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Back and Neck Injuries After A Car Accident

According to the National Safety Council, 4.6 million people were seriously injured in car accidents in 2016. While some injuries can be minor and heal relatively quickly, other injuries, even following minor auto accidents, can cause severe injuries. Injuries can occur from accidents at slow as well as high speeds.

More than one body part can be involved, and symptoms are not necessarily felt immediately following the accident. All symptoms need to be addressed-whether minor or severe.

Back and neck injuries are very common following car accidents.

Neck and back injuries can be from damage to muscles, tendons, ligaments, discs, joints and bones. Some symptoms can include:

  • Pain in the neck, back, head, shoulders
  • Radiating pain, numbness, and tingling
  • Pain that worsens with activity
  • Difficulty focusing, migraines, headaches and dizziness
  • Numbness, prickling, burning, tingling 
  • Restricted range of motion
  • Inability to lift something or difficulty walking, sitting, reaching
  • Bump or deformity near injury
  • Redness, bruising, inflammation or swelling

Some injuries can include:

Whiplash, extremely common following rear-end collisions.

Bone Fractures

The force of an accident can lead to broken bones.

Disc Injuries

Torn, slipped, ruptured, herniated and bulging discs can press against nearby spinal nerves


Vertebra slips forward over the one beneath it and can be caused by a traumatic car crash.

Nerve problems.

Damage to your nerves can be temporary or permanent.

To ensure that your back or neck injury heals as quickly as possible. Early diagnosis and treatment result in improved outcomes.

There are a variety of treatments to help you get back to your life including chiropractic, physical therapy, interventional pain management, and surgery. Andrew Cash, MD can help to guide you through the process for optimal return your life.


Keeping Your Back Healthy During Summer Activities

Keeping Your Back Healthy During Summer Activities

Summer sizzles!  As temperature heat up, and outdoor activities increase, so does the potential for back injuries.

One of the most important--and often overlooked-- preventive measures is:

Stay Hydrated.

We all know, our bodies are mostly water. Water is vital to every function, and especially important as temperatures and activities climb. Without enough fluids in our bodies, muscle cramps or dizziness can develop. Both detrimental to the peak performance--and safety-- of weekend warriors or well-prepared athletes.


Staying hydrated is also important in keeping joints and disks in good working order, preventing back pain and playing an important role in enjoying summertime play time.

Keep a water bottle handy, keep sports drinks at hand, eat fluid rich fruits and veggies:watermelon, celery, strawberries, lettuce, cucumbers, spinach

Luckily, these are easy to find on a summer picnic or BBQ table.

Outdoor? In the heat? If you're thirsty, you're dehydrated!!



You need to move more throughout the day

The typical person sits for over 8 hours per day. On top of this, many people rarely take a break from sitting during the day—getting up only to attend meetings or eat lunch.

You may not think twice about sitting at your desk for hours on end, but this static lifestyle may be provoking your lower back pain—as excessive sitting leads to muscle atrophy and places additional stress on your lumbar spinal discs.



Lifting things that are too heavy and lifting  incorrectly.

Often back injuries happen when we try to lift something that’s too heavy and lift them incorrectly. Bending your knees and use the power of your legs, keeping the weight close to the body; keep your head down and back straight, and be sure to avoid twisting.

Wearing High Heels or Flip Flops

With so many ways to hurt your back, many women may be surprised to learn that a significant cause of back pain could be shows. High heels, worn every day, all day, can affect your back in many ways. Wearing the towering footwear can shorten the muscles in your calves and cause muscle spasms in legs and back.

Flip Flops are not good for your feet    either. Since you have to tighten your toes to keep the flipflop on, you walk in an unnatural way, causing strain on your legs and back. Most flip flops are also made of cheap and thin material which does not support your foot.

Purses that are too heavy

It’s a temptation to throw everything you might need into one purse.  But carrying a too-heavy purse can lead to back strain and pain by forcing your body out of balance. 

Fixes can include

Lighten the load.

Carry only essentials.

Alternate sides.

Switch your purse from your left to right side, and then back again throughout the day.

Carry your purse across the center of your torso, letting the center of your body carry the weight.

Switch everything to a backpack, and carry it over your shoulders and across the back, to balance the load.

The wrong mattress

If your back is hurting when you first wake up but seems to get better with stretching or just the act of moving around throughout your day, the pain may be caused by your mattress. Frequent tossing and turning during the night is also a key indicator that your mattress is making your back sore. Replace an old mattress, find a mattress that offers the right amount of back support for your individual needs.


