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Maximum Medical Improvement (MMI)

When Should Active Curative Treatment Conclude?

In most mild, uncomplicated neck injuries, that is, those cases having no radicular pain symptoms, disc damage, or severe myofascial pain syndromes or fibromyalgia, or tunnel syndromes such as Thoracic Outlet, active curative treatment should no longer be required after 3 to 4 months. If the patient’s daily activities, perpetuating fac­tors, and physical weaknesses have been evaluated and managed, then only an occa­sional future pain-relieving treatment is indi­cated (called supportive care). At those times, the doctor should evalu­ate for any healing residual problems and weaknesses that the patient might not be addressing ad­equately.

The time when a patient’s condition will stabilize is dependent on the injury sever­ity, the type of tissue injured (muscles heal and stabi­lize faster than ligaments and tendons), the patient’s physi­cal fitness, the patient’s motivation to exercise and stretch, and reduction of risk factors such as smoking, postural and ergonomic stresses. Most authors believe that after about 1 year most patients will fail to make significant improvement with the same type of treatment, whatever it is. Some research demonstrates that soft tissue injury (scar tissue) in the neck will take ap­proximately 1 year to reach its permanent status. There is other research indicating that this time frame can be 6 months or 2 years.

MMI should be reached and curative treatment discontinued or severely modified based on two categories of recovery:

1. The patient reaches and has stabilized at the preinjury level for a reasonable time frame, typically 1 to 2 months. Any problems or complaints prior to the in­jury should be treated and billed out­side the personal injury case.

2. The patient continues to have persistent symptoms after a reasonable treatment plan and has not shown any objective or subjective evidence of improvement over a 1- to 3-month period, depending on the individual’s lifestyle, flare-ups, type of in­jury, and response to treatment. This is sometimes referred to as the point at which the patient has reached maximal medical improvement (MMI). All future supportive treatment should focus at keep­ing the injured person’s pain and/or disability at the level it was at the time MMI was reached. In the more serious injuries where ligament remodeling is still ongoing, typically up to 1 year, and the patient has periods of pain, supportive care is focused on maintaining joint and soft tissue mobil­ity and making sure the patient is con­tinuing to exercise properly.