Discover how chiropractic care, combined with an understanding of causation, can address the root causes of pain.
Table of Contents
This educational post explores causation in personal injury cases and its essential partnership with chiropractic care. Written from the clinical perspective of Dr. Alexander Jimenez, DC, APRN, FNP-BC, CFMP, IFMCP, ATN, CCST, it guides readers from legal definitions to physiological mechanisms, evidence-based outcomes, and real-world application in a multidisciplinary clinic. You will learn what causation means (actual cause and proximate cause), what chiropractic care is, how spinal adjustments and related techniques reduce musculoskeletal injuries and their comorbidities, and how careful clinical documentation provides insight for personal injury claims. The post incorporates the latest findings from leading researchers using modern methods such as randomized controlled trials measuring biomarkers, neurophysiological studies, and systematic reviews. It also explains how integrative chiropractic care fits into non-surgical treatment pathways under the medical direction of Dr. Maria Guadalupe Cardenas, MD, Board Certified in Internal Medicine (NPI #1164426749, Texas MD License #J2933), with over 40 years of experience as an internist. At Injury Medical Clinic PA (also known as Mission Plaza Injury Medical Clinic) in El Paso, Texas, Dr. Jimenez and Dr. Cardenas collaborate to integrate chiropractic care, medical oversight, functional medicine, personal injury care, and rehabilitation. The goal is to help readers understand why addressing the root biomechanical and neurological drivers of injury leads to better recovery and clearer causation evidence.
Causation is the critical link connecting a defendant’s actions (or failure to act) to the harm an injured person suffers. Without proving causation, even clear negligence and significant damages do not result in recovery. Courts and insurance adjusters examine two related but distinct elements: actual cause (also called cause-in-fact or the “but-for” test) and proximate cause (legal cause).
Actual cause asks a straightforward question: Would the injury have occurred “but for” the defendant’s conduct? If the answer is no, the defendant’s actions are a factual cause. Multiple actual causes can contribute to one injury. For example, a driver who runs a red light creates the conditions for a collision; the impact itself produces soft-tissue damage, disc injury, or nerve irritation. Medical experts help establish this link by showing that the mechanism of the accident is consistent with the diagnosed injuries and that alternative explanations (such as pre-existing degeneration alone) do not fully account for the findings.
Proximate cause limits liability to consequences that are reasonably foreseeable and closely connected to the defendant’s actions. Courts often apply a “substantial factor” test: Did the defendant’s conduct play a significant, non-trivial role in bringing about the injury? Foreseeability is also examined—would a reasonable person have anticipated that the type of harm that occurred could result from the negligent act? In motor vehicle collisions, neck pain, low back pain, headaches, and radiating extremity symptoms are generally viewed as foreseeable outcomes of impact forces. Medical causation (the scientific and clinical relationship between the event and the condition) supports but is not identical to legal causation. Physicians and chiropractors provide opinions on medical causation; attorneys and the court determine whether that relationship meets the applicable legal standard.
In personal injury practice, expert documentation is essential. Detailed histories, objective examination findings, imaging when indicated, functional assessments, and consistent treatment records create a chronological narrative showing the injury arose from, or was aggravated by, the incident. Delayed symptom onset, common with soft-tissue and disc injuries, must be explained physiologically rather than dismissed. Pre-existing conditions do not automatically defeat a claim; if the trauma substantially contributed to accelerating or worsening the condition, liability can still attach. This differs from many workers’ compensation systems that require the work injury to be the major contributing cause of disability or the need for treatment.
Clinical experience at Injury Medical Clinic PA shows that thorough, objective documentation of range of motion, muscle strength, neurological findings, and functional limitations (for example, the ability to rise from the floor without using the hands or to perform work-related lifts) strengthens the causation analysis more effectively than pain scores alone. Pain can fluctuate; measurable loss of function provides clearer evidence of impairment linked to the event.
