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  • Neck Fracture

    Neck Fracture

    Neck Anatomy

    The cervical spine is formed by seven square shaped bones called cervical vertebrae. The vertebrae are named beginning at the top with C1, C2, C3, down to C7. Together with the supporting ligaments and the overlying neck muscles, the cervical vertebrae form a spinal canal that surrounds and protects the spinal cord. The vertebrae have gelatin-like discs between them which function as shock absorbers.

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    Definition

    A neck fracture occurs when a person breaks one of the cervical vertebrae. There are different types of neck fractures, depending on which bone breaks and how it breaks. Some are much more serious than others. The most feared complication of the neck fracture is damage to the spinal cord which can lead to paralysis. It is crucial to immobilize the spine with a cervical collar as soon as the neck injury occurs to prevent any further shift of bone fragments and potential spinal cord injury.

    Symptoms

    • Neck pain
    • Neck muscle spasm
    • Inability to move the neck or turn the head
    • Weakness or paralysis in the arms or legs
    • Numbness or tingling the arms or legs

    Types of Neck Fractures

    • Atlas (C1) fracture – usually treated with a halo brace; surgical fusion is occasionally necessary.
    • Odontoid fractures (C2) – result from the direct head impact which causes a fracture in the tooth-like projection from C2 v known as dens or odontoid. These fractures are usually managed non-surgically and have a good prognosis.
    • Hangman’s fracture usually results from hyperextension injury during motor vehicle or diving accidents. The name is derived from the similar injury suffered during execution-style hangings. Most cases can be successfully treated with immobilization but surgical fusion may be indicated.
    • Cervical compression fractures can often occur when an athlete uses the head in blocking or tackling or during diving into shallow water. Mild fractures result in neck pain and spasm. Severe fractures can cause quadriplegia and death.
    • Cervical spinous process fracture is a fracture of the tip of the spinous process most commonly involving C7 vertebrae. This type of fracture is commonly seen following trauma from an assault or motor vehicle accident. Treatment consists of cervical collar immobilization and pain relief.

    Tests

    Neck fractures are usually diagnosed with an X-ray or CT scan of the neck.

    Treatment

    Treatment depends on the type of the fracture. Severe neck fractures will require hospitalization and surgery. Neck fractures that are not as serious are usually treated with a special neck collar or brace to hold the neck in place so it can’t move. People need to wear the collar or brace until their fracture heals.

    It may take months for neck fracture to heal. After the fracture heals, a course of physical therapy is usually recommended to strengthen the weakened neck muscles. Eating enough calcium, vitamin D and protein and abstaining from smoking will help to expedite the healing process.

  • Neck Pain

    Neck Pain

    Neck Anatomy

    The cervical spine is formed by seven square shaped bones called cervical vertebrae. The vertebrae are named beginning at the top with C1, C2, C3, down to C7. Together with the supporting ligaments and the overlying neck muscles, the cervical vertebrae form a spinal canal that surrounds and protects the spinal cord. The vertebrae have gelatin-like cushions between them called intervertebral discs which function as shock absorbers.

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    Neck pain causes:

    • Cervical strain is due to spasm of cervical and upper back muscles. It may result from injury or due to physical stress of everyday life, including poor posture, muscle tension from anxiety and high stress level or from poor sleeping habits.
    • Cervical spondylosis is due to wear and tear of the cervical spine that occurs with aging. It results in the gradual narrowing of the disc space and growth at the edges of the bone (bone spurs). These spurs can put pressure on the surrounding tissue and pinch the nerves in the neck.
    • Cervical discogenic pain is the most common cause of the neck pain. It is caused by the changes in the structure of the intervertebral discs.

    Symptoms

    • Pain, stiffness and tightness in the neck, upper back and shoulder muscles
    • Limited ability to move the neck due to pain and stiffness
    • Pain may refer to the arm and/or shoulder
    • Headaches (known as cervicogenic headache)
    • Numbness or abnormal sensation of the arm or shoulders
    • Pain is often worsened by holding the neck in prolonged position such as occurs with driving, reading or working at a computer

    Neck Pain Tests:

    • Your health care provider will usually perform the following physical exam:
    • Evaluation of the range of motion (the ability to move the head in every direction)
    • Testing for neck and arm strength
    • Feeling for muscle tightness

    In some cases, further testing, such as X-ray, CT scan, MRI or electrodiagnostic testing (EMG) may be recommended. The need for these tests depends on person’s symptoms, medical history and examination.

