid back, both hips and both feet. We chose those regions because they matched her most significant complaints and examination findings, and because X-rays are the right first test to look for fracture and to see the overall condition of the bones and joints.

The results were reassuring:

• No fractures in any of the regions imaged.
• Neck: disc narrowing at C4 through C7, consistent with age-related change that had not been causing pain before the crash; and a straightened neck curve, which in the setting of an acute injury typically reflects muscle guarding rather than a structural problem.
• Hips: normal.
• Feet: small heel spurs on both feet, and on one foot a mild bunion and mild arthritis of the big-toe joint.

It is worth pausing on the age-related findings. Studies of people with no pain at all show that disc degeneration on imaging is extremely common and becomes more common with every decade of life; in people in their 50s, most have some disc degeneration on imaging.^[12] Finding disc narrowing in her neck does not mean the narrowing caused her pain. What it does mean is that her neck had less reserve, which can make an injury more painful and slower to recover, and which helps explain why her neck needed careful, graded care.

Knee X-rays were offered because her right knee had been her main complaint. She preferred to wait, and as her knee pain improved steadily, they turned out not to be needed. No MRI was ordered. Guidelines on imaging for back pain advise against routine advanced imaging in the absence of red flags or a specific question that would change treatment, and recommend considering MRI when symptoms persist despite a reasonable course of conservative care or when surgery or injection is being considered.^[6] Her course did not meet those thresholds during care. A lumbar MRI remains on the list of possible future needs if her low back symptoms persist or worsen.

Medical evaluation and medication

She had already been given medication by her primary care doctor before she came to us. She told us early on that she preferred not to take pain medication. That preference was respected. A topical anti-inflammatory gel was used as a local option for sore areas, and her response to care was monitored so that medication could be reconsidered if she was not improving. By the end of care she needed no pain medication at all.

That approach fits current guidelines. The American College of Physicians recommends that for acute and subacute low back pain, clinicians and patients should first choose non-drug treatments such as superficial heat, massage, acupuncture or spinal manipulation, and if medication is desired, start with nonsteroidal anti-inflammatory drugs or muscle relaxants; opioids are reserved for carefully selected cases.^[3] We discuss the medication approach further in the closer look section.

Whole-person screening

In addition to the musculoskeletal and medical screening, her care included attention to the whole person:

• Sleep. Insomnia was present at the first visit and tracked over time. By the final visit she reported that her sleep had been better over the last month.
• Mood and stress. Anxiety appeared early, including the episode of chest pressure that came with anxiety. At release she remained sad and anxious and was afraid of driving, which led to a behavioral health referral.
• Body composition and fluid balance. Bioimpedance body composition testing was done at about week 10 and again at about week 20, using an analyzer similar to the InBody 770 body water analyzer. We explain what it measured in the body composition subsection.
• Foot mechanics. A foot biomechanical laser scan was done in the first week, which supports decisions about foot orthotics and footwear for a person who stands for long hours.
• Work and daily life. Her ability to stand, walk, sit and work was asked about at each re-examination, along with transportation, which turned out to be a major factor in how often she could attend.

Outcome measures

An outcome measure is a standardized way of putting a number on how a person is doing, so that progress can be compared over time and with other patients. In her case, the measures included:

• Pain ratings on a 0 to 10 numeric scale for each body region, recorded at visits. These are the source for the pain graph in the course of recovery section.
• Spinal range of motion, graded as severely, moderately or mildly reduced.
• The Oswestry Disability Index, a widely used low back questionnaire scored from 0 to 100 percent, where higher numbers mean more disability. Scores of 0 to 20 percent are generally described as minimal or mild disability.
• The Functional Rating Index, a questionnaire that covers both neck and back function in daily activities, also scored as a percentage.
• Functional milestones, such as walking on uneven ground, climbing stairs, how long she could stand or sit before symptoms came on, and how many hours she could work.

At release, her Oswestry score was about 16 percent and her Functional Rating Index was about 20 percent, both in the mild range. We explain what that means for her in the final findings.

Treatment plan and what each treatment does

Her treatment plan was built around a few simple goals: calm the pain and swelling, restore normal motion to the spine and the injured joints, reduce muscle guarding, protect her from anything dangerous, and then rebuild strength and endurance so she could stand, walk and work again. The plan was organized in phases, and it changed as she changed. It also had to adapt to a real-world limit: after the first week of daily care, transportation problems meant she could usually come in only once a week.

