Chiropractic Care Treatments Using Causation for Muscle Pain

Learn about the relationship between causation and chiropractic care to enhance your overall health and wellness and reduce muscle pain.

Abstract

This educational post, written by Dr. Alexander Jimenez, DC, APRN, FNP-BC, CFMP, IFMCP, ATN, CCST, explains causation in personal injury cases involving muscle pain, why it is legally and medically required, and how evidence-based methods justify it. It details what chiropractic care is, the physiological mechanisms by which it reduces muscle pain and related comorbidities, and how integrative chiropractic approaches provide clinical insight for non-surgical personal injury management. The post incorporates the latest findings from leading researchers using modern evidence-based methods, including systematic reviews, randomized trials, and mechanistic studies on spinal manipulative therapy. It describes the multidisciplinary model at Injury Medical Clinic PA (also known as Mission Plaza Injury Medical Clinic) in El Paso, Texas, where Dr. Jimenez works collaboratively with Dr. Maria Guadalupe Cardenas, MD (Board Certified in Internal Medicine, NPI #1164426749, Texas MD License #J2933), who brings more than 40 years of experience as an internist and serves as Medical Director and Collaborative Physician. The team integrates chiropractic care, medical oversight from internal medicine, functional medicine, personal injury documentation and rehabilitation, and related non-surgical services to support recovery while addressing the whole person.

Understanding Causation in Personal Injury Cases Involving Muscle Pain

Causation is the legal and medical link that shows a specific event, such as a motor vehicle collision, fall, or workplace incident, produced or materially contributed to a person’s injuries and resulting losses. In personal injury litigation, the plaintiff must prove three core elements: the defendant acted negligently or intentionally, the plaintiff suffered an injury, and the defendant’s conduct caused that injury. Causation itself has two recognized parts. Actual cause, often called the “but-for” test, asks whether the injury would have occurred but for the defendant’s actions. Proximate cause, or legal cause, limits liability to consequences that are reasonably foreseeable and not too remote. Courts also consider whether the event materially contributed to the injury; scientific certainty is not required, only proof on the balance of probabilities that the connection is more likely than not.

For cases centered on muscle pain and other soft-tissue injuries, causation is frequently contested because these injuries do not always produce clear radiographic findings on plain X-rays. Soft-tissue damage—strains of muscle fibers, sprains of ligaments, fascial irritation, and secondary muscle guarding—can cause significant pain, restricted motion, and functional loss even when imaging appears relatively unremarkable. Insurers and defense experts may argue that symptoms reflect pre-existing degeneration, delayed reporting, or non-organic factors. Plaintiffs must therefore provide credible medical evidence linking the mechanism of injury to the clinical presentation. Treating clinicians document the timeline of symptom onset, the consistency of findings on examination (tenderness, muscle spasm or hypertonicity, reduced range of motion, positive orthopedic tests), and the biological plausibility of the trauma producing those findings. Expert testimony from qualified providers further links the incident’s biomechanical forces to the observed tissue injury and the patient’s subsequent course.

The Bradford Hill criteria, originally outlined by Sir Austin Bradford Hill in 1965 for epidemiologic inference, are frequently adapted in medical-legal analysis of injury causation. These viewpoints include strength of association, consistency of findings across examiners and settings, specificity, temporality (the injury follows the event), biological gradient or dose-response where applicable, biological plausibility, coherence with existing knowledge, experimental or interventional evidence, and analogy to similar known injury patterns. In orthopedic and soft-tissue contexts, experts evaluate whether the forces involved could produce the claimed injury, whether the patient experienced the condition, and whether the event caused or materially contributed to it within reasonable medical probability. Documentation of prompt evaluation, progressive findings, and response to care strengthens the narrative. In Texas and many other jurisdictions, expert medical testimony is often required when the causal link involves specialized knowledge beyond common experience, particularly when pre-existing conditions or delayed symptoms are present.

