Missed MVA and Workplace Injuries Causing Pain Solutions

Missed MVA and Workplace Injuries Causing Pain

Abstract

Motor vehicle accidents (MVAs) and workplace accidents can cause injuries that are not obvious during the first medical visit. A person may have normal X-rays and still have pain from damaged muscles, ligaments, spinal discs, facet joints, nerves, or other soft tissues. Mild traumatic brain injuries, including concussions, may also occur without obvious findings on routine imaging. Some symptoms develop hours or days later.

This article explains why hidden injuries can be difficult to identify, including spinal ligament micro-tears, annular disc tears, facet joint capsule injuries, myofascial trigger points, and mild concussions. It also explains how a coordinated approach may combine medical evaluation, integrative chiropractic care, rehabilitation, functional medicine, pain management, and selected biological therapies. At Injury Medical Clinic PA in El Paso, Texas, Dr. Alexander Jimenez, DC, APRN, FNP-BC, CCST, CFMP, IFMCP, ATN, works within a multidisciplinary model that includes medical oversight from Dr. Maria Guadalupe Cardenas, MD.

Why Some Accident Injuries Are Hard to See

After a car crash, fall, lifting injury, or workplace accident, the first goal is usually to rule out emergencies. Doctors may look for fractures, internal bleeding, severe brain injury, spinal cord damage, or other dangerous problems.

This emergency approach is important. However, a normal initial test does not always mean that every tissue is healthy.

Plain X-rays are mainly designed to show bones and their general alignment. They do not provide the same soft-tissue detail as MRI. Therefore, injuries involving muscles, tendons, ligaments, spinal discs, nerves, and joint capsules may require a different type of evaluation when symptoms continue.

The American College of Radiology notes that when ligament, spinal cord, or nerve-root injury is suspected after spinal trauma, MRI may be appropriate even when other imaging has already been performed (American College of Radiology, n.d.).

Several accident-care resources also describe delayed or overlooked symptoms after crashes, especially with whiplash, soft-tissue injuries, back injuries, and concussions (Advantage Healthcare Systems, 2025; Xcell Medical Group, 2026).

The key message is simple: a normal X-ray is useful information, but it does not rule out every possible injury.

Spinal Ligament Micro-Tears

Ligaments are strong bands of tissue that connect bones and help stabilize joints.

During a rear-end collision, side impact, fall, or sudden workplace accident, the spine can move rapidly beyond its normal range. This may stretch or injure the small ligaments that help stabilize the neck and lower back.

A person may develop:

• Neck or back stiffness
• Pain with movement
• Headaches
• Muscle guarding
• Reduced range of motion
• A feeling that the spine is weak or unstable
• Pain that becomes worse with sitting, lifting, or repetitive work

Whiplash-related soft-tissue injuries may not produce an obvious abnormality on a basic X-ray. Careful history, physical examination, neurological testing, and additional imaging may be needed when symptoms or examination findings justify it (Advantage Healthcare Systems, 2025).

Annular Tears in Spinal Discs

Intervertebral discs sit between the spinal bones. Each disc has a softer center surrounded by a stronger outer ring called the annulus fibrosus.

Sudden twisting, bending, compression, or acceleration-deceleration forces can stress this outer ring. Small separations in the fibers are called annular fissures or annular tears.

Some annular tears cause no symptoms. Others may contribute to back or neck pain, especially when nearby structures become irritated. Annular tears can also exist with disc bulges or herniations (Tenny et al., 2023).

Because discs are soft tissues, plain X-rays cannot directly show an annular tear. When clinically appropriate, MRI can provide much more information about discs, nerves, ligaments, and other soft tissues.

This is one reason persistent pain after a normal X-ray deserves a complete clinical assessment rather than assuming nothing is wrong.

Hidden Facet Joint Capsule Trauma

Facet joints are small joints located at the back of the spine. They guide spinal movement and help control excessive motion.

Each facet joint is surrounded by a capsule made of connective tissue. During whiplash or another sudden injury, the capsule can stretch or become irritated.

Facet-related pain may cause:

• Local neck or back pain
• Pain with turning or bending
• Pain that spreads into the shoulders or upper back
• Headaches associated with neck movement
• Muscle tightness around the injured area

Research on whiplash has identified the cervical facet region and its supporting tissues as possible sources of persistent neck pain after trauma.

Because the injury can involve soft tissues rather than a broken bone, it may not be visible on standard X-rays.

Persistent Myofascial Trigger Points

Muscles can also become part of the injury pattern.

After trauma, muscles often tighten to protect an injured joint or spinal segment. Sometimes painful areas develop within these muscles. These areas are commonly called myofascial trigger points.

