When we are involved in an accident and suffer an injury, we expect to experience pain immediately following the incident. However, sometime down the road we also expect to heal and recover ultimately moving on with our lives. Unfortunately, many of us never fully recover and are left with what is commonly termed residual pain and limitation. Many patients cannot come to terms with residual symptoms because, “I didn’t have this pain before the accident” and their expectation is to be the way they were “before the accident”. There are many reasons for residual post-traumatic pain.
How our bodies handle physical trauma such as an automobile or skiing accident is largely dependent on the status of our tissue health and strength at the time of the injury. If you are strong and healthy, you have a better chance of withstanding the trauma and having a complete recovery. If you are very deconditioned and have several chronic diseases, you are more likely to experience residual pain and dysfunction.
Age plays a role in your ability to heal and recover. The older we are the less resilient our tissues are. Therefore when they are stretched or compressed they don’t bounce back like they did when we were younger. Consequently, the damage that occurs may be permanent. When we are younger than 25 years old, we generally heal with new tissue. This is why when we are young and have an injury or a cut there is less scar tissue produced. After the age of 25, we will progressively heal with scar tissue instead of regenerating new tissue. The development of scar tissue results in poor tissue mobility, restricted motion, poor microcirculation, and nerve entrapments.
Our DNA also governs our healing ability. Essentially, our parents and family tree dictates how we will respond to trauma. We won’t know how our bodies will respond until we actually experience the trauma, so this part is a bit of a guessing game. If our parents gave us a product manual it might make it easier but that is not the case.
Other age-related aspects that hinder our ability to recover from trauma is the presence of pre-existing arthritis or degenerative changes. Joints that are arthritic are inherently unstable. When they experience a trauma, the forces result in more damage than had they been healthy at the time of injury. This subset of patients is the most likely to experience some level of long term pain and limitation following a notable injury such as an automobile accident.
Along with degenerated or arthritic joints we usually find degenerated or thinning tissues. Tendons will thin as the corresponding muscles atrophy or weaken. Think of our younger tissues like a washcloth. A washcloth is strong and flexible and can handle a good amount of tugging, pulling, and abrasion before it breaks down. Now think of our older tissues more like a sheet of paper towel. It can handle some pulling and pressure but it doesn’t take very much to damage it beyond recognition. So our younger muscles, tendons and other connective tissues will stretch and absorb impact much better than our older thinner tissues.
The type of force that we are exposed to also plays a role in our ability to recover or continue to have lingering pain and lost function. If we are sitting in our car stopped at a traffic light with our seatbelt on and suddenly we are hit from behind this is commonly referred to as a “whiplash” injury. The restraint system keeps our torso pinned to the seat and our head is free to move back and forth on our neck. Because of the single shoulder harness commonly used it is not an entirely linear force. There is a rotational component. This is why we see more residual neck pain than we did in the days of the “whiplash belt” which was only a waist restraint. Multidirectional accidents usually occur in more high-speed type impacts. Examples would be motorcycle accidents, skiing accidents, or pedestrian accidents. Let’s say you decide to walk home from work one day, and while you are crossing the street in the middle of the crosswalk, a pickup truck fails to see you and hits you on the side sending you airborne approximately 30 feet. While the initial impact may have been linear, the subsequent flight and impact on the ground was multidirectional. We refer to this as “ragdoll syndrome”. Patients in this type of accident are almost guaranteed to experience residual chronic pain and dysfunction for years following the injury.
General health, strength and flexibility are our best assets to withstanding and recovering from a traumatic accident. If you are older when the accident happens, it means you will need to put in more effort to recover and you are looking at a longer road than your younger counterparts.