Phases of care

The original plan called for daily care in the first week followed by about three visits a week for three weeks. That intensity is common in the early, inflammatory phase after a crash, when pain is high, muscles are in spasm and joints are locked. When transportation became a barrier, the plan was adjusted rather than abandoned: visits became weekly, self-care instructions took on more weight, and the home exercise program became the main engine of progress in the last phase. In total she attended 21 treatment visits over about 20 weeks, plus a final evaluation, with two breaks in care of two and three weeks.

Below, each treatment she actually received is described in three parts: what it is, why she needed it based on her own findings, and what the research shows, including where the evidence is limited. Throughout, it is important to keep a principle in mind: passive treatments that are done to a patient, such as cold packs, electrical stimulation and traction, are adjuncts that help control pain and make active care possible; they are not a substitute for movement and exercise.^[1,2]

A closer look at the details

This section goes deeper into a few topics that patients and families often ask about: what the examination tests actually show, how we approach medication, how concussion is screened, how exercise is progressed, and why careful documentation matters.

What each examination test shows

A musculoskeletal examination after a crash is a series of questions asked of the body. Each test answers one question. Here is what the main parts of her examination were looking for. Our chiropractic examination articles cover these in more depth.

Medication approach

Medication after a crash can be very helpful for some people and unnecessary or unwanted for others. Our approach is to match medication to the person and the injury, to start with the safest options, and to avoid stronger drugs unless they are clearly needed. She came to us already having received medication from her primary care doctor, and she told us she preferred not to take pain medication. That preference mattered. Respecting it meant leaning more heavily on non-drug treatments and self-care, offering a topical anti-inflammatory gel that acts locally with less effect on the rest of the body, and checking at each visit whether her pain was controlled well enough to sleep, move and work.

This is in line with the American College of Physicians guideline on noninvasive treatments for low back pain, which recommends non-drug treatment first for acute and subacute pain, nonsteroidal anti-inflammatory drugs or muscle relaxants if medication is chosen, and careful limits on opioids.^[3] Because the same provider was managing both her musculoskeletal care and her medication approach, there was no gap between the two. By release she needed no pain medication at all.

Concussion screening

She hit her head in the crash without losing consciousness and had daily headaches afterward, plus a left-sided head pain “like a blow.” A concussion is a brain injury caused by a blow or jolt to the head or body, and it does not require being knocked out. Screening asks about headache, dizziness, nausea, sensitivity to light or noise, trouble concentrating, memory problems, mood changes and sleep problems, and checks balance, eye movements and basic neurological function. Warning signs that require emergency care include a headache that keeps getting worse, repeated vomiting, unusual drowsiness, confusion, slurred speech, weakness or numbness on one side, seizures or unequal pupils.

Her head symptoms were screened at intake. She had been evaluated in an emergency department on the day of the crash. Her headaches improved alongside her neck as care progressed and had resolved by about week 13. Because a large share of headaches after a crash come from the neck, improvement of the neck and resolution of the headaches together fits that explanation. Had her head symptoms persisted or worsened, further neurological evaluation would have been arranged.

Exercise progression stages

Exercise after an injury is not one thing. It is a progression, matched to the healing phase and to how the person responds. Her progression followed four broad stages.

1. Protected movement (weeks 0 to 2). Gentle range-of-motion movements within comfort, walking as tolerated, positioning, and leg elevation for swelling. The goal is to keep tissues moving without provoking a flare.
2. Restoring motion (weeks 2 to 8). As spasm settled, more range of motion was expected at each visit, and daily activities such as walking and stairs were gradually increased.
3. Building capacity (weeks 15 to 20). The 32-exercise home program introduced strengthening for the hips, trunk and legs: bridges, hip hinges, hip hikes, sit-to-stand, quadruped rocking, extension work and swimming-style exercises.
4. Self-management (release onward). Continuing a smaller set of exercises and stretches on her own, with heat for stiffness, pacing at work and ergonomic adjustments, and a plan to return if symptoms change.

