Author Archives: Barry Marks DC

Surprising Car Accident Injury Study


Japanese Car Accident Whiplash Study Reveals Shocking Data

car accident injury treatment

A 2001 study by Hijioka, Narusawa and Nakamura in Archives of Orthopedic Trauma Surgery  looked at 400 auto accident victims of varying ages and levels of vehicle damage and compared treatment duration.


The researchers excluded any accident victims with nerve or bone damage concluding that those injuries are not considered "whiplash" per se but are injuries that happen to occur from car accident trauma. Apparently to the authors a whiplash injury is simply a muscle and ligament injury, contrary to what whiplash researchers here believe. This removes Grade III and Grade IV whiplash injuries from the study, which skews the results. Had those injuries been included, the results would have been much different with even longer treatment times.

Car Damage and Treatment Duration:

What they found may be shocking to some, but for seasoned whiplash practitioners, it validated what we have known for many years: vehicle damage does not equate with bodily injury in a linear fashion. The longest durations of care were highest for two main groups: crashes that involved no damage at all to the bumper and crashes where one half of the car was damaged (rear bumper, trunk lid and either fender damage or frontal damage). The "no damage" category had the highest total treatment times, while the victims with completely destroyed cars had the shortest treatment duration. This emphasizes what crash experts have long said; a crash that involves no crumpling allows kinetic energy to travel through the vehicle and into the occupant causing injury. Heavy crashes involve much vehicle crumpling and destruction which absorbs or bleeds off kinetic energy and less is transmitted to the occupant.

Occupant Age and Treatment Duration:

Victims below 20 years of age fared the best with the lowest treatment duration. The worst group was the above 70 victims whose worn and stiff spines cause them to suffer more injury and take longer to heal. In the middle was the 30-40 and 50-60 range who were approximately the same.

Because of this study, we now have a set of risk factors that can explain treatment duration after an accident. The highest risk for prolonged whiplash treatment are:

  • No vehicle damage
  • One half of car damaged
  • Age >70
  • Age 30-60

Car accident injuries are complex and in some aspects confounding. For this reason, reviewing treatment durations requires taking into account the aforementioned risk factors.


Degenerative Disc Bulge vs Traumatic Disc Herniation


How to Tell If Disc Problems Found After a Car Accident Are Traumatic or Degenerative

This is not a neuroradiological treatise on disc pathology from trauma. This is an overview to make a difficult topic more understandable to treating physicians, insurance adjusters and personal injury attorneys.

The Dilemma of Disc Pathology

A dilemma facing doctors and personal injury attorneys is whether or not a disc problem is caused by the motor vehicle collision in question or is degenerative and therefore not related to the accident. This single fact can make a huge difference in the case. Obviously, the defendants (the insurance company) will want a radiologist to say the disc problem is old and degenerative and predated the collision to escape responsibility. The Plaintiff on the other hand will want the disc condition to be ruled traumatic in origin and caused by the accident to increase the value of their claim.

The Arbiter of Truth

This is where the treating doctor must make a purely clinical decision and report to each side the facts of the matter. The treating doctor must be the arbiter of truth. Medical ethics insists that a treating physician look at the medical facts and report them regardless what that means to a case. The rub of the matter is, and defense experts and insurers will not like this, but it is a fact, studies have shown that approximately 70% of disc lesions found after a car accident were in fact traumatic herniations. Therefore, a plaintiff attorneys should not fear an impartial and ethical treating doctor. After all, the odds are in their favor. The defense must take solace in the fact that they will get their way 30% of the time.

Disc Pathology: Bulge vs Herniation

(American Society of NeuroRadiologists definitions are used)lumbar-disc-normal-labeled


Disc Bulge: bulging or extension of 50% or more of the annular disc tissue beyond the normal disc margin boundaries.lumbar disc bulge

A disc bulge or a degenerative disc is a condition in which due to long standing pressure, activities, obesity, aging, etc the fibers in the outer disc layers lose integrity and begin to spread and expand. The disc ends up bulging out in every direction. Imagine a water balloon and you sit on it. The balloon will "bulge" outward all around. This finding is a bulge and is always degenerative in nature. Disc bulges are usually 3  mm or less in depth and are often associated with abnormal bone growth (osteophytes) around he areas of bulging. Disc bulges because of their generalized size are not referred to as left or right. You will usually see terms such as "circumferential bulging" or "circumferential bulging with osteophytic ridging."

