Category Archives: Car Accident Injury

Ligament Injuries After a Car Accident

Ligament Injuries After a Car Accident


Auto Accidents Cause Neck Ligament Injuries

Ligament injuries of the neck can occur even in collisions with little vehicle damage. Speeds of less than 5 mph can cause permanent ligament damage.

Ligaments do not show up on x-rays, but evidence of ligament injury may show up if the proper x-rays are taken. Ligaments hold bones together. In the spine, a series of ligaments run up the front and back of the spinal bones to keep them aligned front to back. Called the "longitudinal ligaments," these are ligaments that are often damaged in motor vehicle collisions, particularly rear-impact crashes. Normal longitudinal ligaments keep the vertebral bones in the proper alignment and prevent them from sliding and separating too much when you bend your spine.

Radiographic Evidence of Ligament Damage

Taking x-rays while the neck is being flexed forward and then while extended backwards will show if there is excessive movement. Measurements are taken and compared to known normal values. If the abnormal motion is enough it may be considered an Alteration Of Motion Segment Integrity (AOMSI) which is a very serious permanent injury that equates to a 25-28% total body impairment. In other words as serious as losing a limb.

Neck Ligament Damage After a Car Accident Often Goes Undocumented

Most doctors, medical or chiropractic, do not know how to do this. They often do not order the proper x-rays and a medical radiologist will not make these measurements or compare it to impairment values. This is where a doctor specializing in whiplash injuries comes in. A true whiplash expert knows this and many other methods of objectively proving your injury, providing the proper treatment and reporting to insurance companies and lawyers.

Car Accident? Call One of Orange County's Leading Car Accident Injury Experts Dr Barry Marks, Chiropractor (714) 938-0575

Dr Barry Marks, Chiropractor
Car Accident Whiplash & Brain Injury Specialist
1745 W Orangewood Ave #114
Orange, CA 92868
(714) 938-0575

How to Know if You Have Whiplash

How to Know if You Have Whiplash

how to know if you have whiplash

Been in an accident and not sure if you have whiplash? Here are tips from a car accident whiplash expert on how to find out.

Car Accident Whiplash Injuries

“Whiplash” is the general term used for a neck injury caused by a car accident. It was first used to denote the “whipping” motion of the head and neck during a collision. As science advanced, the mechanism of injury became more clear and precise and doctors moved away from using the term. But because it is a word ingrained within our culture, doctors are trending towards using the term again.

A car accident can injure any part of your body. Injuries are caused by energy that is transmitted from one vehicle into another. As cars collide, energy is dissipated by crunching of plastic and metal, sound, heat and even light energy. After all this energy is bled off, some may remain. This residual energy is what causes an injury. The more residual energy in a collision, the more likely you are to be injured and more severe it may be. Most auto accident injuries are suffered in low to moderate speed collisions in which the amount of vehicle damage is fairly low so less energy is dissipated by the vehicles and more energy is experienced by the occupants.

Symptoms of a Car Accident Whiplash Injury

Symptoms may come on immediately or may take some time to emerge, these are the most common symptoms:

  • Headache
  • Dizziness
  • Nausea
  • Fuzzy headed feeling
  • Sleepiness
  • Irritability, anger
  • Neck stiffness
  • Neck soreness
  • Pain on movement
  • Clunking or crackling sounds on moving neck
  • Upper and middle back pain
  • Pain stabbing into shoulder blade on neck movement
  • Low back pain
  • Buttocks pain
  • Shoulder, arm, wrist or hand pain
  • Numbness and tingling into arms and hands
  • Hip, knee, leg or foot pains
  • Numbness and tingling into the legs and feet

How to Know if You Have Whiplash

Symptoms may be subtle and slowly ramp up over a period of days or even weeks making some people question whether they are hurt from the accident or some other cause. The best way is to take an objective, rational inventory of the situation and how you feel. Many people want to minimize the situation because nobody really wants to think of themselves as injured. Untreated injuries account for prolonged suffering later, so it's best to be honest with yourself and try to determine if you have symptoms related to the accident. In general, symptoms are not a good indicator of severity of injury. You may have moderate injuries, but only experience mild pain and you may have sever pain, but only mild injuries. The key is that any symptoms following a collision indicates injury of some degree.

