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Diagnosing Neck Injuries After a Car Accident: Motion X-Rays


Neck injuries are one of the most common complaints people have after being involved in a car crash. Attorney Gary Martin Hays discusses with Atlanta chiropractor Dr. Chris Connelly in a two-part segment about the diagnosis and treatment options available to those suffering from whiplash, neck pain, and other cervical issues. The transcript has been edited for clarity.

Gary Martin Hays: I'd like to give you some sobering stats from the Insurance Institute for Highway Safety regarding car wrecks. In the U.S., there are approximately 5.5 million motor vehicle collisions a year.

What are the consequences of those wrecks? These range from approximately 35,000 deaths from these collisions to around 50% of the people walking away from the wrecks with no problems whatsoever. But what happens to the other 50%, the 50% that must seek medical care for their injuries?

To address this question, I'd like to introduce Dr. Chris Connelly. He is a board-certified chiropractor who's been treating patients here in Georgia since 1998. Over that time period, he has treated over 5,000 trauma cases, with over 80,000 patient visits. He's also been used as an expert for second opinions on more than 3,000 cases.

If that's not impressive enough, let me give you one more fact: he is one of approximately 20 doctors in the state of Georgia that is listed as a review agent. This means he provides professional opinions about whether or not the care of other chiropractors is reasonable and appropriate. And this expertise certainly garnered some respect from other doctors as well as the insurance industry.

Dr. Connelly, thanks for being with us here today.

Chris Connelly: Glad to be here. Thanks for having me.

Hays: What is the most common complaint/common symptom that your patients have after a car wreck?

Connelly: Neck pain. Without a doubt, neck pain. And it's not just with my patients. The national statistics show that as well. Neck pain attributes for about 8.8 billion dollars a year in claims related to auto injuries.

Hays: Some people refer to these neck injuries as whiplash but this is not really a diagnosis, is it?

Connelly: You're right, Gary, it's not. Whiplash is actually more the mechanism of injury or how the injury occurred. The motion of the neck as it goes back and forwards tears the ligaments. It also could tear the muscles and sometimes could even affect the disc. This can result in muscle strain, the tearing of soft tissue, and other damage like nerve root impingement, ruptures of ligaments, fractures, or even dislocations of the cervical spine.

Hays: Minor neck injuries can become chronic problems over time if they're not treated correctly, can't they?

Connelly: That is correct, Gary. About 10-30% of people do develop lasting symptoms after an auto collision.

Hays: What is the best way to make sure that patients don't develop chronic problems from a collision?

Connelly: Let me give you two things that I focus on in my practice. Number one is to get an accurate diagnosis to find out the cause of the pain, and number two is to lay out a specific course of action or treatment plan to be able to get the patient better based on their diagnosis.

Hays: How do you go about making sure you have an accurate diagnosis?

Connelly: There are a few things that I follow based on our typical guidelines to get patients better and develop a diagnosis. Number one is to take a good history from the patient. Have them tell where the pain is and what the mechanism of injury is.

Number two is to have them indicate, like on a pain drawing or on a problem list, to be able to determine the problems they're having. I use the word “problem” because it's not only pain that a lot of these patients have, they could have numbness, tingling, burning sensation, weakness, or swelling.

Number three is I'll do a consultation based on what they report their problems as. And number four is I'll go through and do a very focused examination based on the area of complaint and some of the things that I picked up from the consultation.

Once we get these things together, then we may do additional testing like X-ray, MRI, or CT scan based on what the findings are from the examination with the patient’s complaints.

Hays: So the combination of the history, your consultation, the examination, and the diagnostic testing helps formulate your diagnosis.

Connelly: That's correct, Gary. Each one has its own particular point that's very important. So they all come together. When they come together, that's called clinical correlation, where all the things add up to give us a good working diagnosis.

Hays: We talked about neck injuries being the most frequently reported injury after a car accident. Tell us more about one of the most common injuries that you see involving the neck.

Connelly: Let me give it to you in medical terms. The term is cervical facet capsule ligament tear.

For the anatomy and physiology of the spinal area we have the disc, which is like a shock absorber, we have the bone, and then on the back, we have two facet joints. With those facet joints, we have articular cartilage, we have a meniscus in between, and on top of it, we have something called a capsule ligament that helps to keep the joint in place.

So when a person gets into a rear-end collision and their head develops a mechanism where it goes backward and forward, a lot of times that mechanism will tear those capsular ligaments.

Hays: What have you found that is an effective test for diagnosing the injuries to these ligaments?

Connelly: Well, motion X-ray is invaluable. Another way to refer to it is functional radiography. Many times patients have a traditional X-ray that may show them in a static position. But when we see them in motion, we can actually see the stability of the facet ligaments and all the other ligaments a lot better.

Hays: I love this technology. The scans and the videos that you're able to record are invaluable, not only by helping you diagnose an injury but for us as attorneys being able to show the insurance company or a jury the injury.

