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Back Pain After Car Accident – Back Injury From Car Accident

Back pain is a common complaint among victims of a car accident. These pains may last months or even years if not identified and treated.

When trying to prove your case after a car accident, it is crucial to show the level of pain you are experiencing, what is causing it, and how long it is expected to last. After years of experience handling car accident claims, our legal team has come to understand which tests offer the needed results to help recover the full compensation for your back injuries from a car accident.

Spinal cord injury in St. Louis car accident
The Hoffmann Law Firm, L.L.C.
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Several lawyers said to call this lawyer because he is the best. You will appreciate this law firm. Helped with the injury and property claims. Attentive and knowledgeable. Great reputation in St Louis.
Would use this accident law firm. Best in Saint Louis. Highly rated and it shows. After one phone call, you just know this attorney is better. 5 Stars!!
Great law firm thanks Leah for the referral
Car accident lawyers on tv are not good . Get this attorney ! He is a pro !!
A+ attorney. Smart. Helpful. Great for automobile accident cases. Located in saint louis, missouri. Use him!
Response from the owner: Thanks. Car accident cases are difficult without the right attorney and great clients. Much appreciated.
Quality lawyer. Best law firm for a car accident. Advice was way better than other lawyers I called in St. Louis. Helped with property and injury.
Response from the owner: Thanks. The TV lawyer advertisers are just car accident settlement mills. As soon as people call a real attorney, they always tell us how much better and more helpful we were. Appreciate this.
Get this lawyer if you have an automobile accident. Simply the best!
Response from the owner: Thanks Lizzy. Recommendations from other is the best way to find a car accident attorney.
This lawyer is big time. Smooth. The other lawyers on the other side were not nearly as good as this attorney. I recommend friends in St Louis to him for accident injuries and they all say the same thing…”that lawyer is great.”
Response from the owner: Very nice of you to say. Our lawyers work hard on auto accident cases.
Family used this car accident attorney after a crash. Located in St Louis. This lawyer answers the phone and will walk you through the process. Knows his stuff!
Response from the owner: Taking calls, going over the car accident injury and property process is important. Clients that call always say we are the only lawyers that explained everything. Much appreciated.
Tried the lawyers on TV. They were not good. Hired this car accident lawyer instead because he had great reviews. The reviews are correct. This attorney is as good as they get. He does big injury cases that need to be litigated.
Response from the owner: Car accident lawyers on TV do not litigate cases. It is mass production. They have quotas. Local attorneys are best on auto accidents.
Very very good at injury claims for car wrecks. Use this St Louis attorney. Two thumbs up!
Response from the owner: Thanks for the review! All we do is accidents. When you specialize, your knowledge base and practice skills grow. Thanks!
Used this attorney for an auto accident. Highly recommend this lawyer in St. Louis. Communicates well.
Response from the owner: Communicating with clients is essential. Taking the client though the car accident claims process is important otherwise major mistakes can occur. It is an effort that we make. Thanks!
Best for car accidents in St Louis. Use this attorney.
Response from the owner: Thanks. Great clients make for great cases!
This lawyer is great for car accident injury claims. Did an uninsured motorist case. Very good attorney.
Response from the owner: Car accidents can be insured or uninsured. The claims are much different. Thanks for the review.
Great lawyer if you are in an auto accident. I recommend this attorneys office.
Response from the owner: Thanks J. Glad we got your auto accident case completed and that for telling others about our lawyers.
Very good car accident attorney. Did my and my relatives claims and paperwork. Highly recommend.
Response from the owner: Thanks for recommending our law firm on car accident cases.
Fantastic law firm, I would recommend! Received free consultation related to an auto accident when my parked car was damaged by a baseball. Very supportive advice, these guys are good!
Response from the owner: Thank you!
Recommend this attorney for auto accidents.
Response from the owner: Thanks for recommending our attorneys for an automobile accident.
Best St Louis lawyer for car accidents.
Response from the owner: Thanks Tana. Appreciate this!
Great Lawyer!!
Response from the owner: Thank you
I was in a car accident in St.Louis and hired Chris as my lawyer. He was amazing!!! He helped me every step of the way and was able to get me a great settlement!!!Highly, highly, highly recommend him!
Response from the owner: Each step is important in a car accident. Thanks for recommending us for car accidents injury claims.
If you have an auto accident and need an attorney in St Louis, I recommend Mr Hoffmann.
Response from the owner: Appreciate this James and you did great as well. Car accident claims always start with a good client.
Great car accident lawyer. Did a very good job on my injury case. Thanks!