Dr. Jimenez’s clinical observations, drawn from decades of treating trauma-related soft-tissue and spinal injuries at the El Paso clinic, emphasize that a clear date of injury, mechanism description, and serial objective measures create a coherent chain. Patients who minimize early symptoms because of adrenaline, delayed inflammatory peaks, or cultural tendencies to “walk it off” still benefit from early documentation that captures the evolution of muscle guarding, restricted motion, and pain patterns. When these elements align with the known biomechanics of the incident—such as rapid acceleration-deceleration in a rear-end collision producing cervical and thoracic muscle strain—the causation analysis becomes more robust.

What Chiropractic Care Is and How It Fits into Non-Surgical Treatment

Chiropractic care is a health profession focused primarily on diagnosing, treating, and preventing disorders of the neuromusculoskeletal system, with special emphasis on the spine and its related structures. Doctors of chiropractic use hands-on techniques, including high-velocity, low-amplitude spinal manipulative therapy (SMT or spinal adjustments), mobilization, soft-tissue therapies, therapeutic exercise, patient education, and lifestyle guidance. The goal is to restore joint mobility, reduce abnormal muscle tone, improve sensorimotor function, and modulate pain through both mechanical and neurophysiological pathways. Chiropractic is widely recognized as a conservative, non-surgical option for many musculoskeletal conditions.

Clinical practice guidelines and systematic reviews support the use of spinal manipulative therapy for non-specific low back pain and neck pain. A major 2019 systematic review and meta-analysis of 47 randomized controlled trials involving more than 9,000 participants found that SMT produces effects similar to other recommended therapies for chronic low back pain and offers small-to-moderate functional advantages compared with non-recommended interventions. Guidelines frequently recommend SMT as a first-line or frontline non-pharmacologic option for low back pain and favor its inclusion for neck pain, often in combination with exercise. Evidence also supports its consideration for certain headache types and other spine-related complaints. Adverse events are typically mild and transient (temporary soreness or stiffness); serious complications are rare with appropriate screening

At Injury Medical Clinic PA, integrative chiropractic care is embedded within a broader non-surgical framework that includes functional medicine, rehabilitation, and medical collaboration. This multimodal approach aligns with contemporary recommendations for chronic pain management that emphasize biopsychosocial care rather than isolated procedures. Dr. Jimenez’s dual licensure as a Doctor of Chiropractic and board-certified Family Nurse Practitioner allows evaluation from both mechanical and broader medical perspectives. At the same time, Dr. Cardenas provides internal medicine oversight for complex cases, co-manages comorbidities, and provides access to medical diagnostics or interventions when indicated.

Physiological Mechanisms by Which Chiropractic Care Reduces Muscle Pain

Muscle pain after trauma often arises from direct tissue strain, secondary protective spasm, inflammation, altered joint mechanics, and central sensitization. Chiropractic interventions address these through interrelated biomechanical, neurophysiological, and neuroimmune pathways, supported by modern research using experimental models, cytokine assays, electrophysiology, and imaging.

High-velocity, low-amplitude thrusts rapidly stretch paraspinal muscles and joint receptors. This afferent bombardment influences segmental spinal processing, reducing nociceptive pathway excitability and altering motoneuron output. Studies demonstrate that SMT can inhibit pain through spinal mechanisms and potentially through peripheral modulation of inflammatory responses. Animal models of intervertebral foramen inflammation have shown that simulated SMT reduces thermal and mechanical hyperalgesia, lessens dorsal-root-ganglion hyperexcitability, and accelerates resolution of local inflammation. In human studies, SMT has been associated with time-dependent reductions in pro-inflammatory cytokines such as TNF-α and IL-1β in whole-blood cultures, while certain anti-inflammatory mediators may increase. These shifts occur without consistent short-term changes in substance P levels, suggesting central regulatory effects.

Neurophysiological research further shows changes in somatosensory processing, sensorimotor integration, H-reflex excitability, and cortical activity following chiropractic care. Resting electroencephalography and somatosensory-evoked potential studies indicate alterations consistent with reduced central sensitization and improved motor control. Stimulating muscle spindle and Golgi tendon organ afferents can normalize abnormal muscle tone and reduce protective guarding that perpetuates pain. Improved joint mobility decreases mechanical irritation of surrounding tissues and may enhance local circulation, supporting resolution of edema and metabolic byproducts.