Disc Herniation: localized extension or displacement of less than 50% of  the disc tissue beyond the normal disc marginslumbar-disc-herniation

Disc herniations, as defined, are discreet areas of disc displacement beyond the disc boundaries. Herniations are a result of trauma. Kinetic forces on the body from a traumatic force causes a significant defect within a portion of the disc and it herniates. The herniation will be seen on MRI immediately after the injury, although it may not appear as symptoms for some time. Annular tears or fissures are actually total disruption of the annulus fibers allowing the nucleus material to migrate through the annulus to the outside. Many tears are usually attributed to degenerative bulging. A solitary tear is caused by a single traumatic event. Any report that reads "left, right or central" as a location of a disc lesion is generally a herniation.

So What's the Problem?

The problem is many fold and has to do with the expertise of the people reading and interpreting the images. A 2009 Study published in Spine, reported a 42.2% misdiagnosis rate among general radiologists reading spine films. Radiologists disagree on terminology and many use lexicon that is outdated. General radiologists who see a few spines a day or even a week may not be up to date on guidelines. Reading radiologists who do not often report on personal injury medical-legal matters may be careless with their words and write ambiguous reports or use erroneous language.

Most doctors rely on the radiology report, but by doing so will be incorrect almost half the time. Few MD's or DC's read their own MR scans and even fewer are actually certified to read them. Sitting in many doctor's files and in narrative reports lawyers rely on to represent their clients are reports that are completely wrong. Reports that say "bulge" and attribute the lesion to aging, but that are in fact traumatically induced herniations. In general, if you read a report that says "bulge" but also gives a direction such as left or right, be wary. This may be a herniation that was incorrectly called a bulge.

What to Do About This Problem?

It is imperative that ALL MR films be read by both the treating doctor who is specifically trained in spine MRI AND a neuroradiologist. With both sets of trained eyes and using the same ASNR definitions and guidelines, the patient's condition is much more likely to be accurately reported. This is a major defining point between doctors who treat personal injury cases and those that are specifically trained in these matters.


FREE Dinner Seminar for Lawyers: Disc Pathology from Trauma

Attention Orange County, California Lawyers
Interested in Personal Injury...

car accident treatment

Disc Pathology from Trauma:

Herniated - Bulged - Protruded - Extruded Discs

Exposing and Overturning Deceptive Defense Medicine

Colossus Algorithms

Correlating Causality to:

  1. Bodily injury and persistent functional losses
  2. Bulged and herniated discs from trauma

Debunking Myths to Verify:

  1. Arthritis increases bodily injury
  2. Strains/sprains are permanent injuries
  3. Asymptomatic herniated discs as obfuscation
  4. No damage crash can cause serious bodily injury

Medical-Legal Documentation

This is a FREE Dinner Seminar for
Lawyers, Paralegals and Staff

Plaintiff - Defense - Arbitrators - Adjusters - Paralegals - Secretaries Welcome

3 CA CLE Credits Pending

Tuesday, April 22, 2014

6:00 - 9:00 PM

Doubletree Hotel

100 The City Drive

Orange, CA 92868


Limited Seating, Reserve Your Spot Today

Sponsored by Orange County Personal Injury Associates:

Dr Barry Marks (714) 938-0575
Dr. Robb Rattray (714) 892-0888
Dr. John Warren (714) 963-0955

What Past Attendees Have Said About Our Seminars:

"Best disc injury seminar I have ever attended." Admitted the bar 37 years

"This was hands down, the most useful CLE I have taken to date." Admitted to bar 4 years ago

"Excellent, very informative. I recommend this program to any party who works in this field."

