Causation & Chiropractic Care: Myths and Facts Uncovered

Uncover the benefits of causation with chiropractic care and how it can promote healing and enhance your quality of life.

Abstract

This educational post explores causation in personal injury and its essential connection to modern, evidence-based chiropractic care. Written from the clinical perspective of Dr. Alexander Jimenez, who holds the credentials DC, APRN, FNP-BC, CFMP, IFMCP, ATN, and CCST, the discussion traces how the body responds to trauma, why musculoskeletal injuries create cascading effects on the nervous system, inflammation, sleep, mood, and overall health, and how targeted chiropractic adjustments help reverse those effects. The post explains the physiology of spinal manipulation and related techniques, how they reduce pain, improve mobility, and lower the risk of comorbidities such as chronic pain syndromes, reduced physical activity, and related metabolic or mood changes. It also explains how careful clinical documentation of mechanism of injury, temporal relationships, objective findings, and functional progress supplies critical insight for personal injury claims. Throughout, the narrative highlights the multidisciplinary model at Injury Medical Clinic PA (also known as Mission Plaza Injury Medical Clinic) in El Paso, Texas, where Dr. Jimenez provides integrative chiropractic and nurse-practitioner care under the medical direction and collaborative oversight of Dr. Maria Guadalupe Cardenas, MD, Board Certified in Internal Medicine (NPI #1164426749, Texas MD License #J2933). With more than 40 years of experience as an internist, Dr. Cardenas provides physician-level medical direction for complex cases while the team integrates functional medicine, rehabilitation, and non-surgical protocols. Latest findings from researchers studying neuroplasticity, biomarkers, clinical practice guidelines, and safety data are woven into a clear, step-by-step journey that prioritizes patient understanding, natural recovery, and long-term resilience without unnecessary surgery or prolonged reliance on medications.

Introduction: Beginning the Journey Toward Understanding Causation and Recovery

Imagine a moment when ordinary life changes in an instant. A rear-end collision on a busy El Paso street, a fall at work, or an unexpected sports impact sends forces through the body that the spine and soft tissues were never designed to absorb in that way. In the hours or days that follow, stiffness appears, range of motion decreases, and pain limits daily activities. At that point, two parallel needs arise: the body requires skilled care to restore motion and calm protective responses, and the legal or insurance process requires clear evidence that the incident caused or substantially contributed to the resulting condition. That dual need is at the heart of causation in personal injury work, and it’s why integrative chiropractic care holds a central place in non-surgical recovery.

I am Dr. Alexander Jimenez. For more than three decades, I have practiced in El Paso as both a Doctor of Chiropractic and a board-certified Family Nurse Practitioner. My training allows me to evaluate biomechanical disruption and systemic responses simultaneously. At Injury Medical Clinic PA (also known as Mission Plaza Injury Medical Clinic), I work alongside Dr. Maria Guadalupe Cardenas, MD. Dr. Cardenas is board-certified in Internal Medicine, holds NPI #1164426749 and Texas MD License #J2933, and brings more than 40 years of clinical experience. She serves as Medical Director and Collaborative Physician. This arrangement is typical of strong integrative injury clinics: the chiropractor delivers precise hands-on care and functional assessment while the internist provides medical oversight for complex presentations, medication considerations, or coexisting conditions. Together with rehabilitation specialists and functional medicine support, the team creates plans that address the injury itself and the wider physiological consequences that can follow.

In the sections that follow, we will explain what causation means, how chiropractic care works at the level of joints, muscles, nerves, and the brain, why these approaches reduce both the primary musculoskeletal injury and related comorbidities, and how the resulting clinical record provides meaningful insight for personal injury matters. The language is deliberately straightforward so that patients, families, and colleagues can follow the reasoning without specialized jargon standing in the way. Key terms appear in bold the first time they are emphasized and whenever they carry particular clinical weight.