Clinically, these mechanisms translate into reduced muscle hypertonicity, improved range of motion, and lower pain ratings. Patients often report less guarding and easier movement after a series of adjustments combined with soft-tissue work and graded activity. Dr. Jimenez has observed that addressing segmental restrictions early in the recovery process limits the cascade of secondary muscle spasm that can otherwise become self-perpetuating. Serial examinations document progressive gains in mobility and reductions in palpatory tenderness, providing objective markers that correlate with the patient’s reported improvement.

How Chiropractic Care Addresses Muscle Pain and Its Comorbidities

Muscle pain rarely exists in isolation. Trauma-related myofascial strain frequently coexists with sleep disruption, elevated stress responses, reduced activity tolerance, postural compensation, and secondary pain in adjacent regions. Chronic or poorly managed muscle pain can contribute to deconditioning, mood changes, and heightened pain sensitivity. Integrative chiropractic care targets these interconnected issues within a non-surgical model.

By restoring spinal and extremity joint function and reducing abnormal muscle tone, chiropractic treatment improves mechanical efficiency and decreases the energy cost of movement. This supports better sleep architecture because less nocturnal muscle tension and pain allow deeper rest. Reduced pain and improved function lessen pain-catastrophizing and kinesiophobia, which are common comorbidities that amplify disability. Studies of multimodal integrative programs that include manual therapy components have shown improvements in health-related quality of life, pain-related disability, and reductions in fatigue, anxiety, and depression scores over weeks to months of care. Older adults with chronic low back pain and multiple comorbidities who received chiropractic manipulative treatment alone or in combination with medical care showed lower overall expenditures and shorter treatment episodes in some analyses compared with medical care alone.

Functional-medicine elements integrated at the clinic—nutritional support for inflammation resolution, stress-management strategies, and graded rehabilitation—further address systemic contributors. Dr. Cardenas’s internal-medicine perspective helps identify and manage medical comorbidities (hypertension, metabolic factors, or medication effects) that might influence recovery, ensuring that chiropractic and rehabilitative interventions proceed safely. Shared documentation allows the team to track both musculoskeletal progress and broader health markers.

In personal-injury contexts, this comprehensive approach generates detailed records of baseline findings, response to care, residual functional limitations, and the relationship of those findings to the original trauma. Objective measures such as range-of-motion degrees, pain-scale scores, and functional testing provide a longitudinal picture that courts and insurers can evaluate.

Chiropractic Care Insights into Personal Injury Cases

Chiropractic clinicians frequently serve as treating providers who document the natural history of soft-tissue injuries. Their records capture the mechanism of injury as described by the patient, immediate and delayed symptom patterns, examination findings (including muscle spasm, segmental restrictions, and orthopedic signs), treatment rendered, and the patient’s response. This information helps establish temporality and biological plausibility. When imaging is obtained, chiropractors correlate clinical findings with any acute soft-tissue or disc changes versus chronic degenerative patterns. When symptoms persist beyond expected soft-tissue healing windows, the records help distinguish ongoing mechanical contributors from other factors.

Dr. Jimenez’s clinical observations highlight the value of consistent, early intervention. Patients treated for whiplash-associated muscle strains or lumbar strains after collisions often show measurable improvements in motion and pain when care addresses both the primary injury and compensatory patterns. Serial re-examinations allow the clinician to note when symptoms stabilize, when new findings appear that may warrant referral, and how functional goals (return to work, household activities, sleep quality) evolve. Because the clinic operates under medical direction from Dr. Cardenas, complex cases can incorporate medical imaging interpretation, laboratory evaluation of systemic inflammation or metabolic status, and coordinated rehabilitation without fragmenting care.

The resulting documentation supports causation analysis by demonstrating a coherent chain: incident forces consistent with the injury pattern, prompt or appropriately timed presentation, objective findings matching the mechanism, and a treatment response consistent with known recovery trajectories for soft-tissue trauma. When residual impairments remain, the records quantify them for impairment rating or future-care projections.

