Neck Strain

Neck Strain Overview

Neck strain is an injury to the muscles and tendons that support and move the head and neck. The neck is susceptible to injury because it is capable of extensive range of motion. It is, as a result, less stable that many other body areas. In addition, the neck muscles are affected by the motion of nearly all other areas of the body.

The neck contains many vital anatomic structures, the most critical being the airway (trachea, breathing tube), the spinal cord, and the blood vessels that supply the brain. Neck strain injuries do not typically involve serious injury to any of these vital structures. Neck strain is also not usually associated with fractures or dislocations of any of the bones of the cervical spine, but injury to all of these tissues can occur with the most severe trauma.

Injuries of tissues that contract and move, such as muscles and tendons, are termed strains. Similar injuries to nonmoving structures, such as ligaments, joint capsules, nerves, bursae, blood vessels, and cartilage, are termed sprains. Both strains and sprains of the neck may involve tears to ligaments covering the cervical vertebrae of the spine, the many muscles of the neck (which move the head), and many other associated structures. They may also result in injury to cervical nerves caused by stretching or compression.

The neck is an area where stability has been sacrificed for mobility, making it particularly vulnerable to injury. Because one can be injured in a number of different ways, a detailed medical and work history (including an analysis of work activity) is often needed to fully evaluate a neck injury. It also helps to predict how long one's recovery will take and what the prognosis will be following an injury.

A thorough physical examination is necessary, particularly in instances where symptoms of nerve injury occur. Other studies using the latest imaging methods and other techniques may also be helpful.

Seeing a doctor is essential for all neck strains with serious injury or for severe, persistent, or unexplained symptoms or problems. Supportive self-care is often enough with the more common minor injuries for someone to have a complete recovery.

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What Are Causes and Risk Factors of Neck Strain?

Neck strains result from injury to the neck. Such injuries are caused most often by indirect trauma when the head is flung backward (hyperextension) or forward (hyperflexion), commonly known as whiplash. Injuries caused by rotation and compression (when the force of impact lands on the top of the head) can also result in neck strains and soft-tissue injury.

  • Automobile accidents are responsible for many whiplash injuries because of hyperextension or hyperflexion. A common scenario is when a seat-belted person's head continues to move forward during a frontal impact and is then often thrown backward (the converse is also true). Side impacts typically result in bending of the head to that side, and rear impact tends to throw the head backward. Any or all of these movements usually result in whiplash.
  • People with occupations requiring repetitive or prolonged neck extension (microtrauma) may develop neck strain injury. Picture someone sitting at a computer keyboard, for example, straining to see a monitor that is not adjusted properly for the person's posture. Also, the person may be trying to see the monitor through poorly adjusted bifocal lenses and must tip the chin upward to view the screen. Now tuck a telephone into the person's shoulder for much of the day and that's the formula for neck strain. With the increase use of computers at home, even the time away from one's work can add to this injury.
  • Some people appear prone to neck strain injuries merely as the result of an abnormal posture while awake or from sleeping in an awkward position.

What Are Neck Strain Symptoms and Signs?

The cardinal symptom of neck strain is pain and often combined with decreased range of motion. Although one typically has pain after an injury, it is not uncommon for someone to be free of discomfort initially, because inflammatory changes may happen slowly. The presence of immediate pain at the time of injury should serve as a red flag that the injuries may be more severe than first thought. The classic events after a whiplash injury are that the patient feels fine the day of the injury but wakes up the next morning with pain and decreased range of motion.

Other symptoms include the inability to perform daily work or activities that one could do before. Be wary of symptoms suggesting nerve irritation or a pinched nerve, such as weakness, numbness, tingling, incoordination, and dizziness. Neck strain does not typically cause lymph node swelling.

Neck stiffness usually occurs and may radiate into the lower back when severe. Difficulty chewing, swallowing, and breathing occur rarely. Anyone with these symptoms should contact a doctor.

Common Cause of Neck Strain

Whiplash

  • Whiplash is a nonmedical term used to describe neck pain following an injury to the soft tissues of the neck (specifically ligaments, tendons, and muscles).
  • It is caused by an abnormal motion or force applied to the neck that causes movement beyond the neck's normal range of motion. It is usually caused by a flexion-extension motion of the neck that pulls and strains the neck muscles and ligaments.

When Should Someone Seek Medical Care for Neck Strain?

If one's symptoms do not go away as expected or if new symptoms appear, seek medical attention without delay.