What Causation Means in Personal Injury

Causation is the link between an event and the injury or condition that follows. In personal injury cases, courts and insurers generally require evidence that the incident more likely than not caused or aggravated the problem being treated. Courts often require reasonable medical probability rather than absolute certainty. Medicine rarely deals in 100 percent certainty; instead, clinicians assess whether the event’s mechanism is biologically plausible, whether the timing of symptoms fits known patterns of tissue response, and whether objective findings and the clinical course align with that history.

Three elements commonly appear in careful evaluations. First is the mechanism of injury. A low-speed rear-end collision can still generate rapid acceleration-deceleration forces that stretch ligaments, irritate facet joints, and produce muscle guarding in the cervical spine. Second is the temporal relationship. Symptoms that begin immediately or within 24 to 72 hours are more readily connected than complaints that appear weeks later without intervening explanation. Third is the absence or clear documentation of similar prior problems, or an honest account of how a preexisting condition was made worse. When these elements are present and supported by examination findings such as reduced range of motion, palpable spasm, positive orthopedic tests, or measurable functional limits, the causal chain becomes clearer.

Chiropractic records support this analysis when they include specific, reproducible observations rather than vague statements. A note that records “cervical flexion limited to 35 degrees with grade 2/4 bilateral paraspinal spasm at C4–C7” is far more useful than a general remark that the neck is tight. Progress notes that track changes in pain, sleep, work tolerance, and specific activities further illustrate the injury’s functional impact and the response to care. In many jurisdictions, a treating chiropractor who has performed a thorough evaluation may offer an opinion on causation limited to conditions within the musculoskeletal and nervous systems that relate to joint dysfunction, provided a proper foundation is laid. The Michigan Court of Appeals has recognized this limited scope when the opinion stays within the chiropractor’s authorized diagnostic role.

At our El Paso clinic, we treat documentation as an integral part of care, not an afterthought. The same careful history, examination, and serial assessments that guide treatment also create a coherent narrative that attorneys and adjusters can review. Dr.Cardenas’ss medical oversight adds another layer of clinical judgment when internal medicine issues intersect with the injury, ensuring the overall record reflects coordinated, medically sound decision-making.

What Chiropractic Care Is and How It Works

Chiropractic care is a health profession focused on diagnosing, treating, and preventing neuromusculoskeletal disorders, with particular emphasis on the spine and its influence on nervous system function. The central clinical tool is the spinal adjustment, also called spinal manipulative therapy (SMT). An adjustment is a precise, controlled force applied to a joint that has restricted motion or altered alignment. The force is typically high-velocity and low-amplitude, delivered by hand or instrument, and directed at the specific segment identified on examination.

The immediate mechanical effect is restoring joint play and reducing abnormal mechanical stress on surrounding tissues. Ligaments, joint capsules, and small deep muscles that have become restricted receive a rapid stretch. This stretch activates mechanoreceptors and proprioceptors—sensors that report position and movement to the spinal cord and brain. The resulting afferent barrage is thought to modulate pain processing at the level of the dorsal horn of the spinal cord through a gating mechanism: large-diameter sensory fibers inhibit the transmission of nociceptive (pain) signals. Over repeated sessions, these inputs appear to influence longer-term neuroplastic changes.

Neurophysiology research groups have documented measurable alterations after chiropractic care. Resting electroencephalography studies have shown shifts in brainwave power, including increases in theta, alpha, and beta activity and decreases in delta activity, along with changes localized to the default mode network. Somatosensory evoked potentials demonstrate altered cortical processing. Parallel clinical improvements include increased muscle force production, improved joint position sense, faster reaction time, and reduced pain unpleasantness. A 2024 study involving people with chronic low back pain found that four weeks of chiropractic care produced these neural changes together with better light sleep and reductions in anxiety, depression, fatigue, and pain scores on the PROMIS-29 instrument. The investigators concluded that many health benefits of chiropractic care stem from altered brain activity.

Biomarker work adds another layer. A pragmatic randomized trial of 12 weeks of chiropractic care reported higher blood levels of brain-derived neurotrophic factor (BDNF), a protein supporting neuronal growth and plasticity, along with lower tumor necrosis factor-alpha, a pro-inflammatory cytokine. These shifts suggest modulation of neuroplastic, inflammatory, and stress pathways beyond simple joint mechanics. While effect sizes are modest and further replication is needed, the findings align with clinical observations that patients often report improved sleep, mood, and energy as spinal function and protective muscle guarding begin to normalize.

