A fender-bender on Route 2 in Edgewater, MD. A trip to urgent care or the ER afterward. An X-ray that comes back "clear," and a discharge note that says something like follow up if symptoms persist. Then, three days later, your neck is stiff, your lower back aches when you stand up from the couch, and you're wondering how you can be hurting when the picture says there's nothing wrong.
We hear this story from neighbors across Anne Arundel County all the time. The short answer is that an X-ray is very good at looking at bone, and many car-accident injuries aren't bone injuries. They involve muscles, tendons, and ligaments, and those are the tissues a standard X-ray was never designed to show.
In this article, I'll explain what soft tissue injuries are, why a "normal" X-ray doesn't rule them out, what a fuller post-accident evaluation looks like, and the signs that mean you should skip the chiropractor and head straight to an emergency room. Our office is at 137 Mitchell's Chance Road, Suite 100, in Edgewater, and we see patients from Annapolis, Severna Park, Davidsonville, Riva, Crownsville, Mayo, and Arnold.
What counts as a soft tissue injury?
"Soft tissue" simply means everything that isn't bone: muscles, tendons (which attach muscle to bone), ligaments (which connect bone to bone and help stabilize your joints), and the fascia that wraps around them. After a collision, the injuries we see most often are:
- Strains: overstretched or partially torn muscle or tendon fibers
- Sprains: overstretched or partially torn ligaments, especially in the neck and low back
- Muscle spasm and guarding: the body tightening up around an irritated area as a protective response
- Contusions: deep bruising from seat belts, steering wheels, or door panels
Whiplash is the best-known example. Cleveland Clinic describes it as a form of neck sprain that can involve muscles, ligaments, nerves and, in more severe cases, bone (Cleveland Clinic: Whiplash). The same forces that strain the neck in a rear-end collision can also affect the mid-back, low back, shoulders, and hips, depending on how you were sitting, which way you were turned, and where the impact came from.
Why the X-ray can look "normal" when you don't feel normal
An X-ray works by passing radiation through the body and recording how much is absorbed. Dense structures like bone absorb a lot and show up clearly. Muscle, tendon, and ligament absorb far less, so they appear as a faint, undifferentiated gray. A stretched ligament or a strained muscle simply doesn't have a distinctive look on a plain film.
That's not a flaw in the X-ray. It's doing exactly what it was ordered to do: rule out a fracture or dislocation. That is an important job, and it's the right first step in an emergency setting. Cleveland Clinic notes that providers begin with a physical and neurological exam and may use X-rays, CT, or MRI scans to rule out other conditions and to identify complications (Cleveland Clinic: Neck sprain). In other words, a clear X-ray is good news about your bones. It just isn't a statement about everything else.
A few other reasons the picture can be incomplete:
- Timing. Some symptoms begin right away, but others can take 12 hours or several days to fully develop, according to Cleveland Clinic. A scan taken in the first hours may not reflect how you feel by the end of the week.
- Position. A standard X-ray captures you lying or standing still. It doesn't show how your joints move, or where they feel restricted or irritated when you turn your head or bend.
- Pain isn't a pixel. Muscle tension, joint irritation, and sensitivity in tissues that have been stretched past their comfortable range are real, but they aren't something a film can measure.
Why soft tissue injuries are easy to underestimate
Part of the problem is that these injuries don't announce themselves dramatically. There's no cast, no stitches, and often no visible bruise. Many people assume that if the car had only minor damage, they must be fine.
The numbers suggest otherwise about how common collisions are around here. The Maryland Highway Safety Office reported 9,636 crashes in Anne Arundel County in 2023, 2,791 of which involved injuries (Maryland Department of Transportation, Highway Safety Office crash summary). Plenty of those were low-speed collisions in parking lots, at traffic lights, or in stop-and-go traffic on Route 50 and Solomons Island Road. Even at low speed, the body can experience a rapid change in motion that the neck and back muscles can't brace for in time.
Timing matters, too. A retrospective review of 149 motor vehicle accident patients published in the Journal of the Canadian Chiropractic Association found that improvement was lower in patients whose care was delayed (Dies & Strapp, 1992). It's a small, older, single-practice study, so it can't prove that earlier care changes outcomes. But it fits with what we see clinically: people who get evaluated sooner have a clearer picture of what's going on and a clearer plan from the start.
Common symptoms to watch for in the days after a crash
If you've been in an accident and your X-ray was clear, these are worth paying attention to:
- Neck or upper back stiffness that is worse in the morning or after sitting
- Pain or tightness that spreads into the shoulders, shoulder blades, or arms
- Headaches, especially at the base of the skull
- Low back pain when standing, bending, or getting out of the car
- Reduced range of motion, such as trouble checking your blind spot
- Muscle knots or spasms that don't ease up with rest
- Tingling or numbness in the arms or hands (which deserves prompt attention; see the warning signs below)
None of these automatically means something serious, and none of them are a diagnosis. They are simply good reasons to have someone examine you.
