After a Car Accident: Your Tests Are Normal, but You're in Pain

If you felt fine on the day of the accident but started hurting the next day

Key points in 30 seconds

1. At the moment of impact, the neck whips back and forth, injuring muscles and ligaments. These tissues don't show up well on X-rays. Being told your tests are normal doesn't mean you weren't injured.
2. Starting to hurt the next day is actually the typical course. You're not imagining it.
3. Most recovery happens in the first 3 months after the accident. After that, it slows down noticeably.
4. No study has found that wearing a neck brace and resting works better. Moving within a pain-free range was better, or at least the same.
5. But if your arm feels weak or the sensation feels strange, it's not for our treatment. Checking for fractures and nerve damage comes first.

What we often hear

• "On the day of the accident I was just shaken up, but fine. From the next morning, I couldn't turn my neck."
• "They took X-rays at the hospital and said nothing's wrong. But it hurts."
• "People around me say it'll get better if I just rest a bit."
• "Do I have to keep wearing the neck brace?"
• "How long is this going to hurt?"

The stories of people who come in after car accidents follow a pattern. And that pattern has a name.

Why it hurts even though tests are normal

At the moment of impact, the neck snaps back and then forward like a whip. This injures tissues such as muscles, ligaments and the membranes around the joints. This is called whiplash injury.

The problem is that unlike bone, these tissues don't show up well on X-rays.

So "your tests are normal" isn't the same as "you weren't injured." Pain that really sets in a day or two later is also the typical course for this kind of injury.

Recovery has a window of time

When studies that followed people with neck pain from right after a car accident were pooled and analyzed, most recovery happened within the first 3 months. After that, the recovery curve flattened out noticeably.

Kamper et al., Pain, 2008

How you spend those 3 months is linked to what comes after.

We'll tell you about the long-term course, too. According to a report by an international research group that brought together studies from several countries, nearly half of people still reported neck pain after a year, and 10–25% had clear difficulty with daily life and work.

Carroll et al., Spine, 2008

But these numbers need to be read with some care. Plenty of people who've never been in an accident have also had neck pain in the past month. You can't say for sure that all the pain remaining a year later is due to the accident.

Even so, the conclusion doesn't change. It can't be treated as just something that passes with a few days of rest.

Should you rest or move?

This is the question we get most often, and it has a fairly clear answer.

No trial found that wearing a neck brace and resting worked better.

In a study comparing people who started neck movement treatment within four days of the accident with people who wore a neck brace and rested, the group that moved had a greater reduction in pain. When they were checked again three years later, they were also doing better in pain, sick leave and how far they could turn their neck.

Rosenfeld et al., Spine, 2000 · 2003

A German study of 200 people also found that early exercise treatment did better than neck brace treatment for pain and discomfort.

Schnabel et al., Emerg Med J, 2004

On the other hand, a large Danish study that split 458 people into three groups found no difference among the three after one year. The group with a rigid neck brace, the group that went about life as usual, and the group with a neck movement program all did about the same.

Kongsted et al., Spine, 2007

To be honest, some studies say moving is better, and some say it's at least the same. No study says that immobilizing and resting is better.

So we don't tell you, "You're injured, so wear a neck brace and rest completely." Keeping up your daily routine and moving your neck within a pain-free range is the direction the evidence so far points to.

What does Korean medicine treatment do?

There are Korean medicine clinical practice guidelines in Korea for people injured in car accidents. These guidelines recommend herbal medicine, acupuncture, Chuna and pharmacopuncture for whiplash injury.

Kim HT et al., Eur J Integr Med, 2018

There's clinical research too. Ninety-seven people admitted to hospital within a week of an accident were split into two groups. One group received acupuncture, pharmacopuncture, Chuna and herbal medicine, and the other received all of that plus motion style acupuncture. Motion style acupuncture is a treatment in which the practitioner moves the patient's neck with them while the needles stay in place.

On day 5 of treatment, pain was clearly lower in the group with motion style acupuncture added, and the time it took for pain to drop by nearly half was shorter. Range of neck movement differed from day 2.

Kim D et al., J Clin Med, 2020

What's worth noting is the principle behind this treatment. Motion style acupuncture adds movement to acupuncture. It points to exactly the same place as the direction we saw earlier: "moving rather than resting."

What this study doesn't say

And there's something we need to be clear about here.

In the same study, when the two groups were checked again after 90 days, there was no difference between them. Both groups had improved a lot.

In other words, what this study showed is "faster recovery," not "more recovery." We won't blur that distinction. Pain going down quickly in the acute phase is valuable in itself, but it isn't evidence of a better long-term outcome.

There's one more thing. In this treatment, both the patient and the practitioner can't help but know which treatment is being given, so the researchers themselves noted that they couldn't rule out the effect of expectations being mixed in. Right after an accident is also a period when recovery is active even if you do nothing.

Sometimes you can't look at the neck alone

Besides how bad the pain was at first, other things are involved in pain lasting a long time after an accident. Evidence has built up that fear of it hurting again, not being able to sleep and emotional strain hold recovery back.

That means there are people whose problem won't resolve by treating the neck alone.

But that doesn't mean you should jump straight into treatment

If you have these signs, it's a different story.

• Weakness in your arm
• Strange sensations in your arm or hand
• Severe pain right in the middle of your neck from the moment of the accident

If you have even one, checking comes before treatment. Fractures and nerve damage need to be ruled out first. The same goes if you're older or have osteoporosis.

Here's what happens when you visit us

We start by ruling things out. At the first visit, we check for nerve symptoms and fracture risk, and if needed, we confirm with X-ray, CT or MRI in partnership with the radiology clinic on the 2nd floor of the same building before starting treatment. If there's a finding that needs checking, tests and referral come before treatment.

We build treatment from what's in the guidelines. We put together a treatment plan with acupuncture, pharmacopuncture, Chuna and herbal medicine. Early on, we focus on pain and getting back your range of neck movement, and we plan in the direction of moving your neck early, within a pain-free range.

We look at it as a 3-month plan. On the first day, we record your pain score and how far you can turn your neck, and during the first 3 months, the window for recovery, we measure again at set points. If the pain is the same after 3 months, we don't repeat the same treatment; we go back and look at what's holding recovery back.

We don't just tell you to rest. We guide you step by step on how to get back to daily life and how far to go with neck exercises. When a neck brace is needed, we use it for a set period.

We look at more than the neck. We check for headaches, dizziness and trouble sleeping on the first day and at every follow-up visit. If we judge that emotional strain is holding back recovery, we'll also recommend care for that.

Treatment after a car accident is covered by Korean auto insurance. We'll explain the procedure when you check in.

Come in when

• Your neck or shoulders started to hurt after an accident
• Your tests are normal but the pain hasn't changed
• You don't know how long you should keep wearing a neck brace
• Headaches, dizziness or insomnia started after the accident
• It's been nearly 3 months and you feel about the same as at the start

How fast you recover and how it progresses varies from person to person depending on the type of accident, how bad the pain was at first, your age and any existing conditions.

And let us say it again: if your arm feels weak or the sensation feels strange, get checked for fractures and nerve damage before coming to us.