    Treatment

    • Pain control with over-the-counter medications, such as Tylenol or NSAIDS (ibuprofen, naproxen, etc.) is helpful for mild to moderate neck pain. Prescription pain medicine may be necessary for severe pain.
    • A prescription muscle relaxant such as Flexeril, Robaxin or Soma
    • Cold therapy
    • Heat therapy
    • Massage
    • Range of motion and stretching exercises
    • Transcutaneous electrical nerve stimulation (TENS) uses a mild electric current to decrease pain and increase mobility and strength.
    • Cervical traction involves the use of weights to realign or pull the spinal column back into alignment.
    • Ultrasound to provide deep heat to muscles and ligaments
    • Trigger point injections of a local anesthetic medicine into the area of the muscle that is tight and tender (“trigger point”)

    Prognosis

    Approximately ten percent of adults have neck pain at any one time. The majority of patients, regardless of the cause of pain, recover with conservative therapy. Surgery is very rarely needed

  • Neck Spasms

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    Neck Spasms

    A neck spasm is an involuntary muscle contraction that usually happens in response to injury or overuse of the muscle, or as a reaction to pain caused by a separate condition. The muscle can remain in spasm for some time, which can severely restrict movement of the head, shoulder, and neck, and cause considerable pain.

    The neck, anatomically known as the cervical spine, is constructed of seven cylindrical stacked vertebrae, beginning at the base of the skull and ending at the beginning of the thoracic spine. The vertebral bones protect the spinal cord, support the head, and allow a great deal of flexibility and movement. Between each bone is an intervertebral disc that acts as a shock absorber and allows the neck to bend and rotate. Openings in the vertebrae allow the passage of nerve fibers and blood vessels.

    Muscles, muscle tendons, and ligaments in the neck and shoulders are crucial to the stability of the neck. They function to support the neck structure and permit a great deal of mobility. Unfortunately, the high level of flexibility in the neck, and the number of anatomical components leaves the neck vulnerable to damage.

    Although a neck spasm is not a serious condition, it can be a symptom of a significant problem. See the symptoms listed below for indications that you should seek medical attention.

    Causes:
    Due to the unique structure and flexibility of the neck, many conditions or injuries can cause neck muscles to spasm.

    Some physical reasons might be muscle strain or sprain, muscle tension generated by pain, muscle exhaustion from overwork, or a bone fracture. Poor posture, particularly when seated for long periods, is a common cause of neck spasm.

    Some underlying conditions that might result in spasm include cervical disc problems such as a herniated disc or degenerative disc disease; fibromyalgia; spinal stenosis (a narrow spinal canal); infection, either viral or of a bone or spinal joint; or a reaction to a prescribed drug such as Reglan or Haldol.

    Psychological reasons for a neck to spasm are stress and depression.

    Symptoms:
    Commonly experienced symptoms of neck spasm include the following:
    • Pain in the neck, upper back or shoulder when attempting to move the head
    • Stiffness of the neck, causing loss of ability to rotate or bend the neck
    • Tight, hard muscle
    • Headache at the back of the head
    • Possible twitching of the muscle
    • Possible twitching of the facial muscles or jerking of the head
    If you experiencing any of the following symptoms as well as the above, you should seek immediate medical assistance:
  • Fever higher than 101 degrees Fahrenheit
  • Intense headache
  • Numbness, tingling or pain in the arm or shoulder
  • Nausea
  • Loss of balance or coordination
  • Unusual sensitivity to light
  • Diagnosis:
    Your doctor will ask you about your medical history, including any previous problems with your neck. You will be asked about the type and severity of your current symptoms, and any circumstances that might have caused your neck to spasm. Your neck will be physically examined, during which the doctor will assess the range of motion that you have in the neck and the strength of your neck muscles.

    If the doctor suspects a particular condition might be causing your symptoms, diagnostic tests such as X-rays, CT (computerized tomography) or MRI (magnetic resonance imaging) scans may be ordered. Depending on which tests are performed, clear pictures of your bones or soft tissues will be provided to aid with diagnosis.