Connelly: The technology is amazing and in fact, my office is one of a few in Georgia that uses this technology and this equipment to detect capsule ligament instability or just instability of facet joints altogether.

A great thing about it is that you can't fake it. When you do the tests, you can actually see the stability of the ligaments and it's reproducible over and over again. Dynamic motion X-ray is great for observing the stability of the ligaments and the motion but also it's better than a static X-ray, which is typically better for arthritis, fractures, or dislocation.

Hays: Before the break, you told us that one of the most effective tests for diagnosing injuries to the neck was the use of motion X-rays.

Connelly: That's correct. It's very similar to a regular X-ray or static X-ray but with one difference. Instead of the patient being still during the X-ray, we evaluate the bones in motion to detect the stability of the joints.

Hays: Now, to me, this just makes sense. My clients don't seem to complain about pain in their necks when they're able to keep themselves still in a stable position. But when they start to move, that's when the pain hits them.

Connelly: This technology is amazing and my office is one of only a handful in Georgia that uses it to determine instability of capsule ligaments. With still or static X-rays, you see fractures, dislocations, arthritis, and abnormal curves of the spine, but with dynamic or functional X-rays it's great for observing the stability of the ligaments and how the spine functions.

Also, another important factor is that this instability can't be faked. It's something that once you see it on X-ray it is reproducible over and over again.

Hays: When do you recommend a patient have the motion X-rays performed?

Connelly: Motion X-rays may be indicated for a person with cervical spine symptoms that persist for more than 8-12 weeks. We don't typically use it right after an accident because what will happen is the muscle spasms prevent normal motion. Usually, most people who have prolonged symptoms for about 8-12 weeks and still have pain, particularly during motion, are great candidates to get a motion X-ray.

Motion X-ray is also very important if an injured victim had facet injections and the injections helped to relieve the pain, but then the pain came back after a few weeks or they noticed the feeling that their heads are too heavy for their body. In these cases, patients may benefit greatly by having a motion X-ray exam.

Hays: Okay, Adam, if I could get you to put the video of the X-ray machine on the screen for us. Dr. Connelly, describe for our viewers what we are seeing.

Connelly: Well, this is called a C-arm or videofluoroscopy machine and it's very commonly used in hospitals and other medical specialist offices. They are used for injections or sometimes vascular procedures.

Because of the video, we could actually see the spine in motion versus the static films you typically see with an X-ray.

Hays: You told us earlier that the motion X-ray will record a video of the test that allows you to see the results. Do you have a video that you can show our viewers?

Connelly: I do, I do, and in fact, you can see in this video that there's gapping of the facet capsule of ligaments. You can see at the c6, c7 level and you can see the facet instability.

Now, this is something where the capsular ligaments — basically when they get stretched, when they get torn — don't heal very well. So basically patients will have reoccurring pain because the instability of the ligament causes them to keep having more facet pain.

But most commonly patients come and they say ‘it just feels like my head's too heavy for my body.’

Hays: And just so we're clear, these findings would not have shown up in a standard X-ray where the person was being still, correct?

Connelly: That's correct. The problem doesn't usually manifest itself until the patient starts moving their neck because the ligaments are put under pressure. Traditional static X-ray doesn't look for the gaps of the facet joints.

Hays: This is incredible technology and it's a tremendous breakthrough that allows you to accurately diagnose a problem.

Connelly: It is and, you know, many patients come in, they're so frustrated because they don't have a diagnosis for why they're having continued pain. Problems such as these do progress sometimes later on and you’ll have arthritis, degeneration, etc.

Typically MRIs are still within normal limits but they're still hurting. So they say, ‘Why am I still hurting if the MRI is normal?' Motion X-rays give us a clear, definitive cause of their pain. It captures it in real-time so we could see where the pain is.

We even have a lot of patients when we see the capsule instability, I'll say, 'Where does it hurt?' and they always point right where we see it on the motion X-ray.

Hays: And once you have an accurate diagnosis, you can then develop the appropriate treatment plan.

Connelly: Patients feel so much better when they know the problem is not just in their heads. It gives them a diagnosis to be able to say this is why I'm still hurting and that the problem is real.

There are also some amazing new treatments that we now have access to for facet capsule ligament instability. They give a patient a good chance of having a recovery down the road.

Hays: Thank you so much for your time and your expertise Dr. Connelly. I know our viewers greatly appreciate the information that you shared with us. Would you mind sharing with our viewers though how they can reach you for an appointment?

Connelly: Sure, they could call us at (770) 469-7330 or they could also get more information about us on our website, which is

Hays: Outstanding. Thank you, again, Dr. Connelly. Have a great rest of the day.

Connelly: You as well and thank you very much.

Hays: Now, if you or a family member have been injured, either from a car wreck or an on-the-job accident then please, if you'd like to speak with me regarding your personal injury claim, I make it easy for you.

Just pick up the phone right now and call me at 1-800-WIN-WIN1. Again, 1-800-WIN-WIN1. The consultation is free. It is completely confidential. There are no obligations. You can learn more about me and my law firm by visiting

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