Because she could only attend weekly, each visit was used to check form and adjust the program. Exercises that caused a lasting flare were scaled back; ones that were easy were made harder. That approach, guided by response rather than a fixed schedule, is consistent with how exercise is used in the trials summarized in the Cochrane review.^[16]

Why documentation matters

Careful records are part of good clinical care, not paperwork for its own sake. A clear record of what she reported at each visit, what was found on examination, what was done and how she responded lets the treating team see trends, spot problems early and change the plan. It allows another clinician, such as a pain-management physician or a behavioral health provider, to understand her history without starting over. And it creates an honest account of the injury and its course that the patient can rely on. Our article on documenting crash injuries with evidence explains what good records include. In her case, documentation captured the pain ratings that make up the graph below, the week 4 swelling that prompted medical testing, and the functional limits at release that shaped her future care plan.

Course of recovery

The table and graph below summarize how her pain changed over the roughly 20 weeks of care. Pain ratings are on a 0 to 10 scale, where 0 is no pain and 10 is the worst pain imaginable. Time is shown as weeks from her first visit.

Weeks 0 to 1: the steep early drop

At her first visit everything hurt at 10 out of 10. During the first week she came in daily for five visits. Care in that week was gentle: soft-tissue work on the low back, cold packs, electrical stimulation, careful adjustments where tolerated, and detailed self-care instructions for ice, leg elevation, fluids and positioning. By the end of that week her low back was at 6, her neck at 5 and her legs at 6 to 7. Her spinal motion improved from severely to moderately reduced. That is a large early change, and it is typical of what happens when protective spasm begins to release and the person starts to feel that recovery is possible.

Weeks 2 to 4: weekly visits, a flare, and a medical check

The plan called for about three visits a week for the next three weeks, but transportation problems limited her to weekly visits. In week 2 her low back and neck were both at 4 and her calf at 5, but her trunk was tilted to one side, a sign that her back was still protecting itself. In week 3 she had a flare: her low back rose to 6, her right foot was worse and she was having pain at night. Flares are common in recovery and often follow a day of more activity, a long shift standing or a poor night of sleep. They are a reason to adjust, not a sign that care has failed.

By week 4 the flare had settled: low back 3 to 4, neck 3, hips 3, and spinal motion only mildly reduced. But the lower-leg swelling was still present at +1, and she described an episode of chest pressure with anxiety. The medical side of her care sent her for blood work, including kidney function and clotting tests, with clear instructions on when to go to the emergency department. X-rays of the neck, mid back, hips and feet were done around the same time and showed no fractures.

Weeks 5 to 14: a plateau, two breaks and a re-examination

From week 5 to week 10 her pain settled in the 3 to 4 range. A two-week break in care was followed by a slight rise to about 4, which then settled again. That pattern, a small rise during a gap in care that comes back down when care resumes, is common and often reflects the loss of regular joint and soft-tissue work combined with the ordinary demands of daily life. At the week 10 re-examination, her goals were partly met and her walking had improved. The first body composition test was done at about this time.

A three-week break followed. When she returned around weeks 13 to 15, her ratings were lower: low back 1 to 2 and hips 2. By then her neck, head, right arm, chest and abdomen had resolved. What remained was concentrated in the low back, hips and lower limbs, the regions that carry her weight all day at work.

Weeks 15 to 21: active rehabilitation and release

Around week 15 the 32-exercise home program began, focused on the low back, hips and lower body. She was referred for a pain-management opinion for her knees and low back. In weeks 17 to 19 her low back stayed at 1 to 2, but she noticed tightness in her legs and short episodes of cramping in the lower back and rib area. Those episodes settled with better hydration and stretching, which fit a muscular cause, and they were tracked alongside her body composition results. By week 20 her low back, knees and mid back were each at 1 out of 10. The second body composition test showed a slight improvement in the extracellular water ratio of the legs, a whole-body ratio within the usual range and a steady phase angle. Her final evaluation took place at about week 21.

Outcome and prognosis

The two body diagrams below show where she hurt during care and how that picture looked at release. Together they tell the story of her recovery more clearly than any list.

