Your neck doesn't lie: pictorial proof of the damage caused by a car accident
Whiplash: What Can Happen to the Cervical Spine?
A car accident, a fall from a bicycle or motorcycle, or any other injury that causes the head to accelerate and decelerate rapidly can result in what is commonly known as “whiplash.”
Even in the absence of a fracture, some people may experience neck pain, stiffness, headaches, limited mobility, or other persistent symptoms following the injury.
Imaging performed immediately after an accident primarily seeks to identify specific traumatic injuries that require medical attention. The absence of a fracture does not necessarily mean there are no symptoms or functional changes following the trauma.
Some studies have also examined changes in cervical alignment parameters—including cervical lordosis and head position—following trauma.
A study using X-rays taken before and after the accident
A study published in 2024 by Evan Katz and his colleagues is particularly valuable because it provides cervical X-rays taken before and after trauma in the same patients.
The authors analyzed various radiographic parameters, including cervical curvature and head displacement, to study the changes observed following the trauma.
These findings are useful for understanding the biomechanical changes that may be observed following certain types of cervical trauma. However, they must be interpreted within the limitations of the study and do not allow us to conclude that a change in lordosis alone explains a patient’s symptoms.
What do the X-rays taken before and after the accident show?
Among the 41 patients studied, the authors observed a significant change in several cervical alignment parameters following the accident.
On average, cervical lordosis at the C2–C7 level decreased by approximately 8°. The decrease was particularly pronounced in the middle cervical region, between C3 and C5, with the average development of mild kyphosis at that level.
The authors also observed a slight increase in the anterior translation of the head relative to the cervical spine.
Finally, 4 of 41 patients (approximately 10%) exhibited new or markedly different segmental displacements following the accident; however, these displacements remained below the radiographic threshold used by the authors to define instability.
Have the symptoms changed as well?
In this series, the average pain score rose from 2.7/10 before the accident to 5.0/10 after the accident.
The Neck Disability Index (NDI), available for 24 of the 41 patients, increased on average from 15.7% to 32.8% after the accident.
These findings show that, in this specific population, the injury was followed by both an increase in symptoms and measurable changes in cervical alignment. However, they do not support the conclusion that a decrease in lordosis alone is responsible for pain or disability. PubMed
Important point: the study's limitations
This study is a retrospective case series, not a controlled trial. Furthermore, the patients were already seeking treatment for cervical problems prior to their accidents, and their mean cervical lordosis was already reduced before the trauma. The authors themselves note that further biomechanical and clinical research is needed to confirm their observations. PubMed Central (PMC)
Haas JW, Oakley PA, Ferrantelli JR, Katz EA, Moustafa IM, Harrison DE. Abnormal Static Sagittal Cervical Curvatures following Motor Vehicle Collisions: A Retrospective Case Series of 41 Patients before and after a Crash Exposure. Diagnostics. 2024;14(9):957. DOI: 10.3390/diagnostics14090957.
After whiplash, is it always necessary to get X-rays?
No. A cervical injury does not automatically warrant an X-ray.
In the acute phase, the decision to perform imaging depends, in particular, on the mechanism of injury, the clinical and neurological examination, and the possible presence of signs suggesting an injury that requires medical treatment.
Some time after the trauma, when symptoms persist or the clinical situation warrants it, imaging may provide additional information. The findings must always be interpreted within the context of the patient’s clinical presentation.
Loss of Cervical Lordosis After an Accident: Should It Be Corrected?
The presence of cervical straightening, a decrease in lordosis, or a reversal of curvature does not automatically mean that it is the cause of the patient’s pain or that it must always be corrected.
On the other hand, when a change in cervical alignment is objectively documented and deemed relevant in light of the symptoms, function, and clinical examination, it may be incorporated into the treatment goals.
At the CCCV, depending on the situation, treatment may combine tailored chiropractic care, exercises, and specific CBP® postural correction techniques. Clinical progress and, when warranted, changes in certain postural parameters can then be reevaluated.
Learn about our approach to CBP® postural correction
After an accident, when should you seek medical attention for neck pain?
After a cervical injury, the course of recovery can vary greatly from person to person. Some pain gradually subsides, while other symptoms may persist and require further evaluation.
A consultation is particularly recommended in cases of persistent neck pain, significant limitation of movement, headaches, pain radiating down an arm, tingling, numbness, or muscle weakness.
However, certain significant neurological signs or a rapid worsening of symptoms following a trauma require urgent medical evaluation.
At the CCCV, the goal is to integrate the history of trauma, clinical and neurological examination, and—when indicated—imaging to determine the appropriate course of treatment.