Nicotine restricts blood flow to the disks that cushion your vertebrae and increases the rate of degeneration. This loss of cushioning can cause back pain. Cigarette smoking also reduces calcium absorption and prevents new bone growth, leaving smokers with an increased risk for osteoporosis (brittle, fragile bones) and slower healing after bone fractures.

Sacroiliac Joint Pain Fact Sheet: About Lower Back Pain

Sacroiliac Joint Pain Fact Sheet About Lower Back Pain 

Up to 85% of all people have lower back pain at some point in life.1 Low back pain is second only to upper respiratory problems as a reason for visits to a physician,2 generating 15 million office visits annually.3 It is the fifth-ranking cause of admission to hospital and the third most common cause of surgical procedures.3,4,5 In 2005, annual direct and indirect costs for treatment of low back pain has reach $86 Billion.6 

What is the sacroiliac joint? 

The sacroiliac joint forms the lowest segment of the spine and distributes the force delivered from the upper body. Sacroiliac joints are located on either side of the sacrum, which is in the low back and the pelvic areas. The sacroiliac joint connects the sacrum, the triangular bone at the bottom of the spine, with the pelvis iliac crest. 

What is the function of the sacroiliac joint? The function of the sacroiliac joint is to transfer weight and forces due to movement from your upper body through the pelvis to your legs and vice versa. The pelvis acts as a central base through which large forces are transferred and dissipated. The primary role of the sacroiliac joint is to provide stability for the pelvis, and to bear the load of the upper body. 

Why does the sacroiliac joint start having problems? 

Potential causes of sacroiliac joint problems include degenerative disease, history of trauma, pregnancy/ childbirth, and other unknown reasons. The sacroiliac joint may be disrupted due to lack of joint continuity (injury, traumatic event or repetitive trauma to the joint) or may suffer from sacroiliitis (swelling) resulting from a variety of causes. 

How does the sacroiliac joint cause pain? 

The sacroiliac joint is a synovial joint and has a nerve supply that originates from multiple lumbosacral root levels with partial innervation from L2 (anterior joint) to S3 (posterior joint). Strong ligaments encase each joint and allow for approximately two to four millimeters of movement during weight-bearing and forward flexion. When these ligaments become damaged either due to normal wear and tear or by injury, they may have excessive motion. This excessive motion may inflame and disrupt the joint and surrounding nerves. When this happens, people can feel pain in their back or buttocks, especially with lifting, running or even walking. 

How common are sacroiliac joint problems? 

It is commonly reported in clinical literature that up to 25% of all low back pain is caused by the sacroiliac joint.7 In addition, the incidence of sacroiliac joint degeneration in post-lumbar fusion patients is 75% at 5 years post-surgery.8 


How is low back pain due to the sacroiliac joint manifested? 

Many people have low back pain associated with the sacroiliac joint that begins spontaneously. However, in just as many reported cases, sacroiliac joint pathology can be related to a specific event, often an injury. It is difficult to directly relate any specific functioning difficulty (including walking, sitting, standing, sleeping on the affected side, job activity, bowel movements, cough, sneeze, etc.) to the sacroiliac joint as a source of pain. One key indication is the specific location of the pain in the lowest back and buttock region. 

Who is at risk for sacroiliac joint problems? 

Injury from accidents, including falling, is a predisposing factor for sacroiliac joint pain. Women may be at increased risk for sacroiliac joint problems because of their broader pelvises, the greater curve of their necks, and shorter limb lengths. Pregnancy often leads to stretching of the pelvis, specifically in the sacroiliac ligaments. In addition, clinical literature has also documented the incidence of sacroiliac joint degeneration in post-lumbar fusion surgery is 75% at 5 years post-surgery.8 

Is the sacroiliac joint part of a low back pain differential diagnosis? 

Most published differential diagnosis for low back pain fail to consider sacroiliac joint as a source of lower back pain.9, 10 Underscoring the need for proper diagnosis is the fact that pain caused by sacroiliac joint dysfunction can mimic discogenic or radicular low back pain potentially leading to the wrong diagnosis and treatment such as lumbar spine surgery.11 

Clinical References: 

1. Frymoyer JW (1988) Back pain and sciatica. N Engl J Med 318:291–300 

2. Anderson GBJ. Epidemiologic features of chronic low-back pain. Lancet 1999; 354:581-5. 

3. Hart, et al. Physician office visits for low back pain. Frequency, clinical evaluation, and treatment patterns from a U.S. national survey. Spine. 1995;20(1):11-9. 

4. Praemer A, Furnes S, Rice DP. Musculoskeletal conditions in the United States. Rosemont: AAUS, 1992: 1–99. 

5. Taylor, et al. Low-back pain hospitalization: recent United States trends and regional variations. Spin 1994; 19: 1207–13. 