Response from the owner: Thanks. Appreciate the compliment. All we do is car accident litigation.
Very accomplished accident attorney in Saint Louis. 5 stars for sure!
Response from the owner: Thanks
A car accident lawyer I would recommend to anyone.
Response from the owner: Thanks. That is great of you to say about our lawyers.
Great car accident attorney!!
Response from the owner: Thanks
When I had my accident he was very professional, honest and caring to me and my family it wasn't about the money it was about the care, he made sure me and my kids were took care of and I really appreciate it this is a gexcellant law firm also his secretary is the best,so I would like to say thank you chris for everything melinda .
Response from the owner: Thank you
Great car accident lawyer in St. Louis. This is a very good car accident lawyer in St. Lious. Takes phone calls. Listens. Experienced in injury litigation.
Response from the owner: Thanks Maddie. Our law firm brings experience to the table on car accident cases.
Great people, helped me through a situation over the phone. His words and advice eventually helped me in my case.
Response from the owner: Glad to hear!
Although Mr. Hoffman did not represent me in my case he was willing to take the time to get me in touch with someone who specializes in the type of incident I needed legal representation with. Attorney's such as Mr. Hoffman are difficult to find. He took personal time to keep in touch with me and give me sound legal advice and guidance. I highly recommend speaking with Mr. Hoffman if you require his services. I truly believe he is the type of person who cares and will make sure the job gets done RIGHT. Do not hesitate to contact him
Response from the owner: Anytime!
In an auto accident in St. Louis, the other car pulled out and hit us. The collision was very bad. We were all injured and used this attorney. He is very experienced in handling injury claims and got a great settlement after filing a lawsuit for us. 5 Stars!
Response from the owner: Thanks Ms. Santoni. Side impact car accidents are some of the worst our lawyers see. We have to file lawsuits on nearly every case because insurance companies deny almost every claim, but I am glad we got yours resolved. I appreciate you recommending our lawyers and giving us a 5 Star rating.
My daughter and I were in an car accident. We for both injured badly. After I finally got out of the hospital, I started looking for lawyers in Saint Louis and found this attorney who does accident and injury claims. It said their attorney would answer 24 hours a day. I called their law firm at 10 p.m. and a injury lawyer answered. He was polite, knowledgeable, and advised me of what needed to be done for myself and my daughter regarding the car accident. I hired them to do or auto accident case. They kept me well informed during the car accident case in Saint Louis County Court. I was well prepared for depositions. He help with everything. I got a good settlement as did my daughter for our injuries. Although the car accident was scary, it was bearable having a good helpful attorney on our side. I highly recommend this Saint Louis car accident law firm. Their attorneys and lawyers are great. Highly recommended
Response from the owner: Happy to help.
The Chris Hoffman law firm takesgreat care of all my legal needs. They are caring and personal and will fight for what you need. I highly recommend them. You will be very satisfied and know he got you the best deal available.
Response from the owner: Great cleints are the start to pursuing any legal case and you are the best! Thanks for the recommendation Barbara!
A true professional in terms of car accident cases. I definitely recommend this lawyer for any injury after a St. Louis accident. Very good at what these attorneys do!
Response from the owner: Thank you very much for such a great review. Our attorneys work hard at providing great service. Car accident cases are fought by insurance companies from the property damage through the personal injury claim. This forces people to get local lawyers to do their claims. Missouri and Saint Louis, in particular, is known for accident claim denial even against your own insurance carrier. Thanks again!
You will not find better attorneys for a car accident in St. Louis. Very experienced. These attorneys know all the facets of an accident case and have great advice when problems come up during the injury claim.
Response from the owner: Thanks Jack. Our attorneys appreciate a great review like this. It helps car accident victims know who are the real lawyers in St. Louis who do this work versus the mere advertisers who refer victims to lawyers they have never met for a kickback. Much appreciated!
Thanks for helping with my car accident case. These lawyers are best in St. Louis.
Response from the owner: You are welcome and thanks for the review! A lot of car accident victims read these and find it helpful in choosing a lawyer for their case. Great cases always start with great clients!
great lawyer for auto accident cases . I thought this law firm did great work .Very happy with their services. I would recommend them to others.
Response from the owner: It was very nice of you to leave a review. Thanks Brenda! A good case always starts with a great client. We appreciated the recommendation. It is good to hear back from clients and have them refer us to other injury victims after a car accident. Wish you well!
