Jordan Loewenstein, D.C. | La Jolla Chiropractor
Quick answer: back pain after a car accident is usually a strain of the muscles and small joints of the low back from bracing against the impact and being held by the seatbelt, and it often shows up a day or two later along with the neck. Pain between the shoulder blades from the seatbelt and pain over one side of the pelvis (the sacroiliac joint) are also common. Most of it responds well to early, gentle, active care. Pain that shoots down a leg, numbness or weakness, or any change in bladder or bowel control needs an exam urgently, and in some of those cases an MRI is the right first step.
In the fraction of a second before impact most people brace: feet pushed into the floor, hands locked on the wheel, trunk stiffened. The seatbelt then holds the pelvis and one shoulder while the rest of the body keeps moving. That combination loads the lumbar spine in compression and twist at the same time, loads the sacroiliac joints unevenly, and drags the thoracic spine and ribs against the diagonal belt. The muscles that were braced get strained; the facet joints at the back of each vertebra get jammed; occasionally a disc is injured.
The first two can signal nerve compression that needs imaging and a surgical opinion quickly. The others can signal fracture or internal injury. If you are cleared at the emergency department, I take it from there.
It depends on the symptoms. Leg pain with numbness or weakness, a significant mechanism, or an exam that points to the disc can make an MRI the right first step, and I will order it. For the more common strain and joint patterns the exam is clear and imaging adds nothing. Either way treatment does not have to wait for a scan; gentle care begins while it is pending. My longer guide on X-rays and MRIs for back pain explains the reasoning.
The same rules as the neck. Bed rest beyond a day makes it worse. Short, frequent walks are the single best thing you can do in the first week. Heat or ice for comfort, whichever you prefer. Avoid long drives and long sitting in the first week if you can; if you cannot, break them up. Then a staged plan: calm the inflammation, restore movement, strengthen the hips and trunk so the low back stops doing their job. My low back program is what I hand out once the acute phase has settled.
The first visit is 45 minutes: a detailed history of the crash and how you were sitting and bracing, range of motion, orthopaedic and neurological testing to sort strain from joint from disc, and with you face down, a look at how the pelvis is sitting and whether the sacroiliac joints are involved. I decide about imaging based on what that shows.
Early care is gentle: heat and electrical stimulation to settle the guarding, flexion-distraction on the Hill table to take load off the disc and open the stiff segments without forcing anything, soft tissue work, and a few home movements. As the inflammation settles over the first week or two, full adjustments of the lumbar spine and pelvis come in, and the strengthening starts. Follow-ups are 30 minutes.
If you do not have an attorney and the crash was not your fault, I connect you with a local San Diego personal injury attorney at the first visit, and care is available on a lien with nothing out of pocket. The full approach is on my car accident injury page; for low back pain in general see the low back pain page.
Why does my back hurt days after a car accident?
Bracing against the impact and being held by the seatbelt strains the low back muscles and joints. Like whiplash, the pain usually appears once adrenaline fades and inflammation peaks, one to three days after the crash.
Can a car accident cause a herniated disc?
Yes, though it is less common than muscle and joint strain. Back pain with pain, tingling or numbness running below the knee, worse sitting or coughing, points toward a disc and needs an exam.
Should I go to the ER for back pain after a car accident?
Go if you have bladder or bowel changes, groin numbness, leg weakness or spreading numbness, severe pain after a high-speed crash, chest or abdominal pain, pain with breathing, or cannot bear weight. Otherwise a same-day exam with a provider who treats accident injuries is appropriate.
Do I need an MRI for back pain after a car accident?
Depending on symptoms, sometimes. Leg symptoms with numbness or weakness or a significant mechanism can make an MRI the right first step. For common strain and joint patterns the exam is sufficient. Treatment does not have to wait for a scan.
How long does back pain last after a car accident?
Simple strains usually improve within two to six weeks with active care. Joint and sacroiliac patterns can take a little longer. Disc injuries with leg symptoms take two to three months on average.
Back pain since a crash? Call (858) 558-3111 or book online for a same-day evaluation at my UTC San Diego office.
Dr. Loewenstein diagnoses the actual source of your pain before treating it — soft tissue work, adjustment, and rehab in one visit. Most major insurance accepted, no packages or contracts.