Trigger points may produce:

• Deep aching pain
• Muscle stiffness
• Referred pain
• Headaches
• Shoulder or back discomfort
• Reduced movement

A study comparing people with whiplash-associated disorders with people who had mechanical neck pain found more active myofascial trigger points in the whiplash group (Castaldo et al., 2014).

This helps explain why a person can have continuing pain even when a basic X-ray does not show a fracture.

Mild Concussions Can Be Difficult to Recognize

A concussion does not always require a direct blow to the head.

The Centers for Disease Control and Prevention explains that mild traumatic brain injury can result from a blow to the head or from a hit to the body that makes the head and brain move rapidly back and forth (Centers for Disease Control and Prevention [CDC], 2025).

Symptoms can include:

• Headache
• Dizziness
• Brain fog
• Memory problems
• Trouble concentrating
• Light or noise sensitivity
• Sleep changes
• Nausea
• Balance problems
• Irritability

Importantly, concussion is usually a clinical diagnosis. Routine CT or MRI is not required to diagnose most mild concussions. Imaging is generally used when a doctor is concerned about problems such as bleeding or another more serious brain injury (CDC, 2025).

This means that a person can have a real concussion even when structural brain imaging is normal.

Workplace Injuries May Develop Slowly

Not every workplace injury occurs during one dramatic event.

Workers may experience cumulative trauma from:

• Repetitive lifting
• Bending and twisting
• Frequent reaching
• Computer work
• Vibrating tools
• Repeated overhead work
• Poor lifting mechanics
• Long periods of standing or sitting

These repeated stresses can gradually affect joints, muscles, tendons, and other tissues.

Workplace injury resources describe sprains, strains, repetitive stress injuries, and cumulative trauma as important causes of work-related pain and disability (Bridgman Gantt Law Offices, 2025; Stern & Cohen, n.d.).

A worker may therefore have a significant physical problem even without one clearly remembered accident.

Finding the Injury Requires More Than One Test

A complete injury evaluation begins with the patient, not the image.

Depending on the situation, the healthcare team may evaluate:

• How the accident happened
• Direction and force of impact
• Location and timing of symptoms
• Range of motion
• Muscle strength
• Reflexes
• Sensation
• Balance
• Gait and posture
• Joint stability
• Orthopedic findings
• Neurological findings
• Changes in work or daily function

Imaging is then selected according to the clinical findings.

X-ray, CT, and MRI are different tools. No single test can identify every injury.

Integrative Chiropractic Care: Restoring Mechanical Function

Once serious injuries have been ruled out and the diagnosis is better understood, recovery often requires more than simply reducing pain.

Integrative chiropractic care can focus on restoring the way the body moves.

Depending on the diagnosis and patient, care may include:

• Gentle chiropractic adjustments or mobilization
• Soft-tissue treatment
• Range-of-motion exercises
• Corrective exercise
• Strengthening
• Neuromuscular retraining
• Posture and movement correction
• Progressive rehabilitation

Clinical guidelines for neck pain recommend a combination of manual therapy, mobility exercises, and strengthening for appropriate patients rather than depending solely on passive treatments (Blanpied et al., 2017).

The goal is not simply to “put a bone back into place.” It is to improve movement, reduce unnecessary mechanical stress, rebuild strength, and help the patient return safely to normal activity.

Combining Mechanical Restoration With Biological Support

An integrative injury model can look at two major parts of recovery:

Mechanical restoration focuses on movement, spinal and joint function, strength, flexibility, and rehabilitation.

Biological support focuses on the injured tissue itself and the physical conditions needed for healing.

Depending on the diagnosis, this broader plan may include rehabilitation, nutrition, sleep support, medical management, image-guided procedures, or selected orthobiologic procedures.

PRP and other biologic approaches are being studied and used for selected musculoskeletal conditions. However, patients should understand that evidence varies greatly by tissue, diagnosis, procedure, and product. Regenerative treatments should not be presented as guaranteed ways to rebuild damaged spinal tissue.

The FDA also warns consumers that many marketed stem-cell, exosome, and other human cell or tissue products have not been approved for orthopedic conditions such as back pain, neck pain, disc disease, tendon problems, or joint pain.

Medical screening and informed decision-making are therefore essential.

Multidisciplinary Injury Care in El Paso

At Injury Medical Clinic PA in El Paso, Texas, Dr. Alexander Jimenez, DC, APRN, FNP-BC, CCST, CFMP, IFMCP, ATN, describes a clinical model that combines chiropractic care, medical evaluation, functional medicine, personal injury care, rehabilitation, and related services.

