Sprain refers to damage to ligaments. Ligaments serve as the primary “static” stabilizer and act to limit end range of motion. Forces causing movement beyond the normal range of motion can damage ligaments. There are numerous ligaments in the neck that could be injured.
Strain refers to damage to muscles. Muscles act as a “dynamic” stabilizer, protecting the cervical spine throughout its normal range of motion. Strains often result from an eccentric muscular contraction in response to an unexpected external force. (1,2) Stressors that cause sustained or overwhelming muscular contraction could damage the cervical muscles. Muscle strains are more common where the muscle meets the tendon (3,4).
Causes of sprain/strain injuries:
- Sprain/strain injuries may result from a single traumatic event or chronic repetitive mechanical overloading.
- Whiplash injuries are the leading cause of acute cervical sprain/strains, followed by sporting accidents (5,6)
- Athletes are at highest risk when playing contact sports like football, hockey or wrestling, or performing high-speed activities like skiing. (7)
- Sporting injuries often occur as the result of a blow to the head while the athlete is moving forward, resulting in an extension injury.
- Activities of daily living like pushing, pulling, moving heavy objects and falls are also frequently associated with acute cervical soft tissue injury.
- Stressors applied over an extended period can lead to muscle fatigue, inflammation, and micro-tearing. Less acute origins of cervical soft tissue injury include:
- prolonged static postures in poor workstations
- overhead activity
- poor bra support
- sedentary lifestyles
- repetitive movements
Weakness of the cervical musculature, particularly the deep neck flexors, may be a predisposing factor to injury. Other predisposing factors include previous sprain/strain injury, which decreases the tissue elasticity.
- Over one million US adults suffer cervical sprain/strain from whiplash injury alone each year. (9)
- Gender prevalence is also difficult to pinpoint, but research has shown that both neck pain and sprains from whiplash-type injuries are more common in females. (9,10,11,13)
- Cervical sprains and strains affect all age groups.
- While adult tissue may be less elastic and more prone to injury, children are at an elevated risk for sprain/strain (12)
- May begin abruptly but more commonly develop gradually in the hours or days following an insult.
- Complaints often include constant dull neck pain that intensifies or becomes sharp with movement.
- Rest may relieve acute symptoms but often leads to inactivity-stiffness. The pain is generally limited to the cervical spine and trapezius but may sometimes refer to the anterior neck and upper arm.
- Suboccipital tension-type headaches are common, particularly when the upper cervical spine is involved.
- Injury to the upper cervical facet capsules can cause altered proprioceptive input and result in varying degrees of vertigo.
- Additional symptoms may be generated from concurrent muscular spasm or overlapping myofascial involvement.
Do I need X-rays?
- Clinicians may need cervical radiographs, including flexion-extension views, to rule out fracture or instability (16).
- The American College of Radiology suggests imaging post-traumatic neck pain when there is a dangerous mechanism of injury.
- High-risk candidates include those who (17):
- are over 65 years of age
- have radiating neurologic signs or symptoms
- have midline cervical spine tenderness
- have significant (greater than 50%) loss of range of motion
Initial goals of treatment include controlling pain and inflammation.
Treatment options during initial treatment:
- Ice, electrical stimulation, ultrasound, and NSAIDs can assist the healing process and help with pain and inflammation control.
- Gentle range of motion exercises and isometric strengthening should be implemented to tolerance in the acute phase of healing.
Poor treatment options:
- In the absence of documented instability, immobilization leads to de-conditioning/atrophy and is rarely indicated. (23,24)
The second goal of treatment is the restoration of normal mobility and joint function.
- Spinal manipulation is a valuable tool for the restoration of normal joint mechanics in sprain/strain injuries. (25)
- Myofascial release and stretching exercises may be needed for the scalene, trapezius, levator, pectoral, SCM and other neck muscles.
- Nerve mobilization techniques may be necessary to restore normal neurodynamics.
- Restrictions in the upper thoracic spine are common in cervical pain patients and need to be addressed. (15)
The final phase of treatment, stabilization, will include home exercises to increase strength and decrease the chance of re-injury.
- Exercises should focus on activating the deep neck flexor muscles in chronic neck pain patients (27).
- Upper crossed syndrome is a common counterpart to chronic sprain/strain injuries and should be identified and managed.
- Ergonomic and postural training may include a discussion of workstation ergonomics, sleep posture and modification of activities of daily living to promote healing and prevent recurrence of symptoms. (28)
Along with Chiropractic, Creekside Performance Center has massage therapy, physical therapy, rehabilitation exercises, acupuncture, 1:1 personal training, small group training, and nutrition experts to help you get to a better, healthier you.
Evidence Based-Patient Centered-Outcome Focused
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