CRMA, AOMSI, and the AMA Guides: The Tools Behind Today’s Whiplash Injury Valuations

In personal injury litigation, whiplash cases live or die on one question:

Can the injury be proven objectively?

Pain complaints alone rarely move adjusters, defense counsel, or juries. What does move cases forward is measurable instability, tied to accepted medical standards and impairment guidelines. That’s where three tools work together:

Individually, these concepts are often misunderstood. Together, they form the backbone of modern whiplash case valuation — and they are central themes in The $66,000 Neck Injury and How Not to Be Misdiagnosed.

Why Traditional Imaging Fails Whiplash Cases

Most whiplash cases stall because MRI and CT scans are static studies. They show anatomy at rest — not function under load.

As outlined repeatedly in the book, ligament injuries do not need to tear to fail. Cervical ligaments may elongate or lose tensile strength during a crash, resulting in instability that:

Produces chronic symptoms
Alters spinal mechanics
Remains invisible on standard imaging

This is why so many legitimately injured clients are labeled “soft tissue” cases — not because the injury is minor, but because it was never measured properly.

What CRMA Actually Does (and Why It Matters)

CRMA is not a diagnosis. It is a measurement system.

Using flexion and extension radiographs, CRMA quantifies:

Vertebral translation (millimeters of movement)
Angular displacement (degrees of abnormal motion)

The book emphasizes a critical point attorneys should remember:

Radiologists observe. CRMA measures.

Without measurement, abnormal motion remains an opinion. With CRMA, it becomes data.

And data is what courts rely on.

When CRMA Findings Become AOMSI

CRMA findings are compared against established biomechanical thresholds. When those thresholds are exceeded, the diagnosis becomes Alteration of Motion Segment Integrity (AOMSI).

AOMSI is not a chiropractic invention. It is explicitly recognized in the AMA Guides to the Evaluation of Permanent Impairment, 6th Edition.

Under the Guides:

AOMSI qualifies as a Category IV spinal impairment
It represents permanent structural failure
It carries impairment values commonly in the 20–28% range, depending on severity

This is the point at which a whiplash case transitions from “subjective complaints” to ratable permanent injury.

Why the AMA Guides Change Case Value

The book makes this clear: impairment ratings drive credibility and valuation, not symptom severity.

When an injury meets AMA criteria:

Causation arguments strengthen
Future medical needs become defensible
Settlement discussions change tone
Defense narratives weaken

An impairment rating anchored in AOMSI shifts the case from negotiation to justification. Adjusters may dispute opinions — but they struggle to dismiss numbers tied to their own accepted standards.

Why These Tools Are Often Missing from Records

Attorneys frequently ask why CRMA and AOMSI weren’t identified earlier. The answer is simple:

Most providers are not trained to look for instability
Flexion-extension imaging is underutilized
Measurement protocols are not standard practice

As discussed throughout The $66,000 Neck Injury, failure to apply the correct tools doesn’t mean the injury isn’t there — it means it was missed.

And missed injuries are undervalued injuries.

What This Means for Attorneys Handling Whiplash Cases

If you’re reviewing a case with:

Persistent neck symptoms
“Normal” MRI findings
Low-speed impact defenses
Resistance from insurers based on lack of objective findings

Ask one question:

Was instability measured — or merely observed?

If CRMA was not performed, the case may be missing the most important evidence.

Final Thought

CRMA, AOMSI, and the AMA Guides don’t inflate whiplash claims — they clarify them.

They separate cases with true ligament failure from those without, and they provide a defensible framework for permanent impairment that courts recognize.

That framework is exactly what The $66,000 Neck Injury and How Not to Be Misdiagnosed was written to address — and it’s the foundation of how I approach whiplash evaluations and expert witness work throughout Allegheny County, PA.

If you’d like assistance reviewing a cervical injury case for instability or impairment potential, I’m available for consultation, reporting, and expert testimony.