In his published clinical observations, Dr. Jimenez reports that patients with traumatic joint and spinal injuries may show changes in posture, gait, muscle control, and spinal movement in addition to pain at the injured site. His approach therefore looks beyond one painful structure and evaluates how the injury affects the larger movement system (Jimenez, 2026). These observations represent his clinical experience and should be distinguished from controlled clinical research.

Clinic materials identify Dr. Maria Guadalupe Cardenas, MD, as a board-certified internal medicine physician, Medical Director, and Collaborative Physician at Injury Medical Clinic PA. The clinic lists her NPI as 1164426749 and Texas medical license as J2933 and describes her as having more than 40 years of experience in internal medicine.

Within this multidisciplinary structure:

• Dr. Jimenez focuses on chiropractic care, musculoskeletal assessment, functional medicine, personal injury care, and rehabilitation.
• Dr. Cardenas provides medical direction and collaborative physician oversight within her scope of practice.
• Rehabilitation helps restore strength, movement, coordination, and work capacity.
• Functional medicine may examine nutrition, sleep, metabolic health, and other factors that can influence overall recovery.
• Medical or interventional options can be considered when conservative treatment alone is not enough.

Multidisciplinary pain and injury programs may similarly combine medical treatment, rehabilitation, exercise, and complementary approaches when appropriate for the individual patient.

The Main Lesson: Normal X-Rays Do Not Always End the Investigation

After an MVA or workplace injury, some problems are obvious. Others are not.

Soft-tissue injuries, ligament sprains, annular disc injuries, facet joint irritation, myofascial pain, and mild concussion symptoms may require careful clinical examination and, in selected cases, different imaging or specialist evaluation.

The best approach is not to assume that every person with pain has a hidden injury. It is also not safe to assume that a normal X-ray means all tissues are normal.

A better approach is to connect the accident mechanism, symptoms, examination findings, imaging, and response to treatment.

For appropriate patients, coordinated care can then combine mechanical restoration through chiropractic and rehabilitation with medical oversight and evidence-based biological support. This gives the healthcare team a broader view of both the damaged tissue and the way the whole body is functioning after an accident.

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References

American College of Radiology. (n.d.). ACR Appropriateness Criteria: Acute spinal trauma.

Advantage Healthcare Systems. (2025). The hidden soft-tissue injuries most people miss after a car accident.

AlpernSchubert, P.C. (n.d.). What are the most commonly overlooked car accident injuries?.

Blanpied, P. R., Gross, A. R., Elliott, J. M., Devaney, L. L., Clewley, D., Walton, D. M., Sparks, C., & Robertson, E. K. (2017). Neck pain: Revision 2017 clinical practice guidelines. Journal of Orthopaedic & Sports Physical Therapy, 47(7), A1–A83.

Bridgman Gantt Law Offices. (2025). 5 common injuries that lead to a workers’ comp claim.

Castaldo, M., Ge, H.-Y., Chiarotto, A., Villafañe, J. H., & Arendt-Nielsen, L. (2014). Myofascial trigger points in patients with whiplash-associated disorders and mechanical neck pain. Pain Medicine, 15(5), 842–849.

Centers for Disease Control and Prevention. (2025). About mild TBI and concussion.

Edwards & Ragatz, P.A. (2025). 3 commonly misdiagnosed conditions that could put you at risk.

Horwitz, Horwitz & Associates. (2020). Common overlooked workplace injuries to be on the lookout for.

Jimenez, A. (2026). Integrative chiropractic and regenerative medicine in El Paso.

Jimenez, A. (2026). MVA joint trauma: Comprehensive chiropractic approaches.

Jimenez, A. (2026). Regenerative medicine and integrative chiropractic strategies.

Jimenez, A. (2026). How regenerative medicine and chiropractic care work together.

Jimenez, A. (n.d.). Dr. Alex Jimenez: El Paso chiropractor and personal injury care.

Cohn, J. (n.d.). Regenerative orthopedics: PRP, stem cells, and healing from within.

MHK Attorneys. (n.d.). Top 5 personal injury claims that often go undetected.

Morgan & Morgan. (2025). 15 work injuries you may not know about.

Ramos Center. (n.d.). Non-surgical pain management: Eight treatment approaches.

Sherwood Law Group. (n.d.). Personal injury cases that often get overlooked but shouldn’t.

Stern & Cohen. (n.d.). Workplace cumulative trauma and your right to compensation.

U.S. Food and Drug Administration. (2021). Important patient and consumer information about regenerative medicine therapies.

Virtaj Singh, MD. (n.d.). Radiculopathy (pinched nerve).

Xcell Medical Group. (2026). The most overlooked injuries after a crash.

Zlotolow & Associates. (n.d.). Five easily missed injuries common in personal injury cases.