Chiropractic care is a licensed health profession focused on diagnosing, treating, and preventing neuromusculoskeletal disorders, with particular emphasis on the spine and its relationship to the nervous system. Doctors of Chiropractic use manual techniques, primarily spinal manipulation or adjustment, along with soft-tissue therapies, rehabilitative exercise, and patient education. The central clinical finding is often vertebral joint dysfunction—sometimes called a vertebral subluxation in the chiropractic literature—characterized by restricted motion, altered muscle tone, tenderness, and abnormal joint end-feel. These findings correspond to the ICD-10-CM code M99.1 (vertebral subluxation complex).
The physiological rationale begins with biomechanics and neurology. The deep paraspinal muscles contain dense concentrations of muscle spindles that provide continuous proprioceptive feedback to the central nervous system about spinal position and movement. When a motion segment becomes hypomobile, this afferent input becomes altered. Over time, the central nervous system adapts through neuroplastic changes: altered sensorimotor integration, modified reflex excitability, changes in cortical processing, and shifts in autonomic balance. These adaptations can contribute to pain, muscle inhibition or guarding, reduced coordination, and secondary effects on other body systems. High-velocity, low-amplitude adjustments deliver a rapid stretch to the paraspinal tissues, producing a barrage of proprioceptive signals that can reset aspects of this altered processing.
Modern research supports these mechanisms. Studies demonstrate that spinal manipulation can improve joint position sense, alter cortical excitability, reduce reflex hyper-excitability, and improve motor control. A 2024 study on neuroplastic responses found changes in EEG power spectra and source localization within the default mode network after chiropractic care, accompanied by improvements in sleep, anxiety, depression, fatigue, and pain. These findings suggest benefits extend beyond local joint mechanics to central nervous system function.
Chiropractic care is not limited to “cracking” the spine. Contemporary practice includes multimodal approaches: flexion-distraction for disc-related conditions, instrument-assisted soft-tissue mobilization (such as Graston or Gua Sha) for fascial restrictions, spinal decompression to reduce intradiscal pressure, and progressive rehabilitation to restore strength and motor control. When integrated with medical evaluation, functional medicine laboratory assessment, and nutritional support, the approach addresses both the mechanical drivers of injury and the systemic factors that influence healing.
In personal injury cases, chiropractic care serves two complementary roles: treating injuries and generating clinical evidence that helps establish causation. Early evaluation captures baseline deficits that can be compared over time. Objective measures—restricted cervical rotation after a rear-end collision, positive orthopedic tests for disc or facet irritation, muscle weakness in a specific myotome, or altered gait—create a record that links the mechanism of injury to the clinical findings.
Treatment itself provides further support. When range of motion, strength, and function improve with consistent care and then plateau or regress after an interruption, the pattern reinforces that the condition responds to addressing the trauma’s biomechanical and neurological sequelae. Conversely, failure to improve after an appropriate trial may indicate the need for additional diagnostics or co-management, which is also documented.
Dr. Jimenez’s clinical observations emphasize that function tells more than isolated pain scores. A patient may report reduced pain yet still be unable to rise from the floor independently or complete a work-specific lift. Documenting these functional deficits, along with the specific adjustments and rehabilitative protocols used to address them, creates a coherent narrative for causation. Timing matters: symptoms that begin or worsen after the incident, even if delayed by hours or days, align with the inflammatory cascade and delayed muscle guarding that follow soft-tissue and joint trauma.
The collaboration with Dr. Maria Guadalupe Cardenas, MD, strengthens this process. As Medical Director and Collaborative Physician, Dr. Cardenas provides oversight in internal medicine. She evaluates for comorbidities (hypertension, diabetes, inflammatory conditions, nutritional deficiencies) that can slow healing or complicate recovery. When medical conditions are identified and managed, the remaining deficits can be more confidently attributed to the traumatic event rather than to uncontrolled systemic disease. This multidisciplinary documentation—chiropractic biomechanical findings plus medical evaluation—produces a more complete picture of medical causation.
Traumatic musculoskeletal injuries commonly involve ligaments, discs, facet joints, muscles, and surrounding neural structures. The initial mechanical disruption triggers an inflammatory response: cytokine release, increased vascular permeability, and nociceptor sensitization. If motion remains restricted and proprioceptive input stays altered, central sensitization can develop. Dorsal horn neurons become hyperexcitable, expanding the receptive field so that non-painful stimuli produce pain (allodynia) and pain spreads beyond the original injury site (secondary hyperalgesia). Comorbidities frequently appear: sleep disruption, anxiety, reduced physical activity leading to deconditioning, metabolic changes, and, in some patients, contributions to conditions such as tension-type or cervicogenic headache, pelvic pain, or upper-extremity neuropathy.