Comparing the two pictures

Comparing Figure 1 and Figure 2 shows three things. First, the upper body cleared: her head, neck, right arm, chest and abdomen, all painful at intake, had resolved. Second, the intensity in the remaining areas dropped dramatically, from 7 to 10 out of 10 to about 1 out of 10 in the back and knees, with what remained described mainly as tightness. Third, the problem shifted downward. At intake her worst complaints were her neck, back and right knee. At release, her feet, left more than right, hurt more than her back. That shift is common in people who stand for work: as the spine improves and the person returns to longer days on their feet, the feet carry the load, and any injury or underlying vulnerability there becomes more noticeable.

Final findings and what comes next

At her final evaluation she said she felt much better and no longer needed any medication. She still felt tight in her back and hips, had tightness from the hip to the foot on one side, and both feet were painful, the left more than the right; the feet were now worse than the back. She became stiff after sitting for about 10 minutes and developed pain after standing for 5 to 6 minutes. She tired after 3 to 4 hours of work and was working about half her previous hours. Her sleep had improved over the last month. Emotionally, she remained sad and anxious and was afraid of driving.

Her Oswestry score of about 16 percent places her low back disability in the mild range, meaning she can do most daily activities but with some pain and limits, particularly with prolonged sitting, standing and lifting. Her Functional Rating Index of about 20 percent tells a similar story across neck and back function.

She was released to self-care with a clear plan:

• continue stretching of the back, hips, calves and feet, and use heat for stiffness;
• apply ergonomic changes at work and at home, such as supportive footwear, breaks from standing, a footrest or anti-fatigue mat, and changing positions often;
• pace her activity, increasing work hours gradually as tolerated;
• return as needed if symptoms change or flare;
• attend the behavioral health evaluation for post-traumatic anxiety, depression and fear of driving.

Her record also lists possible future needs if her symptoms persist: a re-examination; foot imaging and a podiatric assessment for the persistent foot pain; a lumbar MRI if low back symptoms persist or worsen; a course of physical therapy; and platelet-rich plasma injections for the feet. We want to be careful about that last option. Platelet-rich plasma, or PRP, is made from the patient’s own blood and injected into an injured area. A 2025 meta-analysis on plantar fasciitis found no difference from corticosteroid injections in the short term but better pain scores with PRP in the medium term.^[11] A 2025 meta-analysis on tendinopathy found mid-term benefits over corticosteroids, while noting that long-term effects still need confirmation,^[10] and a 2025 review of PRP for chronic non-cancer pain reported moderate pain reductions compared with corticosteroid and hyaluronic acid injections.^[15] The evidence varies by condition, preparation method and study quality, and PRP is not appropriate for everyone. It would be considered only after a proper foot diagnosis.

Prognosis

Her prognosis for continued improvement is fair. On the positive side, she improved substantially, her upper body symptoms resolved, she no longer needs medication, her back pain is low, her disability scores are in the mild range, and she has a home program and a plan. On the cautious side, she still has stiffness and foot pain that limit standing and work, she has ongoing anxiety and low mood, and she is in her mid-50s with age-related changes in her neck and feet.

Large reviews of whiplash put this in context. The Bone and Joint Decade Task Force review found that about half of people with whiplash-associated disorders still report neck pain a year after the crash, that greater initial pain and more symptoms predict slower recovery, and that psychological factors such as depressed mood, passive coping and fear of movement predict slower or less complete recovery.^[7] A systematic review and meta-analysis of the course of whiplash found that most recovery happens in the first three months, after which improvement slows.^[20] She began with very high pain and later showed signs of distress, both of which are associated with a slower course. Her neck recovered well despite that. Her residual stiffness and foot pain may persist or recur, especially with long days of standing, and her behavioral health care may influence how well she recovers physically.

We do not promise outcomes. We can say that she leaves care with much less pain, a clear understanding of her body, a structured plan, and an open door to return.

How we process a case like this

Behind every patient story is a process. For a crash case with injuries in many regions, careful organization of the record is part of good care. It helps the treating team, any specialist the patient sees, and the patient herself. Here is how our team approaches it.

Record compilation and review

We gather every relevant document: intake forms and questionnaires, visit notes, examination findings, imaging reports, outside records such as emergency and primary care notes when available, laboratory results, body composition reports, exercise programs and referral letters. We put them in date order and review them for completeness and consistency. Where records disagree on a fact, we note the disagreement rather than choosing a side. That review is part of quality control: it lets us see whether anything was missed and whether the plan followed the findings.

