How do soft tissue injury claims work?

By Michael Shemtoub, trial attorney, Beverly Law. Updated November 2026.

What counts as a soft tissue injury

Johns Hopkins Medicine groups soft-tissue injuries as damage to muscles, ligaments and tendons. Its list includes:

• Contusion: a bruise, often from blunt force such as a fall or a blow
• Sprain: a partial tear of a ligament, often from a wrench or twist
• Strain: an injury to a muscle or tendon from force or stretching
• Tendonitis and bursitis: inflammation of a tendon, or of a bursa, the fluid-filled sac that cushions bones against muscles or tendons

Johns Hopkins lists rest, ice, compression and elevation as a common treatment for many of these injuries, and notes that a ligament or tendon that is completely torn may need surgery. A sprain in the neck or low back after a crash belongs in this group. A disc injury or a fracture does not, and our page on what a neck injury claim is worth covers those.

Pain that looks like a strain can hide something worse. MedlinePlus tells people to call 911 for a suspected spinal injury and not to move the person unless there is urgent danger, and it lists loss of bladder or bowel control and spreading numbness among the warning signs. If you hit your head, read about concussion after a crash.

Why insurers question these claims

From the adjuster’s desk, a sprain or strain is a claim built largely on what you report and what an examiner feels with their hands. That leaves room to argue the pain was mild or short-lived, or came from something else. Adjusters read for lines that help them, such as an emergency room note saying “no acute distress” or a therapy note saying you felt “much better.”

The strongest records describe what the provider measured and saw. Useful entries include range of motion in degrees, muscle spasm or tenderness found on exam, swelling, photos of bruising taken in the first days, written work restrictions and therapy goals tied to tasks you could not do, like lifting a child or sitting through a shift. Notes that say why care continued, and why it ended, answer the “too much treatment” argument before it is made.

Gaps in treatment and the duty to limit your losses

A long pause in care gives the defense an easy opening. California’s jury instruction on mitigation says a plaintiff cannot recover for harm the defendant proves could have been avoided “with reasonable efforts or expenditures” (CACI No. 3930). The same instruction tells jurors to judge those efforts in light of the person’s circumstances, including whether they could be made “without undue risk or hardship.”

That second part matters. If you stopped therapy because you could not pay, lost your ride, had no childcare or your clinic closed, say so to your provider and ask that it go in the chart. A gap with a written reason reads very differently from an unexplained one. If cost is the problem, see a car accident with no health insurance.

The defense medical exam

Once a lawsuit is filed, the defense can have a doctor of its choosing examine you. This is a defense medical exam: the doctor is hired by the other side. The rules on when it happens and who may watch differ by state.

Go to the exam on time, answer honestly, and describe your pain the way you have described it to your own doctors. Do not exaggerate or play it down. Afterward, write down how long the exam took and what the doctor did, since that can be compared with the report.

Proving the medical bills in Texas

Texas has a specific tool for proving medical charges. Under Civil Practice and Remedies Code § 18.001, an affidavit about the charges can be enough evidence for a judge or jury to find that the charges were reasonable and the services necessary, unless the other side serves a controverting affidavit. That counter-affidavit is due 120 days after the defendant answers or, if earlier, by the date that side must designate the witnesses who will give professional opinions at trial.

Texas cases are handled by the firm’s Texas-licensed attorneys, Joyce Ondich and John Efstathiou.

What this means for your case

Treat the injury as the injury, and let the records follow. Tell each provider about the accident at the first visit, report every area that hurts, and return if symptoms spread. Keep appointments, and when you finish, ask for a discharge note that says whether you improved, plateaued or were referred on.

Avoid posting about workouts or heavy chores while the claim is open, because adjusters look at public profiles. Keep receipts for prescriptions and mileage to appointments.

Common questions

Related pages

Injury law FAQs

Important: This page is general information, not legal or medical advice, and reading it does not create an attorney-client relationship. Every case is different; talk to a lawyer about yours. Texas cases are handled by the firm’s Texas-licensed attorneys, Joyce Ondich and John Efstathiou. Last reviewed: November 7, 2026.