Chiropractic care targets these processes at multiple levels. Restoration of segmental motion reduces abnormal mechanical stress on ligaments and discs and normalizes afferent input from muscle spindles. The rapid proprioceptive barrage from an adjustment can modulate nociceptive processing at the spinal cord and higher centers, decreasing central sensitization. Soft-tissue techniques address fascial adhesions and myofascial trigger points that perpetuate local inflammation and referred pain. Progressive rehabilitation restores motor control, preventing the compensatory movement patterns that overload other joints and create secondary injuries.
A 2025 pragmatic randomized controlled trial published in PLOS ONE examined the effects of 12 weeks of chiropractic spinal adjustments on physiological biomarkers in adults with subclinical spinal pain. Compared with sham care, the chiropractic group showed higher blood levels of brain-derived neurotrophic factor (BDNF), a marker associated with neuroplasticity; higher IL-6; and lower TNF-α at 12 weeks. At 16-week follow-up, the chiropractic group demonstrated lower blood cortisol and IFN-γ. These findings suggest modulation of neurotrophic, inflammatory, and stress pathways. While effects were modest and further research is needed, the results provide preliminary evidence that chiropractic care influences systemic physiology beyond local musculoskeletal outcomes (Amjad et al., 2025).
Additional research supports benefits for specific conditions. Systematic reviews and network meta-analyses indicate that spinal manipulative therapy can produce small-to-medium improvements in pain and function for chronic low back pain compared with sham or no treatment, with a favorable safety profile when performed by trained clinicians. For cervicogenic headache, cervical manipulation and sustained natural apophyseal glides have ranked highly for short-term pain and disability reduction. Integrative approaches that combine manual therapy with exercise and lifestyle measures address both the primary injury and the secondary effects of reduced activity, poor sleep, and elevated stress hormones.
Comorbidities decrease because the same neural and inflammatory pathways that drive pain also affect mood, sleep, and autonomic function. Improved sensorimotor integration and reduced nociceptive drive can decrease the allostatic load that contributes to fatigue, anxiety, and metabolic dysregulation. In the clinic, patients often report better sleep and reduced overall body tension once segmental motion and muscle tone normalize, even when their primary complaint was localized pain.
Chiropractic care offers several unique insights into personal injury cases. First, it documents joint dysfunction and soft-tissue injury that static imaging may not fully capture. Dynamic findings—restricted intersegmental motion, palpable muscle hypertonicity, and positive functional tests—explain why a patient with “negative” imaging still has significant impairment. Second, serial examinations track recovery or the lack of recovery, providing objective evidence of the duration and extent of disability. Third, the response to specific interventions (improvement after targeted adjustment of a hypomobile segment, reduction in radiating symptoms after decompression) supports the mechanistic link between the trauma and the residual findings.
Clinical observations from Dr. Jimenez’s practice illustrate these points. Patterned symptoms—for example, neck tightness that reliably begins at the same hour each afternoon—often point to cumulative load or a specific postural or occupational factor interacting with the residual injury. A winged scapula during a push-up is treated as a sign of possible serratus anterior inhibition or nerve-related dysfunction rather than an automatic diagnosis of long thoracic nerve injury; further testing and co-management clarify the contribution of the recent trauma versus chronic factors. The ability (or inability) to rise from the floor without using the hands serves as a practical measure of overall functional capacity that can be reassessed over the course of care. These observations are recorded alongside standard orthopedic and neurological testing, creating a detailed clinical picture that attorneys and insurers can evaluate.
When symptoms persist despite appropriate conservative care, the documentation supports the need for additional medical evaluation or referral, which Dr. Cardenas coordinates under medical direction. This transparency strengthens rather than weakens the overall causation analysis by showing that alternative explanations were considered and addressed.