The Multidisciplinary Team Model at Injury Medical Clinic PA

Injury Medical Clinic PA is a collaborative environment where chiropractic care led by Dr. Jimenez is integrated with medical oversight from Dr. Maria Guadalupe Cardenas, MD. With more than 40 years of experience in internal medicine, Dr. Cardenas provides physician-level direction for complex presentations, reviews systemic factors that may influence recovery, and collaborates on treatment plans that may include prescription management, diagnostic testing, or referral when indicated. This structure is common in integrative injury clinics and allows patients to receive hands-on neuromusculoskeletal care alongside medical evaluation within a coordinated record system.

Functional-medicine principles (Dr. Jimenez holds CFMP and IFMCP credentials) address root contributors such as inflammation, nutritional status, and lifestyle factors. Rehabilitation specialists implement progressive exercise and movement strategies. Personal-injury care includes thorough documentation oriented toward both clinical recovery and the evidentiary needs of a claim. The result is a patient-centered pathway that prioritizes non-surgical resolution of muscle pain and related impairments while maintaining medical safety and a complete clinical narrative.

Conclusion

Causation remains an essential element in personal injury cases involving muscle pain because soft-tissue injuries require clear medical linkage between the traumatic event and the patient’s symptoms and limitations. Evidence-based chiropractic care, grounded in biomechanical and neurophysiological research, offers a non-surgical way to reduce muscle pain, modulate inflammation, improve function, and address common comorbidities. When delivered within a multidisciplinary model that includes internal medicine oversight from an experienced physician such as Dr. Cardenas, integrative chiropractic care supports both clinical recovery and the documentation needed for fair evaluation of injury claims. Ongoing research continues to refine the specific contributions of spinal manipulative therapy and multimodal approaches, reinforcing their place among recommended conservative options for musculoskeletal trauma.

References

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• Bradford Hill, A. (1965). The environment and disease: Association or causation? Proceedings of the Royal Society of Medicine, 58(5), 295–300. https://doi.org/10.1177/003591576505800503https://doi.org/10.1177/003591576505800503
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• Pickar, J. G. (2002). Neurophysiological effects of spinal manipulation. The Spine Journal, 2(5), 357–371. https://doi.org/10.1016/S1529-9430(02)00400-X
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• Song, X. J., Gan, Q., Cao, J. L., Wang, Z. B., & Rupert, R. L. (2006). Spinal manipulation reduces pain and hyperalgesia after lumbar intervertebral foramen inflammation in the rat. Journal of Manipulative and Physiological Therapeutics, 29(1), 5–13. https://doi.org/10.1016/j.jmpt.2005.10.001
• Teodorczyk-Injeyan, J. A., Injeyan, H. S., & Ruegg, R. (2006). Spinal manipulative therapy reduces inflammatory cytokines but not substance P production in normal subjects. Journal of Manipulative and Physiological Therapeutics, 29(1), 14–21. https://doi.org/10.1016/j.jmpt.2005.10.002
• Wallace Pierce Law. (2026). How do I prove my back pain and muscle spasms were caused by a car accident? https://www.wallacepierce.com/accident-qa-series/how-do-i-prove-my-back-pain-and-muscle-spasms-were-caused-by-a-car-accident-durham-nc/
• Weeks, W. B., Goertz, C. M., Long, C. R., Meeker, W. C., & Marchiori, D. M. (2016). Association between use of chiropractic care and costs of care among older Medicare patients with chronic low back pain and multiple comorbidities. Journal of Manipulative and Physiological Therapeutics, 39(5), 307–317.e1. https://doi.org/10.1016/j.jmpt.2016.02.006
• Clinical observations and practice descriptions are drawn from materials available at https://sciatica.clinic/ and https://www.linkedin.com/in/dralexjimenez/, as well as publicly available descriptions of the multidisciplinary model at Injury Medical Clinic PA (Mission Plaza Injury Medical Clinic), El Paso, Texas, involving Dr. Alexander Jimenez, DC, APRN, FNP-BC, CFMP, IFMCP, ATN, CCST, and Dr. Maria Guadalupe Cardenas, MD.

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