By Katie E. Golden, MD
Patients frequently come to the ER for evaluation after car accidents, or motor vehicle collisions (MVCs) as we refer to them in the medical field. While most MVCs do not lead to serious bodily injury, they often lead to a significant amount of emotional distress for understandable reasons. They are unexpected, provoke anxiety and a sense of fragility, and can come with significant logistical and financial disruption to our lives. This makes it all the more important to have an objective medical evaluation to ensure these emotional and mental stressors do not mask the pain from traumatic injury. This also means that patients may have trouble remembering or paying attention to the details of their ER visit, or their care instructions after they return home. Here, we will review general guidelines to aid in a speedy and safe recovery, so that your mind and body can get back to normal, even if your car is still in the shop.
What is typically done in the ER visit after an MVC?
When a patient comes to us after a collision, the most important part of the evaluation is the physical examination. The responsible clinician will use exam findings, along with details about the accident, to determine if any further testing is needed. This testing is almost exclusively Xrays and/or CT scans that look for broken bones or injuries to any internal organs. There are many occasions when the patient does not need any radiology studies, especially if the patient’s exam is reassuring and they are not experiencing any severe pain. When further testing is needed, common studies include Xrays of the chest and ribs, Xrays of the spine or bones in the arms or legs, and CT scans of the brain or neck.
What are the most common injuries?
In the large majority of MVC patients, there are fortunately no serious injuries. That doesn’t mean, however, that everyone walks away without pain or minor injuries. The most common outcome for an MVC patient is muscle strain and spasm, particularly of the muscles and tendons that stabilize the neck and back. Other common injuries include bruising or sensitivity in the chest wall or ribs, concussion, skin burns from airbag deployment, and minor broken bones or bruising of the hands or wrist from bracing the steering wheel before impact.
More serious, but uncommon injuries include bleeding in the brain, broken facial bones, fractures in the spine, or injury to the internal organs in the abdomen (such as the spleen, liver, kidneys, or intestine).
What can MVC patients expect after they leave the ER?
Nearly all MVC patients experience some degree of pain from muscle strain and spasm, particularly in the neck, shoulders, and lower back. This typically occurs because the patient, in anticipating the crash, braces and holds tension in their core stabilization muscles, which then sustain a rapid and significant force as they absorb the impact. The pain from this type of injury does not typically start immediately after the incident. Patients often come to the ER with minimal pain, or mild soreness, and then characteristically develop increasing pain that evening, and especially when they awake the following morning. The height of muscular pain is typically in the 24 to 72-hour window after a collision, though lasts 1-3 weeks (or even longer, especially in patients with pre-existing sources of musculoskeletal pain). During this time period, the patient may notice new or unexpected areas of pain, which can often develop as a chain reaction when supporting or nearby muscles respond to this initial strain.
That is the bad news. The good news is that this pain is treatable, temporary, and the patient typically makes a full recovery.
What can a patient do at home to help with recovery?
The approach to the expected neck and back pain after an MVC follows a similar approach to the way a patient would treat their muscle soreness after a particularly strenuous workout (and you might feel like your body ran a marathon when you wake up the next morning).
- We recommend over the counter medication (such as Tylenol or Advil), which not only provides pain relief but also decreases the inflammation that builds in the muscle after a significant strain (and is the underlying source of the pain). We often suggest patients use BOTH acetaminophen (Tylenol) and ibuprofen (Advil/Motrin) to alleviate the discomfort, as these medications are safe and often beneficial when taken together.
- Patient’s sometimes get significant relief with direct application of heat (such as warm showers or heating pads) or topical medications (such as muscle rubs and ointment).
- Gentle stretching exercises, and even light exercise, often accelerate healing as they increase blood flow and oxygen to the muscles. We warn patients that staying in bed, or ‘guarding’ the injured area from movement (not moving your neck, for example), will likely result in worsening pain and prolonged recovery. While stretching and movement may bring some pain, we try and remind patients that not all pain is bad, and is a natural part of muscle recovery.
- Most importantly, be patient with your body and your recovery! Take time for self-care and attention to your areas of pain, especially if you are experiencing a sense of anxiety or emotional trauma after the accident.