Mechanism and clinical correlation

We describe the mechanism of injury from the history, such as crash direction, vehicle sizes, restraint use, airbag deployment, head position and body contacts, and we compare it with the pattern of symptoms and examination findings. In her case, the frontal crash, belt loading, knee and foot contact and low head restraint fit the distribution of her injuries from neck to feet. We also identify what was present before the crash, such as her age-related disc narrowing and heel spurs, and how those findings interact with the new injury. Our collision dynamics section explains these principles in general terms.

Visual course of care

We turn the visit-by-visit numbers into pictures: body diagrams of the areas reported during care and at release (Figures 1 and 2), and a graph of pain ratings over time (Figure 3). These visuals help the patient see her own progress, help other clinicians understand the case at a glance, and make trends such as flares and breaks easy to spot.

Future care planning

At release we list what the patient may need if symptoms persist, such as re-examination, imaging, specialist opinions, therapy or injections, and the clinical reasons for each. That list is a plan, not a prediction; many patients do not need everything on it. We do not publish costs in a case study like this one.

Medical and chiropractic perspectives in one report

Because our provider holds both chiropractic and nurse practitioner licenses, and because our practice includes medical providers, our reports combine the musculoskeletal findings and the medical findings in one place: joint restrictions next to swelling grades, adjustments next to blood-work decisions, exercise progressions next to behavioral health referrals. That is the integrated model applied to the record itself.

Questions patients ask

I felt fine at the scene. Why do I hurt more days later?

At the scene, stress hormones blunt pain. Over the next one to three days, inflammation builds, muscles tighten to protect injured areas, and swelling and bruising develop. Many people feel worst two to three days after a crash. That is why it is a good idea to be checked even when you feel fine, and to be checked again if new symptoms appear. Our patient was seen in an emergency department the same day and was still at 10 out of 10 eleven days later.

Can a frontal crash really cause whiplash?

Yes. Whiplash describes a rapid back-and-forth motion of the neck, and it can happen in frontal, side and rear impacts. In a frontal crash the head moves forward and then rebounds backward, sometimes striking the head restraint. Our whiplash page explains the mechanism.

My X-rays were normal except for “degeneration.” Does that mean my pain is from aging?

Not necessarily. Disc narrowing and other age-related changes are very common in people with no pain at all, and they become more common with each decade of life.^[12] Our patient had disc narrowing in her neck but no neck pain before the crash. Those changes may make tissues less able to absorb a sudden load and slower to recover, but finding them on an X-ray does not explain away new pain after an injury.

Do I need an MRI?

Most people with neck or back pain after a crash do not need an MRI right away. MRI is generally considered when there are red flags such as progressive weakness or signs of nerve compression, when symptoms persist despite a reasonable course of care, or when the result would change the treatment plan, for example before an injection or surgery.^[6] Our patient did not need an MRI during care; a lumbar MRI remains a possible future step if her back symptoms persist.

Why would a chiropractic office send me for blood work?

Because some problems after a crash are medical, not musculoskeletal. Persistent leg swelling, especially with chest symptoms, can be a sign of a blood clot, which can be dangerous. In our practice, the treating provider is also a board-certified family nurse practitioner, so when our patient’s lower-leg swelling persisted and she described chest pressure, she was sent for blood work including clotting and kidney function tests. You can learn more about our nurse practitioner services.

Is spinal decompression proven to work?

The research evidence for traction and decompression is limited. A Cochrane review found that traction has little or no effect on pain or function for low back pain on average.^[17] Some patients find low-force decompression comfortable and helpful as part of a broader plan. We use it as an adjunct, not as a stand-alone cure, and we put more weight on manual therapy, education and exercise, which have stronger support.

How long will my recovery take?

It varies widely. Many people improve substantially in the first three months, with slower improvement after that.^[20] Higher initial pain, more symptoms, and low mood or fear are linked with a slower recovery.^[7] Our patient went from 10 out of 10 to about 1 out of 10 in her back over roughly 20 weeks, while her feet remained a problem at release.

Why are my feet hurting more now that my back is better?

When the spine settles and you return to longer days on your feet, the feet and ankles carry more load. If they were injured in the crash, or have pre-existing changes such as heel spurs, they may become your main problem. That is what happened in this case. A foot evaluation, footwear and foot orthotics, stretching and, if needed, imaging and a podiatric opinion are reasonable next steps.

