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. The legal concept of injury directed to a “paper-thin” skull is also well established. In wartime bullet and other missile injuries are frequently dealt with. These are all situations where the cause and effect are usually clearly evident.
It is in situations where the trauma itself not severe but significant as in the proverbial “whiplash” (or hyperflexion-hyperextension) soft tissue (strain or sprain) injury to the neck that the clouds begin to roll in. Also in this category are circumstances where the real bodily injury has actually been slowly progressive in nature occurring over a long, period of time, and the clinical signs and/of symptoms do not become evident until a minor event (the “straw which breaks the camel’s back”) to tip a previously existing fine balance between an individual being symptomatic or symptomatic.
A patient 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 then 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 such a delicate 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 disabled by pain. If there is no objective radiographic or neurologic evidence of acute injury the great majority of such patients (if they are non-smokers) have their symptoms relieved with appropriate conservative care within a period of weeks or months.
The human body has a amazing ability to acclimate to insult and injury as long as these events occur gradually over a long period of time. Even when neural structures are displaced and also 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 in such cases. 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 accurately decipher these situations and be guides for a return to health ad normal function.
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.