MRI Biomarkers of Nerve Root and Brachial Plexus Inflammation in Whiplash: A New Window Into Chiropractic Assessment
Written by: James Demetrious, DC, DABCO
Board-Certified Chiropractic Orthopedist
Founder and CEO, PostGradDC
Emerging MRI research is reshaping our understanding of whiplash-associated disorders (WAD). A 2025 study published in PAIN provides compelling evidence that a significant subset of patients with acute WAD grade II exhibit measurable peripheral neuroinflammation involving the brachial plexus nerve roots and cervical dorsal root ganglia (DRG). [1] These findings not only challenge traditional WAD classification but also offer an exciting opportunity for chiropractors: objective MRI biomarkers that may help identify patients most likely to benefit from neurodynamic, manual, and chiropractic interventions.
MRI Identification of Neuroinflammation After Whiplash
The featured study used high-resolution T2-weighted MRI neurography to evaluate the cervical nerve roots and brachial plexus within four weeks of a whiplash injury. Several key observations emerged:
- Elevated T2 Signal Ratios in C5–C8 DRG
Patients with acute WAD demonstrated significantly elevated T2 signal ratios at the dorsal root ganglia (DRG), especially at C5 and C6. Increased T2 signal is associated with intraneural edema, a hallmark of neuroinflammation.
- Inflammatory Changes in the C5–C6 Brachial Plexus Roots
The symptomatic side showed higher T2 signal ratios in the upper plexus, consistent with nerve root irritation, subtle tensile overload, or traction-related microtrauma during the cervical acceleration-deceleration event.
- Widespread Sensory Changes
Nearly half of WAD patients exhibited clinical sensory alterations (gain or loss of function) across multiple dermatomes, correlating with multilevel MRI findings.
- Mechanosensitivity and Neurodynamic Positivity
More than 50% of participants demonstrated signs of heightened nerve mechanosensitivity, including:- Positive ULNT1 or ULNT3
- Reduced elbow ROM during neurodynamic testing
- Pain on digital palpation of the brachial plexus
These functional findings further support an underlying neuroinflammatory process.
MRI Neuroinflammation as a Potential Chiropractic Biomarker
This research suggests that T2-weighted MRI hyperintensity at the DRG or brachial plexus could serve as an objective biomarker for:
- Identifying neuroinflammatory phenotypes within WAD II
- Stratifying patients based on nerve involvement
- Monitoring recovery or treatment response
- Supporting clinical decision-making for manual spine care
For chiropractors, this opens the possibility of combining traditional orthopedic and neurodynamic assessments with advanced imaging markers to better characterize nerve involvement in post-traumatic neck pain.
Why This Matters for Chiropractic Care
Chiropractic approaches may help promote axonal blood flow, reduce intraneural edema, modulate mechanosensitivity, and restore physiological movement patterns.
Objective Support for Clinical Findings
MRI confirmation of nerve root inflammation, multi-level DRG involvement, and sensory pathway disturbance provides objective correlates for symptoms frequently seen in chiropractic practice, radiating pain, mechanical sensitivity, and altered neurodynamic tension.
Enhanced Patient Education and Confidence
Patients often feel validated when advanced imaging reveals physiological changes—not “nothing wrong”—especially early after injury. This can enhance trust, adherence, and therapeutic alliance.
Toward a Modern Model of Whiplash Evaluation
Traditional WAD classifications rely heavily on symptoms and gross neurological findings, often missing subtle or early nerve involvement. This research suggests:
- Many WAD II patients actually exhibit minor neuropathic features.
- MRI biomarkers could prompt earlier chiropractic referral.
- Future guidelines may integrate neurodynamic testing + MRI neurography to better detect neuroinflammation.
As chiropractors specializing in neuromusculoskeletal disorders, we are uniquely positioned to assess and manage this subgroup using evidence-informed manual care.
Conclusion
High-resolution MRI is providing unprecedented visibility into the subtle nerve injuries that occur after whiplash. The identification of DRG and brachial plexus neuroinflammation represents a powerful new biomarker, one that aligns strongly with the chiropractic understanding of neurodynamics and segmental dysfunction.
For patients experiencing post-whiplash pain, especially those with sensory changes or arm symptoms, chiropractors can play a central role in evaluation and early conservative intervention. As imaging biomarkers evolve, chiropractic practice continues to stand at the intersection of functional neurology, biomechanics, and evidence-based soft-tissue and spinal care.
References
- Rideghalgh et al. PAIN 166 (2025) 2285–2299
Disclosure
The information provided in this article and all PostGradDC coursework should not be considered standards of care. We provide this information for educational purposes only. This information is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always consult your physician or a qualified healthcare provider with any questions you may have regarding medical conditions or treatment. Seek the opinion of your legal representative. Errors and omissions are unintended.
Conflict of Interest Statement
Dr. James Demetrious is a board-certified chiropractic orthopedist, founder and CEO of PostGradDC, a privately operated provider of chiropractic continuing education. Dr. Demetrious is an independent member of the NCMIC Speakers’ Bureau. Dr. Demetrious teaches coursework on behalf of chiropractic colleges, state, and national organizations throughout the United States. Dr. Demetrious has published peer-reviewed research on these topics and provides consultation services to chiropractic physicians, attorneys, and professional organizations. His coursework and opinions are his own and are shared for educational purposes.
This commentary was written independently and without external funding. While his educational and advocacy activities promote evidence-based chiropractic practice, the views expressed herein are his own and are based on an interpretation of the current scientific literature. Any omissions are unintended, and concerns about COI can be amended.
PostGradDC offers advanced post-graduate chiropractic continuing education. Our founder, Dr. James Demetrious, is a distinguished board-certified chiropractic orthopedist, educator, author, and editor.
© 2025 – James Demetrious, DC, DABCO. Open Access. Unrestricted use, distribution, and reproduction are allowed in any medium, provided you give appropriate credit by citing the original author and source: Demetrious J. Chiropractic Care and Stroke: MRI Biomarkers of Nerve Root and Brachial Plexus Inflammation in Whiplash—A New Window Into Chiropractic Assessment PostGradDC.com; 2025.