You may want to ask yourself these questions:

  • How do I feel overall compared to just prior to the accident? Are my eating, sleeping, energy levels any different?
  • How does my head, neck, back, arms and legs (any area that feels some soreness) feel compared to just prior to the accident?
  • Are my thinking, reading, speaking, balance, coordination and emotions different than prior to the accident?
  • Are there any activities like washing hair, bathing, dressing, household chores, child care, recreation or work, that cause discomfort, make me change the way I do them or that I avoid since the accident?
  • If you already had pain before your accident, did it change after the accident? Does it hurt more intensely or more often, has the nature changed from dull ache to sharp, does your pain now interfere with activities that you could do before? In other words, if you felt one way prior to the accident and after you feel different, that is a sign that you may have suffered an aggravation of a pre-existing injury from your car accident.

Consult with a Car Accident Doctor Specializing in Whiplash

Once you've taken an inventory of how you feel, the next step is to seek an evaluation with a doctor who specializes in these types of injuries. General doctors lack the training and experience to identify many car accident injuries. Less obvious signs will be missed and even more serious injuries such as concussions and damaged ligaments are often overlooked by family medical physicians and general chiropractors. And when it comes to proper treatment, these doctors often prescribe treatments that are lacking.

How a Specialist Will Know if You Have Whiplash

A doctor specially trained in the diagnosis and treatment of car accident injuries will be able to objectively and systematically locate any injuries and determine if they are caused by the accident.

The doctor will review your complaints, the specifics of the accident, your past history and have you complete specific standard medical questionnaires for each symptoms or area of injury. With this information the doctor will be able to assess whether it is possible or likely for an injury to occur.

You will then undergo a physical examination involving your spinal nerve system, your brain, your bones, joints and muscles and a specific chiropractic analysis of spinal alignment and function.

In most cases imaging such as x-rays will be requested that will be able to tell the doctor what degree of injury has been suffered and if there are any pre-existing problems such as arthritis or spinal anomalies that may complicate your injury. Under some circumstances you may be referred out for a CT scan or MRI as well.

Once all of this information is gathered, your car accident specialist doctor will then compile it to document whether an injury has occurred, if it is due to the accident in question, the severity of the injuries, what treatments are available and appropriate for your specific condition and what the long term outlook for recovery is.

After your injuries are located and documented, the next step is a plan for treatment for whiplash from car accident.

Recently Suffered a Car Accident? You Need to Be Evaluated by a True Whiplash Expert. Call (714) 938-0575 for an Appointment with Dr Barry Marks, Car Accident Chiropractor in Orange County Since 1986.

What is a Sprain?

What is a sprain?

neck sprain torn ligaments

Practically everyone at one time or another has suffered a “sprain,” but while it is a common problem, most people do not understand exactly what it is.

The casual use of the word “sprain' adds to the confusion. Additionally, because the word is often incorrectly used, the severity and long-term consequences of these injuries are often minimized. If you've been unlucky enough to be injured in a car accident, you may hear the opposing insurance company say things like “it's just a sprain” or “just a soft tissue injury” it's not a serious injury. You may have also heard someone say these injuries heal by themselves rather quickly with no consequences.

To make a sprain injury more understandable, let's take a look at what a sprain actually is from a medical standpoint.

If you were to search on the internet the term “sprain” you will likely see this definition:

To sprain is to wrench or twist the ligaments of (an ankle, wrist, or other joint) violently so as to cause pain and swelling but not dislocation.


A sprain is the result of a wrench or twist of the ligaments of a joint.

This definition is incomplete. It does show that a sprain has a traumatic cause, which is true and it also states that it is an injury to a ligament, also true. What it doesn't describe is the actual medical, anatomical injury and that is very important in understanding this type of "soft tissue" injury.

Compare the above definition with the definition from the American Academy of Orthopedic Surgeons.1


A sprain is a stretch and/or tear of a ligament, a strong band of connective tissue that connect the end of one bone with another. Ligaments stabilize and support the body's joints. For example, ligaments in the knee connect the thighbone with the shinbone, enabling people to walk and run.

A sprained knee can be the result of a sudden twist, and a wrist sprain can occur when falling on an outstretched hand.


Sprains are classified by severity:

Grade 1 sprain (mild): Slight stretching and some damage to the fibers (fibrils) of the ligament.

Grade 2 sprain (moderate): Partial tearing of the ligament. There is abnormal looseness (laxity) in the joint when it is moved in certain ways.

Grade 3 sprain (severe): Complete tear of the ligament. This causes significant instability and makes the joint nonfunctional.