    Treatment:
    Treatment for neck spasm will depend on the underlying cause and will be geared towards resolving that problem.

    For symptoms generated by overwork, stress, muscle injury or similar, the following treatments should provide relief. It may take anywhere from a few days to a few weeks for your pain to completely resolve.
    Rest: Avoid any activity or movement that makes your pain worse. Sometimes, wearing a soft cervical collar for the first few days can help by supporting the head and relieving pressure on damaged tissues. Do not wear the collar excessively however, as this can lead to weakened muscles and a prolonged recovery.
    Ice: Apply ice, crushed in a bag and wrapped in a towel, to your neck and shoulder for as long as is comfortable, several times a day during the first two or three days of pain.
    Heat: After the first two or three days, you can apply heat to the neck and shoulders. Some people find that a warm moist towel is a good way to do this. Heat will relax your muscles, relieving spasm, and promote blood supply to the damaged tissues, stimulating healing.
    Pain medication: Acetaminophen (Tylenol) can help with pain relief. NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen (Advil), naproxen (Aleve), or aspirin, taken according to directions, will relieve inflammation and associated pain. If necessary, your doctor may prescribe a muscle relaxant. These tend to cause drowsiness so should only be taken at bedtime. If your symptoms do not improve, your doctor may administer a corticosteroid injection into the painful area.
    Massage: Massage can help to relieve muscle spasm, and will promote blood supply. You can do this yourself, or have someone else give you a massage.
    Physical therapy: When your neck spasm has completely resolved, you may be advised to undertake an exercise program in order to stretch and strengthen the neck muscles, thereby reducing the risk of further injury. A therapist can also help you correct any postural problems you may have. You may also consider treatment for stress or depression if these conditions are causing your symptoms.

    Exercises:
    Always seek medical approval before beginning an exercise program. Be very careful with these exercises: go slowly and do not force. You should not feel any pain.
    Stretch: Gently bend your head forwards, towards your chest. Bring your head back to neutral, and then bend the head backwards, as though you are looking at the ceiling. Bring your head back to neutral. Turn your head to the right and then the left. Tilt your head so that your ear moves towards the shoulder. Repeat to the opposite side. Rest.
    Strengthen: While performing these exercises, do not move the neck.
    1: Sitting, place the fingers of both hands on the forehead. Press the fingers against the head for a count of 5. Repeat 5-10 times.
    2: Sitting, place both hands on the back of the head. Press the hands against the head for a count of 5. Repeat 5-10 times.
    3: Sitting, place one hand against the side of the head, above the ear. Press the hand against the head for a count of 5. Repeat 5-10 times. Repeat exercise with the other hand.

  • Neck Sprain

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    Neck Sprain

    Definition:
    A neck sprain is primarily an injury to the ligaments in the neck, but can also be used to describe damage to other soft tissues such as muscles and tendons. Ligaments are bands of strong, slightly elastic, connective tissue that join one bone to another. Ligament fibers can become stretched, frayed or broken by a trauma, leading to the painful symptoms of a neck sprain.

    The neck, anatomically known as the cervical spine, is constructed of seven cylindrical stacked vertebrae, beginning at the base of the skull and ending at the beginning of the thoracic spine. These are named C1 through C7. The vertebral bones protect the spinal cord, support the head, and allow a great deal of flexibility and movement. Between each bone is an intervertebral disc that acts as a shock absorber and allows the neck to bend and rotate. Openings in the vertebrae allow the passage of nerve fibers and blood vessels.

    Muscles, muscle tendons, and ligaments in the neck and shoulders are crucial to the stability of the neck. They function to support the neck structure and permit movement, but they also limit the extent of movement, thereby helping to prevent injury. Unfortunately, the high level of mobility in the neck, and the number of anatomical components, does leave it vulnerable to damage. Any injury to the neck can result in muscle spasm, where the muscle contracts and remains contracted in an effort to protect itself from further damage.

    Causes:
    A neck sprain can occur when a force is applied to the body that causes the neck to extend beyond its normal range of motion, stretching or tearing ligament fibers. Examples of situations that might result in a neck sprain are motor vehicle accidents in which the head is violently thrust in one direction and then the other, as in a typical whiplash injury, or a fall from a height.