This is the best choice for a car accident attorney. These lawyers get great settlements.I was recommended to them from some people I know and was happy to get a great recommendation.
Response from the owner: Our attorneys appreciate the compliment! It is great to hear we are doing well. It means a lot when you recommend our lawyers to other car accident victims. Thanks again!
Glad I switched to this auto accident lawyer. These lawyers fight hard for their injury clients. I highly recommend these lawyers.
Response from the owner: We are happy you switched as well. Good clients are the basis for a good case. Fighting to protect your rights after an accidental injury is our sole focus. Your recommendation means a lot. Thanks again for the review.
If you are injured in a car accident you should hire this attorney. This is the best legal representation. These attorneys are very professional.
Response from the owner: Thank you for reviewing our law firm and recommending our lawyers. Attorneys appreciate feedback on whether they are doing well on cases and reviews are one of the best means for this.
ST.LOUIS AUTO ACCIDENT? I RECOMMEND THIS LAWYER FOR ANY ACCIDENT CASE INVOLVING INJURIES. VERY GOOD LAWYERS!
Response from the owner: Appreciate the Good Words! SInce our law firm started focusing exclusively on car and auto accidents, the focus had increased our knowledge and the learning curve has greatly benefited out settlement results. Specializing is key for any lawyers! All benefit from this. Thanks again for the review!
Selecting a lawyer is tough. I would rate this firm as top car accident lawyers in the St. Louis Area. Easy to work with attorneys who I would definitely recommend to friends and family. This lawyer really took his time to help us out.
Response from the owner: Selecting a lawyer would be tough. Going local and going with smaller law firms is always smart. Never use the TV lawyers. I cannot imaging getting inundated with TV ads all day and then attempting to decide on a lawyer. TV advertisers get a well earned reputation as settlement mills because they have too many clients and give their employees quotas, hence they take low settlements and earn the nickname "settlement mills." I always tell people to hire someone local and never someone on television. Jurors hate TV advertisers as well, hence not good for your case value. Thanks for the review! Glad we did well!
I was recommended to this car crash attorney. This is a very good law firm. I rate them 5 stars because they are very professional, communicate well, and get good case results. You should definitely hire these lawyers!
Response from the owner: Hey Tina! Thanks for posting this review of our law firm. Good to hear our attorneys are doing good work on car accident claims. If you ever need any help in the future, please give us a call. Thanks again!
Very experienced auto accident attorney if you are injured in a wreck . From the 1st phone call through the end of the process, this lawyer took the time to explain each step. I would recommend these lawyers if you have an accident or injury claim.
Response from the owner: Thanks Ruby! It is good to hear we kept you informed from start to finish on the steps of the car accident case. Glad our lawyers could help in this regard and appreciate you recommending our law firm to others who have been hurt as a result of another drivers negligence.
Glad I switched to this car accident lawyer. Very professional attorney. He really spent alot of time explaining the process and had solutions for every problem. Hiring this law firm is the smart choice.
Response from the owner: Thanks for the review Michael. Our attorneys appreciate getting a good review. Keeping clients informed during both the the car accident injury claim and litigation process is paramount. The importance of having answers to the problems that arise after an auto accident cannot be understated. Thanks against for recommending our St. Louis law firm.
Car Accident lawyer in St. Louis. When you need an attorney, look no further after a car accident. Great legal representation for your case. This attorney explains the process, takes on car insurance companies and will litigate if they are not being fair on your claim. Simply the best!
Response from the owner: The car accident claims process takes time. Although the property damage can get resolved quickly, the injury claim takes the majority of time and is commonly the issue that is denied by almost every insurance company. In St. Louis and throughout Missouri, car insurance companies deny claim after claim after claim...or they offer 10 cents on the dollar for medical bills as settlement in full. It is a sad reality for car accident injury victims. This is the same whether filing a claim against the at fault parties' insurance or filing a claim against your own uninsured or underinsured motorist coverage. 99 out of 100 claims are denied. We fight this abuse and litigate those 99 claims. Thanks for the review!
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Before your treating physician can diagnose your neck or back pain, they will need to conduct a thorough examination and document the events that led up to your injury. It is important to give as many details about the accident as you can remember, including the vehicle’s speed and the area in which it collided. This information can help the physician pinpoint the source of your pain.

