Ankle and foot injuries require close examination for swelling and tenderness. The examiner should note swelling, pitting edema, bruising and foot positions that increase pain.

Several studies have concluded that spinal injury may promote early degenerative joint disease also known as arthritis. There are long term effects of injuries that do not become evident until years after the insult for example osteoarthritis.

Blurry vision after whiplash is common. Chronic symptoms are probably due to brain stem lesions or nerve irritation.

Chronic pain is generally defined as pain that lasts beyond the normal time to heal from an injury. This is commonly thought of as more than three months. Chronic pain maybe categorized into two large groups.

Cervical disc injuries may occur in motor vehicle collisions in which rapid rotational accelerating forces cause tearing of annular fibers or in cases in which a seatbelt acts as a focal point for bending the body.

Minor head or neck injury may be associated with post injury dizziness. Head and neck motion should increase dizziness if it has originated in the neck. Cervicogenic dizziness can be secondary to nerve overstimulation, altered neck or lumbar unbalanced musculature, neck or lumbar muscle spasm or vertebral artery problems.

The proposed mechanism of elbow and wrist injuries was found to include a direct blow or compressive force between the palmar aspect of the wrist and the steering wheel or dashboard causing wrist hypertension and median nerve stretch and trauma.

Hip injuries may be seen in occupants using seatbelts having excessive flexion (forward movement) around a lap belt or sliding under the seat belt or submarining.

Shoulder, elbow and wrist injuries are commonly seen in private practice after automobile crashes. These injuries most frequently occur to the driver holding onto the steering wheel in front or rear end crash or to the front passenger bracing against the dashboard or window in a frontal crash.

Most knee injuries are due to direct impact with the knee bolster, dashboard, steering column, steering wheel, console or side door structures.

Lumbar spine injury and pain are common problems following motor vehicle accidents. The mechanism of lumbar spine and disc injury is primarily due to restraint of the pelvis by a lap belt while the lumbar spine is flexed and stretched.

The primary mechanism of thoracic spine injury for the restrained occupant includes rapid deceleration as the rapidly forward moving torso suddenly stops at the end of strap causing the side of the torso that does not have the shoulder strap to twist forward to flexion.