Cervical Sprain and Strain: All About That "Pain in the Neck"

At the San Diego Center for Spinal Disorders (SDCSD), we see many patients with neck pain; it is one of the most common complaints. The most frequent diagnosis of these patients is a neck strain or sprain. The pain can be severe and even temporarily disabling, preventing the patient from engaging in his or her everyday activities.

Lifestyle Matters
The frequency of this condition is closely related to our lifestyles. For example, awkward positions such as cradling the phone between the ear and shoulder, sitting in a chair that offers no support, or working at an ill-designed computer station can contribute to neck strain. Another example is whiplash, which is a type of neck strain. It may develop after an automobile accident when the head is suddenly and quickly forced forward and backward (excessive flexion and extension) during a rear-end collision. Other causes of whiplash include injuries during sports or biking.

Sometimes, the initial neck pain is so severe that patients fear they have done something terribly wrong to their neck. Fortunately, the good news is that most neck strains and sprains are easily treated and do not require spine surgery.

Strains and Sprains: How They Happen
To understand how a sprain or strain happens, we must first understand some basics about the anatomy of the neck (i.e. the cervical spine). Remarkably, only 7 small vertebrae and an intricate system of soft tissues (muscles, tendons and ligaments) support the head and enable it to move in a wide range. The cervical spine is the most mobile segment of the spine, but this mobility also makes it susceptible to strain and injury.

Sprains and strains are soft tissue injuries. A strain affects muscles and tendons, while sprains affect ligaments. While these soft tissues provide reinforcement of the cervical vertebrae, they can be stressed and forced to the point of injury. Excessive flexion (bending forward) and extension (bending backwards) activities, especially when combined with poor posture and movement mechanics, can lead to injury.

Symptoms
The typical symptoms of cervical strains and sprains include sharp pain, stiffness and difficulty when moving, and swelling. Whiplash shares these symptoms and may include headache, dizziness, difficulty swallowing and chewing, burning sensations, and shoulder discomfort.

Diagnosis
Although these symptoms might exist, it does not necessarily mean that the patient has a sprain or strain. To make a correct diagnosis, doctors at our practice take several steps. First, we will take a detailed patient history, asking for information about when the pain started, what makes the pain worse, and so forth.

Following this step, we will conduct a physical and neurological examination. The physical exam will include palpation, during which the physician feels the patient's spine to detect muscle spasm and areas of inflammation. The range of motion examination helps to measure the degree of mobility of the neck. For example, can the patient turn his or her head from side to side comfortably or bend the neck forward and backward without pain? The neurological segment of the exam tests the patient's reflexes, motor and sensory responses. For example, are there areas of tingling or numbness in the shoulders, arms or hands?

Finally, it is possible that physician will order an x-ray to evaluate the spine. Seldom is further diagnostic testing initially required.

Treatment Options
Most sprains and strains do not require surgery. Treatment options thus focus on non-operative techniques.

The majority of patients will be prescribed medications to relieve pain and muscle spasm. Medications may include an anti-inflammatory, a muscle relaxant, and other medications for pain. A narcotic is only prescribed temporarily when a non-narcotic medication is insufficient to relieve pain.

Some patients will be instructed to wear a soft cervical collar. This is a removable, padded, adjustable collar worn about the neck that serves to support tender and painful neck tissues. A cervical collar is a short-term treatment (two to three weeks) to help the patient manage muscle spasm, neck fatigue, and pain.

Finally, there is physical therapy. Therapeutic exercise programs begin slowly to acclimate the patient to stretching and strengthening routines. The patient is usually provided with a home exercise program to continue on a regular basis. A strong and agile spine is one step toward preventing future injury.

In addition, physical therapy incorporates "hands on therapies" such as ultrasound, massage, heat or ice packs, and electrical stimulation. These therapies work to increase neck mobility and decrease inflammation, muscle spasm and pain. Manual therapies of this type also increase circulation to the site of injury and facilitate healing.

At SDCSD our affiliated physical therapy program has an outstanding reputation across the nation. Not only will it help you recover from your strain or sprain, it will also help you learn exercises and techniques to help minimize the likelihood of future injuries.