Transcript: Proving Disc Herniations in Low-Speed Collisions: The Biochemical Strategy for Trial Attorneys

  📍 Hey guys. I'm Linda, the Attorney's NP. Thanks for joining me this week to discuss a really fun topic that I know you will appreciate. Proving disc herniations in low speed collisions.

Every defense attorney has the same playbook. The property damage was minimal, so the injury must be minimal. They use physics to make your client's pain seem impossible. Today we're changing the playbook. We're going to look at the spine, not as a series of bones, but biochemical activation versus mechanical impact, and why minimum impact soft tissue cases are high value.

If you want to win, you have to stop talking about the car and start talking about the nucleus pulposus. This show is for informational purposes only and is not medical or legal advice. See our show notes for the full professional disclosure.

I am almost certain that if you have had a client with a disc herniation after a low impact collision, you have heard the defense argue that the impact was not enough to cause a herniation within the spinal column. I'd bet they had expert mathematicians and physicists testify that the speed alone was not enough to herniate a disc.

You've heard that jumping off of a step or gardening can create more force than the accident your client was in. The physics is not wrong. In many cases, an accident that occurs under 25 miles per hour doesn't create enough force to herniate a disc in a young, healthy person. But did you know that there is a chemical component to back pain that is invisible on MRI?

Yes, the physics and math don't add up, but the biology is as clear as day.

Before we get into the full biology of the pain, let me give you a bit of background. Almost every vertebrae has an intervertebral disc sitting between the bones of the spine that act as a shock absorber.

We talked a bit about this last week, but we're going to get into some fun detail this week that will help you better understand how to frame your argument for your client. When you think of the spinal cord picture, the round flat portions pointing in towards your body and the spike like portions facing out towards your back.

The discs that sit on the rounded flat portions of the spine and the back of those discs is where the nerves exit the spinal column. Can you now picture why that could be problematic if there is a herniation of the disc?

Just for fun, let's define what a herniation really is. It's a protrusion of an organ or disc through a weakness in its surrounding structural wall. Discs are made of a dense outer layer called the annulus fibrosis and a gelatinous center called the nucleus pulposus, this is the portion that herniates. These little discs are so amazing. Discs are made of three basic components.

The annulus fibrosis is the containment wall. . The cartilaginous end plates help facilitate nutrient transportation for the discs, and there's the nucleus pulposus, the gooey center. This center is highly hydrated. It's mostly water, proteins, and sugars. It allows the spine to be flexible and aids with strength.

The gooey center is able to redistribute forces placed on the spine to the annulus fibrosus and cartilagenous end plates. Can you now see why these discs are so important? They do so much. Just to give you an idea of how much pressure these little guys are under, intradiscal pressure during bending and lifting is significantly more than anyone ever thinks about.

Discs function to absorb, impact or shock so you can imagine how much pressure these guys are under every day, all day. If you can't picture this, let me help you put this into real world scenarios. Standing, not moving, creates 72.5 psis of pressure on your discs. Really let that sink in. That is about double what the pressure of your tires in your car currently is.

Bending forward creates about 160 PSI of pressure on your little discs. Lifting 20 kilograms of weight creates 333 PSI of pressure. Really let that sink in. That is a lot of pressure on those little discs in your spine. You apply that pressure every day. When the annulus fibrosis, the outer wall, tears or becomes compromised, the fluid that leaks out is not just some innocuous goo, it is a biologically active substance. Once it leaks out, it begins to irritate the surrounding tissue.

And what did we just learn is right next to our discs? That's right. Our nerves. Nerves are very sensitive in general, and when you have a chemical spill all over them, as in our herniated disc case, the irritant can't be removed quickly. The result is a cascade of inflammation since the fluid that leaked has a host of inflammatory mediators that are now out of containment and causing chemical injury to the tissue it touches. Your body treats that leaked goo like a foreign invader the same way it would treat a splinter or a virus.

What happens after the disc leaks is amazing from a biological standpoint. Once the gooey center of the disc is no longer contained, the body mounts an immune response to clean up the spilled fluid. The way the body cleans this up is by sending out the cleaning crew or the immune system. The body treats the spill as a foreign invader, which then triggers a cascade of inflammation near the site of the spill.

Cytokines are released to recruit more help to clean up the spill, but they also contribute to increased local inflammation as they do this. The cytokines signal to the body that something is wrong and needs to be fixed. They help recruit, backup, tell the body to make more backup and help regulate the inflammatory response.

This ultimately results in localized inflammation around a very sensitive nerve that follows a direct path down, an arm or a leg. The body sends macrophages or immune cells to eat the leak. This creates a zone of localized chemical warfare, that burning, sharp shooting pain. That's not just a pinch, that's a chemical burn.