So as you can see the more precise definition is a traumatic jerking or twist of a joint that results in “overstretching” of a ligament that causes damage, tearing of the fibers of the ligament. The severity of the sprain depends on how many fibers are torn. The reason this is important is because, especially in a medical-legal scenario, automobile insurance adjusters often claim a “sprain” in the spine is just an “injured” or “damaged” ligament and not an actual “torn” ligament. They classify this as only a "soft tissue injury."

ligament sprain gradesA sprain is a torn ligament

You now know the truth, that a sprain is in fact a “torn” ligament to some degree. A Grade 1 sprain basically heals with little treatment over a period of weeks and leads to no discernible instability. A Grade 2 takes much longer to heal, months in fact, and NEVER returns to the same strength or elasticity as before because enough fibers have been torn to permanently affect the function of the ligament. It is a serious injury. A Grade 3 sprain is a very serious injury that involves a complete tear of the ligament and the joint is rendered totally nonfunctional and requires surgical repair.

Why are sprains serious?

Remember the function of a ligament is to hold a joint together. If the ligament loses its strength and elasticity it cannot properly hold the joint together. It's similar to the elastic in your socks; once its stretched too far, your socks will never stay up. When this happens, the joint malfunctions and osteoarthritis sets in within 5 years. In the spine it is especially problematic because excessive motion of the vertebral bones in the spine can lead to damage to nerves. If the instability is severe enough, it is classified as a very high degree of permanent impairment.

How do I know what Grade of sprain I have?

If you twist an ankle, and you experience only mild pain on walking and there is only slight swelling and no bruising in the area in the next 24 hours, you have a Grade 1 sprain. Let's say in the same injury you have difficulty walking and notice more swelling that obscures part of your ankle bone and you notice bruising in the area within 24 hours, you likely have a Grade 2 sprain. A Grade 3 sprain will be very painful, enough to totally prevent walking and the ankle may seem very loose and or make popping or cracking noises. Swelling will be severe and much bruising will be seen.

What about a sprain in the spine?

Spraining ligaments in your spine requires a high amount of stress on the ligaments. Car accidents and high intensity sports injuries are the most common causes. Because the ligaments are deep, you will not see swelling or bruising. An MRI can sometimes show larger tears in a spinal ligament, but not always. Additionally, an MRI is a static test, meaning the patient is lying still and not moving so you have no idea if any function is altered. You cannot see joint laxity or instability on a static MRI.

The best method for determining ligament damage in the spine is not by “seeing” the actual damaged ligaments, but by seeing the evidence of abnormal function due to ligament tearing.2 Remember a Grade 2 or 3 ligament sprain will allow for excessive movement in the joints. This can be viewed on motion or stress x-rays. In the spine x-rays are taken from the side in the neutral position, then with head flexed forward and again with the head extended backward for the neck or bending forward and back at the waist for the lower back. The spinal bones are then analyzed as they move to see if excessive motion exists. The amount of excess movement is measured and compared to a normal value. Bones that move too far are due to ligaments being “torn” to some degree and unable to hold the bones together properly. A Grade 2 sprain will show up as unstable motion on a bending x-ray, a Grade I will not. A Grade 3 would show extreme instability, enough to require surgery immediately. Grade 1 sprains often have very mild symptoms, so these victims often do not seek medical attention. Grade 2 sprains occur in around half of rear impact car accident cases, while Grade 3's are not nearly as common.

To recap, a sprain is a traumatic injury to a ligament in which the ligament is overly stretched. The severity of the sprain depends on how much of the ligament fibers are torn. A Grade 1 sprain is an overstretching with very little tearing, a Grade 2 is a partial tearing of the ligament and causes instability of the joint. A Grade 3 is a complete tear that results in total loss of joint integrity and requires surgery. Grade 2 & 3 sprains are common and serious injuries after a car accident that can be documented on “stress x-rays.”



American Academy of Orthopedic Surgeons

Brownstein SP, Jefferey Cronk DC, Joseph Cioffi BA. Evaluation of Spinal Ligamentous Injuries using Computerized X-ray Interpretation. Orthop Rheumatol Open Access J. 2015;1(1): 555551. DOI: 10.19080/OROAJ.2015.01.555551


Car Accident Pain

Car Accident Pain

car accident pain

Pain After a Car Accident
Orange County, CA

Pain after a car accident may be mild or more severe and may begin immediately or take days to weeks or longer to fully emerge.