"Highly researched and imperative to any new or experienced attorney." Admitted to the bar 52 years

Do NOT Pass Up This Opportunity to Hone Your Skills and Learn the Science Behind Your Clients Complaints, Enjoy Dinner with Colleagues and Earn CLE... For FREE.

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What NOT to Do After a Car Accident in Orange County

What NOT to Do After an Orange County, CA Car Accident

car accident settlement advice orange county

Today is just like any other day. You hop in your car, jump on the freeway and get movin towards work. And just like every other day, there's the same slowing traffic just before you hit the 55 and 5 merge. As you begin to slow down, you catch a glimpse in the mirror and you have a sudden sickening sinking feeling because you immediately realize today is NOT going to be just like very other day.


Just as you thought, although it's not that easy to think straight right now because your head is in a swirl and you feel as if you are under water. That glimpse in the mirror flashes back to you; the driver behind looking down in his lap rather than at the slowing cars, your car, in front. The noise of the crash still reverberates in your ears.

No, today is NOT like every other day because today has started out with a car accident.

Fast forward two weeks

Fortunately for you, you read this blog post What to Do After a Car Accident in Orange County, and you followed the advice therein. Your car is in the shop being repaired, you are on your way to see your chiropractor for whiplash and concussion treatment in a rental car and things are under control.

But now you are about to be thrown a curve ball...

You get a call and the voice mail is from the other person's automobile insurance company. The claims representative  (they like that term now because "claims adjuster," which implies adjusting your claim ever downward to save their company lots of money, doesn't focus study as well) says she would like to come to your house and take a statement and talk to you about your claim.

"Wait a minute," you think to yourself. I already spent half an hour at lunch talking to this woman and she took a recorded statement. What else can she possibly want?

Here's what she is trying to do:

She wants a face to face meeting with you to size you up. This claims rep is a specialist. Her job is to shake easily intimidated claimants loose in order to minimize damages to her company. She wants to look at your lifestyle, see your facial expressions and how you handle yourself because she will get an idea of what kind of trial witness you could potentially be. It's all about profiling. She's going to handle a financially stressed, twenty-something single mom in an apartment different than a middle aged, CEO living on a golf course near the beach.

In any event, at the end of the polite conversation in which promises will be made by her to take care of you, she will slide over a check (amounts vary from $200 to $3,000) and ask you to sign a release of liability form. That's the curve ball. It looks like an easy hit, but as soon as you swing, the ball jiggles and swoosh, strike!

Unless that check is a very big check with lots of numbers on the left side of the decimal point, DO NOT ACCEPT IT.

The offer by this first rep is always a very low ball offer--always. It is the reason she is there. To get you to accept a settlement that is any where from one tenth to one half the value of your actual case. And she's good at it. She probably has a 50% average or more at duping unsuspecting car wreck victims.

What you should do at this point is:

Smile, kindly slide the check back and ask for a complete offer in writing for you to consider. And tell her you do not make major decisions on the spot and to please not call that you will return your decision by mail when you are ready. Stand up, shake hands, nod to the door.

At this point, 2 weeks post-accident, you have no idea how much your medical costs will be. You may need an MRI in the next few weeks, you may need to be referred to another specialist for co-treatment, you could be one of the 40% of rear-impact car accident victims who suffer a permanent injury. You have no idea what the value of your case is, but the claims rep does. It's her business to know and she is eager and may get very aggressive to get you to accept her "kind" offer, but don't.

When you reject her offers, an interesting thing will happen: she will go away. You will receive a letter from a different claims rep who says they are taking over your file. "The closer" has failed, so now they put your file with a regular adjuster. After that, you will usually receive less calls or letters and they understand that you will not be taken advantage of easily. The new rep will try later during settlement negotiations, but that's a blog post to be written at a later time.

So what not to do after a car accident?

Do NOT Accept Any Initial Offer to Settle Your Car Accident Claim Until You Know What Your Long-term Medical Outlook is and How Much It's Worth