How Computer-Measured X-Rays Document Whiplash and Ligament Injury for Personal Injury Cases

If you were hurt in a crash and your ER X-ray came back "normal," that does not mean nothing is wrong. Standard X-rays are taken while you hold still. Ligament injuries only show up when the spine is moving.

At Champion Chiropractic & Spinal Injury in Clive, Iowa, we take X-rays of the neck while the patient bends forward and leans back, and we have a computer measure what those images show. This page explains what that measurement is, what it proves, and what it does not.

The short version

Ligaments are the strong bands that hold your vertebrae in position. A crash can stretch or tear them. When that happens, the bones move more than they should.

You cannot see a stretched ligament on a regular X-ray. But you can measure the extra movement it allows. That is what we do, and the measuring is done by software, not by us.

What we actually do

We take X-rays of the neck in two positions: bent forward (flexion) and leaned back (extension).

Those images go to SpineCAMP, software made by Medical Metrics, Inc., a medical imaging company in Houston. The software measures how each vertebra moves relative to the one above and below it, flags anything outside normal range, and returns a report.

You may see this work called "CRMA," or motion X-ray analysis. Same thing. We use plain language here because most of the people who need to understand this report — patients, adjusters, paralegals, jurors — are not radiologists.

Why it matters that a computer does the measuring

The treating doctor does not draw the lines.

That single fact removes the most common attack on this kind of evidence. Nobody can argue the doctor measured it to get the answer he wanted, because the doctor did not do the measuring. SpineCAMP is automated third-party software. It is a regulated medical device, and it is used by radiologists and spine surgeons, not only chiropractors.

Why a "normal" ER X-ray doesn't mean you're fine

This is the most common frustration our patients bring in, and it has a straightforward explanation.

A ligament does not break the way a bone does. It stretches and tears on a small scale, and loses its ability to hold the vertebrae in place. Sitting still, the spine can look perfectly lined up. Moving, that same spine can show movement well outside normal.

So when an insurer points at a clean ER X-ray as proof that nothing happened, that argument is answering a question the X-ray was never asked. A neutral image cannot rule out a ligament injury, because a neutral image is not a test for one.

What the measurements mean

Excess movement between vertebrae has a formal name in the impairment world: Alteration of Motion Segment Integrity, or AOMSI. It is defined in the AMA Guides to the Evaluation of Permanent Impairment, the standard reference used for impairment ratings in most states.

The thresholds SpineCAMP applies:

• One vertebra sliding at least 3.5 mm forward or backward on the one below it (5th edition)

• One segment bending more than 11° further than the level above or below it (5th and 6th editions)

• One vertebra offset more than 20% forward in flexion or backward in extension (6th edition)

Read the second one carefully, because it is the item most often gotten wrong: it is 11 degrees more than the neighboring level, not 11 degrees on its own. A report that applies that threshold to a single segment's raw angle is measuring the wrong thing. Ours does not.

Where measurements do cross those thresholds, that finding supports an AOMSI diagnosis, which carries meaningful weight in an impairment rating. What that is worth in any particular case depends on the case.

What we won't claim

SpineCAMP measures. It does not diagnose. The manufacturer says so directly: it should not be used in place of a full patient evaluation, and it should not be relied on by itself to make or confirm a diagnosis.

So the measurements come from us as one piece of a clinical picture — alongside the history, the exam, and how the patient is actually functioning — not as the whole case. We would rather hand over a finding with its limits attached than an overstated one that comes apart under questioning.

Two more honest limits. This measures the consequence of a ligament injury, not the ligament itself; an MRI looks at soft tissue directly, and the two answer different questions. And a finding under threshold is not proof a patient is uninjured.

What the evaluation includes

• Intake and causation history. How the crash happened, the forces involved, when symptoms started and how they progressed, and any prior spine history.

• Flexion and extension X-rays. Taken under a standardized protocol.

• Computer measurement. Translation and angulation at each cervical level, against reference ranges and AMA threshold criteria.

• A written report. Measured values, normal ranges, any thresholds crossed, the diagnosis, and the clinical interpretation — readable by someone with no medical background, on purpose.

• A causation narrative, on request. A separate document stating how the documented injuries relate to the crash, and what that opinion is based on.

Who should get one

Consider an evaluation after a collision if you have:

• Neck pain, stiffness, or reduced range of motion

• Headaches coming from the neck

• Shoulder, arm, or hand pain, numbness, or tingling

• Dizziness, visual changes, or trouble concentrating

• Symptoms that persist or worsen past four to six weeks

• A significant crash mechanism — rear-end impact, high speed, airbag deployment

Timing matters. Documentation is strongest when a clear timeline connects it to the crash. Practically, flexion and extension views work best once acute muscle guarding has settled enough to allow real movement — usually one to four weeks out. Waiting much longer makes the connection harder to establish.

For attorneys and paralegals

What this gives you:

• Measured values rather than clinical impressions, produced by third-party software

• Threshold findings tied to AMA Guides methodology, with the edition stated

• A causation opinion that says what it is based on

• Reports written to be read by a lay reader, usable in demand letters, mediation, and trial

• Findings reported with their limits attached, which is harder to attack than findings that are not

We work with attorneys throughout central Iowa, including on a lien. Our full documentation standards — imaging, records, concussion screening, referral thresholds — are on our page for attorneys and paralegals.

Common questions

How is this different from a regular X-ray?
A regular X-ray is taken while you hold still, and shows the bones in one position. This takes images while the neck moves, and measures how much each segment shifts. Movement is the thing being tested.

Can it prove a ligament tear?
Not directly. It measures the functional consequence of a damaged ligament — movement beyond normal limits. An MRI images soft tissue directly. The two answer different questions, and neither is the whole picture on its own.

What are the thresholds?
3.5 mm of forward or backward slide (5th edition), more than 11° of bending compared with the neighboring level (5th and 6th), or more than 20% offset (6th edition). Crossing one supports an AOMSI finding.

How soon after a crash should I be evaluated?
Get examined early. The imaging itself is usually best one to four weeks out, once guarding has eased enough for full movement.

Does this affect my settlement?
Objective measurement generally makes an injury easier to document and harder to dispute, and AOMSI findings feed directly into impairment ratings. What any individual case is worth depends on facts we cannot predict, and we do not make promises about settlement value.

Can I be treated while my case is with a lawyer?
Yes. That is a large part of what we do.

About the author

Justin Luneburg, DC, FPSC(C) is the clinic director at Champion Chiropractic & Spinal Injury in Clive, Iowa, and holds a Fellowship in Primary Spine Care conferred by Cleveland University and the SUNY Buffalo Jacobs School of Medicine.

Related reading: Auto Accident Chiropractor in Des Moines · Whiplash Treatment in Des Moines · Personal Injury Chiropractor for Attorneys

Contact

Champion Chiropractic & Spinal Injury
11050 Hickman Road, Clive, IA 50325
(515) 777-1014

General health information only. Not medical advice, and reading this doesn't make you our patient. Not legal advice either.