What Happens to Your Body During a Car Accident?

A car crash is a very traumatic event. Even slow speed crashes that leave little vehicle damage, causes a great deal of energy to be transmitted to your body. Upon impact your body will feel as it is being jolted or thrown towards the striking vehicle. The jolt or jerk is extremely quick and sudden. When your body twists and turns so quickly due to the crash, your muscles and ligaments ability to protect your spine is exceeded and they become damaged.

What Becomes Injured After a Car Accident?

The sudden impact of a car wreck causes damage to the following tissues:

  • Muscles
  • Ligaments
  • Discs
  • Joint cartilage
  • Brain
  • Nerves
  • Bones

Where is My Car Accident Pain Coming from?

Each tissue that becomes injured has a particular pain pattern or sensation

Muscles usually exhibit injury by a burning, cramping, spasming or grabbing pain usually on movement.

Ligaments are often the cause of sharp pains or deep burning pain within a joint at rest and on movement. If your ligament is badly damaged you may feel a popping, clicking or clunking on movement.

Disc pain comes in two varieties; if the disc itself is torn or damaged it will cause a deep ache around the midline of the spine near the site of the injury. If the disc is damaged and becomes herniated (an inner gel substance pokes out) it can irritate nerves causing numbness, tingling, sharp shooting pain, electric shock sensations, burning into an arm/hand or leg/foot. Neck discs cause arm/hand pain. Low back discs cause leg/foot pain.

Joint cartilage can be damaged when joints suddenly collide together due to force. The pain is commonly an ache, burn or poking sensation when the joint is compressed. If you bend your neck backwards and sideways simultaneously and you feel pain poking into the shoulder blade or upper back, then it is likely you have a damaged joint.

Brain injuries can cause wide ranging symptoms, the most common are headache, daytime sleepiness, dizziness, lack of mental clarity, anger, sadness, forgetfulness and more

Nerves can be irritated by disc herniations or your nerves can be injured by being stretched or compressed by excessive motion of the spine. Nerve pain is electric, shooting, burning, tingling or you may have areas where you feel nothing at all, numbness.

Bones can be fractured in an auto accident due to the extreme forces involved. You could have a fracture and not have extreme pain. Bone pain is mostly deep aching, burning, boring in nature.

Pain Intensity Has Nothing to Do With Injury Severity

Some people experience very little pain despite the fact that they have suffered ligament damage or a concussion. Others feel severe pain, but show very little actual tissue damage. Pain is an individual experience; no two people experience it the same way. Your pain is yours only and you should not compare yours to others, even people who may have been in the same car as you. What matters is that you explain and describe your pain clearly and completely so your doctor will be able to determine what tissues are damaged and perform the appropriate examinations and tests. It is only through a competent, specialized exam and imaging studies can the severity of your injury be found.

It doesn't matter whether your car accident pain is mild or severe after a car accident, the important thing is to seek an examination with a doctor specializing in car accident injuries.

For an evaluation by Dr Marks, one of Orange County's most experienced car accident injury specialists, call (714) 938-0575.

Dizzy After a Car Accident in Orange County? It Might Be Vertigo…

Dizziness After a Car Accident Is a Very Common Complaint.

woman with vertigo dizziness nausea treatment orange countyDizziness and nausea treatment in Orange County, CA

There are many causes of dizziness or vertigo after an auto accident injury:

  • Concussion
  • Disc herniation
  • Neck sprain
  • Inner ear problem called BPPV

This article discusses BPPV or Benign Paroxysmal Positional Vertigo. This can be a mild dizziness on moving your head to a debilitating problem preventing most activities. Whether the symptoms are mild or severe, the good news is there are fairly simple treatments that can fix the problem.

It Starts in Your Ear...

In your inner ear there is an organ system that senses where you are in space and tells the brain. When you move your head a gelatin-like substance that has tiny crystals embedded on top moves hair cells that detect movement. If the system is working ok, normal head movements can be made without causing dizziness. A common problem can occur though, that causes a malfunction in the system. If your head is shaken very hard, some of the crystals may dislodge and find themselves where they don’t belong. If enough of them are loose they can clump together into a stone. This can cause changes in fluid flow so that when your head moves the fluid continues to flow abnormally and your brain detects motion even though you are no longer moving your head. Your brain becomes confused and you interpret this as dizziness or vertigo. Along with the vertigo you will often also have a rapid twitching or cycling of the eyes from side to side called nystagmus. This results in blurred or double vision.