Clinical practice guidelines consistently support SMT as part of multimodal care for low back pain, whether acute, subacute, or chronic. Many guidelines also favor its use for neck pain and certain headache types when combined with exercise and education. Serious adverse events are rare; transient local soreness is more common. Appropriate screening for contraindications—such as significant trauma with suspected fracture, vascular risk factors, or progressive neurological deficit—remains essential. In an integrative setting like ours, Dr. Cardenas’s medical direction reinforces that screening.

How Chiropractic Care Reduces Musculoskeletal Injuries and Their Comorbidities

When trauma or repetitive stress restricts joint motion, several overlapping processes unfold. Muscle guarding increases to protect the area, further limiting motion and creating ischemic pain. Proprioceptive input becomes distorted, so the brain receives inaccurate information about body position; this can perpetuate poor motor control and compensatory patterns in adjacent regions. Inflammatory mediators rise locally and, in some patients, systemically. Pain and the inability to find a comfortable position disrupt sleep. Reduced activity follows, which can contribute to deconditioning, weight gain, elevated blood pressure, and mood changes. These comorbidities transform an acute musculoskeletal injury into a longer-term health burden.

Chiropractic adjustments interrupt this cycle at multiple points. Restored joint motion reduces mechanical irritation of nociceptors and decreases the need for protective muscle spasm. The proprioceptive “bombardment” that accompanies the adjustment helps recalibrate the central nervous system’s sensorimotor maps, improving motor control and reducing the likelihood of secondary strain in neighboring joints. Modulation of dorsal-horn excitability and descending inhibitory pathways lowers pain intensity and unpleasantness. As pain decreases and movement returns, patients sleep better and gradually resume activity. The resulting increase in movement supports circulation, lymphatic drainage, and metabolic health, while reduced inflammatory signaling (suggested by lower TNF-alpha in some studies) may ease systemic effects.

These benefits are especially relevant in personal injury populations. Soft-tissue injuries from motor-vehicle collisions frequently involve the cervical and lumbar regions. Early restoration of motion and reduction of guarding can limit the transition from acute inflammation to chronic sensitization. Observational data indicate that patients who receive chiropractic care for spine-related pain have lower odds of receiving opioid prescriptions, particularly when care begins within the first 30 days. While observational designs cannot establish causality, the pattern aligns with guideline recommendations that prioritize non-pharmacologic approaches first.

At Injury Medical Clinic PA, we combine adjustments with active rehabilitation, soft-tissue techniques, and functional medicine strategies. Corrective exercise rebuilds endurance and coordination so patients maintain gains from the adjustment.t Nutritional support and stress-management education address the inflammatory and allostatic load that often accompanies injury. Dr. Cardenas’s oversight ensures that any coexisting medical conditions—such as hypertension, diabetes, or sleep apnea—are considered when designing the overall plan. The result is a non-surgical pathway that treats the injured tissues while simultaneously reducing the risk that the injury will cascade into broader health decline.

How Chiropractic Care Provides Insight for Personal Injury

The same clinical process that guides recovery also generates the evidence needed to establish causation and damages. A thorough initial history records the exact mechanism, the patient’s position at the time of impact, immediate versus delayed symptoms, and any prior similar complaints. The physical examination quantifies range of motion, strength, neurological status, and orthopedic test results. Serial re-examinations document measurable change—or the lack of change—over time. Functional outcome measures capture effects on work, driving, sleep, and household tasks. When these elements are recorded consistently, the file creates a clear timeline linking the incident to the condition and demonstrating the necessity and reasonableness of the care provided.

In soft-tissue cases, where imaging may be normal, the clinical record becomes especially important. Objective findings of spasm, restricted motion, and positive tests, combined with a biologically plausible mechanism and appropriate timing, support the opinion that the incident caused or aggravated the injury. Progress notes showing gradual improvement with care further illustrate that treatment addressed the consequences of that injury. When maximum medical improvement is reached, a discharge summary can outline residual limitations and any recommended future care, information that is relevant to both clinical planning and claim valuation.

