After a collision

AFTER A COLLISION

The imaging came back normal, the pain did not go away, and somewhere around week six the tone of the conversation changed. That sequence is the ordinary course of a facet-mediated neck injury, not evidence that you are exaggerating.

What actually gets injured

In a rear-end impact the head lags the torso for a fraction of a second and the cervical spine passes through an S-shaped deformity before it extends. The structures loaded hardest at that moment are the zygapophysial joints — the facet joints — and their capsules. They are richly innervated, they do not appear on a routine scan when injured, and they are the single most common identified source of chronic neck pain after a collision.

Facet involvement is present in a substantial share of chronic neck pain overall, and the proportion rises with age. That is a prevalence figure from a clinic population rather than a prediction about you, which is exactly why it is established with a block rather than assumed.

Three things are happening at once, and only one is mechanical

The joint injury is real. So is the change in how the nervous system processes input from that segment once pain has persisted for months — the same afferent barrage that made the pain useful in week one keeps the dorsal horn sensitized long after the tissue has done what healing it is going to do.

And the third driver is neither. It is what an open claim does to sleep, to work, and to the ordinary sense that the problem will resolve. Litigation stress is not a character flaw and it is not malingering. It is a physiological load on a nervous system that is already sensitized, and a treatment plan that ignores it is treating two thirds of the problem. Sleep is a treatment variable, not an afterthought.

Why the scan does not settle it

An MRI images anatomy. Facet-mediated pain is a functional diagnosis, and a normal study is the expected finding rather than a surprise. The report describes what your neck looks like; it does not explain what your neck is doing. Why a normal MRI does not close the question.

What settles it is a diagnostic medial branch block: anesthetize the nerves that supply a specific joint and see whether the pain goes. If it does, the target is identified. If it does not, we have learned something real and we have not treated the wrong structure for a year.

The delay that gets used against you

Neck symptoms after a collision commonly begin hours or days later, not at the roadside. That is physiology — the inflammatory response and the protective spasm take time. It is also the single most common thing an adjuster points at.

Which is why the record matters. Get evaluated, describe the symptoms as they actually are rather than as you hope they will be next week, and let the notes accumulate contemporaneously. A gap in treatment is read as a gap in injury whether or not that is fair.

How care gets paid for while the case is open

• Medical payments coverage on your own auto policy, where you have it, pays early treatment regardless of fault.
• Your health insurance, which usually still applies and may assert its own right to be repaid from a settlement.
• A lien or a letter of protection, where treatment proceeds now and is paid from the resolution of the case. See what a medical lien is and how a letter of protection works.

One thing said plainly, before treatment rather than after

The bill is for services rendered. A lien changes when it is paid. It does not change whether it is owed, and you remain responsible for it whether the case is won or lost.

We say that at the start deliberately. An arrangement where the bill disappears on a bad outcome quietly invites treatment to accumulate at no apparent risk, and that is not a footing either of us should be on.

Which state the collision happened in

Missouri and Illinois handle injury claims differently and the practice treats both sides of the river. It changes the paperwork, not the treatment. Say which one at the first appointment.

Where to read next

• Whiplash, and what is actually injured
• Cervical facet syndrome
• Headache that starts in the neck
• When neck symptoms are urgent