The effects of severe trauma to the human body are generally well understood by the medical and legal professions. When lesser injuries produce significant incapacitation or disability the situation becomes more difficult to assess.  If for example a young student is struck in the head with a basketball and quickly lapses into unconsciousness and is found to have a blood cgreat deal secondary to a congenital arterio-venous malformation (or aneurysm) of the brain the reasons why this happened are readily appreciated and addressed.  The legal dictum of injury directed to a "paper-thin" skull is also well-known and appreciated.  In wartime bullet and missile injuries are frequently dealt with on an acute basis.  These are all situations where the cause and effect are clearly evident.

It is in situations where the trauma is not severe but significant as in the proverbial "whiplash" (or hyperflexion-hyperextension) injury to the neck that the clouds begin to roll in.  Also in this category are circumstances where the real injury has actually been slowly progressive, over a long, period of time, and the clinical signs and/of symptoms do not become evident until a "straw which breaks the camel's back" occurs as either the continued progression of the long-existing pathology or the occurrence of an event which tips the balance between asymptomatic and symptomatic.


Examples:
A patient who presents with a one-week history of headache is found, on imaging studies, to have a benign intracranial tumor the size of an orange. The tumor has probably been present for 20-30 years.  Why headache of only one weeks duration?  The answer is that because the growth of the tumor was so slow that the brain was able to continually adapt to the insult but finally reached the point where such a response could no longer be maintained.  In a situation such as this even a minor head injury could have had devastating results for the patient by destabilizing the situation.

A patient who has unknown congenital abnormalities of development of the spine, such as juvenile discogenic disease, is involved in a minor motor vehicle accident following which the individual is incapacitated by pain and/or neurologic problems.  Diagnostic evaluation shows significant long-standing spinal pathology which was previously "silent" (because of its slow progression) until the accident.  In this case there was not severe trauma but the effects of the relatively minor injury were totally disabling to the individual.

Summary:
The human body has a amazing ability to acclimate to insult and injury as long as these occur gradually over a long period of time.  Even when neural structures are displaced and deformed they can remain normally functional until a point is finally reached where further acclimatization is not possible.  It is at this point that clinically evident associated signs or symptoms occur.  How many of us are treading on this sort of "thin ice" without knowing it?  How does one differentiate such an individual from the crowds of malingerers?  The answer lies in two factors:

Access to knowledgeable and experienced individuals who can decipher these situations.

Improved means of screening to allow individuals, at an early age, to become aware of such important liabilities.  How many of those reading these words have unnoticed "swords" hanging over their heads?

Fortunately for us all "Mother Nature", the great healer, appears to, in most cases, allow most of the situations described above to heal or to stabilize spontaneously during one's lifetime and not cause the individual disability or incapacitation.  How do we know this?  We know it from advanced imaging studies such as magnetic resonance imaging scanners (MRI); of which there are more and more all the time (with some dramatic exceptions) and autopsies performed; of which there are less and less all the time.