This common car accident injury can exist in the neck and back, involves the discs in our spine, and can cause serious pain and disability (although the doctor hired by your auto insurance company may disagree!)
I recently wrote about the process of an MRI to help people understand what the results of this common diagnostic test means.
Obviously, I’m a lawyer and not a doctor. But far too many time-pressed doctors are lacking a bedside manner these days, and I’m often the one explaining to my bewildered clients who were just told they have a bulging disc or a herniated disc at a doctor’s office what this means. And, since I’ve deposed and cross-examined a few hundred doctors on the subject as well, as bulging discs and herniated discs are some of the most common neck and back injuries that people in car accidents suffer, it’s also an injury that I know well.
“What is a bulging disc?”
Both a bulge and a herniation (also commonly called a protrusion) are very common injuries – the most common injuries that people suffer in car accidents by far. The problem is, some doctors who perform insurance medical exams, and the defense lawyers and claims adjusters sometimes don’t treat them that way.
To start, our spinal discs act as very important cushions and shock absorbers between the vertebrae in our spine. Spinal discs are composed of an outer layer of tough cartilage that surrounds a softer cartilage in the center. Think of jelly doughnuts, with a tough exterior called the annulus between your vertebrae.
A bulging disc extends outside the space that this disc should normally occupy. The bulge typically affects a large portion of the disc. I often hear treating doctors and neurosurgeons describe bulging discs as a hamburger that’s too big for its bun.
Here’s where it gets a bit tricky when it comes to establishing whether a bulging disc can cause pain.
The part of the disc that’s bulging might be part of the normal aging process in some people. Or it may be the result of trauma, such as from an automobile accident. It can be symptomatic (causing pain), or asymptomatic and people can be walking around with bulging discs or sometimes even herniated discs and feel pain-free. There can also be bulging in our necks and backs and we can be pain-free and asymptomatic, and then a trauma such as a jolt from getting rear-ended by a truck causes a traumatic activation of a previously asymptomatic disc.
To sort it out, doctors (and lawyers) look at temporal relationship and causation. This is also the gold standard that they teach doctors in medical school, so a doctor can determine medical causation. If it is clinically correlated to an event, and the onset of pain is close in time to a trauma that can cause such an injury to occur, then doctors would say the most likely explanation is the traumatic event. There would be reasonable medical certainty that the event is what caused the injury.
If there is a long delay in symptoms, then it is most likely not the result of a trauma.
Analysis of the bulging disc by personal injury lawyers
Personal injury lawyers use a similar analysis to establish proximate cause in car wreck lawsuits. And the easiest way for lawyers and lay people to understand if a car accident caused an injury is to compare a person’s lifestyle and activity level from before a car wreck to after. I learned in law school from my old torts professor to draw a horizontal line that represented a person’s pre-accident life. This would represent work, hobbies and recreational activities, and other activities that were a part of someone’s life.
Then I would draw a vertical line, which would represent the date that a traumatic event occurred, again, such as a car accident. Put the date on the top of the vertical line.
Now draw a new horizontal line to represent life impact post-crash starting at the date the car wreck occurred on the vertical line. If there is no change in lifestyle from before and after, then there is no proximate cause between the crash and the injury.
If there is a change, such as a person could work before and can’t now, then you drop the new horizontal line to reflect the life impact of the changes that have occurred in someone’s life. The bigger the changes, the more things they cannot do, the longer they missed work and had to go to doctor appointments, the more you drop that horizontal line from the one representing the pre-accident lifestyle of the accident victim.
So, does a bulging disc cause pain?
As I discussed in my MRI blog post, many doctors who are hired by insurance companies (so-called IMEs or independent medical examiners, who in reality make vast amounts of money and tend to be anything but independent) to perform these one-time evaluations of people who get hurt in car accidents or on the job in workers’ comp cases. Many of these insurance medical doctors will say that bulging and herniated discs cannot cause pain (that’s why the insurance companies pick them to do these one-time exams).
But as you can see above, that’s not always true.
It may be true. But it’s also true that a spinal disc bulge may cause very severe and very disabling pain.
The key is to look at whether a temporal relationship exists between an event that is clearly capable of causing a bulging disc,. and how soon thereafter there were pain complaints consistent with this injury. Then, injury lawyers must establish whether there’s also a change or impact in a person’s life that will establish legal causation.