Non-surgical management of musculoskeletal trauma is the preferred first-line approach for the majority of soft-tissue, disc, and joint injuries. Integrative chiropractic care plays a central role in this pathway because it directly addresses biomechanical and neurological components while coordinating with medical, functional medicine, and rehabilitative services.
At Injury Medical Clinic PA, the model includes:
Each element is based on physiological reasoning. Adjustments and decompression reduce mechanical stress and aberrant afferent input, thereby decreasing nociceptive drive and central sensitization. Soft-tissue work addresses the fascial and muscular components that maintain local inflammation and restricted motion. Rehabilitation rebuilds motor patterns altered by pain and guarding, helping prevent recurrence. Functional medicine identifies and corrects systemic barriers to healing—elevated inflammatory markers, micronutrient deficiencies, or sleep disruption—that can prolong recovery. Medical direction ensures that any underlying internal medicine issues are managed so that the musculoskeletal treatment can proceed safely and effectively.
This integrated approach is particularly valuable in personal injury because it produces comprehensive records that demonstrate both the nature of the injuries and the efforts made to achieve maximal medical improvement through non-surgical means. When surgery is ultimately required, the prior conservative care and clear documentation of failure to improve support the medical necessity of the more invasive intervention.
Dr. Alexander Jimenez, DC, APRN, FNP-BC, CFMP, IFMCP, ATN, CCST, leads the chiropractic and integrative clinical care. His dual licensure as a Doctor of Chiropractic and board-certified Family Nurse Practitioner allows him to perform advanced musculoskeletal assessment, order and interpret diagnostic studies, and coordinate care across disciplines. Additional certifications in functional medicine, spinal trauma, and nutrition further inform the protocols used for complex injury and chronic pain cases.
Dr. Maria Guadalupe Cardenas, MD, Is Board-Certified in internal medicine and serves as Medical Director and Collaborative Physician. With over 40 years of experience as an internist (NPI #1164426749, Texas MD License #J2933), she provides medical direction, evaluates systemic conditions, and ensures that treatments remain appropriate within the broader context of the patient’s health. This arrangement is common in integrative and injury care clinics: the physician supplies medical oversight and internal medicine expertise while the chiropractor directs biomechanical diagnosis, manual therapy, and rehabilitation.
The team integrates:
Patients benefit from a single coordinated plan rather than fragmented care. Imaging, laboratory results, treatment notes, and functional progress are shared, allowing each provider to contribute within their scope while maintaining a unified clinical narrative. This structure supports both optimal recovery and the clear causation documentation required in personal injury matters.
Years of practice have reinforced several practical principles. Pain scores are useful but incomplete; measurable function—rising from the floor, completing a controlled lift, maintaining posture during prolonged sitting—provides more reliable information about recovery and residual impairment. The goal of rehabilitation is not to teach patients a list of movements to avoid permanently; it is to restore the capacity to perform those movements safely and efficiently. A procedure (adjustment, injection, or modality) is one component of a plan, not the entire plan. Signs such as a winged scapula, a painless hip click, or pain that begins at a consistent time of day are treated as clinical clues that guide further testing rather than immediate diagnoses.
The clinic applies these observations daily and documents them so the connection between the traumatic event, the residual findings, and the response to care remains transparent. Combined with the medical evaluation provided under Dr. Cardenas’s direction, this creates a comprehensive record that supports both the patient’s recovery and the legal analysis of causation.
Contemporary research continues to refine the understanding of how manual therapies influence physiology. The 2025 PLOS ONE trial (Amjad et al.) showed measurable changes in BDNF, TNF-α, IL-6, and cortisol after 12 weeks of chiropractic care, preliminarily supporting effects on neuroplasticity, inflammation, and stress regulation. Earlier work by Haavik and colleagues has shown alterations in cortical processing, sensorimotor integration, and muscle function following spinal adjustments. Systematic reviews of spinal manipulative therapy for chronic low back pain report small-to-medium benefits in pain and function with low rates of serious adverse events. Network meta-analyses of manual therapies for cervicogenic headache identify manipulation and specific mobilization techniques as effective short-term options when delivered by experienced clinicians.
