Fast Five Quiz: Back and Neck Pain

Stephen Kishner, MD, MHA


June 11, 2020

The predominant cause of cervical strain injury is motor vehicle accidents. The term "whiplash" is used generically to denote both the injury mechanism that produces neck injury in crashes as well as the injury itself. The most common symptoms of cervical disorders are suboccipital cervicogenic pain and/or ongoing or motion-induced neck pain. Other signs and symptoms associated with cervical strain include:

  • Neck pain: Neck pain may be minimal at the time of the accident, with an onset of symptoms occurring during the subsequent 12-72 hours.

  • Headache: Headache is a frequent symptom of cervical strain.

  • Shoulder, scapular, and/or arm pain

  • Visual disturbances (eg, blurred vision, diplopia)

  • Tinnitus

  • Dizziness

  • Concussion

  • Neurologic symptoms

  • Difficulty sleeping due to pain

  • Disturbed concentration and memory

  • Bladder or bowel dysfunction

During the postural assessment, the clinician may note stiffness of the neck, forward head, flexed neck, rounded shoulders, asymmetry of the neck or shoulders, neck tilt or rotation, and one shoulder higher or tighter than the other.

Although not pathognomonic for cervical sprain/strain, imaging results are important for excluding other diagnoses and more extensive injuries. Radiography is useful in the evaluation of cervical sprain and strain to rule out more extensive injuries. Three views are obtained for the basic evaluation: anteroposterior, lateral, and odontoid. Five views, including the three basic views plus bilateral oblique views, are used to evaluate the intervertebral foramen. Flexion/extension views may be obtained if instability is suggested. Obtain radiographic studies with any neurologic deficits, and obtain studies early in any of the following cases: when significant pain or dysfunction develops; when a chronic condition develops; or when documentation of the patient's condition is required for medicolegal purposes. Radiographs of the lateral cervical spine may show straightening or reversal of the normal lordotic curve. This finding may represent spasm, guarding, or splinting of the muscles that stabilize the neck. The rates are higher in the injured population, although these findings may be seen in healthy control subjects.

Overall, MRI is the best noninvasive and detailed imaging study for evaluating the status of the disks and spinal cord. Order MRI if detailed analysis of spinal structures (eg, spinal cord, disk) is indicated, as in, for example, an evaluation for underlying herniated nucleus pulposus. CT scanning may be performed if detailed bony imaging is indicated, such as when a fracture or instability is a concern. CT scanning may be used as an alternative to MRI in patients with claustrophobia, although disk imaging with CT scanning offers low resolution.

Early rehabilitation in patients with cervical sprain or strain helps to prevent chronic pain and disability. Passive modalities include the application of heat or ice, electrical stimulation, massage, myofascial release, and cervical traction. Passive modalities are often used to decrease pain or inflammation and to facilitate participation in an active rehabilitation program, which often involves stretching and strengthening. Extended use of passive modalities without a more active program is generally inappropriate.

Active treatment refers to therapeutic exercises that are aimed at improving the patient's strength, endurance, flexibility, posture, and body mechanics. The goal is to obtain an independent home program or community fitness program at the conclusion of formal physical therapy. The typical therapy prescription is recommended up to 3 times per week for up to 4 weeks. An early, active strategy is recommended to improve functions, increase activity, and prevent chronicity.

Read more about cervical sprain and strain.


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