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Why Isn’t MRI Always the Solution for Diagnosing Whiplash Pain? - Advance Physical Therapy

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  • Why Isn’t MRI Always the Solution for Diagnosing Whiplash Pain?
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If you have neck pain after a car accident, you may wonder if an MRI is necessary to diagnose it. If you’ve been told about herniated discs after motor vehicle accidents, you may want to know if an MRI is the best way to diagnose it. However, diagnosing whiplash pain can be a complex issue, and MRI scans may not always provide the answer.
Research published in 2008 in European Spine Journal by Kongstead et al (1) concluded that MRI is not the answer to the diagnosis of pain in most of the patients that develop long-lasting pain after a whiplash injury
Patients who experience long-lasting pain after a whiplash injury often do not show trauma-related findings in an MRI scan. Trauma-related MRI findings, such as fractures, dislocations, disc separation from vertebral endplates, bleeding, spinal cord injury, and cord compression, are not very common in the majority of MRIs. However, the findings of disc bulges and herniations are very common, and the presence of these findings in asymptomatic MRIs raises questions about the origin of the pain.
Whiplash injuries are believed to be a more complex phenomenon resulting from tissue injury at the time of the accident, followed by neuromodulation, central hypersensitivity, lowered pressure pain threshold, and hyperalgesia (2). These mechanisms will maintain a heightened state of pain, lower activity participation, increased muscle tension, movement impairments, etc. Therefore, whiplash injuries must be evaluated by clinicians trained in traumatic injuries. Clinical assessment often reveals positive findings of muscle spasms, trigger points, altered muscle activation patterns, impairments to the range of motion, nerve involvement, strength deficits, and other factors. The majority of which will not be revealed on MRIs. While MRIs are very necessary for more catastrophic injuries and non-resolving pain, a careful physical examination by trauma-trained physicians and physical therapists is always important.
A well-developed treatment plan should combine your MRI results with clinical examination to provide the most effective improvements. Therefore, it is important to understand the complexities involved in whiplash injuries and what they could mean for patients.
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References:

1. Kongsted A, Sorensen JS, Andersen H, Keseler B, Jensen TS, Bendix T. Are early MRI findings correlated with long-lasting symptoms following whiplash injury? A prospective trial with 1-year follow-up. Eur Spine J. 2008;17(8):996-1005. doi:10.1007/s00586-008-0687-9
2. Astrup J, Gyntelberg F. The Whiplash Disease Reconsidered. Front Neurol. 2022;13:821097. Published 2022 Mar 10. doi:10.3389/fneur.2022.821097

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