  • Call a doctor if experiencing the following symptoms:
    • Severe, unremitting neck pain
    • Neck pain unaffected by changes in position or pain that is not controlled or if relief is not provided with appropriate medication
    • Severe night neck pain
    • Severe, persistent neck muscle spasms
    • Inability to perform daily work or activities that one could do prior to the illness
  • In addition, symptoms suggesting possible injury to the vital structures contained in the neck should prompt early contact with a doctor. These may include the following:
  • If unable to reach a doctor, one should go to a hospital's emergency department without delay for evaluation of any of these types of problems.
  • If one gets sick or reinjured while neck pain is present, contact a doctor.

Seek immediate medical attention for any symptom suggesting a problem affecting the nervous system, airway, or spinal cord.

  • Symptoms of spinal cord injury
  • Evaluation by an orthopedist or neurosurgeon may be required to check for a condition requiring urgent surgical treatment.
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What Types of Doctors Treat Neck Strain?

Neck strain is treated by general-medicine physicians, including primary-care providers and internal-medicine specialists, as well as emergency-room physicians, orthopedists, physiatrists, neurosurgeons, and ear, nose, and throat specialists.

What Exams and Tests Do Health-Care Professionals Use to Diagnose Neck Strain?

Pain

Pain perception varies from person to person and is hard to measure. The doctor will rely on one's description of symptoms to better quantify the pain. Someone may be asked to rate pain on a scale from 0 to 10, with 0 representing no pain and 10 as the worst pain. Although difficult to generalize, the following types of symptoms usually predict the types of anatomic structures injured:

  • Cramping, dull, aching pain may indicate that muscles may be injured.
  • Sharp, shooting pain could be injury to a nerve root.
  • Sharp, lightning-like pain may indicate that a nerve is injured.
  • Burning, stinging pressure may indicate nerve injury.
  • Deep, nagging, dull pain could be injury to a bone.
  • Sharp, intolerable, severe pain could indicate a fracture.
  • Throbbing, diffuse pain may be injury to blood vessels.

History

As well as trying to determine the severity of someone's pain, a doctor will focus on several other key areas as he/she makes a diagnosis:

  • The patient's age
  • How the patient was injured
  • Previous injuries
  • One's usual level of activities
  • The presence (or absence) of head impact and loss of consciousness
  • The way and the time frame the symptoms developed
  • Factors that make the patient feel better or worse
  • Radiation of the symptoms away from the neck and the presence of any symptoms that suggest nerve problems such as weakness, altered sensation, tingling, and (particularly ominous) any bowel or bladder dysfunction
  • Any treatments someone has already tried and their outcomes

Physical Examination

Physical evaluation for neck strain may be divided into the phases of observation, touching the muscles and other structures in the neck (palpation), examination of the blood vessels in the neck, nerve testing and, finally, an assessment of the ability to move. In most cases of trauma involving a significant mechanism of action, a complete examination is usually not completed until a set of preliminary X-rays has confirmed the lack of fractures (broken bones) and dislocations of the cervical spine.

  • Observation
    • The doctor may wish to see the patient walk into and around the examination room.
    • Typically, the patient's posture, gait, facial expression, willingness to move for examination, and ease of movement will be assessed.
    • The doctor will be interested to see whether the patient's head is rotated to one side. This usually indicates muscle spasm of the neck (called torticollis).
    • The position of the patient's chin and head will be noted as well as his/her habitual posture and the symmetry of the neck contour formed by the trapezius muscle.
    • The posture of the patient's head and neck may also be checked while the patient sits and then stands. Any differences will be noted.
    • The patient's shoulders will be checked to see if they are level when relaxed. Asymmetry often indicates muscle spasm.
  • Observation is often also sufficient to lead to a suspicion of a problem causing an inadequate blood supply (ischemia) in one of the upper limbs. A doctor will examine the blood vessels in the neck by feeling the pulses to assess for briskness of upstroke and fullness, and the presence of any abnormal sounds heard with a stethoscope placed over the blood vessel (auscultation). The doctor will also look for any evidence of any increased pressure in the neck veins (distended or bulging jugular veins). The doctor will check the patient's trachea, particularly if there are any symptoms of hoarseness.
  • The doctor will also palpate the patient's head, neck, shoulders, and possibly other areas. Palpation is useful in detecting differences in tissue tension, texture, and thickness, tenderness, and abnormal sensation. In addition, differences in temperature and dryness (or excessive moisture) become readily apparent. Tremor (shaking) and muscle twitches may also be checked in this manner.
  • The doctor will perform neuromuscular testing to determine whether the patient has any injuries to the nerves and joints in the neck. These tests typically involve moving the body both passively (with assistance) and actively, to assess for strength, range of motion, and any loss of sensation.