I am afraid to drive since the crash. Is that normal?

Fear of driving, anxiety, poor sleep and low mood are common after a crash. About one in five people who survive a road traffic crash develop post-traumatic stress disorder.^[13] Effective treatments exist, especially trauma-focused talk therapies.^[8] Please tell your provider. Our patient was referred for a behavioral health evaluation at release.

Do I have to take pain medication?

No. Medication is a choice. Guidelines recommend starting with non-drug treatments for acute and subacute back pain, and using medication when it helps you function.^[3] Our patient preferred not to take pain medication; she used a topical gel and needed no medication by the end of care. If your pain prevents sleep or movement, talk with your provider about safe options.

A practical guide for patients

This guide is based on what helped our patient and on general principles from the research. It is not a substitute for being examined. If you have been in a crash, please see a qualified provider. You can schedule an appointment or contact our team.

The first days

• Get checked. Go to an emergency department for any head injury with worsening symptoms, chest pain, shortness of breath, abdominal pain, severe pain, numbness or weakness, or inability to walk.
• Use cold for swelling. Apply a cold pack wrapped in a thin cloth for 10 to 20 minutes at a time, several times a day, to painful, swollen areas.
• Elevate swollen legs. Raise your legs above the level of your heart while resting.
• Keep gently moving. Short walks and gentle range-of-motion movements are usually better than strict bed rest.
• Drink enough fluids. Staying hydrated supports healing and can help with cramping.
• Protect your sleep. Use pillows to support painful areas and keep a regular sleep schedule.
• Write things down. Note your symptoms, where they are, and how bad they are each day. This helps your provider and gives you a clear picture of progress.

The first weeks

• Keep your appointments if you can. Early, frequent care helps calm pain and restore motion. If transportation is a problem, tell your provider so the plan can be adjusted, as it was in this case.
• Expect ups and downs. A flare after a busy day does not mean you are getting worse. Our patient had a flare in week 3 that settled by week 4.
• Watch your legs. If one or both legs stay swollen, become warm, red or painful, or turn purple, or if you develop chest pain or shortness of breath, seek medical care right away.
• Ask about medication. If you prefer to avoid pain pills, say so. Topical options and non-drug treatments are available.
• Notice your mood. Anxiety, poor sleep, fear of driving and sadness are common. Tell your provider early.

As you improve

• Shift from passive to active care. As pain settles, exercise becomes the most important part of recovery. Do your home program regularly.
• Progress gradually. Add repetitions, time or difficulty a little at a time. If an exercise causes pain that lasts into the next day, scale it back.
• Switch from cold to heat for stiffness. Heat and stretching help with tightness once the early swelling phase has passed.
• Stay hydrated and stretch for cramps. Short cramping episodes, like the ones our patient had in weeks 17 to 19, often respond to fluids and stretching.

Setting up the day

• Break up sitting and standing. If you get stiff after 10 minutes of sitting or sore after 5 minutes of standing, change positions before you reach that point.
• Use supportive footwear. Cushioned, supportive shoes, and orthotics if recommended, can ease foot pain for people who stand at work.
• Consider an anti-fatigue mat or footrest. These reduce strain during long periods of standing.
• Plan rest breaks. Short, regular breaks are better than pushing until you are exhausted.

Returning to family, work and recreation

• Return to work gradually. Our patient returned to about half her previous hours. Increase hours step by step and talk with your provider about any work limits.
• Return to household tasks in pieces. Break chores into short blocks with rests in between.
• Return to recreation with care. Start with low-impact activities such as walking or swimming, then build up. For sports, ask about a structured return; see our sports injury services.
• Get help with driving fears. Gradual exposure, ideally guided by a behavioral health professional, can help you return to driving.

