Overlooked Injuries After Car and Workplace Accidents

Hidden Injury Warning Signs

Abstract

After a car accident or workplace injury, it is possible to have pain even when standard X-rays look normal. X-rays are excellent for finding many fractures and bone problems, but they do not show most muscles, ligaments, spinal discs, joint capsules, fascia, or mild brain injuries in detail.

Some commonly overlooked injuries include small ligament injuries, annular tears in spinal discs, facet joint capsule trauma, myofascial trigger points, concussions, and repetitive workplace injuries.

At ChiroMed in El Paso, Texas, an integrative approach looks beyond the location of pain. The goal is to identify how an injury affects movement, muscles, joints, nerves, and normal function. Chiropractic care, medical oversight, rehabilitation, functional medicine, and other supportive treatments can work together to address both mechanical problems and biological tissue healing.

Why Some Accident Injuries Are Easy to Miss

After a motor vehicle accident, fall, lifting injury, or workplace accident, many people visit an emergency room, urgent care center, or primary care office.

These evaluations are important. The first goal is usually to identify serious problems such as:

• Major fractures
• Internal bleeding
• Spinal cord injuries
• Brain bleeding
• Dislocations
• Other medical emergencies

However, not every injury is visible on a basic X-ray.

Soft-tissue injuries may affect the:

• Muscles
• Ligaments
• Tendons
• Spinal discs
• Joint capsules
• Fascia

These structures can become stretched, torn, compressed, or irritated during an accident.

Advantage Healthcare Systems explains that soft-tissue injuries may be harder to identify immediately after a collision. Pain and stiffness can also become more noticeable as inflammation develops during the hours or days after the accident (Advantage Healthcare Systems, 2025).

This is why a person may leave an emergency department with no broken bones but still experience significant neck pain, back pain, headaches, or limited movement.

A Normal X-Ray Does Not Always Mean There Is No Injury

A normal X-ray can be reassuring, but it doesn’t always tell the whole story.

Standard X-rays are mainly designed to show bones and alignment. They provide much less information about discs, ligaments, muscles, nerves, and other soft tissues.

At ChiroMed, the clinical examination is important because it helps determine whether pain could be coming from structures that are difficult to see on a plain X-ray.

Small Spinal Ligament Injuries

Ligaments are strong bands of connective tissue that hold bones together and help control joint movement.

During a collision or workplace accident, the neck or lower back can move very quickly.

For example, the spine may be:

• Bent forward
• Forced backward
• Twisted
• Compressed
• Pulled beyond its usual range

These forces can stretch or injure spinal ligaments.

Possible symptoms include:

• Neck stiffness
• Lower back pain
• Pain with turning
• Muscle tightness
• Headaches
• Pain after prolonged sitting
• Pain while lifting or bending

Small ligament injuries usually do not show clearly on a standard X-ray.

When symptoms, examination findings, or neurologic changes suggest a more complex injury, MRI or another form of imaging may sometimes be considered. The American College of Radiology notes that MRI can provide more information about soft tissues in selected spinal trauma cases (American College of Radiology [ACR], n.d.).

Annular Tears and Disc Injuries

The bones of the spine are separated by intervertebral discs.

Each disc contains:

• A soft inner center
• A tougher outer layer called the annulus fibrosus

During a motor vehicle accident, the spine can experience compression, twisting, bending, and sudden movement.

These forces may contribute to small tears or fissures in the annulus.

Possible symptoms can include:

• Deep back or neck pain
• Pain when sitting
• Pain when bending
• Muscle spasms
• Pain that spreads into the arm
• Pain that spreads into the leg

Annular tears cannot normally be seen on standard X-rays.

Some disc injuries can be seen on MRI. Studies have described MRI findings associated with annular tears and disc-related pain, although imaging findings must always be compared with the patient’s symptoms and physical examination (Lam et al., 2000; Saifuddin et al., 1999).

It is also important to remember that not every disc abnormality is caused by an accident. Some changes can develop with age or normal wear.

This is why the patient’s history matters.

Clinicians may consider:

• When the pain started
• Whether symptoms existed before the accident
• How the accident occurred
• What movements increase the pain
• Whether numbness or weakness is present

Facet Joint Capsule Injuries

The spine contains small joints called facet joints.

Facet joints help control movement between the spinal bones.

Each facet joint is surrounded by a capsule. This capsule contains connective tissue and nerve endings that can become irritated after trauma.

During whiplash, the facet joint capsule may be stretched very quickly.

Research has identified cervical facet joint structures as possible sources of pain after whiplash injuries (Chen et al., 2009).

Facet-related pain may become worse with:

• Looking upward
• Turning the head
• Twisting the back
• Standing for long periods
• Repeated bending
• Certain sleeping positions

Facet joint capsule injuries may not be obvious on a standard X-ray.