These findings align with clinical experience: addressing joint dysfunction and altered proprioceptive input can reduce pain, improve function, and modulate some of the systemic processes that contribute to comorbidities. Ongoing research is needed to clarify dose, duration, and the patient subgroups most likely to benefit, but existing evidence supports including chiropractic care in evidence-informed, non-surgical injury management.
Causation in personal injury is the essential bridge between an event and the resulting harm. Grounded in biomechanics and neurology, chiropractic care both treats the musculoskeletal consequences of trauma and generates objective clinical evidence that helps establish that link. By restoring segmental motion, normalizing afferent input, reducing inflammatory and nociceptive drive, and supporting functional recovery, integrative chiropractic care reduces the burden of injury and its comorbidities. When delivered within a multidisciplinary setting that includes medical oversight from an experienced internist such as Dr. Maria Guadalupe Cardenas, the approach becomes even more robust. Patients receive coordinated, non-surgical care aimed at maximal recovery, and the resulting documentation provides a clear, physiologically reasoned account of medical causation. This combination of clinical effectiveness and evidentiary clarity is why integrative chiropractic care remains a valuable component of modern personal injury practice.
Amjad, I., Niazi, I. K., Kumari, N., Ghani, U., Rashid, U., Duarte, F. C. K., Fortuna, F., Iglesias, S., Gonzalez, D., Sumich, A., Fabre, B., Holt, K., & Haavik, H. (2025). The effects of 12 weeks of chiropractic spinal adjustments on physiological biomarkers in adults: A pragmatic randomized controlled trial. PLOS ONE, 20(12), e0338730.
Haavik, H., & Murphy, B. (2012). The role of spinal manipulation in addressing disordered sensorimotor integration and altered motor control. Journal of Electromyography and Kinesiology, 22(5), 768–776.
Jimenez, A. D. (n.d.). Clinical observations and practice resources. Sciatica Pain and Treatment Clinic.
Jimenez, A. D. (n.d.). Professional profile and clinical insights. LinkedIn.
Nolo. (2024). Proving causation in a personal injury case.
Trial Lawyers Journal. (2025). What is causation in personal injury cases?.
Additional supporting literature includes systematic reviews on spinal manipulative therapy for low back pain, network meta-analyses on manual therapies for cervicogenic headache, and neurophysiological studies examining proprioceptive input and central nervous system plasticity after spinal manipulation.
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The information herein on "Causation and Chiropractic Care Explained in Detail" is not intended to replace a one-on-one relationship with a qualified health care professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional.
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Welcome to El Paso's Premier Wellness and Injury Care Clinic & Wellness Blog, where Dr. Alex Jimenez, DC, FNP-C, a Multi-State board-certified Family Practice Nurse Practitioner (FNP-BC) and Chiropractor (DC), presents insights on how our multidisciplinary team is dedicated to holistic healing and personalized care. Our practice aligns with evidence-based treatment protocols inspired by integrative medicine principles, similar to those found on this site and our family practice-based chiromed.com site, focusing on restoring health naturally for patients of all ages.
Our areas of multidisciplinary practice include Wellness & Nutrition, Chronic Pain, Personal Injury, Auto Accident Care, Work Injuries, Back Injury, Low Back Pain, Neck Pain, Migraine Headaches, Sports Injuries, Severe Sciatica, Scoliosis, Complex Herniated Discs, Fibromyalgia, Chronic Pain, Complex Injuries, Stress Management, Functional Medicine Treatments, and in-scope care protocols.
Our information scope is multidisciplinary, focusing on musculoskeletal and physical medicine, wellness, contributing etiological viscerosomatic disturbances within clinical presentations, associated somato-visceral reflex clinical dynamics, subluxation complexes, sensitive health issues, and functional medicine articles, topics, and discussions.
