In personal injury litigation, there’s often a frustrating disconnect: your client has ongoing neck pain after a car crash, but their imaging reports — MRI, CT, or static X-rays — show little or nothing. The defense leans on this to argue the injury is minor or subjective.
But what if the most significant injury is one no radiologist ever measured?
That’s where CRMA — Computerized Radiographic Mensuration Analysis — changes the game. It quantifies something most imaging overlooks: ligamentous instability.
And in the world of spinal trauma cases, that can completely alter value, causation, and settlement trajectory.
What Exactly Is CRMA?
CRMA is a software-assisted analysis that evaluates flexion-extension radiographs of the cervical spine. It measures:
- Translation (anterior-posterior movement in mm)
- Angular deviation (degree of excessive flexion or extension between vertebrae)
When those numbers cross AMA-defined thresholds — ≥3.5mm translation or ≥11° angular change — the diagnosis becomes AOMSI (Alteration of Motion Segment Integrity), a permanent, ratable injury.
Why is that important?
Because it qualifies the client for Category IV impairment under the AMA Guides to the Evaluation of Permanent Impairment, 6th Edition — and that drives value far beyond general “soft tissue” claims.
Why You Rarely See CRMA in Records
CRMA isn’t taught in most medical schools. It’s not a standard hospital procedure. And general radiologists aren’t trained — or paid — to perform it.
Instead, chiropractors or physicians with post-doctoral training in spinal biomechanics and impairment rating use CRMA as part of a forensic approach. It requires both the right imaging protocol (neutral, flexion, and extension films) and the software to process those images against established norms.
That’s why so many injuries go undiagnosed.
Why Insurers Often Push Back
Insurance carriers tend to resist CRMA-based findings for one simple reason: it introduces objective evidence of permanent injury that can’t be argued away by “low-speed impact” theories or “normal MRI” defenses.
A CRMA report that meets AOMSI criteria:
- Establishes permanent ligament damage
- Supports impairment ratings of 20–28%
- Refutes the “no objective findings” narrative
- Often significantly increases settlement value
That’s why we see some adjusters downplay or reject CRMA — not because it’s unscientific, but because it’s inconvenient.
What This Means for Attorneys
If your client presents with chronic neck pain, post-crash headaches, or instability — and their records lack clear diagnostic findings — ask whether CRMA was performed.
Start with:
- Were flexion/extension views taken?
- Were they measured by a CRMA-certified expert?
- Are there AMA-compliant measurements exceeding AOMSI thresholds?
If not, the case may be missing a critical piece of evidence — one that could validate injury, justify impairment, and improve litigation leverage.
Our Role As A Chiropractor
As a chiropractor certified in forensic ligament analysis, I provide:
- Proper imaging referrals for flexion-extension studies
- CRMA interpretation using certified platforms
- Court-ready narrative reports aligning with AMA Guides
- Expert witness services throughout Allegheny County
I’ve co-authored The $66,000 Neck Injury and How Not to Be Misdiagnosed — a guide focused on exactly these overlooked injury types…Download it Here
Final Takeaway on CRMA
CRMA doesn’t guess. It measures.
And in a courtroom where subjective complaints carry little weight, having objective, ratable ligament instability can make all the difference.
If you have a case that feels undervalued or under-documented, I’d be happy to review records and discuss whether CRMA is warranted. A single measurement may change the course of your client’s recovery — and your case.