The combination of a detailed history, physical examination, and one or more imaging procedures should enable the doctor to exclude, or identify, any serious injury to the neck and thereby plan a course of treatment.

What Types of Diagnostic Imaging Assess Neck Strain?

Many different types of imaging studies are available.

  • Plain film radiography (X-rays)
    • Plain X-rays are still the primary means of looking for trauma to bones involving the cervical spine. They have the advantages of low cost, wide availability, and good anatomic resolution. X-rays do not give a good image of soft-tissue structures (muscles and ligaments).
    • The technician will customarily obtain multiple views.
    • The actual reading of cervical spine radiographs is a science in itself and may be performed by any knowledgeable doctor with the backup of a radiologist.
  • CT scan
    • This painless, noninvasive technique produces cross-sectional images of tissues.
    • CT scans offer far better tissue contrast resolution when compared to plain X-rays and are excellent for displaying bony architecture, although soft tissues are seen less well.
    • It is useful in assessing for complex fractures and dislocations, disk protrusions, disease of the joints of the vertebrae, and spinal stenosis (a narrowing of the space containing the spinal cord).
  • Myelography (spinal cord imaging)
    • In this technique, a water-soluble contrast dye is injected into the epidural space via lumbar puncture and allowed to flow to different levels of the spinal cord.
    • Plain X-rays, or more commonly CT scan, are then performed, to indirectly visualize structures outlined by the dye.
    • This technique is very sensitive at detecting disk disease, disk herniation, nerve entrapment, spinal stenosis, and tumors of the spinal cord. Side effects of the procedure include headache, dizziness, nausea, vomiting, and seizures.
    • Because of the invasive nature of this test and the advances in MRI and CT technology, myelography is reserved nowadays for very specialized indications.
  • MRI
    • MRI is another noninvasive, painless imaging technique used to obtain images of bone and soft tissue. It uses magnetic fields and is based on detecting the effect of a strong magnetic field on hydrogen atoms contained in water.
    • So-called T1 images show very good anatomic detail, whereas T2 images demonstrate any soft tissue problems that alter tissue water content. Both offer excellent tissue contrast and have no known side effects, although claustrophobia is a problem in some people.
    • MRI cannot be used for people with implanted or other metallic foreign bodies not firmly fixed to bone but is reportedly safe with prosthetic joints and internal fixation devices. It is often preferred over myelography for the assessment of disk disease because it is noninvasive.
  • Discography
    • This involves the injection of radiopaque dye into the center of an intervertebral disk (nucleus pulposus), using radiographic guidance, and may be used to determine disk disruptions.
    • It is uncommonly performed but is sometimes used in cases where the precise cause of the patient's symptoms is difficult to ascertain to see whether the injection brings on symptoms.
  • Radionuclide scanning
    • This technique uses a very short-lived radioactive isotope (technetium 99m) administered by IV and absorbed by actively metabolizing bone tissue during bone turnover. The amount of uptake is proportional to the amount of metabolism.
    • Localized "hot spots" may then be visualized through the use of a special camera, which can detect the gamma rays emitted by the radioisotope. This technique is very sensitive for detecting fractures or other bone problems.
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Are There Home Remedies for Neck Strain?

If the pain is not severe and one does not have any new numbness, weakness, or other symptoms of nerve failure, mild neck strain can be safely treated at home.

  • If pain is moderate, bed rest may be necessary. A cervical collar may be beneficial.
  • It is helpful to place a small pillow under the nape of the neck to provide proper neutral positioning.
  • Dry or moist heat applied to the area often provides relief from pain caused by muscle spasm. However, it has not been shown to speed the healing process.
  • Pain control with a nonsteroidal anti-inflammatory drug (NSAIDs), such as ibuprofen (Advil or Motrin) or acetaminophen (Tylenol), is frequently helpful. An opioid, such as codeine, may be added if needed but will need to be prescribed by a doctor. Muscle relaxants are often used also. They are also available by prescription only.
  • One should guard against neck extension because this will make the pain worse. Stay active and perform one's daily work as tolerated, unless this involves heavy physical labor. Contact a doctor for recommendations.

What Is the Treatment for Neck Strain?

