I Have Neck Pain After a Car Accident: Do I Need X-rays?
Being in a car accident can be one of the scariest events in your life, and one of the most common questions you might have is whether you need to get imaging done if you have neck pain. Thankfully, there has been a lot of research done and there are some basic rules that healthcare providers use to make this determination. In this post, we will look at the rules that are most commonly used for determining when neck X-rays are recommended.
Neck X-ray Rules
Between the neck and the low back, it is much more important to catch injuries in the neck, because it is smaller and therefore more likely to be injured by trauma, and injuries in this area are more likely to lead to serious problems compared to injuries to the low back. Luckily, there has been a lot of research in this area, which has produced several guides for determining when X-rays are necessary. Of all of these guides, the one that is most often used (and, in my opinion, is the best) is the Canadian C-Spine Rules (CCSRs).
The CCSRs were created about 20 years ago with the intention of creating a set of rules that would very rarely produce false negatives – a situation where the rules said there was no need for X-rays when there actually was. As a result, this set of rules is very conservative, because it’s much better to order an X-ray for a neck that’s intact rather than miss an injury that could lead to severe problems. One of the largest studies on the CCSRs found that the CCSRs only produced a false negative one time when examining a group of over 8,000 people, 169 of which had positive findings on an X-ray.
Canadian C-Spine Rules Overview
The CCSRs have 3 questions to answer. The first is whether or not the injury involved a high-risk factor which mandates X-rays. There are three possible factors to consider: age >65, numbness/tingling in the arms, and a dangerous mechanism. Zooming in further, the dangerous mechanisms related to a car accident are a car crash that was either >60 mph, a rollover, or an ejection; being a bicyclist; or being a pedestrian that was struck by a vehicle. If the answer is yes to any of these questions, X-rays are recommended.
If the answer to question one was no, we move to question two, which wants to know if there is a low-risk factor present that allows for the assessment of the neck’s range of motion. There are 5 low-risk factors to consider: simple rear-end motor vehicle collision (a rear end accident that does not involve being pushed into oncoming traffic, being hit by a bus or large vehicle, having a rollover, or being hit by a high-speed vehicle), sitting upright in the doctor’s office, walking, having delayed onset of neck pain, and having no tenderness with palpation of the spine. If the answer to any of these questions is yes – and the rear-end collision was simple – then we move to question 3.
Question 3 is an assessment of neck range of motion. If the patient is able to rotate the neck 45 degrees in each direction, then X-rays are not recommended. I have attached a flow sheet of this process, which is much easier to look at.
Summary
As I mentioned at the top, these rules are very good for making sure a broken bone in the neck is not missed. However, these rules are also very strict, and I see a lot of people who cannot rotate their neck 45 degrees after a car accident but don’t have any broken bones. That’s ok! We would much rather spend a relatively small amount of money to make sure your neck is ok, rather than spend tens or hundreds of times more to address a problem that was initially missed. When in doubt, it is best to see a healthcare provider to make sure serious injuries are not missed.
Western Slope Rehab and Performance is Here to Help
If you are struggling with injuries or have recently been in a motor vehicle accident, we can help. We are a physical therapy company that provides home-based orthopedic services in the Grand Junction, CO, area, as well as telehealth appointments throughout Colorado. If you would like to schedule a free consultation, you can call us as 970-462-9177, or fill out our contact form here.
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