Once a disc herniates, it not only causes mechanical pressure, the biochemical response it triggers creates long-term impacts. The inner gel of the disc ultimately releases inflammatory mediators, creating localized inflammation that immediately impacts your client. Intact discs have a pH of 7.2, think baking soda, and a disc that is degenerating can have a pH around 5.2, Think tomato juice.

This environmental change from basic to acidic creates an environment that leads to additional disc degeneration. All that inflammation that occurred to clean up the initial leak has now created an environment that has destabilized that little disc, making it that much harder for the disc to maintain its structural integrity, leading to more breakdown.

As for treatment, most of the time, conservative treatment will help, or the pain will likely resolve after 8 to 12 weeks. This is why you see so many provider notes that say to follow up in six to eight weeks. The doctors, nurse practitioners and physicians assistants are following guidelines on managing herniated discs or back injury in general. We talked about conservative therapy in the last episode, but I'll give you a quick overview this week in case you didn't get a chance to listen to the last episode.

Conservative therapy are therapies that are non-invasive, think ibuprofen, Tylenol, steroids, muscle relaxers, physical therapy, and acupuncture. Interventional pain management is another avenue your client may take. This includes things like trigger point injections that are aimed at relieving localized soft tissue injuries that may be contributing to the client's pain.

These treatments are as effective as surgery when compared over time. That's right. Surgery is not the magical cure all that most people think it is. Surgical interventions can lead to immediate pain relief, but in the long run, outcomes are about the same when surgical versus conservative therapy are compared head to head over about a two year period.

It really makes you think a bit differently when your clients have surgery for their back pain, doesn't it? At the time you're helping your client. If it's been weeks to months out from the surgery, they're probably feeling the best they will feel. This directly impacts damages because although your client feels better today, the likelihood that they will have their symptoms return and restrict their ability to lead their lives in a way that was similar to their pre-accident way of life, is not realistic anymore.

That low impact collision that led to a disc herniation has changed your client's life for good. Instead of arguing that the disc broke because of the accident, we need to talk about the biochemical activation. Defense experts love to talk about physics, but they can't argue with the inflammatory cascade triggered by a leak of the nucleus pulposus.

Typical imaging you may see for back pain are the classics with an x-ray. We talked a bit about the limitations last week. We know these are great for dense tissues like bone, but discs aren't made of bone, they're mostly water, and that means these x-rays can show things like a loss of disc height fractures in the bone, but they can't give us any good information on whether or not a nerve is being compressed or if the disc is actually herniated.

CT scans are great for advanced imaging of bony structures and calcified herniated discs, and these are also great alternative for clients who can't have an MRI, but they have similar limitations to x-rays.

MRIs are the best way to find herniated discs, if your client is able to get one. MRIs show soft tissue better than most other imaging that's currently available. How do you use this in court?

Stop arguing that the disc snapped or broke, argue that the disc was sensitized. You don't have to argue that the accident was forceful enough to tear or break the disc. If you focus on the swelling and inflammation that occurred after the accident, instead you can build a stronger case. Working to understand how inflammation affects the nerves and causes pain, even at low impacts, can help you build a stronger case for your clients.

Your client was in the car, tapped from behind by another car, and now their already compromised disc is pushed over the edge. You now know that the body responds to the leak by sending out the cleanup crew. The cleanup crew creates localized swelling that compresses the nerve and chemically burns the nerve contributing to radiculopathy.

The acid-based balance in the area is changed, creating an environment where degeneration of the disc continues to occur leading to an even weaker disc. The cleanup crew creates localized swelling that compresses the nerve and chemically burns it contributing to radiculopathy. Acid-based balance in the area is changed. Creating an environment where degeneration of the disc continues to occur, leading to an even weaker disc.

You don't need massive force to trigger an inflammatory cascade. You just need the right movement to cause the initial leak. The collision was the catalyst that turned an asymptomatic disc into a symptomatic one.

When you prepare your expert witness, don't ask them to prove the car was hit hard. Ask them to prove that the inflammatory markers in the client's clinical history are consistent with a chemical nerve irritation.

📍 Physics measures, the metal biology measures the misery. Be the advocate for biology. That's all for today's deep dive. If you wanna stop guessing and start proving your client's pain, head over to clearadvantagelnc.com. I've put together a specialized guide on the specific labs and imaging you need to request to uncover the objective data hidden in those medical records.

Click the link in the bio to email me directly to get that list. Let me handle the clinical heavy lifting so you can focus on the win. Until next time, stay medical legal ready.