How Cityside Evaluates a Patient After a Motor-Vehicle Collision

 This is the evaluation process Dr. Mark Mulak uses at Cityside Chiropractic's Providence and Cranston, Rhode Island offices.

Step 1: History, mechanism, and prior health

The first step is a detailed history of the collision, symptom onset, prior injuries, prior treatment, current medications, and functional changes. The purpose is not to assume that every symptom came from the crash. It is to understand the timing and clinical context so that the examination can test reasonable possibilities and identify competing explanations when they exist.

A patient who reports neck pain alone may need a different workup than a patient with neck pain plus arm numbness, dizziness, visual complaints, severe headache, or balance problems. Those differences shape the rest of the evaluation.

Step 2: Orthopedic, neurologic, and functional examination

The physical examination is matched to the presentation. It may include range of motion, orthopedic testing, myotomes, deep tendon reflexes, sensory testing when indicated, strength and endurance, functional movement, and additional neurologic screening when symptoms warrant it. The goal is to identify findings that support a working diagnosis, reveal red flags, and determine whether chiropractic and rehabilitation care are appropriate.

Step 3: Additional testing only when it answers a clinical question

Supplemental testing is not useful simply because technology is available. A test should help answer a defined clinical question. Depending on the presentation, Cityside may consider computerized range-of-motion assessment, balance or oculomotor screening, neurocognitive screening, flexion-extension radiography with computerized mensuration, or musculoskeletal ultrasound.

No isolated device result should be interpreted as automatic proof of diagnosis, crash causation, permanency, or legal damages. Results are interpreted together with the history, examination, function, imaging, prior records, and response to care.

Step 4: Decide whether to treat, refer, co-manage, or obtain more information

Some patients are appropriate for conservative care. Others need medical evaluation first or in parallel. Progressive weakness, significant neurologic change, concerning headache or concussion features, suspected fracture, worsening symptoms, or findings outside the scope of conservative musculoskeletal care may change the plan immediately.

When referral is appropriate, the clinical question matters: Does the patient need neurologic evaluation? Orthopedic assessment? Advanced imaging? Vestibular rehabilitation? Primary care follow-up? The purpose of referral is to obtain information or treatment that can change management.

Step 5: Build a treatment plan around measurable goals

Treatment recommendations should be based on diagnosis, functional limitations, examination findings, and recovery goals. Frequency and duration are not fixed in advance. A useful plan states what is being treated, what improvement is expected, how progress will be measured, and when the patient will be reassessed.

Step 6: Reassess and change course when the facts change

Recovery is not always linear. At reassessment, the key questions are whether the patient is improving, whether function is returning, whether important findings are changing, and whether the original diagnosis and plan still fit. Improvement may justify reducing frequency and advancing self-management. A plateau may justify a revised diagnosis, additional testing, referral, or a change in treatment. Worsening may require medical escalation.

Step 7: Discharge is part of the plan

The endpoint of care is not the end of an insurance claim. It is the point at which the patient has met reasonable goals, can continue independently, has plateaued and needs a different strategy, or should be transferred or referred for another type of care. A patient may still have some symptoms at discharge; the decision is based on the overall clinical picture, function, and expected benefit of continued treatment.

A transparent collision-injury evaluation should make the decision process understandable from the first visit through discharge. That is the model Cityside aims to use for personal-injury care in Providence and Cranston.