Diagnosing the Cause of Neck or Back Pain after a Car Accident

back and neck injury lawyer St. Louis

MRI v. Nerve Conduction Study (EMG)

The Physical Exam

The physician will conduct routine tests to determine where the neck or back pain originates. You will be asked to twist, bend, and move to see which motions bring on bursts of pain. They will also look for signs of lost flexibility.

Magnetic Resonance Imaging (MRI)

An MRI diagnostic tool can create a real-time 3-D spine image. This will show changes in the soft tissues like nerves and ligaments to help a physician isolate the area where the pain originates. An MRI is also helpful in diagnosing herniated discs and other back injuries from car accidents.

Electromyography (EMG)

Your treating physician might also order an EMG test. This test can examine the function of the nerves in the back and neck by placing tiny electrodes in the lower extremity muscles. The electrodes read the electrical signals in the muscles to determine if a nearby nerve is being pinched, helping to measure the exact conditions of the nerves.

While the MRI can provide a physical picture of the damage to your neck and spine, the EMG can measure the extent of your injury. Together, the two can provide a perfect analysis of the neck and spine to submit as evidence of your back injury from the car accident.

Types of Back Injuries

The back is a complex network of bones, muscles, nerves, and other tissues that extend from the neck to the pelvis. Many injuries can occur to a person’s back. The lower back is the most common site of back injury and pain. Some of the most common types of back injuries from car accidents include:

  • Herniated Disc
  • Spinal Cord Injury
  • Compression Fractures
  • Sprains and Strains

Herniated Disc

Small, sponge-like discs cushion the bones in the back that form the spine. When a disc becomes damaged, it can break open or bulge. This is also often referred to as a slipped or ruptured disc.

herniated disc can occur anywhere in the spine, but it is more common in the lower back. An injury to the spine can cause small tears or cracks in the hard outer layer of the disc. When this happens, the soft gel inside the disc can leak out or bulge.

Some common symptoms of a herniated or ruptured disc may include pain and numbness in the back, leg, or buttock.

Spinal Cord Injuries

spinal cord injury (SCI) is a trauma-related injury to the nerves or the bones and tissues surrounding them. The spinal cord consists of many nerves that carry impulses to and from the brain and out to the rest of the body. Depending on where the injury is, the symptoms can vary from pain to paralysis.

There are two types of spinal cord injuries: complete and incomplete. In the case of a complete injury, all sensation and voluntary movement below the affected area are lost. Conversely, an individual can function below the injured area with an incomplete injury.

Compression Fractures

The spine is made up of bones that are called vertebrae. When one of these vertebrae breaks and then collapses, this is known as a vertebral compression fracture. This type of back injury most commonly occurs in the middle portion of the spine. When this happens, it can put pressure on the spinal cord. These back injuries can cause severe pain and may result in chronic back pain.

Sprains and Strains

Sprains and strains have similar symptoms. A series of ligaments and muscles hold the bones in your spinal column in place throughout your back. A sprain occurs when a ligament is stretched or torn, while a strain occurs when a muscle or tendon is stretched or torn.

Symptoms of a lower back strain are pain and stiffness in the back, buttocks, and legs.

Chronic Back Pain After a Car Accident

Chronic back pain, characterized as pain in the back that persists beyond six months, afflicts millions of Americans. It can manifest in varying degrees of severity, from minor inconvenience to excruciating and incapacitating pain.

While chronic pain typically stems from an initial injury, such as a car accident, it can also exacerbate preexisting issues. Coping with chronic back pain can give rise to additional complications, such as anxiety, fatigue, and stress, underscoring the need for ongoing medical care to manage the condition.

The three different types of back injuries that could cause a broken back include:

  • Fractures occur when more pressure is exerted on the bone than it can take. This can cause the vertebrae to break or collapse. If the trauma is severe, it can push the broken bone fragments into the spinal canal.
  • Dislocation occurs when the discs or ligaments that connect two vertebrae are torn or stretched, causing the bones to push out of alignment.
  • Fractured dislocations: This type of back injury combines a fracture and a dislocation. A fractured dislocation is a severe injury often requiring surgical repair.

