Abstract
After a motor vehicle accident (MVA) or workplace injury, a person may be told that their X-rays look normal. That is good news because an X-ray can help rule out many major fractures and other bone problems. However, a normal X-ray does not always mean that every injured structure is healthy. Ligaments, spinal discs, joint capsules, muscles, fascia, and even some small or hidden bone injuries may require a more detailed examination or different imaging.
Soft-tissue injuries, subtle annular disc tears, facet joint capsule injuries, myofascial trigger points, mild concussions, and repetitive workplace injuries can sometimes be difficult to recognize during the first medical examination. The best approach is not to assume everyone needs more testing. Instead, the examination, symptoms, mechanism of injury, neurologic findings, movement patterns, and recovery over time should guide the next step.
At Injury Medical Clinic PA in El Paso, Texas, an integrative model combines medical oversight, chiropractic care, functional medicine, personal injury care, and rehabilitation. The goal is to address both sides of recovery: mechanical restoration and biological tissue healing.
Why Some Accident Injuries Can Be Easy to Miss
Emergency and urgent medical evaluations have an important job. Their first priority is to find conditions that could threaten a person's life or cause serious disability. Doctors may look for major fractures, internal bleeding, spinal cord damage, brain bleeding, or other emergencies.
The problem is that many accident-related injuries involve tissues that are not clearly visible on a standard X-ray.
X-rays are especially useful for examining bones. They do not directly show most muscles, tendons, ligaments, spinal discs, or joint capsules in detail. Advantage Healthcare Systems explains that soft-tissue injuries may become more noticeable after the first hours or days as inflammation, stiffness, and muscle guarding develop (Advantage Healthcare Systems, 2025).
Research on whiplash has also shown that pain can occur even when obvious tissue damage is not seen on basic imaging. The rapid forces created during a collision can strain the muscles, ligaments, discs, and small joints of the cervical spine (Chen et al., 2009).
This is why the phrase "nothing is broken" should not automatically mean "nothing is injured."
Spinal Ligament Micro-Injuries
Ligaments are strong bands of tissue that connect bones and help control joint movement.
During a rear-end collision, side impact, fall, lifting accident, or sudden workplace injury, the spine may move beyond its usual range. A ligament may stretch or become injured without completely tearing.
These smaller injuries may cause:
Neck or lower back stiffness
Pain with bending or turning
Muscle guarding
Headaches
A feeling that the spine is unstable or easily irritated
Pain after sitting or standing for long periods
Standard X-rays usually cannot directly show small ligament injuries. MRI provides much better soft-tissue detail and may identify ligament, muscle, bone marrow, or other injuries when clinically appropriate. The American College of Radiology notes that MRI can reveal traumatic soft-tissue findings that may not be seen on other imaging in selected spinal trauma cases (American College of Radiology [ACR], n.d.).
MRI is not required for every accident patient. Select imaging based on the examination, symptoms, neurologic findings, and clinical concern.
Annular Tears in Spinal Discs
Between the bones of the spine are intervertebral discs. Each disc has a softer center surrounded by a strong outer ring called the annulus fibrosus.
Sudden compression, twisting, bending, or impact can stress the annulus. Small fissures or tears may develop even without a large disc herniation.
These injuries can produce:
Deep neck or back pain
Pain while sitting
Pain during bending or lifting
Muscle spasms
Pain that sometimes travels into an arm or leg
Annular tears are not visible on a standard X-ray. Some can appear on MRI as a high-intensity zone or other changes within the disc. Research has linked certain MRI findings with annular disruption and painful internal disc problems, although imaging findings must always be interpreted along with the patient's symptoms and examination (Lam et al., 2000; Saifuddin et al., 1999).
An abnormal MRI also does not automatically prove that a disc finding was caused by an accident. Age-related disc changes are common. Timing, prior symptoms, mechanism of injury, and clinical findings all matter.
Facet Joint Capsule Injuries
The spine contains small joints called facet joints. These joints help guide and control movement.
