Question
Hello Doctor:  12 yrs ago, in 60-car pileup on grapevine, had a bulging disk, which still goes out and I pop back in in C5-C6 area of neck. 11 mos ago rearended hard and thrown into vehicle ahead of me. Foot on brake very hard, but still picked vehicle up and threw it at vehicle in front, so I had two impacts. ER said cervical strain, my VA x-rays taken 7 mos after this last accident said: mild degenerative changes of facet joints at C5-C6. Disc spaces narrowed (C5-C6) w/subarticular mild DJD. Soft tissues normal and lordotic curvature mildly straightened. Impression: Mild degenerative changes and Diagnostic code: Minor Abnormality. I'm a 63 yr old and concerned how reinjuring my neck/upper spine is going to affect me in future.  Do I need continuing physical therapy treatments too?  In constant pain/soreness and neck, when turned can grate and be very painful. Now getting more headaches and have some degenerative changes in pelvis and now getting pain/stiffness behind right knee, feels more like a muscle?  What's your prognosis?  Thank you!  Sharron  

Answer
Dear Sharron,

First of all, just to clarify, it is anatomically impossible for a disk to pop out and then be popped back in...it just doesn't happen.
Once you have a disk injury, you will always have a disk injury. However, If there was a bulge, or a small herniation, it can improve with physical therapy, chiropractic care, or decompression therapy.

Concerning the C5/C6 articulation in the neck, what you are probably experiencing is where the joint spaces around that disk are being locked up, and when you move certain ways, you hear it pop allowing for improved mobility and reduced pain.  The pop is the result of gas inside the joint space escaping the joint capsule.  the only problem with this is the popping is likely comming from the joint above and below the C5/C6 articulation, and this is actually creating hypermobility at those areas rather than releasing the C5/C6 joint capsule.  Here's the good news, you still have a cervical curve according to the x-rays, which is good.

Now, you probably sustained ligament tears in the neck with the last crash.  This the most common injury in the neck after a rear-impact vectored collision.  The most commonly affected ligaments are the:  Posterior Longitudinal Ligament, Anterior Longitudinal Ligament, capsular ligaments (around the joint), and the upper cervical ligaments (alar, accessory, and cruciform).  I see these injuries all the time in my patients.  You have to take stress view x-rays (flexion/extension) to be able to see the damage or special a MRI
sequence called a FLAR (fluid attenuation) study.  The doctors at the ER do not commonly take these views, so I suspect the damage was never found or documented.  Typical pain patterns associated with ligament injury in the neck are the entire neck, shoulder, and upperback between the shoulder blades.  Headaches and facial pain are very common with damage to the alar/accessory ligament.

What I would recommend for you, is first have these views taken to see if the ligament damage is there.  Second, yes you need to continue with active exercises for the neck to promote proper scar tissue formation.  If the scar tissue forms in a haphazard manner, you will be more susceptible to pain, have reduced motion, and faster degeneration.  lastly, chiropractic adjustments to the neck are the only way to free up fixated segments of the spine, and I am sure that the C5/C6 area is chronically fixated from what you have described.  Spinal adjustments to the low back and pelvis will also reduce the likelihood of accelerated degeneration in those joints.  Not to mention that spinal adjustments have been proven to lessen pain, increase proper nerve firing patterns to the brain, and normalize functional movement inside the joint space.  It is important to note that physical therapists are prohibited by law from trying to perform spinal adjustments...They are not educated in these techniques, or the diagnosis of spinal pathology, and they are only allowed to mobilize tissue.  So I would suggest that you find a good local chiropractic physician.

For more information on spinal injury and rear impact collisions, the Spine Research Institute of San Diego has a great website:  www.srisd.com.  Good Luck Sharron.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net