When to seek urgent care

Ten key takeaways

1. A frontal crash can injure the whole body, from head to feet. Belt loading, a low head restraint, knee contact with the dashboard and feet braced on the floor or pedals together explain how one collision hurt her neck, back, chest, hips, knees and feet.
2. Every complaint deserves to be mapped and examined. Her long list of painful regions matched real findings on examination, including joint restrictions from the skull to the feet, widespread spasm and swelling.
3. Medical screening continues throughout care, not only at the first visit. Persistent +1 leg swelling and an episode of chest pressure at week 4 led to blood work, including clotting tests, to exclude a blood clot.
4. Imaging should answer a specific question. Targeted X-rays excluded fractures and showed age-related changes; knee films were offered and turned out not to be needed; an MRI was not required during care.
5. Age-related findings on X-ray do not explain away new pain. Her neck disc narrowing had been painless before the crash, and such findings are very common in people her age without pain.
6. Respecting a patient’s preferences is part of good medicine. She preferred not to take pain medication; a topical gel and non-drug treatments were used, and she needed no medication by release.
7. Passive treatments help, but exercise does the heavy lifting. Cold, electrical stimulation, massage and decompression were adjuncts; the 32-exercise home program from week 15 targeted the strength and endurance she needed to stand and work.
8. Real life shapes the plan. Transportation problems reduced her visits to weekly after the first week, and two breaks in care produced small rises in pain; the plan was adapted rather than abandoned.
9. Recovery can shift the problem to a new place. As her back improved and she returned to standing at work, her feet became her main complaint, which points to foot-focused next steps.
10. The mind and body recover together. Her ongoing sadness, anxiety and fear of driving led to a behavioral health referral, because distress after a crash is common, treatable and linked to slower physical recovery.

Glossary of terms

Adjunct

A treatment used alongside the main treatment to help it work or to improve comfort, rather than on its own.

Antalgic lean

A protective tilt of the trunk away from a painful structure.

Bioelectrical impedance analysis (bioimpedance)

A painless test that uses a tiny electrical current to estimate body water, muscle and fat.

Bunion

A bony bump at the base of the big toe, often with the toe angled toward the others.

Cervical spine

The seven vertebrae of the neck, numbered C1 to C7.

Concussion

A brain injury caused by a blow or jolt to the head or body; loss of consciousness is not required.

Deep vein thrombosis

A blood clot in a deep vein, usually in the leg, which can travel to the lungs.

Disc narrowing

Loss of height of the disc between two vertebrae, usually from gradual age-related change.

Extracellular water ratio

The share of body water that is outside the cells; a higher value can reflect swelling.

Facet joint

A small paired joint at the back of each spinal segment that guides movement.

Flexion-distraction

A gentle chiropractic technique that rhythmically bends and opens the low back on a special table.

Functional Rating Index

A questionnaire that measures how neck and back pain affect daily activities, scored as a percentage.

Heel spur

A small bony growth on the heel bone, common in adults and often painless.

Multimodal care

A combination of treatments, such as manual therapy, exercise and education, used together.

Oswestry Disability Index

A widely used questionnaire about how low back pain affects daily life, scored from 0 to 100 percent.

Phase angle

A bioimpedance value used as a general marker of cell health and integrity.

Pitting edema (+1)

Swelling that leaves a small dent when pressed; +1 is the mildest grade.

Platelet-rich plasma (PRP)

A concentrate of the patient’s own blood platelets injected into an injured area to support healing.

Range of motion

How far a joint or the spine can move in each direction.

Red flag

A sign or symptom that may point to a serious condition requiring urgent medical evaluation.

Sensitization

A state in which the nervous system amplifies pain signals, making pain more widespread or persistent.

Spinal decompression

A motorized table treatment that applies a gentle, cyclic pull along the spine.

Spinal manipulation (adjustment)

A quick, controlled, small-amplitude thrust applied by hand to a restricted spinal joint.

Whiplash-associated disorder (WAD)

The range of neck-related symptoms after a sudden acceleration-deceleration of the head, graded 0 to IV.

Explore more

These pages on our two websites cover the conditions, tests, treatments and services discussed in this case study.