What’s it Feel Like to Have BPPV?

Dizzy. Nauseous. If you are suffering from BPPV the main symptom is dizziness or feeling like the room is spinning whenever you move your head or change positions from down to up or side to side. You may have double vision, many people become nauseated and some actually vomit because the symptoms of BPPV are so severe. A common complaint is “I get dizzy when I turn in bed and can only lie on one side or I have to sleep with my head propped up.” Others will say, “I get dizzy and feel like I’m going to fall whenever I try to get up out of a chair.”

These symptoms are also associated with low blood pressure, iron deficiency anemia and certain medications, especially drugs acting on the heart. It’s important to distinguish between these other causes of dizziness because they can be very serious.  If your doctor has already told you, you have vertigo and given you a prescription for anti-vert and not done the treatment suggested in this article, you may want to give this a try to see if your BPPV goes away and you will not need the drugs any longer.

What Causes BPPV?

This vertigo problem can seemingly come out of nowhere with no known precipitating event. Elderly patients are more likely to suffer BPPV with no identified cause. The older we get the easier it is for this to occur. In younger people it is very often the result of your head being shaken or jolted quickly such as after a slip and fall, a sports injury, car accident, having your head tilted back too long at the dentists or hair salon, bumpy mountain bike rides, body surfing, bouncing as in aerobics or Zumba, etc. The sudden movement of the head causes embedded crystals to break off and wander into the canals. If enough of them do this and they coalesce into a sizeable little rock (otolith) they can wreak havoc with the fluid movement in your ear and create dizziness.

How Do You Diagnose Benign Vertigo?

The description you give to the doctor is a strong indicator; sudden onset dizziness on turning your head with recent accident or bumpy activity, no changes in medications recently, etc

Once BPPV is suspected, it is definitively diagnosed with a simple maneuver called the Hallpike Test or Dix-Hallpike Test. This is a provocative test, meaning it is designed to specifically re-create your dizziness in order to determine if it is BPPV and which ear is involved. It can be both ears! Your dizziness and nausea will be aggravated by this test, but it is crucial to properly diagnosing your condition and the good news is, the test is halfway to the treatment and resolution of your vertigo because the treatment will immediately follow the test and only take a short time.

The Hallpike test involves turning your head 45 degrees and lying on your back with your head still in 45 degrees rotation while your head is dangled over the edge of the table or bed. Your head is held in this position for up to 30 seconds to see if your vertigo worsens and most importantly, your doctor is looking for “nystagmus” or a rhythmic jumping of the eyes. If this occurs it indicates that is the problem side. The test is repeated to the opposite side just in case you have it on both sides.

test for vertigo dizziness bppv

What is the Treatment for BPPV?

Once the side is figured out, your doctor will then perform what is called “Epley’s Maneuver” or “canalith or otolith repositioning maneuver.” This procedure is similar to the Hallpike test in that you are quickly brought back with your head lying over the edge of the exam table with your head turned to the bad side. You are held in this position for up to 2 minutes or when dizziness and nystagmus stops.  Your head is then turned to 45 degree angle the opposite angle with head hanging and held another 2 minutes. You may feel dizziness moving. You are then directed to roll onto the side you are turned to with your head facing down towards the table and hold for 2 minutes. Lastly, you are brought upwards to a sitting position holding your head turned. You then straighten out your head and look forward and sit for about 10 minutes. It is important not to tilt your head up or down while waiting for the 10 minutes. Afterward, if your symptoms recur, your doctor will repeat the procedure on subsequent visits until no symptoms return.

Tips for After the Treatment

  • Avoid tilting head back or forward for the rest of the day.
  • Avoid sudden head movements for a day or two
  • Avoid activities that cause a lot of bumping or vibration for a day or two
  • Avoid sleeping on the affected side for about a week

If the symptoms return, go back to your doctor right away and have the procedure done again. In some cases you may need to have this done 3-5 times. The majority however clear up after only 1 session.

Benign Paroxysmal Positional Vertigo can be a very scary and disabling condition. Luckily it is fairly easy to diagnose and treat without drugs or surgery. If you’ve suffered from vertigo you might want to consider getting checked for BPPV.

Dizziness and nausea treatment in Orange County, CA. Dr Barry Marks, Chiropractor, car accident whiplash and brain injury doctor Orange, CA