Each facet joint is surrounded by a capsule containing connective tissue and pain-sensitive nerve endings. During whiplash, the capsule may be stretched very quickly.
Biomechanical research has identified the cervical facet joint capsule as one possible source of neck pain following whiplash (Chen et al., 2009).
Facet-related injuries may cause pain that becomes worse with:
Turning the head
Looking upward
Twisting the lower back
Standing for long periods
Repeated movement
The painful structure may not be obvious on a plain X-ray. A detailed physical examination and, when necessary, further diagnostic evaluation may be needed.
Myofascial Trigger Points and Deep Muscle Injuries
Muscles often tighten after an accident to protect an injured joint or spinal area.
Sometimes this protective response does not completely settle down.
Sensitive areas called myofascial trigger points may form within tight muscles. These areas can cause local pain or refer pain somewhere else.
For example, a neck muscle injury may contribute to pain in the:
Head
Shoulder
Upper back
Arm
A lower-back trigger point may create discomfort in the hip or buttock.
These problems normally do not appear on X-rays. They are usually identified through the history, physical examination, movement testing, and palpation.
Dr. Alexander Jimenez's clinical observations also emphasize that accident-related joint and soft-tissue injuries frequently occur along with altered posture, gait, spinal motion, and protective movement patterns. Looking beyond the exact location of pain can help clinicians identify mechanical problems that may continue to stress healing tissues (Jimenez, 2026a).
Mild Concussion Can Exist With Normal Imaging
Not every important accident injury involves the spine.
A person can experience a mild traumatic brain injury, or concussion, during a collision, fall, or workplace accident without having an obvious skull injury.
Possible symptoms include:
Headache
Dizziness
Nausea
Brain fog
Trouble concentrating
Memory problems
Sensitivity to light or noise
Sleep changes
Balance problems
Some symptoms may begin immediately, while others may appear hours or days later (Centers for Disease Control and Prevention [CDC], 2025a).
A normal CT does not rule out concussion. The CDC explains that a brain scan is generally not required simply to diagnose a mild TBI or concussion. CT is mainly useful when clinicians are concerned about problems such as bleeding or other serious structural injury (CDC, 2025b).
Research also shows that conventional CT and MRI can appear normal in people who still have a mild traumatic brain injury (Shenton et al., 2012).
Persistent headache, confusion, repeated vomiting, weakness, worsening neurologic symptoms, loss of consciousness, or major behavior changes after a head injury require prompt medical attention.
Workplace Injuries Can Develop Slowly
Not every workplace injury happens during one dramatic accident.
Some injuries develop little by little from:
Repetitive lifting
Poor workstation positioning
Frequent twisting
Repeated tool use
Prolonged sitting
Vibration
Overhead work
Repetitive gripping
Awkward posture
This is called cumulative trauma.
Stern and Cohen describe cumulative trauma as conditions that develop gradually from repetitive movement, overuse, or sustained physical strain. Common examples include tendinitis, carpal tunnel syndrome, shoulder problems, and chronic lower-back strain (Stern & Cohen, 2025).
Work-related stress fractures can also develop gradually from repeated loading rather than one major impact (Morgan & Morgan, 2025).
This makes a good work history important. A clinician may need to understand what the person lifts, pushes, pulls, carries, reaches for, or repeats throughout the workday.
Why the Physical Examination Still Matters
Imaging is valuable, but imaging should not replace the clinical examination.
An injury evaluation may include:
Range-of-motion testing
Orthopedic testing
Neurologic examination
Muscle strength
Reflexes and sensation
Posture and gait
Joint movement
Functional movement testing
Review of the accident mechanism
Review of symptoms that have changed since the injury
This information helps determine whether additional studies such as MRI, CT, electrodiagnostic testing, specialist evaluation, or other testing may be appropriate.
Integrative Chiropractic Care: Restoring the Mechanical Side
Once serious injuries have been identified or ruled out, rehabilitation can focus on restoring safe movement.
