Question
I was rear-ended by an 18-wheeler carrying a 33,000 pound load when I was 36 weeks pregnant. My truck was totaled, not to mention I was towing a horse trailer and horse. I experienced early labor and slight low back pain that evening and was admitted to the hospital. Two weeks later, my back went out on me as I was putting on a sock. I felt the shift above my right buttock near my spine. I immediately fell to the floor and was unable to walk or put pressure on either leg for a period of days and it took two week before I could walk normally. Because I was pregnant, no MRI or CT was done. I had horrendous back pain in the spot where I felt my back "shift" during labor. My OB/GYN just assumed it was a slipped disk and I saw a chiropractor for about six weeks after I delivered. My back went out on me again in the same spot approximately three months after the delivery. An MRI was finally done and showed a herniated disk. My question is, is this definitely, or most likely, a result of the car accident? This was my third pregnancy, I am only 32 years old and in good health and shape with minimal weight gain during all of my pregnancies. I have never experienced back pain like this before.
I recently began experiencing sciatica where I originally felt my back give out above my right buttock. The pain goes across my right buttock, around my right pelvic side, down to my knee and to my ankle. Granted, this only happens occasionally. Will continued PT help with this condition?

Answer
Dear Alyssa,

I believe this is definitely due to the crash.  You had no problems before and these problems only came on after the collision.  Forces generated in a high kinetic energy crash such as yours can easily kill a person, so herniating a disk is more than likely.  I have spent years studying forces, impact, occupant kinematics, and injury from car crashes, especially rear-impact vectored collisions, and I have seen herniated disks after crashes frequently.

To complicate matters, the fact that you were pregnant at the time makes you more susceptible to injury.  this is because of a hormone called "Relaxin".  Relaxin stimulates the laxity of ligaments and specifically in the low back and pelvis during pregnancy to allow for the baby to transition through the pelvis easier.  This means that your ligamentous system had relaxed (compared to normal) and therefore it is easier for a herniated disk or ligament tear to happen due to the crash forces (transfer of energy from the semi truck to your body).

I would suggest that you continue with chiropractic care and active rehabilitation protocols, and I would further suggest that you make sure that your chiropractic physician, medical doctor, and/or therapists all understand the magnitude of these injuries.  Often people who have been injured in a car crash have problems for the rest of their lives.  Moreover, the American medical Associations 5th edition guidelines to impairment state that a herniated disk qualifies for a whole body impairment rating of 12-18%.  If there are ligament injuries as well that can be documented by radiographic measurement, the impairment rating can be increased by 25-28%.  That should show you how bad these injuries are.  (You should have your neck checked for ligament injury as well)

Now, I would also recommend that you hire an attorney to represent you in this matter as you are likely to have ongoing medical costs due to the crash, and you need to protect your interests.  I cannot advise you on legal matters, but I have often seen my patients need the help of a qualified personal injury attorney.  In the mean time, please go to The spine research Institute of San Diego's website fro more information on crashes and injury:    WWW.SRISD.COM   This site also has a physician's listing to show the doctors who have been through the training programs offered at the institute.  It may help you find qualified doctors in your area.

Alyssa, I would love to give you more information on this, but it is too comprehensive for this format.  Please feel free to e-mail me through my website, and I would be more than happy to forward you more information on crash generated injuries, the forces, and treatment protocols.  

Good luck to you!
Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net