This is one reason why orthopedic testing, range-of-motion testing, and a complete musculoskeletal examination can be important after an accident.

Muscle Injuries and Myofascial Trigger Points

Muscles commonly tighten after an injury.

This is sometimes called muscle guarding.

The body may tighten muscles around an injured area to protect it from further movement.

However, prolonged muscle guarding can lead to additional pain and stiffness.

Sensitive areas called myofascial trigger points can develop within muscles and fascia.

These trigger points may cause pain in the injured area or refer pain to another location.

For example, neck trigger points may contribute to pain in the:

• Head
• Upper back
• Shoulder
• Arm

Trigger points in the lower back may cause pain near the:

• Hip
• Buttock
• Pelvis

These problems do not appear on standard X-rays.

They are usually identified through the patient’s history, examination, muscle testing, movement testing, and palpation.

Mild Concussion After an Accident

Not every hidden injury involves the spine.

A person may experience a mild traumatic brain injury, commonly called a concussion, after:

• A car accident
• A fall
• A workplace accident
• A sudden blow to the body
• Rapid acceleration and deceleration

The head does not always need to strike an object for a concussion to occur.

Possible symptoms include:

• Headache
• Dizziness
• Nausea
• Brain fog
• Trouble concentrating
• Memory problems
• Light sensitivity
• Noise sensitivity
• Balance problems
• Sleep changes

The Centers for Disease Control and Prevention explains that some concussion symptoms may appear immediately, while others can develop later (Centers for Disease Control and Prevention [CDC], 2025a).

A CT scan or standard MRI can also appear normal in a person with a mild traumatic brain injury.

Imaging is often used to look for serious problems such as bleeding rather than to diagnose every concussion (CDC, 2025b; Shenton et al., 2012).

Any worsening neurological symptoms after a head injury require medical evaluation.

Workplace Injuries Can Build Over Time

Not every workplace injury happens during one major event.

Some injuries develop slowly because of repeated physical stress.

This may happen with:

• Repetitive lifting
• Repeated twisting
• Long periods of sitting
• Poor workstation position
• Overhead work
• Repetitive gripping
• Tool use
• Vibration
• Frequent bending
• Awkward body positions

This type of injury may be described as cumulative trauma.

Stern and Cohen explain that cumulative trauma injuries can develop because of repeated movements, physical stress, or long-term overuse (Stern & Cohen, 2025).

Examples can include:

• Tendinitis
• Carpal tunnel syndrome
• Chronic low back pain
• Shoulder injuries
• Repetitive strain injuries

Because these conditions can develop slowly, a detailed work history may be important.

A clinician may ask:

• What does the patient lift?
• How often does the patient bend?
• Does the patient sit most of the day?
• Does the job involve repetitive hand movements?
• Does the patient work overhead?
• Does the job involve heavy tools or vibrating equipment?

These questions may help identify the source of ongoing physical stress.

Why the Physical Examination Matters at ChiroMed

Imaging can be useful, but it is only one part of an injury evaluation.

At ChiroMed, a complete evaluation may look at how the body moves and functions after the injury.

Depending on the patient’s condition, the examination may include:

• Range-of-motion testing
• Orthopedic testing
• Neurological examination
• Muscle strength testing
• Reflex testing
• Sensory testing
• Posture assessment
• Gait evaluation
• Joint movement
• Functional movement testing
• Review of the accident
• Review of symptoms

This information helps the clinical team decide what type of care may be appropriate.

It may also help determine whether the patient needs:

• MRI
• CT imaging
• Electrodiagnostic testing
• Specialist referral
• Further medical evaluation

How Integrative Chiropractic Care Fits Into Recovery

At ChiroMed, chiropractic care isn’t focused only on the area that hurts.

Accidents can change the way a person moves.

For example, a patient with neck pain may start turning their entire body instead of just their neck.

A patient with lower back pain may place more weight on one leg.

A shoulder injury can also change posture and upper-back movement.

These compensations may place additional stress on other muscles and joints.

Integrative chiropractic care may include:

• Chiropractic adjustments when appropriate
• Joint mobilization
• Soft-tissue treatment
• Mobility exercises
• Corrective exercises
• Stabilization training
• Rehabilitation
• Posture training
• Movement retraining

The goal is to improve movement while reducing unnecessary stress on injured tissues.

Clinical practice guidelines support exercise and selected manual therapies for certain forms of neck and lower-back pain when they are properly matched to the patient’s condition (George et al., 2021).

Combining Mechanical Recovery With Biological Healing

Accident recovery can involve two major areas:

Mechanical restoration and biological tissue healing.

Mechanical recovery focuses on how the body moves.

This may include improving:

• Joint movement
• Muscle function
• Posture
• Stability
• Balance
• Strength
• Flexibility

Biological healing focuses on how damaged tissues repair themselves.

