Soft Tissue Injuries

  1. Definition

  2. Soft tissue injuries, which are also known as myofascial injuries, involve damage to tendons, muscles and ligaments. They can be caused by a sprain, a strain and/or a contusion. Symptoms include pain, swelling, bruising and impaired function.Soft tissue injuries that occur in the cervical and thoracolumbar spine (which is the vast majority of the spine) heal within about six months. 5-10% will continue to have discomfort beyond six months. Some patients with soft tissue injuries develop chronic pain.

    There are a number of risk factors that contribute to increased pain or disability. Some of these include genetics, prior injury, age, gender (females are more likely to be affected by this type of injury than males), preexisting spinal abnormalities, etc.

    Some common spinal abnormalities are: ankylosing spondylitis (occurring most often in the lower back), where vertebrae in the spine fuse making the spine less flexible; spondylolisthesis (occurring most often in the lower back), where one of the vertebrae in the spine slips out of place into the vertebrae below it thereby putting pressure on a nerve located in the spine; and spinal stenosis (occurring most often in the lower back and neck), where the spaces within the spine narrow thereby putting pressure on nerves in the spine.

    Soft tissue injuries most commonly occur in the neck and back.

    1. Soft Tissue Injuries to the Neck

    Neck sprains are also known as whiplash associated disorders (“WAD”). It occurs due to a rapid back and forth movement of the neck which may cause the neck’s tendons and ligaments to stretch and tear. Motor vehicle accidents (MVA), falls, contact sports and domestic abuse are events that can lead to WAD. Symptoms include neck stiffness and pain, headaches, dizziness, difficulty concentration or remembering, irritability and sleep disturbances. Short-term treatment might include physiotherapy, application of cold/heat and/or medication. Ongoing sequelae may include chronic pain, headaches, restricted range of motion and/or altered mood. On a long-term basis, a patient may experience impairment in their abilities to undertake self-care, caregiving, work and leisure activities, as well as sleep disturbances. A patient may need, in terms of long-term care, either or a combination of counseling, pain management and/or medication.

    1. Soft Tissue Injuries to the Back

    Soft-tissue injuries to the mid and low back are caused by blunt force trauma (injury resulting from impact with a dull object), hyperextension (movement of a spinal joint beyond its normal range of motion) and/or flexion (bending of the spine). MVAs, falls, contact sports and physical assaults are events that can lead to soft tissue injuries to the mid and low back. Symptoms include back stiffness, pain and swelling, restricted range of motion, burning and numbness, and pain radiating to the legs. Short-term treatment might include physiotherapy, massage therapy, application of cold/heat and/or medication. Ongoing sequelae may include chronic pain, restricted range of motion, restricted tolerances and altered mood. In the long term, a patient may have impairment in their abilities to undertake self-care, caregiving, work and leisure activities, as well as sleep disturbances. A patient may need, in terms of long-term care, either or a combination of counseling, pain management, exercise programs, surgery, and/or medication.

    1. Legal Ramifications

    In a tort claim against a negligent driver, to secure compensation for one’s general damages (aka pain and suffering costs) and health care expenses, one must have sustained either a permanent serious disfigurement or a permanent serious impairment of an important physical, mental or psychological function. This is called the statutory threshold. As indicated above, research indicates that soft tissue injuries to most parts of the spine will heal within six months and thus be not permanent in nature. However, as shown in the precedent explored below, it is possible in certain cases for a soft tissue injury to result in a permanent impairment.

    In an accident benefits claim against an insurance company, it makes a difference as to whether an injury is classified as minor, nonminor or catastrophic. Benefits are less (subject to the Minor Injury Guideline or MIG) for minor injuries and are more for nonminor injuries. A minor injury is defined in the Statutory Accident Benefits Schedule as including a sprain, a strain or a whiplash associated disorder; therefore, most soft tissue injuries will be classified as minor in nature. However, as explored in a case below, it is possible in some cases to be removed from the MIG, such as in the case of medical benefits if the injury is not predominantly minor in nature.

    1. Examples

     

  1. Tort Claim
    Terzis v. Terzis (https://canlii.ca/t/1vt7f) is a case where a MVA victim with soft tissue injuries and resulting back pain met the threshold, for seeking general damages, by establishing a permanent serious impairment of an important physical, mental or psychological function. The plaintiff was injured in a MVA when she was 17 years of age, causing her soft tissue injuries which left her with continuing back pain which impaired her ability to walk, sit, stand and lift weights. She was a pedestrian who was struck by a vehicle owned by the defendant. She sued the defendant for general damages. The defendants moved for an order dismissing the claim on the ground that she did not meet the statutory threshold. The court ruled that the defendant’s motion be dismissed. Her argument that she had sustained a permanent serious disfigurement – on the basis of her physical scars from the accident – was dismissed because, although it was a disfigurement, it was not a permanent and serious disfigurement. On the other hand, the court gave effect to her argument that her soft tissue injuries resulted in a permanent serious impairment of an important physical, mental or psychological function. The impairment of her physical ability to talk, sit, stand and lift were permanent. As well, these functions were important to her. The impairment of these bodily functions was serious as it limited her career choices and made it difficult for her to find work.
  1. Accident Benefits
    17-003735 v. Certas Direct Insurance Company (https://canlii.ca/t/hrvck) is a case where a MVA victim with a whiplash associated disorder and chronic pain was removed from the MIG. The applicant was injured in a MVA on August 11, 2015. She sought accident benefits from her insurer, Certas Direct, which denied a number of them, taking the position that she should be subject to the minor injury guideline. The Licence Appeal Tribunal held that she was removed from the MIG because her injury, Chronic Post Traumatic Pain Syndrome, was not predominantly minor in nature. It held that she was entitled to all of her proposed treatment plans (including physiotherapy and psychological services) because she had proven that they were reasonable and necessary. A report from a “pain specialist” diagnosed her with Chronic Post Traumatic Pain Syndrome, associated with neck pain, shoulder pain, upper and lower back pain, left ankle pain, sleep disturbances and mood abnormalities; and with Chronic Cervical Zyapophyseal Joints Pain of the neck. He based these diagnoses on physical and psychological tests, a range of motion test and interview. The tribunal only accepted the first diagnosis because it was supported by the tests; it did not accept the second diagnosis because the report did not explain what this condition is. Further, the insurer’s independent examination report did not address the chronic pain issue; therefore the tribunal preferred the report, the insured’s expert’s, which addressed the chronic pain issue, over the report, the insurer’s expert’s, which did not. The tribunal also rejected the insurer’s argument that the insured’s expert’s report should be doubted because she was not referred to the pain specialist by her family doctor.
  1. Conclusion

If you are suffering from soft tissue injuries as a result of an injury or accident, Azimi Law can help you obtain the compensation you deserve.

References

https://www.canlii.org.

Insurance Act, R.S.O. 1990, CHAPTER I.8.

Mayo Clinic, “Ankylosing Spondylitis – Symptoms and Causes”, “Spinal Stenosis – Symptoms and Causes” and “Whiplash – Symptoms and Causes”: https://www.mayoclinic.org/.

Lisa Zaretsky and Bonnie Koreen, “Soft Tissue Injuries”, Sprains, Strains and Automobiles: A Medically Illustrated Guide to Commonly Litigated Injuries. Toronto, Ontario: Carswell, January 1, 2011.

Statutory Accident Benefits Schedule (or “SABS”), made under the Insurance Act, R.S.O. 1990, c.I.8, s 3(1).

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