Integrative chiropractic care may use a combination of carefully selected treatment methods, including joint mobilization or manipulation, soft-tissue care, corrective exercise, mobility work, stabilization training, and rehabilitation.
The goal is not simply to "put a bone back into place."
The broader goal is to improve movement, reduce harmful mechanical stress, rebuild strength, and help the patient return safely to normal activity.
Clinical practice guidelines support exercise and selected manual therapies, including spinal manipulation, as options for certain forms of neck and lower-back pain when properly matched to the patient's condition (George et al., 2021).
Dr. Jimenez describes this as addressing the mechanical side of injury recovery. When joints become stiff and muscles tighten after trauma, people often begin moving differently to avoid pain. Those compensations can place extra stress on other areas of the body (Jimenez, 2026b).
Biological Tissue Repair and Regenerative Care
Some injuries may also need attention to the biological healing environment.
Regenerative approaches such as platelet-rich plasma, or PRP, use concentrated components from the patient's own blood. Platelets contain signaling proteins involved in normal repair processes. PRP has been studied for several tendon, ligament, and joint conditions, although results vary greatly depending on the injury, preparation method, injection location, and patient (Cohn, n.d.).
Regenerative treatment should therefore never be presented as a guaranteed cure.
When appropriate, the concept is simple:
Rehabilitation and chiropractic care work on mechanics, while selected regenerative procedures may support the biological environment of damaged tissue.
Dr. Jimenez's published clinical approach describes the same relationship: biological therapies may support tissue healing, while chiropractic and rehabilitation help patients use the recovering tissue more effectively and reduce repeated mechanical stress (Jimenez, 2026b).
Multidisciplinary Injury Care in El Paso, Texas
At Injury Medical Clinic PA in El Paso, Dr. Alexander Jimenez, DC, APRN, FNP-BC, CCST, CFMP, IFMCP, ATN, works within a multidisciplinary injury-care model.
His areas of care include:
Chiropractic and musculoskeletal care
Personal injury evaluation
Functional medicine
Rehabilitation
Movement and biomechanical assessment
Coordination of medically appropriate supportive therapies
Dr. Jimenez works with Dr. Maria Guadalupe Cardenas, MD, an internal medicine physician with more than four decades of medical experience. Clinic materials identify Dr. Cardenas as the medical director and collaborative physician for Injury Medical Clinic PA. Her Texas physician license is J2933, and public provider information identifies her NPI as 1164426748. Her Texas physician license is listed through May 31, 2027.
This type of multidisciplinary setup allows different parts of an injury to be evaluated together.
Dr. Cardenas provides internal medicine and medical oversight, while Dr. Jimenez addresses chiropractic, neuromusculoskeletal, functional, and rehabilitation needs within his scope of practice. The team can also coordinate referrals or further medical evaluation when symptoms suggest a condition requiring another specialist.
This structure can be especially valuable when an injury involves several systems at once.
Mechanical Restoration + Biological Repair
A motor vehicle accident or workplace injury can affect more than bones.
The injury may involve:
Ligaments → discs → muscles → fascia → joints → nerves → movement patterns
That is why recovery may require more than looking at one X-ray.
A complete care plan begins with the correct diagnosis. It then addresses inflammation, mobility, strength, neurologic function, mechanical stress, and tissue healing as needed.
Dr. Jimenez's clinical observations support a whole-body approach in which an injured tissue is not viewed by itself. How the patient stands, walks, bends, moves, sleeps, works, and compensates can influence recovery.
The main principle is straightforward:
Find the injury first. Protect the patient. Restore movement. Support tissue healing. Rebuild function.
That approach can help patients move beyond simply controlling pain and toward a safer return to work, family activities, exercise, and everyday life.
References
Advantage Healthcare Systems. (2025, December 11). The hidden soft-tissue injuries most people miss after a car accident.
American College of Radiology. (n.d.). ACR Appropriateness Criteria: Acute spinal trauma.
