One of the most difficult challenges for Boston personal injury attorneys is the client with persistent whiplash symptoms months after a car crash—despite “normal” imaging.
In cases throughout Boston and the Greater Boston Area, this scenario is common. Clients report ongoing neck pain, headaches, dizziness, and functional limitations, while the defense relies on unremarkable MRIs to argue “no injury.”
Emerging evidence suggests something critical is often overlooked: alar ligament injury.
A 2015 study by Chen et al. in the Journal of Central South University of Medical Science examined MRI findings in patients with chronic whiplash and suspected alar ligament injury, particularly in older adults—offering a clearer explanation for persistent symptoms and a pathway to stronger causation arguments.
What Are the Alar Ligaments?
The alar ligaments are key stabilizers of the upper cervical spine, connecting the dens (C2) to the occiput. They:
Limit excessive head rotation
Stabilize the upper cervical spine
Protect nearby neurological and vascular structures
Given their role, these ligaments are vulnerable during rear-end collisions, where rapid rotation and extension occur before muscular protection can engage.
Why These Injuries Are Commonly Missed
Standard MRI protocols are not designed to fully assess the alar ligaments.
Routine studies prioritize:
Disc pathology
Spinal cord findings
Gross structural abnormalities
Subtle upper cervical ligament injuries may be missed without targeted sequences or expert review—creating the classic litigation problem:
👉 Symptoms are real
👉 The injury exists
👉 The MRI appears “normal”
What the Study Demonstrates
Chen et al. identified alar ligament abnormalities on MRI in a subset of chronic whiplash patients. Their findings support:
A structural basis for persistent symptoms
The importance of upper cervical evaluation
The role of MRI—when properly applied—in identifying otherwise hidden injuries
These injuries can explain:
Chronic neck pain
Occipital headaches
Dizziness and imbalance
Reduced cervical stability
Why This Matters in Boston Personal Injury Cases
1. Explains Chronic Symptoms
Alar ligament injury provides a biomechanical explanation for ongoing complaints when other findings are limited.
2. Counters “Normal MRI” Arguments
A standard MRI is not a complete evaluation of cervical ligaments—particularly at C0–C2.
3. Strengthens Causation
The forces in a rear-end collision are consistent with stress placed on the alar ligaments, especially with head rotation.
4. Supports Advanced Imaging & Expert Review
These cases often require specialized interpretation to identify clinically relevant findings.
The Elderly Patient Factor
The study’s focus on older patients is particularly relevant in Boston demographics.
Age-related changes may:
Reduce ligament elasticity
Increase susceptibility to injury
Delay or impair recovery
This helps explain why seemingly minor collisions can lead to prolonged disability in older individuals.
Strengthening Documentation in Boston Cases
For attorneys handling cases in Boston, Cambridge, Newton, Brookline, Quincy, and Somerville, consider:
Mechanism of injury (including head position)
Persistence and consistency of symptoms
Functional limitations (work, ADLs)
Whether upper cervical ligaments were specifically evaluated
Expert review of MRI studies
Why Expert Involvement Matters
This is precisely where expert consultation becomes critical.
In complex whiplash cases involving persistent symptoms and “normal” imaging, you should consult with an experienced clinician who understands upper cervical ligament injury and advanced imaging interpretation.
👉 This is why attorneys frequently consult with car crash experts like Dr. Quigley, who specializes in correlating:
Clinical findings and causation
Biomechanics of injury
Advanced imaging interpretation
Comprehensive narrative reports that connect these elements can significantly strengthen causation, damages, and case clarity for insurers and juries.
The Bottom Line
Chronic whiplash cases are often misunderstood because the most important injuries—like those involving the alar ligaments—may not be visible on routine imaging.
For Boston personal injury attorneys, the key takeaway is clear:
The absence of findings on standard MRI does not rule out significant injury—especially in the upper cervical spine.
Understanding these nuances—and involving the right expert—can make the difference between a disputed claim and a well-supported case. Call Dr. Quigley today at 617-720-1992 to discuss your case. Click here to view his credentials.
Literature Citation
Chen J, Wang W, Han G, Han X, Li X, Zhan Y. MR investigation in the evaluation of chronic whiplash alar ligament injury in elderly patients. PMID: 25652377. doi:10.11817/j.issn.1672-7347.2015.01.011.
“I was majoring in chemistry at Villanova University when my path turned to chiropractic. I was going on interviews to be a pharmaceutical sales representative, and they always asked me what I wanted to be doing in five years. My answer was always the same: “I want to be helping people, enjoying my work, while making a difference.”
Looking for a Boston chiropractor focused on conservative, drug-free spine care? At Charles Street Family Chiropractic in Beacon Hill, Dr. Chris Quigley helps patients with back pain, neck pain, sciatica, disc problems, and recurring spinal conditions. Chiropractic care can support mobility, function, and active living while reducing reliance on medications and invasive procedures. Even major medical centers, including the University of South Florida Neurosurgery program, are integrating chiropractic care into collaborative spine treatment and research.
A 2015 MRI study found signs of alar ligament injury in 55% of older patients whose chronic neck pain had no other identifiable cause. For Boston and Massachusetts personal injury attorneys, that finding speaks to a familiar problem: the client who still hurts months after a car crash, but whose standard imaging reads as “normal” or “age-related degeneration.”
The number that should stop every elective-surgery patient in their tracks is 94%. In a large 2017 Journal of Pain Research study of 1,842 people who had undergone lumbar spine surgery, 94% reported some degree of residual low-back pain. That does not mean 94% had severe pain, nor does it mean 94% of the operations were surgical failures. But for an invasive procedure that many patients understandably hope will eliminate their back pain, the persistence of any low-back pain in such a large proportion of respondents is difficult to dismiss. The same study found that 20.6% met the researchers’ criteria for failed back surgery syndrome —roughly one out of every five patients. Residual numbness was reported by 69.8%, cold sensations by 43.3%, and paresthesia such as tingling or abnormal sensations by 35.3%.
