Rear-end collisions are known for neck injuries, but low back pain is common after them too, and it matters for recovery. In a meta-analysis of whiplash prognosis, low back pain at the start was one of the factors that predicted a poorer outcome. It is often underreported because the neck hurts more in the first days. I ask every patient in Charlotte about the low back for that reason.
Low Back Pain Predicts Recovery
A 2013 meta-analysis of prospective whiplash cohorts identified 12 significant predictors of poor outcome. Reporting low back pain at the start was one of them, along with high neck pain, headache, high disability scores, and prior neck pain (Walton, J Orthop Sports Phys Ther 2013). Low back pain was not among the factors that held up when the authors tested for publication bias, so its effect size is less certain than that of pain intensity or headache.
In a British series of 40 whiplash patients followed for an average of 15.5 years, half reported low back pain at follow-up (Squires, J Bone Joint Surg Br 1996). That was one small series from one center, and it does not give a general rate.
First Rule Out Fracture
The American College of Radiology estimates that thoracolumbar fractures occur in 4% to 7% of blunt trauma patients in the emergency department, and notes that screening criteria for the thoracic and lumbar spine are less validated than for the neck (Beckmann, J Am Coll Radiol 2019). Tenderness over the middle of the low back, pain with gentle load, or new leg numbness or weakness after a crash needs imaging before treatment.
Most Low Back Pain Has No Identified Cause
A 2017 Lancet review describes most low back pain as non-specific, without a known anatomical cause, with a course that is often favorable. It also identifies overuse of imaging as a widespread problem (Maher, Lancet 2017). Imaging every patient with back pain after a rear-end crash is not justified by the evidence.
Imaging Findings Need Careful Reading
When lumbar MRI is done, degenerative findings are common in people with no pain. Disc degeneration ranges from 37% at age 20 to 96% at age 80, and disc bulge from 30% to 84% (Brinjikji, AJNR 2015). A post-crash lumbar MRI will often show something. Whether it explains the pain depends on the exam and on prior imaging.
A Possible Mechanism
Panjabi's hypothesis of chronic back pain proposes that subfailure ligament injury and damaged mechanoreceptors lead to altered muscle control and persistent pain (Panjabi, Eur Spine J 2006). It was framed for the low back. It is a hypothesis, and it explains how pain could persist without a visible lesion. It does not prove that it does in a given patient.
What I Document
Whether low back pain was present at the first visit, its intensity, whether it began with the crash, and any prior back problems or imaging. Those details carry prognostic weight and are hard to reconstruct later.
For an example of how post-collision imaging findings and outcomes are documented in the peer-reviewed literature, read the published case report on refractory lumbar pain following a motor vehicle accident in a geriatric patient by Dr. Justin M. Dick, DC.
Frequently Asked Questions
Can a rear-end collision cause low back pain?
Yes. Low back pain is common after rear-end collisions, and reporting it at the start predicted poorer whiplash outcome in a 2013 meta-analysis (Walton, J Orthop Sports Phys Ther 2013).
Does low back pain after a car accident affect recovery?
Low back pain at the start was a significant predictor of poor outcome, though its effect size is less certain than that of neck pain intensity or headache.
Do I need an X-ray for low back pain after a car accident?
Not always. Midline tenderness, pain with gentle load, or new leg numbness or weakness calls for imaging. Otherwise imaging should answer a specific question from the exam.
Will a lumbar MRI show what is causing my back pain?
Not necessarily. Degenerative findings are common in people without pain, so findings need to be matched to the exam and prior imaging (Brinjikji, AJNR 2015).
Why does Dr. Justin M. Dick, DC ask about low back pain after a neck injury?
Because low back pain at the start carries prognostic weight and is often underreported. Dr. Justin M. Dick, DC in Charlotte, NC documents it at the first visit.
Where can I get low back pain evaluated after a car accident in Charlotte, NC?
Dr. Justin M. Dick, DC, CNMT, ARRT(N)(CT), sees car accident patients at Clear Life Scoliosis and Chiropractic Center, 8814 Rachel Freeman Way, Suite 103, Charlotte, NC 28278, phone 980-368-0766. Personal injury patients are treated on a lien basis, with no out-of-pocket payment at the time of care.
Sources and Evidence Tiers
- Walton DM, MacDermid JC, Giorgianni AA, Mascarenhas JC, West SC, Zammit CA. Risk factors for persistent problems following acute whiplash injury: update of a systematic review and meta-analysis. J Orthop Sports Phys Ther. 2013;43(2):31-43. PMID 23322093. LinkEvidence tier: Systematic review and meta-analysis
- Squires B, Gargan MF, Bannister GC. Soft-tissue injuries of the cervical spine: 15-year follow-up. J Bone Joint Surg Br. 1996;78(6):955-957. PMID 8951014. LinkEvidence tier: Case series with long-term follow-up (40 patients)
- Beckmann NM, West OC, Nunez D, et al. ACR Appropriateness Criteria: Suspected Spine Trauma. J Am Coll Radiol. 2019;16(5S):S264-S285. PMID 31054754. LinkEvidence tier: Evidence-based guideline with expert panel rating
- Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet. 2017;389(10070):736-747. PMID 27745712. LinkEvidence tier: Narrative clinical review
- Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811-816. PMID 25430861. LinkEvidence tier: Systematic review
- Panjabi MM. A hypothesis of chronic back pain: ligament subfailure injuries lead to muscle control dysfunction. Eur Spine J. 2006;15(5):668-676. PMID 16047209. LinkEvidence tier: Hypothesis paper (mechanistic reasoning)
About the author. Dr. Justin M. Dick, DC, is the owner and treating clinician at Clear Life Scoliosis and Chiropractic Center in Charlotte, NC. He holds dual imaging credentials as a Certified Nuclear Medicine Technologist (CNMT) and as an ARRT-registered technologist in nuclear medicine and CT, ARRT(N)(CT). He is a Senior Fellow of the CLEAR Institute, holds the ISICO World Masters credential, is a SOSORT provisional member, and is a certified DOT medical examiner on the FMCSA National Registry. He has multiple peer-reviewed publications indexed in PubMed and serves as adjunct faculty at Life, Sherman, and Palmer chiropractic colleges.
Service Area
Clear Life Scoliosis and Chiropractic Center sees personal injury and spinal imaging patients from Charlotte NC, Huntersville NC, Ballantyne NC, Matthews NC, Concord NC, Mooresville NC, Rock Hill SC, and Fort Mill SC.
Related Pages
- Personal injury and car accident spinal care in Charlotte
- Research by Dr. Justin M. Dick, DC
- Case report: refractory lumbar pain after a motor vehicle accident
- Research and evidence at Clear Life
- Questions and answers
- Our team
- Press
- Book your evaluation
- Contact Clear Life
Clear Life Scoliosis and Chiropractic Center
8814 Rachel Freeman Way, Suite 103
Charlotte, NC 28278
Phone: 980-368-0766
Email: office@clearlifescoliosis.com
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