Common symptoms of a broken back

When a person suffers a broken back in a car accident, they will likely experience severe back pain and other symptoms. While back pain could also result from a less severe injury such as a back sprain, it is always important to seek medical attention immediately. Timely treatment could mean the difference between complete recovery and a lifetime of disability. Some common symptoms to watch out for include:

  • Pain
  • Tingling
  • Numbness
  • Weakness
  • Muscle Spasms
  • Stooped Over Posture
  • Inability to Move
  • Difficulty Walking

When a person suffers a broken back, the pain will likely increase when the victim tries to walk or attempts to perform even simple movements such as stretching or bending down.

Treatment options for a broken back

When someone suffers a broken back, the first step should be immobilizing the back to prevent further injury. If the victim cannot receive medical attention immediately, they can use over-the-counter medication to relieve pain and ice to reduce inflammation.

When the victim reports to the emergency room with a back injury after a car accident, the doctor may perform a physical exam and order X-rays to diagnose the exact problem and determine the best possible course of treatment.

Common treatments for back injuries include:

  • Bed Rest
  • Pain Medication
  • Anti-inflammatory medication
  • Back Brace
  • Surgery

Surgery may be the best recourse for severe back injuries from car accidents, such as those with a risk of bone fragments damaging the spinal cord. The car accident victim may require physical therapy for an extended period to regain mobility and strengthen the back.

Common types of back surgeries

Four common types of back surgeries are often needed after a severe back injury resulting from a car accident. These include:

  • Spinal Fusion – This surgery treats various spinal conditions, including herniated discs, degenerative disc disease, and spinal stenosis. The surgeon will use bone grafts, metal implants, and/or screws to fuse two or more vertebrae together during the surgery. The bone grafts serve as a bridge between the vertebrae, promoting the growth of new bone tissue that eventually fuses the vertebrae. This is done to stabilize the spine, alleviate pain, and correct deformities. Spinal fusion surgery is typically performed under general anesthesia and can take several hours. Recovery time can vary depending on the extent of the surgery but typically includes a period of immobilization and rehabilitation to help patients regain mobility and strength.
  • Laminectomy – This surgical procedure removes the lamina, the rear portion of the vertebra covering the spinal canal, to relieve pressure on the spinal cord or surrounding nerves. This pressure can develop after a car crash; however, it is also common among people with spinal arthritis.
  •  Vertebroplasty – This surgical procedure helps stabilize the spine in case of a spinal fracture resulting from high-speed car accidents. It is minimally invasive and involves creating a small hole in the back through which special bone cement is injected. This acrylic bone cement fills up the spaces and cracks in the bones and acts as an internal cast.
  •  Diskectomy – This surgical procedure involves removing a portion of the herniated disc in the spine. Herniated discs often compress or irritate nearby nerves and cause intense pain. Besides the pain, the compression can cause weakness or numbness in the arms, neck, and legs. The surgeon uses a small camera and a minimally invasive incision to treat the herniated disc during the surgical procedure.

Although these surgical procedures have become less invasive and more efficient, they are still major procedures with long recovery times. During the recovery period, the car accident victim may be unable to work or perform daily activities, which can result in lost personal time and income.

When Does an Injured Patient Require Back Fusion Surgery?

Spinal fusion is generally required when a patient has injured the discs or vertebrae in the neck or back. The injury can occur due to twisting, falling, or an impact injury caused by a jolt that leads to a fracture or herniated disc. This often happens in traumatic car accidents. If the patient has constantly been in pain after the injury, they would probably require back fusion surgery. Such pain is normally caused by body movement that exerts pressure against the spinal nerves and is often disabling. Back fusion surgery stops this movement of the vertebrae and treats the cause of pain.

medical-attention-after-st-louis-car-accident

The Importance of a Medical Exam

Back injuries are common after car accidents and can happen anywhere along the spine or across the shoulders. These injuries can result from strains, sprains, spinal damage, or disc injuries, and their symptoms may not show up immediately. That’s why it’s crucial to seek medical attention promptly, regardless of how you feel following an accident. Delaying treatment could jeopardize your chances of obtaining compensation for your injuries. Therefore, it’s imperative to undergo an immediate medical examination after any car accident, regardless of its severity.

