According to the American Medical Journal, more money is spent each year on back problems than any other body part. Back injuries can be long lasting and are easily susceptible to exacerbation. This makes them especially difficult to manage. Making the problem worse is that your back is constantly in a state of degeneration as you age. It is no wonder that back injuries are one of the most litigated issues in personal injury cases.
Insurance companies know this. They typically fight back injuries by saying that a client’s problem was “pre-existing.” Many times they do this despite strong medical records showing a direct causal link between the accident and the injury.
In a jury trial, experts are needed for the plaintiff to prove that an injury was caused by the accident. Two issues stem from this. Does the patient need to get surgery? If so, what is the value of that future surgery?
An expert will be able to review the medical records and determine if the patient has done all they can to manage their condition. If they have, experts will recommend surgery as the final option. This decision, however, is not one that is made quickly or lightly. Experts will usually not recommend an individual has back surgery before all conservative treatment options have been exhausted. So just what are conservative treatment options?
After an accident, an individual usually treats with a medical doctor, either at the emergency room or with their personal doctor. Medical doctors often prescribe muscle relaxers and mild pain medication with instructions to follow up if the pain persists.
Doctors often refer injury victims to either a chiropractor or a physical therapist for continued care of their injuries. Chiropractors are generally considered passive treatment while physical therapy is considered active treatment. Chiropractic treatment is usually given to a patient 20-30 visits over the course of 2-4 months.
If someone does not see positive results from passive treatment, they usually go back to their medical doctor for a referral for active treatment with a physical therapist. Physical therapy sessions may last 4-8 sessions over the course of 1-2 months. This is considered active care as the individual is expected to perform the recommendation stretches and exercises on their own between sessions.
If neither treatment works, the next step is usually a referral to a pain management specialist. Here pain injections (often Toradol) are given over the course of 2-3 months. If the patient does not respond to these injections, the next step is to see an orthopedic surgeon.
Assuming the back injury is severe, at some point during the patient’s treatment, an MRI is needed to show if there are any changes to the discs in the back. While emergency rooms and chiropractors generally take x-rays for anyone coming in complaining of back pain, these are not the best imaging source for back injuries. MRIs and CT Scans are the two imaging sources that best show soft tissue injuries. Without getting one or both of these, an individual will only have the results of the objective testing from the chiropractic or physical therapy records to prove their injury. Again – not all cases require this. But when individuals have completed chiropractic and physical therapy treatment and remain symptomatic, MRIs provide much needed evidence to show that this is not a minor back pain.
After pain management injections are given, if the individual is still symptomatic, they should be seen by an orthopedic surgeon to see if they are a candidate for surgery. This is the nuclear option and one that should not be arrived at lightly.
In preparation for trial, insurance companies retain their own experts to refute the plaintiff’s expert. They will be looking for a reason to minimize the plaintiff’s claims. This can be done in a lot of different ways. They can use the medical records to argue that plaintiff’s injury was pre-existing. All humans experience wear and tear on their back as they age. If the plaintiff is older, they are especially likely to have some problems or some treatment on their back. A defense expert could also argue that the plaintiff did not exhaust all conservative treatment options first.