Centers for Disease Control and Prevention. (2025a). Symptoms of mild TBI and concussion.
Centers for Disease Control and Prevention. (2025b). About mild TBI and concussion.
Chen, H., Yang, K. H., & Wang, Z. (2009). Biomechanics of whiplash injury. Chinese Journal of Traumatology, 12(5), 305–314.
Cohn, J. (n.d.). Regenerative orthopedics: PRP, stem cells, and healing from within.
George, S. Z., et al. (2021). Interventions for the management of acute and chronic low back pain: Revision 2021. Journal of Orthopaedic & Sports Physical Therapy, 51(11), CPG1–CPG60.
Jimenez, A. (2026a). MVA joint trauma: Comprehensive chiropractic approaches.
Jimenez, A. (2026b). How regenerative medicine and chiropractic care work together. LinkedIn.
Jimenez, A. (2026). Regenerative medicine and integrative chiropractic strategies. El Paso Back Clinic.
Lam, K. S., Carlin, D., & Mulholland, R. C. (2000). Lumbar disc high-intensity zone: The value and significance of provocative discography in the determination of the discogenic pain source. European Spine Journal, 9, 36–41.
Morgan & Morgan. (2025). 15 work injuries you may not know about.
Saifuddin, A., Mitchell, R., & Taylor, B. A. (1999). Extradural inflammation associated with annular tears: Demonstration with gadolinium-enhanced lumbar spine MRI. European Spine Journal, 8(1), 34–39.
Shenton, M. E., et al. (2012). A review of magnetic resonance imaging and diffusion tensor imaging findings in mild traumatic brain injury. Brain Imaging and Behavior, 6, 137–192.
Stern & Cohen. (2025, April 1). Workplace cumulative trauma and your right to compensation.
Texas Medical Board. (2026). Maria Guadalupe Cardenas, MD—Texas physician license J2933.
The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, and physical medicine, as well as wellness, sensitive health issues, and functional medicine articles, topics, and discussions. We provide and facilitate clinical collaboration with specialists across disciplines. Each specialist is governed by their professional scope of practice and the jurisdiction in which they are licensed. We utilize functional health and wellness protocols to treat and support care for musculoskeletal injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters and issues that directly or indirectly support our clinical scope of practice. Our office has made a reasonable effort to provide supportive citations and identify relevant research studies for our posts. We provide copies of supporting research studies upon request to regulatory boards and the public.
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Blessings
Dr. Alex Jimenez, DC, MSACP, APRN, FNP-BC*, CCST, IFMCP, CFMP, ATN
email: coach@elpasofunctionalmedicine.com
Multidisciplinary Licensing & Board Certifications:
Licensed as a Doctor of Chiropractic (DC) in Texas & New Mexico*
Texas DC License #: TX5807, Verified: TX5807
New Mexico DC License #: NM-DC2182, Verified: NM-DC2182
Multi-State Advanced Practice Registered Nurse (APRN*) in Texas & Multi-States
Multi-State Compact APRN License by Endorsement (42 States)
Texas APRN License #: 1191402, Verified: 1191402 *
Florida APRN License #: 11043890, Verified: APRN11043890 *
New York APRN License #: N25929, Verified: APRN-N25929*
License Verification Link: Nursys License Verifier
* Prescriptive Authority Authorized
ANCC FNP-BC: Board Certified Nurse Practitioner*
Compact Status: Multi-State License: Authorized to Practice in 40 States*
Graduate with Honors: ICHS: MSN-FNP (Family Nurse Practitioner Program)
Degree Granted. Master's in Family Practice MSN Diploma (Cum Laude)
Dr. Alex Jimenez, DC, APRN, FNP-BC*, CFMP, IFMCP, ATN, CCST
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Dr. Maria Cardenas, MD
(Board Certified in Internal Medicine)
Medical Director & Collaborative Physician
NPI # 1164426749
MD License #: J2933