What is an epidural?

An epidural is a medical procedure that involves injecting anti-inflammatory medication into the epidural space, the area between the spinal cord and the dura mater. This helps to alleviate nerve pressure and numb pain in the affected area. It’s important to note that an epidural steroid injection differs from the epidural anesthesia administered during surgeries or childbirth.

The patient is typically asked to lie face down on an X-ray table during an epidural. The injection is then administered into the lower back, and fluoroscopy may be used to ensure proper needle placement. Patients are advised to stay still during the procedure, even if they feel some pressure in the area. After the procedure, patients are typically monitored for 15-20 minutes before being discharged. The effects of the epidural can take anywhere from 1 to 7 days to fully kick in. Overall, epidural injections are a quick and effective method for managing pain and can be performed in a clinic or hospital setting.

Risks and side effects of epidural

While this is generally a safe procedure, some complications may exist. Some of the common complications may include:

  • A headache, Stomachache, Dizziness
  • Allergic reaction to the medicine
  • Leg pain from nerve root damage
  • Spinal epidural hematoma, a serious condition requiring immediate medical attention
  • Brain or nervous system problems
  • Spinal infections

Some side effects of a spinal epidural include:

  • Anxiety
  • Sleeplessness
  • Steroid flush or facial flushing
  • Increase in pain in the area
  • Headaches that may take 24 hours to resolve
  • Fever

Nearly 50 percent of people find epidurals effective for short-term relief. The injection may relieve symptoms for weeks or months; however, the effects are unlikely to last longer. Following this treatment with regular exercise is crucial, as it will help relieve pain even as the effect fades. If back pain returns, you may need another epidural shot.

Recovering Compensation for Epidural Steroid Injections

Epidural injections can be costly, typically ranging from $2000 or more. Additional procedures such as fluoroscopy may further increase the costs.

However, you may be entitled to compensation if you sustained an injury due to another driver’s negligence. To have a valid claim, you must establish several factors, including that the other driver had a duty of care towards you, they breached this duty by driving recklessly, intoxicated, or ignoring traffic signals, the breach of duty was the cause of the accident, and as a result, you suffered damages such as medical expenses and lost wages.

If you can prove these four elements, you may be able to recover any costs related to your injuries, including expenses related to your back pain caused by the car accident. Speaking with an experienced St. Louis car accident attorney as soon as possible after an accident is essential to protecting your rights and ensuring you receive fair compensation.

Case Study – Back Injury to Lumbar Spine

Back injuries to the lumbar spine can be challenging to diagnose and may not manifest immediately after a car accident. This was the situation for a St. Louis driver who experienced a disc bulge and lumbar spine injury following a car crash. The case was resolved for the policy limit of $100,000 after presenting compelling medical evidence that the car accident was the cause of the injuries.

Determining the Value of Your Back Injury From a Car Accident

A car accident can happen in a fraction of a second, but the pain and suffering can last a lifetime. An auto accident lawyer can examine different factors following the crash to create a case that accurately reflects your pain and suffering.

The Long-Term Impact of Your Back Injury

Back injuries from a car accident can range in severity from mild to extremely debilitating. Chronic pain resulting from a back injury can profoundly impact the victim’s quality of life.

st. louis car accident victim with a back injury

The Extent of Your Losses

When evaluating a back injury case, a jury will consider the financial burden the victim has endured and how their life has been affected. Keeping a detailed diary can help to document missed events, activities that can no longer be enjoyed, and any negative impact on mental health and well-being.

Lost Wages

Back injuries from a car accident frequently result in missed workdays and lost wages, creating a significant financial burden. However, victims of car accidents resulting in back injuries may be entitled to compensation for lost wages.

Compensation for Future Medical Care

In many cases, the impact of a back injury from a car accident is long-lasting, requiring ongoing medical treatment and care. This ensures the victim has the necessary resources to receive treatment even after the case. It is critical to factor in the cost of future medical care when seeking compensation in a car accident lawsuit involving a back injury.

Free Consultation with a St. Louis Car Accident Lawyer

Don’t talk to an insurance claims adjuster before speaking with The Hoffmann Law Firm, L.L.C. We can help you avoid making statements that may affect the outcome of your case. The consultation is free; you don’t pay unless we get you money!

Free Consultation (314) 361-4242