How the neck and back are injured

A rear-end collision throws the head backward and then forward faster than the neck muscles can react. That is the mechanism behind whiplash, and the reason neck pain is so often the first complaint after a collision on the Long Island Expressway or Sunrise Highway. The lower back takes a different load: the lap belt holds the pelvis while the trunk flexes over it, and a body twisting in a side impact loads the discs and facet joints unevenly.

Falls tend to compress the spine — a hard landing on the buttocks on a wet floor, or a tumble down a stairway. At work, the classic pattern is lifting with a bend and a twist: a box off a low shelf, a patient transfer, a tool bag hauled out of a van. Our back injury care page covers everyday symptoms; this page is about the orthopedic assessment. The physician looks for:

• Strain of the muscles and ligaments of the neck or lower back
• Disc injury — see herniated disc — with or without nerve involvement
• A compressed nerve root sending symptoms into a limb — pinched nerve, cervical radiculopathy in the neck, sciatica in the leg
• Irritation of the small facet joints at the back of the spine
• Bone injury such as a vertebral compression fracture, a particular concern after a hard fall or in people with thinner bones

What the orthopedic spine exam checks

The physician asks where the pain sits, whether it travels into an arm or a leg, and what has changed since the injury. Then the examination works through the spine and the nerves that leave it:

• Movement: how far you can bend, turn and extend, and which movements reproduce the pain
• Tenderness: over bone, which raises concern for a fracture, as opposed to over muscle
• Strength by nerve level: muscle groups in the arms and legs, each supplied by a particular nerve root
• Sensation and reflexes: the pattern of change points to the level involved
• Nerve tension signs: such as a straight-leg raise for the lower back
• Spinal cord signs: balance, walking and hand dexterity

Patients are often unsure which kind of spine clinician they need; our spine specialist guide sets out the different roles.

Imaging, and what the findings do and do not mean

Digital X-ray, on site at select offices, shows alignment and bone, and is the first step when tenderness over the spine or the force of a fall raises fracture concern. MRI shows the discs, the nerves and the spinal canal; it is ordered through diagnostic imaging when there are nerve findings or when the exam leaves the picture unexplained. The general reasoning is in do I need an MRI after a car accident. When arm or leg symptoms need to be traced to a level, EMG nerve testing measures how the nerves are conducting.

A spine MRI report needs careful reading. A bulging disc is often an incidental, age-related finding that appears on the scans of many adults with no pain at all. Spinal stenosis, a narrowing of the canal, is degenerative and develops gradually. The orthopedic physician records what the imaging shows and correlates it with your examination and with your symptoms before and after the injury. A finding on a scan is not, by itself, evidence of when or how it arose.

What a non-surgical spine plan coordinates

Your written plan is built around the diagnosis and adjusted at each visit. For the neck and back it can bring together several IRMD services:

• Physical therapy for mobility, trunk and neck stabilisation, and movement retraining
• Chiropractic care where the diagnosis makes it appropriate
• Epidural steroid injections when nerve-root pain is holding back progress
• Pain management, including facet-directed procedures where indicated
• Written work restrictions — lifting limits, sitting and standing tolerances, whether bending or climbing is appropriate — reviewed as the injury changes

There is no standard timeline for a disc injury or a pinched nerve, and nerve symptoms can change in either direction. That is why the plan is reassessed at every visit rather than run to a calendar, and why it stops when your goals are met. Your physician will set expectations after evaluating you.

When the spine needs a surgical opinion

A surgical opinion enters the conversation when there is progressive weakness, a nerve deficit that is not settling, an unstable fracture, pressure on the spinal cord, or pain from a confirmed structural problem that has not responded to a thorough non-surgical plan. Injury Recovery MD does not perform surgery. The spine surgeon is your choice; we assemble the imaging, examination findings and treatment history for their review. If you have an operation, your operating surgeon sets the rehabilitation protocol and milestones, and the rehabilitation can continue with IRMD. Background on two operations patients ask about is on our discectomy and spinal fusion pages.