6. Martin, et al. Trends in Health Care Expenditures, Utilization, and Health Status Among US Adults With Spine Problems, 1997-2006 Spine. 2009; 34(19):2077-2084 

7. Cohen, Steven P. Sacroiliac Joint Pain: A Comprehensive Review of Anatomy, Diagnosis, and Treatment. Anesth Analg 2005; 101:1440-1453 

8. Ha et all. Degeneration of Sacroiliac Joint After Instrumented Lumbar or Lumbosacral Fusion. Spine 2008: 33(a): 1192-1198 

9. Deyo RA, Weinstein JN, Low Back Pain, N Engl J Med 2001: 344(5): 363-370 

10. National Institute of Neurological Disorders and Stroke (NINDS). Low Back Pain Fact Sheet. Bethesda, MD: National Institute of Neurological Disorders and Stroke; 2003 

11. Weksler, et al. The role of SI joint dysfunction in the genesis of low back pain: the obvious is not always right. Archives of ortho and trauma surgery. 2007 Dec; 10(127) 858-8 



Your back hurts!

And you're looking for a treatment that will make the pain stop. You’ve read about Laser Spine Surgery, and you're interested in how it may help relieve your back pain.

There's been lots of press about Laser Spine Surgery.

And, while it can help some back conditions and it does benefit some people, it seems to benefit those with only minor spine problems.

What IS Laser Spine Surgery?

Laser spine surgery uses a laser to remove tissue with heat rather that with traditional instruments.  While it may be seen as "modern" or a "magic bullet", in truth, the use of lasers has been around for a long time. Lasers use a focused beam of light to cut soft tissue.  Beneficial for 

What are the PRO’S:

It's Minimally Invasive

Fast Recovery Time

For Minor Conditions, Laser Spine Surgery Can Be Effective

What are the CON’S:

For most painful back conditions, Laser Spine Surgery is Not Effective

Laser spine surgery can truly only be used for a very small number of minor spine conditions.

Laser surgery can result in an procedure which does not completely address or alleviate the problem (inadequate operation) ,which sometimes means you’ll need additional surgery.

Pain may be from back instability. Laser surgery does not address or alleviate this condition. The basic problem is missed.

Using a laser during surgery can sometimes limit nerve damage. But in the hands of an inexperienced surgeon, a laser can actually increase the chances of tissue or nerve damage,

Using a Laser Scalpel can be less effective and pose more risk than other minimally invasive procedures.

The heat from the laser can damage adjacent nerves and lead to increased pain. 

Laser Spine Surgery is not taught in medical schools and is not considered a viable approach to spine surgery by medical advisory boards.

Laser Spine Surgery is generally not covered by health insurance.


A very important consideration:

Laser Spine Surgery does not have to be performed by a Spine Surgeon.

Practitioners who do not have the education, experience or understanding of the anatomy and function of the spine can legally perform Laser Spine Surgery.

A wise plan of action is to have an exam and consultation with a Spine Surgeon who is both Board-Certified and Fellowship Trained. At that exam, your spine surgeon can explain all options available for treatment of your particular (and unique) condition.

Before committing to any spinal procedure, it's wise to consider non-surgical options such as physical therapy, medication, and supervised exercise.

If surgery is indicated, explore all options available, including minimally invasive procedures that offer the benefits of less post-procedure pain and shorter recovery time.

Statistics prove, more complicated back problems often require traditional surgery for the best outcome.



Along with specific back exercises, aerobic exercise that increases the heart rate for a sustained period is very beneficial for helping back problems. Aerobic exercise increases the flow of blood and nutrients to back structures which supports healing, and can decrease the stiffness in the back and joints that lead to back pain. While many patients with back pain are able to participate in vigorous exercise like running or step aerobics, others find it easier to engage in low-impact exercise, which does not jar the spine.

Benefits of Aerobic Exercise

Reconditioning through aerobic exercise is very useful for both rehabilitation and maintenance of the lower back. Patients who regularly undertake aerobic exercise to condition the back will benefit in several ways:

They have fewer episodes of low back pain, and will experience less pain when an episode occurs.

They are also more likely to stay functional (e.g. continue working and carry on with recreational activities), whereas those patients with chronic low back pain who do not engage in aerobic exercise are more likely to experience the gradual loss of functional capabilities.

It is easier to control weight or lose weight, decreasing the stress placed on the spine structures and joints.

An increased production of endorphins after 30 or 40 minutes of exercise can combat pain. These bio-chemicals are the body's natural painkiller, and frequent release of them can help patients reduce their reliance on pain medication.

Endorphins can elevate mood and relieve symptoms of depression, a condition common in those with back pain or a back injury.