Because our clinic operates under Dr. Cardenas’s medical direction, the record also reflects coordinated decision-making. We document referrals for imaging, specialist consultation, or co-management of medical comorbidities, reinforcing that care remained within the appropriate scope and followed accepted standards. This multidisciplinary transparency strengthens the overall narrative for personal injury purposes while keeping the primary focus on the patient’s recovery.

The Integrative Team Model at Injury Medical Clinic PA

The collaboration between chiropractic and internal medicine is not ornamental; it is structural. As Medical Director and Collaborative Physician, Dr. Cardenas reviews complex presentations, provides medical clearance when needed, and ensures treatment plans remain consistent with the patient’s overall health status. Patients who arrive after a motor-vehicle collision may have elevated blood pressure from pain and stress, undiagnosed metabolic issues that slow healing, or medication regimens that must be considered. Having an experienced internist available for these questions allows the chiropractic and rehabilitation components to proceed safely and efficiently.

Functional medicine assessments complement the structural work. Detailed history of diet, sleep, environmental exposures, and stress patterns often reveals modifiable factors that prolong recovery. Rehabilitation specialists design progressive exercise that restores capacity without re-injury. The entire team shares a common goal: return the patient to the highest possible level of function using non-surgical methods whenever they are appropriate. Clinical observations from our El Paso practice confirm that patients who receive this coordinated care frequently report not only reduced pain but also better sleep, improved mood, and greater confidence in their ability to resume normal activities.

Conclusion: A Practical Path Forward

Causation in personal injury is established by carefully evaluating the mechanism, timing, and objective clinical findings. Integrative chiropractic care supplies both the therapeutic intervention that addresses the musculoskeletal and neurological consequences of trauma and the detailed documentation that makes the causal link visible. By restoring joint motion, modulating pain processing, supporting neuroplastic recovery, and reducing inflammatory and functional comorbidities, these approaches help patients move beyond the acute injury. When delivered within a multidisciplinary setting with medical direction from an experienced internist such as Dr. Maria Guadalupe Cardenas, the care remains comprehensive, safe, and aligned with current evidence.

Patients in El Paso and the surrounding region navigating the aftermath of an injury can expect a process that begins with a thorough evaluation, moves through targeted non-surgical treatment, and includes the clear records needed for recovery and any related claim. The journey is practical, evidence-informed, and focused on restoring the ability to live, move, and fully participate in daily life.

References

Brown, S. (2024). Review of nine malpractice cases with allegations of causation of cervical artery dissection by cervical spine manipulation: No evidence for causation. Journal of Forensic and Legal Medicine. https://www.sciencedirect.com/science/article/abs/pii/S1752928X24001458

Church, E. W., Sieg, E. P., Zalatimo, O., Hussain, N. S., Glantz, M., & Harbaugh, R. E. (2016). Systematic review and meta-analysis of chiropractic care and cervical artery dissection: No evidence for causation. Cureus. https://pmc.ncbi.nlm.nih.gov/articles/PMC4794386/

Haavik, H., Niazi, I. K., Amjad, I., Kumari, N., Rashid, U., Duehr, J., Navid, M. S., Trager, R. J., & Holt, K. (2024). Neuroplastic responses to chiropractic care: Broad impacts on pain, mood, sleep, and quality of life. Brain Sciences, 14(11), 1124. https://www.mdpi.com/2076-3425/14/11/1124

Trager, R. J., Cupler, Z. A., Srinivasan, R., Casselberry, R. M., Perez, J. A., & Dusek, J. A. (2024). Association between chiropractic spinal manipulation and cauda equina syndrome in adults with low back pain: Retrospective cohort study of US academic health centers. PLOS ONE. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0299159

Additional clinical practice guidelines and biomarker studies referenced in the text are available through PubMed and the Journal of Clinical Medicine.

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