    Symptoms:
    Symptoms will vary according to the individual injury, but commonly experienced symptoms of a neck sprain can include the following:
    • Pain, not necessarily felt at the time of injury, but typically worsening over the first 24 to 48 hours
    • Pain, felt particularly in the back of the neck, made worse with movement
    • Headache felt at the back of the head
    • Stiffness in the neck
    • Muscle spasms in upper back or shoulder
    • Decreased ability to rotate or bend the neck
    • Possible numbness, weakness or tingling in the arms
    • Cognitive impairment, such as difficulty concentrating
    • Irritability
    • Impaired sleep
    Pain felt immediately after an accident, or any weakness, numbness or tingling in the arms, should be assessed by a medical professional as soon as possible in order to rule out a more serious injury.

    Diagnosis:
    After taking your medical history, your doctor will ask you about the circumstances of your current injury, and the type and severity of your symptoms. Your neck will then be physically examined to assess the range of motion and strength of your neck, and to check for areas of tenderness. Blood flow to the neck will be checked, as will nerve responses.

    X-rays may be ordered to look for a possible fracture, dislocation, arthritis or other condition that may be causing your symptoms. CT (computerized tomography) or MRI (magnetic resonance imaging) scans may also be taken as these provide more detailed pictures of internal structures. MRI scans, in particular, are extremely good at detecting damage to ligaments and other soft tissues.

    Treatment:
    Most neck sprains heal with time and conservative (non-surgical) treatment. Recovery times vary with the individual, but can take anywhere from two weeks to three months. Symptoms lasting longer than three months should be investigated further.
    Rest: Avoid movements that cause your symptoms to worsen, but try not to completely immobilize your neck as this can lead to increased stiffness and loss of muscle tone. It might be helpful to wear a soft cervical collar for a few days, to allow the damaged ligaments to rest, but do not wear it excessively.
    Ice: Apply ice, crushed in a bag and wrapped in a towel, to your neck and shoulder for as long as is comfortable, several times a day during the first two or three days.
    Heat: After the first three days, heat applied to the neck and shoulder will promote blood supply to the damaged tissues, stimulating healing. It will also relax muscles, relieving spasm.
    Pain medication: Acetaminophen (Tylenol) can help with pain relief. NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen (Advil), naproxen (Aleve), or aspirin, taken according to directions, will relieve inflammation and associated pain. If necessary, your doctor may prescribe a muscle relaxant. These tend to cause drowsiness so should only be taken at bedtime.
    Physical therapy: Gentle massage can help to relieve muscle spasms, and will promote blood supply to the painful area. Cervical traction can be used to gently stretch the neck, relieving pressure on damaged tissues. An exercise program designed to strengthen the neck muscles and increase flexibility will help to prevent future injury.

    Exercises:
    Before doing any exercises, obtain medical approval. While performing these exercises, do not move the neck.
    1: Sitting, place the fingers of both hands on the forehead. Press the fingers against the head for a count of 5. Repeat 5-10 times.
    2: Sitting, place both hands on the back of the head. Press the hands against the head for a count of 5. Repeat 5-10 times.
    3: Sitting, place one hand against the side of the head, above the ear. Press the hand against the head for a count of 5. Repeat 5-10 times. Repeat exercise with the other hand.

    Repeat the above exercises, but in this sequence bend the neck downwards during exercise 1, backwards during exercise 2, and to each side, moving the ear towards the shoulder, during exercise 3.

  • Neck Strain

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    Neck Strain

    A neck strain is the term used to describe an injury, which can range from mild to severe, to the muscles of the neck. Muscle fibers become stretched or torn, resulting in inflammation and pain. An injured muscle often goes into spasm, which means that it contracts and stays contracted, as a way of protecting itself from further injury. Both a strain and a spasm can severely restrict movement of the head, shoulder, and neck, and cause considerable pain.

    The neck, anatomically known as the cervical spine, is constructed of seven cylindrical stacked vertebrae, beginning at the base of the skull and ending at the beginning of the thoracic spine. These are named C1 through C7. The vertebral bones protect the spinal cord, support the head, and allow a great deal of flexibility and movement. Between each bone is an intervertebral disc that acts as a shock absorber and allows the neck to bend and rotate. Openings in the vertebrae allow the passage of nerve fibers and blood vessels.