No-Fault and workers’ compensation billing

Neck and back care after a motor vehicle accident is billed directly to New York No-Fault; our No-Fault doctor page explains how that works. The No-Fault application must be filed within 30 days of the accident — see the No-Fault 30-day deadline guide.

A back injured lifting, carrying or falling at work goes through workers’ compensation instead, and the workers’ comp orthopedic doctor page covers the reporting. It is $0 out of pocket for covered patients, and under both systems you choose your own treating provider. Under workers’ comp, that choice is among providers authorized by the New York Workers’ Compensation Board, and Injury Recovery MD is one.

Where to be seen for a neck or back injury

Orthopedic physicians see spine injuries at all 7 IRMD offices, from Mineola in Nassau County to Stony Brook, Smithtown, Islandia, Bohemia, East Islip and our main office in Medford; addresses are on the locations page. Same-day and next-day visits are often available — call (631) 560-8357. If a crash hurt more than your spine, car accident orthopedic care covers the whole picture, and the orthopedic care hub links every body area, including the shoulder, where neck pain and shoulder pain often overlap.

Where to see an orthopedic physician

• Medford3243 NY-112, Bldg 1, Suite 4, Medford, NY 11763Suffolk County
• Islandia1717 Veterans Memorial Hwy, Suite 100, Islandia, NY 11749Suffolk County
• East Islip11 Carleton Ave, East Islip, NY 11730Suffolk County
• Mineola300 Old Country Rd, Suite 321, Mineola, NY 11501Nassau County
• Bohemia1690 Washington Ave, Bohemia, NY 11716Suffolk County
• Smithtown732 Smithtown Bypass, Suite 200, Smithtown, NY 11787Suffolk County
• Stony Brook2500 Nesconset Hwy, Building 10A, Stony Brook, NY 11790Suffolk County

Orthopedic physicians see patients at every Injury Recovery MD office. Intake books the office and time that suit you. Call (631) 560-8357 — answered 24/7.

Frequently asked questions

Why does my neck hurt more after a rear-end collision than it did at the scene?

In a rear-end collision the head is thrown backward and forward faster than the neck muscles can respond, and soreness and stiffness often build after the adrenaline fades. A delayed start does not make the injury less real. An orthopedic exam checks strength, sensation and reflexes as well as movement. Neck pain after a high-speed crash with numbness or tingling, or any new weakness in an arm or leg, needs the emergency department now.

My MRI shows a bulging disc. Did the accident cause it?

Not necessarily. A bulging disc is often an incidental, age-related finding that appears on the MRI scans of many adults who have no symptoms. An orthopedic physician compares the imaging with your examination, your symptoms and your history before and after the injury, and documents what the findings show. A scan on its own cannot establish when a disc bulge developed.

How long does a herniated disc or pinched nerve take to get better?

There is no standard timeline. Nerve-root symptoms from a herniated disc or a pinched nerve vary a great deal between people and can change in either direction, so your orthopedic physician reassesses at each visit and sets expectations after examining you. New weakness, numbness in the groin or saddle area, or any change in bowel or bladder control needs the emergency department the same day.

Does IRMD do spine surgery?

No. IRMD’s orthopedic spine care is non-surgical: examination, X-ray, MRI and EMG when indicated, a written plan, physical therapy, chiropractic, injections and pain management. If a surgical opinion is needed you are referred and choose your own spine surgeon. IRMD prepares the records for that consultation, and rehabilitation can continue at IRMD afterwards under the protocol the surgeon sets.

Is neck and back treatment covered by No-Fault or workers’ comp?

Medically necessary treatment after a New York motor vehicle accident is covered by No-Fault, and spine injuries that happen at work are covered by workers’ compensation. Both are billed directly by IRMD, and it is $0 out of pocket for covered patients. File your No-Fault application within 30 days of the accident. You choose your own treating provider. Under workers’ comp, that choice is among providers authorized by the New York Workers’ Compensation Board, and Injury Recovery MD is one.

Which IRMD office can see me for a back or neck injury?

Every IRMD office has orthopedic physicians who see neck and back injuries: Mineola, Medford, Stony Brook, Smithtown, Islandia, Bohemia and East Islip. Same-day and next-day appointments are often available by calling (631) 560-8357.