Types of Low-Impact Exercise

There are several types of aerobic exercise that are gentle on the back and, when done on a regular basis, highly effective in providing conditioning.

Walking. In general, walking for exercise is very gentle on the back, and walking two to three miles three times per week is very helpful for patients. Walking also has the advantage of not requiring special equipment (except a good pair of shoes suitable for walking) and it can be done inside or outside, in almost any location, including at home on a treadmill.

Stationary bicycling. For those patients who are more comfortable seated rather than standing, biking or stationary biking may be preferable. Bicycling or 'spinning' classes have grown in popularity over the last decade as more people realize the benefits of this lower impact form of exercise. There are several upright and recumbent (reclining) bikes that can be purchased for home use, and many come with programs preloaded so that patients have a good variety of sessions from which to choose.

Elliptical trainer or step machine. These machines provide a low-impact workout because the participant is using pedals suspended above the ground to move in a continuous oval motion, as opposed to continuously stepping on a hard surface. The motor on the machine facilitates a smoother step or forward glide motion, which is less jarring than walking. The benefit of these machines is that they provide an aerobic workout as well as strengthening or resistance training because the arms of most cross-training machines can be pushed and pulled, thus working the upper body, and the resistance of the pedaling motion increased to require greater muscle exertion to maintain the movement.

Water therapy. Doing exercise in the water provides for effective conditioning while minimizing stress on the back because the buoyancy of water counteracts the gravitational pull that can compress the spine. When 'unweighted' in water, a patient becomes more mobile, and stretching and strengthening exercises are less painful. Exercises such as hip abduction lifts, bicep curls, arm circles to exercise deltoids and shoulders, and tricep kickbacks are all easier done water for most people. All these muscles build strength in the low back or neck, and reduce back pain. Water therapy exercise is especially useful for patients in too much pain to tolerate land exercises on a mat or hard floor, or for elderly patients.

What is a syrinx?

By Brooke Strickland and Dr. Andrew Cash

Around the spinal cord and brain, a watery substance called cerebrospinal fluid flows regularly to transport nutrients and remove waste. When this fluid abnormally collects and develops inside your spinal cord to form a cyst, it’s called a syrinx. With time, it may grow and damage the spinal cord and cause significant pain, pressure, weakness, stiffness, or numbness. In addition, headaches can also be a symptom.

What are facet synovial cysts?

Synovial cysts are fluid-filled sacs that are benign and develop in the facet joints of the spine. They are somewhat uncommon and usually occur because of degeneration of the spine. If the sacs get large enough, spinal stenosis may develop.  It is most common to see these types of cysts in older patients.

What are the symptoms?

What are pain pumps?

 Dr. Andrew Cash

A pain pump is a way to deliver medication directly to your spinal cord. It is a small metal device that surgically fixed under the skin in your abdominal area and has a catheter that gives regulated doses of medication to your spinal cord. When the device’s reservoir is empty, a doctor or nurse will refill the pump by inserting a needle through the skin. The procedure is also reversible, meaning that the pain pump can be removed at any time if results are not as optimal as expected.

How do I know if I need a pain pump?

What is epidural fibrosis?

By Brooke Strickland and Dr. Andrew Cash

Epidural fibrosis is a condition that develops when scar tissue forms around the nerve root.  It is common to see people develop this condition after back surgery.

What are the symptoms?

What is congenital fusion?

By Brooke Strickland and Dr. Andrew Cash

Congential fusion happens when two or more vertebrae of the spine are fused together permanently, usually while in the womb.  This condition often puts the patient living with this condition at an increased risk for spinal cord injury.

What is Klippel-Feil Syndrome?

By Brooke Strickland and Dr. Andrew Cash

Klippel-Feil Syndrome is a rare disease that is present at birth, but sometimes can be diagnosed later in life when symptoms first become more apparent. The syndrome causes two or more spinal bones in the neck to fuse or join together, which means the person living with the disorder will have a short neck, have limited head or neck movement, or low hairline at the back of the head.

What is spinal cord stimulation?

By Brooke Strickland and Dr. Andrew Cash

For individuals living with chronic back pain, spinal cord stimulation is a procedure that can help. It uses an electrical current that sends pulses to the spinal cord, which react with nerve impulses in the spine that allow you to feel pain. This treatment plan is often used for individuals living with failed back syndrome, nerve pain, or other chronic pain syndromes.

What is post-laminectomy syndrome?

By Brooke Strickland and Dr. Andrew Cash

Even after back surgery is complete, you may have persistent pain. This often depends on type of pain you had before surgery, what type of surgery you had done, and if you have had multiple operations in the same area.

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