On dralexjimenez.com

• About Dr. Alexander Jimenez, DC, APRN, FNP-BC
• Board-certified family nurse practitioner care
• Our internal medicine physician
• Personal injury doctor
• Auto injury articles
• Whiplash injuries and chiropractic care
• Whiplash articles
• Collision and injury dynamics
• Documenting crash injuries with evidence
• Neck pain articles
• How spinal manipulation works
• Spinal decompression articles
• Decompression treatments
• Body composition analysis
• InBody 770 body water analyzer
• Foot orthotics
• Physical therapy center
• Mobility and flexibility
• Chiropractic examination
• Functional medicine
• Schedule an appointment
• Legal disclaimer and scope of practice

On chiromed.com

• About ChiroMed
• Integrated medicine services
• Chiropractic care
• Nurse practitioner services
• Rehabilitation
• Nutrition
• Acupuncture
• Naturopathic medicine
• Sports injuries
• Contact us

Whole-person approaches to recovery, including diet, hydration and lifestyle, are discussed in our functional medicine articles, and our full range of services is listed on the ChiroMed services page.

References

All references were verified in PubMed. Each links to its DOI.

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2. Bussières AE, Stewart G, Al-Zoubi F, et al. Spinal manipulative therapy and other conservative treatments for low back pain: a guideline from the Canadian Chiropractic Guideline Initiative. J Manipulative Physiol Ther. 2018;41(4):265-293. doi:10.1016/j.jmpt.2017.12.004
3. Qaseem A, Wilt TJ, McLean RM, Forciea MA. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166(7):514-530. doi:10.7326/M16-2367
4. Paige NM, Miake-Lye IM, Booth MS, et al. Association of spinal manipulative therapy with clinical benefit and harm for acute low back pain: systematic review and meta-analysis. JAMA. 2017;317(14):1451-1460. doi:10.1001/jama.2017.3086
5. Furlan AD, Giraldo M, Baskwill A, Irvin E, Imamura M. Massage for low-back pain. Cochrane Database Syst Rev. 2015;(9):CD001929. doi:10.1002/14651858.CD001929.pub3
6. Hutchins TA, Peckham M, Shah LM, et al. ACR Appropriateness Criteria low back pain: 2021 update. J Am Coll Radiol. 2021;18(11S):S361-S379. doi:10.1016/j.jacr.2021.08.002
7. Carroll LJ, Holm LW, Hogg-Johnson S, et al. Course and prognostic factors for neck pain in whiplash-associated disorders (WAD): results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. J Manipulative Physiol Ther. 2009;32(2 Suppl):S97-S107. doi:10.1016/j.jmpt.2008.11.014
8. Schnurr PP, Hamblen JL, Wolf J, et al. The management of posttraumatic stress disorder and acute stress disorder: synopsis of the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline. Ann Intern Med. 2024;177(3):363-374. doi:10.7326/M23-2757
9. Koc TA Jr, Bise CG, Neville C, et al. Heel pain – plantar fasciitis: revision 2023. J Orthop Sports Phys Ther. 2023;53(12):CPG1-CPG39. doi:10.2519/jospt.2023.0303
10. Ye Z, Yuan Y, Kuang G, et al. Platelet-rich plasma and corticosteroid injection for tendinopathy: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2025;26(1):339. doi:10.1186/s12891-025-08566-3
11. Rayo-Martín R, Rayo-Rosado R, Rayo-Pérez AM, et al. Comparison of PRP injections versus corticosteroid injections in plantar fasciitis: systematic review and meta-analysis. Foot Ankle Spec. 2025. doi:10.1177/19386400251363002
12. Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811-816. doi:10.3174/ajnr.A4173
13. Shahsavarinia K, Sabahi Z, Tahmasbi F, et al. A systematic review and meta-analysis of the prevalence of post-traumatic stress disorder (PTSD) in road traffic accident survivors. Health Promot Perspect. 2025;15(3):213-235. doi:10.34172/hpp.025.43651
14. Ye X, Funk J, Forbes A, et al. Case series analysis of hindfoot injuries sustained by drivers in frontal motor vehicle crashes. Forensic Sci Int. 2015;254:18-25. doi:10.1016/j.forsciint.2015.06.015
15. Wang F, Meng F, Chan TCW, Wong SSC. Platelet-rich plasma for treating chronic noncancer pain: a systematic review and meta-analysis of randomized controlled trials. Pain Ther. 2025;14(4):1169-1188. doi:10.1007/s40122-025-00751-5
16. Hayden JA, Ellis J, Ogilvie R, Malmivaara A, van Tulder MW. Exercise therapy for chronic low back pain. Cochrane Database Syst Rev. 2021;9(9):CD009790. doi:10.1002/14651858.CD009790.pub2
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