Explaining Neck and Back Injuries

FREQUENTLY, I AM ASKED TO REPRESENT PEOPLE WHO SUFFER INJURIES TO THEIR NECK AND BACK in car accidents. These injuries are unique in that they are difficult to completely diagnose initially and often worsen over time. To understand these injuries it is important to understand how our backs are constructed.

The spine is the structural support system for our head and upper body and it surrounds and protects the spinal cord. The spinal cord is the main nerve "Super Highway" from our brains to our various body parts. Many individual nerves "branch off" this "Super Highway" and run down to our individual body parts. This is why someone who suffers a neck injury with nerve impingement can feel pain, numbness and tingling in the hand and fingers even though they never suffered a hand injury. Picture a car accident that stops traffic at the "hand" exit ramp on the "Super Highway". The effects of this car accident, no traffic, will ultimately be felt at the endpoint of the exit.

The bones of the spine are called vertebrae. The bodies of the vertebrae are separated by discs. The role of the discs is to connect one vertebra to another while allowing for movement between them. Discs also contribute to the stability of the spine and provide shock absorbency. The easiest way to understand what a disc is and how it works is to picture a Zip Lock baggie filled with Jello. This Jello filled baggie is spongy and pliable and acts as a shock absorber between the bones of our spine (vertebrae). The vertebrae are at the front of the spine with bony components at the sides and back of the vertebrae that surround the spinal cord. The vertebrae have openings through the bone that allows the nerves exit the spinal column.

Our spine is divided into five segments. The neck, or cervical spine is the top portion; it is made up of 7 vertebrae. Below the cervical spine is the mid back or thoracic region, whose 12 vertebrae are attached to our ribs by cartilage. The low back or lumbar spine has 5 thick vertebrae. Below the lumbar spine is the sacrum, which lies between the two pelvic bones. It is actually one bone that was formed by the fusing of what initially were five. The lowermost segment is the coccyx, or tailbone.

Many have heard friends and/or relatives complain they have a "slipped disc", technically, there is no such thing as a slipped disc. The more frequently used medical terms are "bulging disc" or "herniated disc". Discs have a firm fibrocartilaginous outer shell (the Zip Lock baggie) and a softer, more gelatinous interior that contains a great deal of water, collagen and proteins (the Jello). Discs help to absorb the stress on the spine caused by everyday life such as moving, carrying, bending etc. In car accidents discs are most often injured in the neck and low back because this is the areas where there is the greatest movement and stress to the spine.

Sometimes due to the force of the impact and stress placed upon the spine the disc's outer shell (Zip Lock baggie) bulges out of its normal shape. This is called a "bulging disc". This injury is less likely to produce significant nerve damage. This is because the baggie has not actually torn and so the inner gel (Jello) of the disc remains contained inside. As a result of suffering a bulging disc the immediate area may hurt because of irritation of pain receptors and other nerve endings, localized swelling and inflammation.

When the disc's outer shell (Zip Lock baggie) tears, or herniates, the inner gel (Jello) leaks out. Once the Jello is no longer contained in the baggie it can physically press on the nerve roots, where the nerves exit the spine, or on the spinal cord itself. This injury is called a "herniated disc". Herniated discs can cause sensory symptoms such as numbness or tingling, as well as motor symptoms, or weakness. The type and degree of symptoms depends on which portion of the disc herniates and where or what the Jello is pressing on. Symptoms include neck pain, pain that radiating or travels from the injured disc down to another body part, and/or numbness or weakness into the arm or hand on the same side as the disc herniation. With a herniated disc pain is generally intensified with neck movement, especially leaning backward into an extended position. Turning from side to side can often further compress the nerve, increasing symptoms.

Over the years practicing here in Toms River and Ocean County I have observed many different types of treatment for neck and back injuries. This treatment includes but is not limited to; chiropractic manipulation, traditional physical therapy, oral pain and anti inflammatory medications, invasive pain management and unfortunately sometimes surgery. We are very fortunate to have many physicians specially trained and board certified to treat these injuries in the Ocean County area.