Some patients may also be evaluated for regenerative or supportive treatments when medically appropriate.

For example, platelet-rich plasma, or PRP, uses concentrated components from a patient’s own blood. Platelets contain signaling proteins that are involved in normal healing processes.

Regenerative treatments are being studied for various tendon, ligament, and joint conditions, but outcomes can vary depending on the patient, injury, and treatment method (Cohn, n.d.).

These treatments should not be described as guaranteed cures.

Instead, the goal is to create a treatment plan based on the patient’s specific condition.

An Integrated Medical and Chiropractic Model

ChiroMed supports a multidisciplinary approach to injury care in El Paso.

Dr. Alexander Jimenez, DC, APRN, FNP-BC, CCST, CFMP, IFMCP, ATN, incorporates chiropractic, physical medicine, functional medicine, rehabilitation, and personal injury care into a coordinated clinical model.

His clinical observations emphasize looking beyond the painful body part.

An injury can affect:

muscles → joints → ligaments → discs → nerves → posture → movement

Understanding these connections can help guide treatment and rehabilitation.

Dr. Jimenez also works under the medical oversight of Dr. Maria Guadalupe Cardenas, MD, a board-certified internal medicine physician with more than 40 years of clinical experience.

Dr. Cardenas serves as a medical director and collaborative physician within Injury Medical Clinic PA.

This type of integrated arrangement brings chiropractic and medical care together while allowing each clinician to work within the appropriate professional scope.

Medical oversight may help with:

• General medical evaluation
• Medication considerations
• Chronic medical conditions
• Clinical safety
• Medical coordination
• Appropriate referrals

Dr. Jimenez’s role may include:

• Chiropractic care
• Musculoskeletal evaluation
• Functional medicine
• Personal injury care
• Rehabilitation
• Movement assessment
• Care coordination

This collaborative model can be especially useful when a patient has several health concerns after an accident.

The ChiroMed Approach to Hidden Injuries

The most important lesson is simple:

Pain after an accident should not be ignored only because an X-ray is normal.

A complete injury evaluation looks beyond bones.

The clinical team may need to examine the:

• Ligaments
• Muscles
• Spinal discs
• Facet joints
• Nerves
• Posture
• Balance
• Movement patterns
• Neurological function

At ChiroMed, the goal is to identify problems that interfere with normal movement and recovery.

From there, the care plan can focus on reducing pain, restoring movement, rebuilding strength, and supporting healing.

A clear recovery path often follows these steps:

1. Identify the injury
2. Rule out serious conditions
3. Reduce pain and inflammation
4. Restore healthy movement
5. Support tissue healing
6. Rebuild strength and stability
7. Return the patient to daily activity

For many accident and workplace injury patients, recovery is not about treating one painful spot.

It is about helping the body function as a connected system again.

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References

Advantage Healthcare Systems. (2025). The hidden soft-tissue injuries most people miss after a car accident.

American College of Radiology. (n.d.). ACR Appropriateness Criteria: Acute spinal trauma.

Centers for Disease Control and Prevention. (2025a). Symptoms of mild TBI and concussion.

Centers for Disease Control and Prevention. (2025b). About mild TBI and concussion.

Chen, H., Yang, K. H., & Wang, Z. (2009). Biomechanics of whiplash injury. Chinese Journal of Traumatology, 12(5), 305–314.

Cohn, J. (n.d.). Regenerative orthopedics: PRP, stem cells, and healing from within.

George, S. Z., et al. (2021). Interventions for the management of acute and chronic low back pain: Revision 2021. Journal of Orthopaedic & Sports Physical Therapy, 51(11), CPG1–CPG60.

Jimenez, A. (2026). MVA joint trauma: Comprehensive chiropractic approaches.

Jimenez, A. (2026). How regenerative medicine and chiropractic care work together. LinkedIn.

Jimenez, A. (2026). Regenerative medicine and integrative chiropractic strategies.

Lam, K. S., Carlin, D., & Mulholland, R. C. (2000). Lumbar disc high-intensity zone: The value and significance of provocative discography in the determination of the discogenic pain source. European Spine Journal, 9, 36–41.

Morgan & Morgan. (2025). 15 work injuries you may not know about.

Saifuddin, A., Mitchell, R., & Taylor, B. A. (1999). Extradural inflammation associated with annular tears: Demonstration with gadolinium-enhanced lumbar spine MRI. European Spine Journal, 8(1), 34–39.

Shenton, M. E., et al. (2012). A review of magnetic resonance imaging and diffusion tensor imaging findings in mild traumatic brain injury. Brain Imaging and Behavior, 6, 137–192.

Stern & Cohen. (2025). Workplace cumulative trauma and your right to compensation.