What a fuller post-accident evaluation looks like
At Maryland Chiropractic & Physical Medicine, a post-accident visit is built around listening and hands-on assessment, not just imaging. A typical evaluation includes:
- A detailed history. What happened, where you were sitting, how the impact felt, what you noticed at the scene and since.
- Orthopedic and neurological screening. Checking reflexes, strength, sensation, and specific movement tests to see which structures are irritated.
- Range-of-motion and palpation. Looking for restricted joints, tender areas, and muscle guarding, and comparing one side to the other.
- Review of any imaging you've already had, and, when something in the exam warrants it, a referral for further imaging or to another provider.
- A clear explanation. What we found, what it may mean, and what a conservative care plan could look like.
If anything in the exam suggests a problem outside the scope of chiropractic care, we'll tell you plainly and refer you appropriately. Our goal is to make sure you're in the right hands, not to make every problem a chiropractic one.
How conservative care may support recovery
When the evaluation points to a soft tissue problem and there are no red flags, a conservative plan may include some combination of gentle chiropractic adjustments, soft tissue work, massage therapy, cupping, and guidance on movement and posture at home. The aim is to support your body's natural healing process, restore comfortable motion, and help you get back to normal activities. Individual results may vary, and every plan is tailored to the person in front of us.
For stubborn tendon or soft tissue areas that linger well after the initial injury, some patients also explore PulseWave therapy, which uses focused acoustic waves designed to stimulate the body's natural healing response in targeted tissue. It's not for everyone and isn't a first step after an accident, but it's one of the tools we can discuss if a specific area hasn't settled down over time. You can read more on our conditions page.
When to go to the ER instead
Soft tissue care is for people without red flags. Call 9-1-1 or go to the nearest emergency department right away if, after an accident, you have:
- Loss of consciousness, confusion, or a worsening headache
- Severe neck pain with numbness, weakness, or loss of control in your arms or legs
- Loss of bladder or bowel control
- Chest pain, difficulty breathing, or abdominal pain or swelling
- Repeated vomiting, vision changes, or trouble speaking
- Pain after a high-speed collision or any impact where a fracture is possible
A note on insurance and records
Many patients ask how care after an accident is paid for. Coverage depends on your own auto policy and circumstances, so we encourage you to check with your insurer, and our front desk can walk you through what we can and can't tell you. We keep clear, dated records of every visit, which helps you and any other provider involved in your care understand what's been going on. For payment questions outside of insurance, see our financing options. For questions about claims or legal matters, please consult a licensed attorney.
Frequently asked questions
My X-ray was normal. Does that mean I'm not injured?
Not necessarily. A normal X-ray is reassuring about fractures and dislocations, but it isn't designed to show strained muscles or sprained ligaments. If you're still having symptoms, an exam focused on soft tissue and movement can fill in the picture.
How soon should I get checked after a car accident?
Sooner is generally better, even if you feel fine. Some symptoms don't appear for 12 hours to several days. If you have any red-flag symptoms, go to the ER first.
Will I need an MRI?
Not usually. Most soft tissue injuries are evaluated with a history and hands-on exam. If something in your exam suggests that more imaging would be useful, we'll refer you for it.
Can I see a chiropractor if I already went to the ER or urgent care?
Yes. Many patients come to us after an ER or urgent care visit has ruled out fractures. We're happy to review your paperwork and imaging as part of your evaluation.
How long do soft tissue injuries take to settle down?
It varies a great deal from person to person, depending on the type and severity of injury, your overall health, and how soon you start care. Individual results may vary, and we don't promise a timeline.
Do you treat patients from outside Edgewater?
Yes. Many of our patients come from Annapolis, Severna Park, Davidsonville, Riva, Crownsville, Mayo, and Arnold, and from elsewhere in Anne Arundel County.
Schedule an evaluation in Edgewater
If you've been in a crash and something still doesn't feel right, even with a clear X-ray, we'd be glad to take a look. Call us at (443) 294-6873 or contact us online. You can learn more about Dr. Curran and our team, or book a PulseWave consultation if a lingering soft tissue problem is what brought you in.
Maryland Chiropractic & Physical Medicine 137 Mitchell's Chance Road, Suite 100, Edgewater, MD 21037 Phone: (443) 294-6873 Hours: Monday and Thursday 8:30–12:30 and 2:30–6:30; Tuesday 8:30–12 and 2–4; Wednesday 8:30–2; Friday 8:30–2:30
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This article is for general educational purposes only and does not constitute medical or legal advice, diagnosis, or treatment. It is not a substitute for an evaluation by a qualified healthcare provider. Chiropractic care and the therapies described above are not represented as cures for any condition, and individual results may vary. If you have any of the emergency warning signs listed above after an accident, call 9-1-1 or go to the nearest emergency department immediately. For questions about insurance claims or legal matters, consult your insurer or a licensed attorney.
