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Cervical Sprains and Strains

What are Cervical Sprains and Strains?

A spine strain is an injury to the muscles or tendons of the spine when they overstretch or tear. The spine muscles are attached to spinal bones by tendons

A spine sprain is an injury to the ligaments of the spine to a point of overstretching or tearing. A ligament is like a very tough band which connects bone to bone. Sprains tend to be more significant injuries than sprains, because they can potentially make the spine unstable.

However, the terms “strain” and “sprain” are often used interchangeably since doctors frequently cannot tell if the muscle, tendon or ligament is injured. This is due to the fact that there is no good objective test such as a specific spine image which can tell the difference unless the injury is very severe. Most spine sprains and strains are mild to moderate and are therefore difficult to see with spine imaging.

In the neck (cervical spine), over 1 million sprains and strains occur every year. A significant percentage of these will become chronic problems.

Why do Cervical Spine Sprains and Strains happen?

Sprains and strains of the spine often occur due to a type of trauma, such as a car accident. The common scenario is an accident where the victim is rear-ended. The spine is first thrown forward (flexion) and then backward (extension). The head will usually go in the opposite direction. When the spine is subjected to a force, which exceeds normal forces encountered by it, an injury such as a sprain or strain will occur. In the case of a rear-ending, the injury is often referred to as a “whiplash”. The term “whiplash” is not a medical term. It describes an injury sustained by an acceleration-deceleration force in the neck.

However, sprains and strains do not require a violent incident. Simple overuse over time or having the spine in an unusual position for a period of time can cause these injuries as well.

Sprains and strains often result in pain, stiffness and spasms.

What are some common situations which cause Sprains and Strains of the Cervical Spine?

Here are some scenarios which may cause sprains and strains:

  1. Motor vehicle  accidents
  2. Falls
  3. Contact sports such as football, hockey
  4. Working overhead
  5. Frequent repetitive lifting

How do Spine Specialists judge the severity of a Cervical Spine Strain?

Strains can be graded on a scale depending on the severity of the injury:

  1. Grade I:

Few muscle or tendon fibers are torn. Muscle strength is not impaired

      2. Grade II:

A greater number of muscle or tendon fibers are torn. Muscle strength is impaired.

      3. Grade III:

The muscle or tendon is completely torn. The muscle function is completely lost.

How do Spine Specialists grade the severity of a Cervical Spine Sprain?

Sprains are grade from mild to severe:

  1. Mild Sprain:

Only a few fibers of the ligaments are torn. The stability of the joint which the ligament supports is still intact.

      2. Moderate Sprain:

More fibers of the ligaments are torn. There is some loss of the stability of the joint which the ligaments support.

      3. Severe Sprain:

The ligaments are torn completely. The joint which is supported by these ligaments is now unstable.

What are the usual symptoms from Cervical Spine Strains and Sprains?

Here are some of the common symptoms of sprains and strains of the neck:

  1. Pain in the back of the spine
  2. Muscle spasms
  3. Stiffness of the neck
  4. Headaches
  5. Fatigue
  6. Sleeplessness
  7. Swelling in the area of the injury

How are Sprains and Strains of the Cervical Spine diagnosed?

Spine specialists use information gained from the patient history, physical examination and special tests to diagnose this conditions:

  1. History

The patient may report a type of trauma or event to the spine. Examples are car accidents or lifting injuries. Most patients report pain and stiffness very soon after the event. This typically gets more intense over the following hours. Spasms of the spine muscles tend to occur later.


      2. Physical Examination

The physical exam often focuses on ruling out a more severe injury such as an injury to the spinal nerves, spinal cord, discs or vertebrae.

Here are some examination techniques which might be used

  1. Palpation (Touching and pushing) on the spine to look for tenderness or swelling
  2. Spine mobility tests (range of motion)
  3. Strength (motor) examination of the arms and legs
  4. Sensation (sensory) examination of the arms and legs
  5. Reflexes of the arms and legs
  6. Mobility (range of motion)of the neck


      2. Imaging

Depending on the severity of the event or trauma, your doctor may order imaging studies. Here are some:

a. X-Ray

Spine X-Rays can be useful in ruling out injuries to the bone or joints of the spine. However, they cannot show sprains or strains, except when the injury is so severe that it impairs the spine’s stability. In that instance a forward and backward bending (flexion/extension) X-Ray of the neck is taken. This can show instability between the vertebrae of the spine.

b. CT Scans

A CT scan cannot show sprains or strains directly, but can help evaluate the bones of the spine to rule out a fracture.

c. MRI-Scans

MRI technology can show some of the swelling from severe sprains and strains, however this is not a given. MRI images can rule out more severe injuries, such as an involvement of the disc, joints, spinal nerve and spinal cord.

What is the treatment of Cervical Sprains and Strains?

Here are some of the common Non-Surgical treatments for these conditions:

  1. Non-Surgical Care

A. Activity Level

Bed rest is discouraged and has not been shown to help. Light activities as tolerated are best. Avoidance of the activity which produced the symptoms is recommended. Activity levels should be increased soon after improvement is noted to avoid long-term issues.

B. Ice and Heat

Ice is the most useful in the first 24-72 hours after a Strain or Sprain of the Neck. After that period of time, heat may bring more comfort.

C. Alternative Health Care

Alternative health options can complement traditional medical care. They include Massage Therapy, Acupuncture, Meditation exercises and Herbal Remedies amongst others.

D. Chiropractic Care

Chiropractic adjustments can help in these conditions especially when an underlying misalignment compounds the problem. Severe sprains which result in instability of the neck should not be treated with manipulation.

E. Spine Exercises

Generally, only gentle Range of Motion exercises are tolerated. They can maintain the spine’s motion and may help with the common spasms. Any high impact exercises should be avoided.

F. Physical Therapy (PT)

Some physical therapy technique such as moist heat, manual therapy, ultrasound, and gentle exercises can be helpful.

G. Self Help Devices

Neck Braces can be very helpful for these conditions. They can prevent some of the painful movements of the neck. For moderate or severe sprains and strains, bracing with a soft brace may provide some comfort or stability. For a severe sprain resulting in spinal instability, a rigid brace may have to be used.

However, they are generally only recommended in the early phase after the injury and should be weaned as the pain improves


H. Medications

    1. Muscle Relaxants
    2. Pain Killers
    3. Nerve Pain Medications

I. Injections

Trigger Point Injections can be helpful for the muscle spasms often felt in cases of cervical sprains and strains.

           2. Surgical Care

Surgery for Neck Strains is rarely done unless there are other associated injuries of the spine. However, sprains which result in significant instability of the neck may have to be surgically stabilized.

Here are some surgical procedures which are done for severe sprains with instability:

  1. Anterior Cervical Decompression and Fusion (ACDF)
  2. Posterior Cervical Fusion