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Dr. Alex Jimenez DC, MSACP, APRN, FNP-BC*, CCST, IFMCP, CFMP, ATN
Email: coach@elpasofunctionalmedicine.com
Multidisciplinary Licensing & Board Certifications:
Licensed as a Doctor of Chiropractic (DC) in Texas & New Mexico*
Chiropractic Licenses:
Texas DC License #: TX5807, Verified: TX5807
New Mexico DC License #: NM-DC2182, Verified: NM-DC2182
Nurse Practitioner Licenses:
Texas APRN License #: 1191402, Verified: 1191402 *
New Mexico CNP License #: 90560, Verified 90560
Florida APRN License #: 11043890, Verified: APRN11043890 *
Colorado License #: C-APN.0105610-C-NP, Verified: C-APN.0105610-C-NP
New York License #: N25929, Verified N25929
Georgia APRN License #: GAA-NP005701
Multi-State Advanced Practice Registered Nurse (APRN*) Texas & Multi-States
Multi-state Compact APRN License by Endorsement (43 States)
Compact Status: Multi-State License: Authorized to Practice in 43 States*
Nursing Licensure Compact: Updated Here
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All medical (MDs) and family practice providers (FNP-APRN) are registered and licensed to offer various levels of medication.
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Board Certification:
ANCC FNP-BC: Board Certified Nurse Practitioner*
Education:
Graduate with Honors: ICHS: MSN-FNP (Family Nurse Practitioner Program)
Degree Granted. Master's in Family Practice, MSN Diploma (Cum Laude)
Dr. Alex Jimenez, DC, APRN, FNP-BC*, CFMP, IFMCP, ATN, CCST
(Board Certified: Family Practice Nurse Practitioner—Multistate)*
(Licensed Nurse Practitioner & Chiropractor - Multistate)*
Clinical Director
DC & FNP License (Review Above)
Digital Business Card
NPI: 1205907805
Dr. Maria Cardenas, MD
(Board Certified: Internal Medicine)
(Licensed Medical Doctor)
Medical Director, Clinical Director & Collaborative Physician
NPI # 1164426748
MD License #: J2933
Licenses and Board Certifications:
MD: Medical Doctor
DC: Doctor of Chiropractic
APRNP: Advanced Practice Registered Nurse
FNP-BC: Family Practice Specialization (Multi-State Board Certified)
FNP-BC: Family Practice Across Life Span (Neonatal to Geriatrics)
RN: Registered Nurse (Multi-State Compact License)
CFMP: Certified Functional Medicine Provider
MSN-FNP: Master of Science in Family Practice Medicine
MSACP: Master of Science in Advanced Clinical Practice
IFMCP: Institute of Functional Medicine
CCST: Certified Chiropractic Spinal Trauma
ATN: Advanced Translational Neutrogenomics
Family with Primary Care Focus (Family Nurse Practitioner or FNP)
Memberships & Associations:
TCA: Texas Chiropractic Association: Member ID: 104311
TNA: Texas Nurse Association: Member ID: 06458222
TNP: Texas Nurse Practitioner Association ID: 2025091511
AANP: American Association of Nurse Practitioners: Member ID: 2198960
ANA: American Nurses Association: Member ID: 06458222 (District TX01)
| Primary Taxonomy | Selected Taxonomy | State | License Number |
|---|---|---|---|
| No | 111N00000X - Chiropractor | NM | DC2182 |
| Yes | 111N00000X - Chiropractor | TX | DC5807 |
| Yes | 363LF0000X - Nurse Practitioner - Family | TX | 1191402 |
| Yes | 363LF0000X - Nurse Practitioner - Family | FL | 11043890 |
| Yes | 363LF0000X - Nurse Practitioner - Family | CO | C-APN.0105610-C-NP |
| Yes | 363LF0000X - Nurse Practitioner - Family | NY | N25929 |
| Yes | 363LF0000X - Nurse Practitioner - Family | NM |
90560 |
| Yes | 363LF0000X - Nurse Practitioner - Family | GA | GAA-NP005701 |
Dr. Alex Jimenez, DC, APRN, FNP-BC*, CFMP, IFMCP, ATN, CCST
(Board Certified: Family Practice Nurse Practitioner—Multistate)*
(Primary Care Across Lifespan—Neonatal / Pediatric / Adult / Geriatrics)
(Licensed Nurse Practitioner & Chiropractor - Multistate)*
Clinical Director
Digital Business Card
NPI: 1205907805
Dr. Maria Cardenas, MD
(Board Certified: Internal Medicine)*
(Licensed Medical Doctor)*
Medical Director, Clinical Director & Collaborative Physician
NPI # 1164426748
MD License #: J2933
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