After the assessment of one's condition by a doctor, a plan will be formulated, in conjunction with the patient and his/her family, to treat the injuries. Consideration will be given to the length of time that might be involved for recovery. The vast majority of neck strains heal themselves with appropriate supportive self-care alone. Many people do not need specific medical intervention.

Rest and apply local heat for symptomatic relief, and gradually resume one's usual daily physical activity and work.

If pain lasts beyond two to three weeks, consideration should be given for further evaluation.

Osteopathic manipulative therapy (administered by a physician trained in manipulative medicine), chiropractic care, acupuncture, or an evaluation by a physical therapist should all be considered.

Several treatment plans are available for the person with persistent pain, including home cervical traction, under the direction of a doctor and physical therapist. Contact your doctor for a referral, as needed.

Are There Medications for Neck Strain?

In most people with a neck strain, the acute phase of pain typically lasts only one to two weeks and may be helped by using nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen (Tylenol). (It is important to note that NSAIDs should be avoided by any person with a history of peptic ulcer disease, gastrointestinal bleeding, or kidney disease, and that long-term use of these agents has been associated with kidney failure.) Typical over-the-counter preparations that could be used include the following:

  • Ibuprofen (Advil and Motrin are brand name examples) taken with food three to four times daily as needed, for no longer than five days
  • Acetaminophen taken every four to six hours, as needed, for no longer than three to five days of continued use
  • Naproxen sodium (Aleve) taken with food every 12 hours, as needed, for no longer than five days of continued use

Other drugs may be offered by a doctor to treat pain when it is not controlled with over-the-counter remedies. They include a short course of corticosteroids such as prednisone, and opioid-containing pain relievers such as codeine and others. They are often used in combination with acetaminophen or, less commonly, with ibuprofen. As will all medications, side effects can occur; if taking any of these medications long term, one should discuss with a doctor and pharmacist the potential dangers associated with the medications.

Is Follow-up Necessary After Treatment of Neck Strain?

It is important to follow up with a doctor for recommendations for proper rehabilitation of a neck strain. This is particularly important for older people in whom the healing process is often prolonged where underlying medical conditions require monitoring. Physical therapy as a core part of rehabilitation can be very beneficial.

Typically, for an uncomplicated neck strain, follow-up should be within two weeks, or at the patient's discretion, unless symptoms warrant otherwise.

  • For motor-vehicle crash victims, earlier follow-up is recommended, within one week of the accident.
  • Immediate follow-up should be sought for any unbearable symptoms or any unexpected progression or worsening of one's condition. Go to a hospital's emergency department if necessary.
  • Follow-up should also occur for medical clearance to return to work and for all people requiring prescription medication for pain relief.

People with neck strain and new or worsening symptoms or symptoms that won't go away should contact their doctor. If one does not have a regular doctor and is unable to find one, seek help at the hospital's emergency department for any unexpected or severe symptoms. The primary goal for people and their doctors is always early and complete recovery.

Is It Possible to Prevent Neck Strain?

The key to reducing the incidence of neck strain involves trying to reduce the likelihood of injury to the neck, including from motor-vehicle accidents. The American College of Physicians recommends that all automobile occupants wear seat belts, including the use of child safety seats of appropriate size and construction, for all children weighing less than 40 pounds. In addition, head restraints must be properly adjusted for height so that early contact with the back of the head should occur during a collision, particularly from the rear. Automobile manufacturers have modified vehicles to include devices that add tension to the seat belt during a collision and have devised a multitude of airbag devices to cushion vehicle occupants during crashes. Drive defensively and never while under the influence of mind-altering drugs.

Appropriate safety equipment should also be used by those engaged in dangerous or physical occupations. In addition, home builders are attempting to build safer homes, with fewer opportunities for accidental injury.

What Is the Prognosis of Neck Strain? What Is the Recovery Time for Neck Strain?

With appropriate diagnosis and treatment, the overall prognosis for complete recovery from neck strain is excellent. With appropriate management, the vast majority of people with neck strain recover completely, rapidly, and without incident. In the absence of complicating factors such as nerve problems, a previously healthy person may reasonably expect complete recovery within a few days to a few weeks. Neck strain injury is a major source of lost days of work and can occasionally lead to a chronic pain syndrome.

Reviewed on 11/20/2017

REFERENCE:

Klippel, John H., et al., eds. Primer on the Rheumatic Diseases. 13th ed. New York: Springer and Arthritis Foundation, 2008.

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