NECK STRAIN |
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General Information
DEFINITION--Injury to the muscles or tendons that attach to the vertebral column in the neck, to the skull and to the shoulder. Muscles, tendons and bones comprise units. These units stabilize the neck and head and allow their motion. A strain occurs at a unit's weakest part. Strains are of 3 types:
Mild (Grade I)--Slightly pulled muscle without tearing of muscle or tendon fibers. There is no loss of strength.
Moderate (Grade II)--Tearing of fibers in a muscle, tendon or at the attachment to bone. Strength is diminished.
Severe (Grade III)--Rupture of the muscle-tendon-bone attachment with separation of fibers. Severe strain requires surgical repair. Chronic strains are caused by overuse. Acute strains are caused by direct injury or overstress.
BODY PARTS INVOLVED
Tendons and muscles with multiple attachments to bones in the neck, skull and shoulder.
Bones in the neck, shoulder and skull.
Soft tissue surrounding the strain, including nerves, periosteum (covering to bone), blood vessels and lymph vessels.
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SIGNS & SYMPTOMS
Pain when moving or stretching the neck.
Muscle spasm in the neck.
Swelling in the neck area.
Loss of strength (moderate or severe strain).
Crepitation ("crackling") feeling and sound when the injured area is pressed with fingers.
Calcification (visible with X-ray) of the injured muscle or tendon.
CAUSES
Prolonged overuse of muscle-tendon units in the neck.
Single violent injury or force applied to the muscle-tendon units in the neck.
RISK INCREASES WITH
Contact sports, especially wrestling and football.
Any cardiovascular medical problem that results in decreased circulation.
Medical history of any bleeding disorder.
Obesity.
Poor nutrition.
Previous neck strain.
Poor muscle conditioning.
HOW TO PREVENT
Participate in a strengthening and conditioning program appropriate for your sport.
Warm up before practice or competition.
Wear proper protective equipment, such as fabric neck rolls.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's diagnosis.
Self-care during rehabilitation.
Physical therapy (moderate or severe strain).
Surgery (severe strain).
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of the neck to rule out fractures.
POSSIBLE COMPLICATIONS
Prolonged healing time if activity is resumed too soon.
Proneness to repeated injury.
Unstable or arthritic neck joints following repeated injury.
Inflammation at the attachment to bone (periostitis).
Prolonged disability (sometimes).
PROBABLE OUTCOMEIf this is a first-time injury, proper care and sufficient healing time before resuming activity should prevent permanent disability. Torn ligaments and tendons require as long to heal as fractured bones. Average healing times are:
Mild strain--2 to 10 days.
Moderate strain--10 days to 6 weeks.
Severe strain--6 to 10 weeks. If this is a repeat injury, complications listed above are more likely to occur.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AIDUse instructions for R.I.C.E., the first letters of REST, ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
CONTINUING CARE
Rest in bed with traction on the neck if your doctor advises you to do so.
Use ice massage 3 or 4 times a day for 15 minutes at a time. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a softball.
After the first 24 hours, apply heat instead of ice, if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments and ointments.
Use a support collar to reduce movement and support the neck during healing.
Massage gently and often to comfort and decrease swelling.
MEDICATION
For minor discomfort, you may use:
Aspirin, acetaminophen or ibuprofen.
Topical liniments and ointments.
Your doctor may prescribe:
Stronger pain relievers.
Muscle relaxants.
Tranquilizers.
Injection of a long-acting local anesthetic to reduce pain (rare).
Injection of a corticosteroid, such as triamcinolone, to reduce inflammation (rare).
ACTIVITYResume your normal activities gradually after pain subsides.
DIETEat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
REHABILITATIONBegin daily rehabilitation exercises when support collar is no longer needed. Use ice massage for 10 minutes prior to exercise. See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have symptoms of a moderate or severe neck strain, or a mild strain persists longer than 5 days.
Pain or swelling worsens despite treatment.
Symptoms of neck strain recur after treatment.
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