    Muscles, muscle tendons, and ligaments in the neck and shoulders are crucial to the stability of the neck. They function to support the neck structure and permit movement, but they also limit the extent of movement, thereby helping to prevent injury. Unfortunately, the high level of flexibility in the neck, and the number of anatomical components, does leave it vulnerable to damage.

    Causes:
    Neck strain is caused when force applied to the neck is stronger than the muscle is capable of resisting.

    There are several common causes of neck strain. One of the most common is an extended period of time spent with the body in a poor posture. Examples of this might include sitting slumped in a car seat while driving, seated in a unsatisfactory chair while working at a computer with the screen improperly positioned, cradling a telephone between the ear and shoulder, carrying a heavy load on one side of the body, or sleeping with a pillow that is an incorrect height or firmness for the way you sleep.

    Trauma can very easily cause neck strain. A whiplash injury is a well-known example of such trauma, but any fall or awkward movement of the head or neck might lead to neck strain.

    Symptoms:
    Symptoms of a neck strain will vary according to the severity of the injury, but the most commonly experienced symptoms are:
    • Pain, usually felt in a shoulder muscle
    • Stiffness of the neck
    • Pain when trying to rotate the head or bend the neck
    If the strain is severe enough to have completely ruptured the muscle (usually where the muscle tendon inserts into the bone) the symptoms will be:
    • Intense pain
    • Bruising
    • Muscle spasm
    • Swelling
    • Disability
    Diagnosis:
    For many cases of mild neck strain it is not necessary to visit the doctor. You should make an appointment if your symptoms last for more than two or three days, or if you are experiencing pain, numbness, or tingling in your arm, as this may indicate nerve damage that could have serious consequences.

    If your neck strain is the result of a car accident or other trauma, you should see a doctor who would carefully examine you and perhaps order diagnostic tests such as X-rays, CT (computerized tomography) or MRI (magnetic resonance imaging) in order to rule out other injuries.

    If your symptoms indicate that you may have ruptured a muscle, see your doctor as soon as possible.

    Treatment:
    Rest: Avoid movements that cause your symptoms to worsen, but try not to completely immobilize your neck as this can lead to increased stiffness and loss of muscle tone. It might be helpful to wear a soft cervical collar for a day or two, to allow the damaged muscle to rest, but do not wear it excessively.
    Ice: Apply ice, crushed in a bag and wrapped in a towel, to your neck and shoulder for as long as is comfortable, several times a day during the first two or three days.
    Heat: After the first day, heat applied to the neck and shoulder will promote blood supply to the damaged tissues, stimulating healing. It will also relax muscles, relieving spasm.
    Pain medication: Acetaminophen (Tylenol) can help with pain relief. NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen (Advil), naproxen (Aleve), or aspirin, taken according to directions, will relieve inflammation and associated pain. If necessary, your doctor may prescribe a muscle relaxant. These tend to cause drowsiness so should only be taken at bedtime.
    Massage: Gentle massage can help to relieve muscle spasm, and will promote blood supply.

    Prevention:
    Probably the most important thing you can do to prevent neck strain is to practice good posture, particularly when sitting for long periods. Make sure your chair or car seat is at the correct height so that you do not have to bend your neck to view the screen, book or road.

    If you are prone to neck injuries, strengthen your neck muscles by performing exercises such as those listed below. You should always check with a medical professional before starting any exercise program.

    Exercises:
    While performing these exercises, do not move the neck.
    1: Sitting, place the fingers of both hands on the forehead. Press the fingers against the head for a count of 5. Repeat 5-10 times.
    2: Sitting, place both hands on the back of the head. Press the hands against the head for a count of 5. Repeat 5-10 times.
    3: Sitting, place one hand against the side of the head, above the ear. Press the hand against the head for a count of 5. Repeat 5-10 times. Repeat exercise with the other hand.

    Repeat the above exercises, but in this sequence bend the neck downwards during exercise 1, backwards during exercise 2, and to each side, moving the ear towards the shoulder, during exercise 3.

  • Stingers & Burners

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    Stingers & Burners

    A burner or stinger is an extremely painful injury to the nerve supply in the neck or shoulder, commonly sustained in contact sports.

    Nerves originate in the spinal canal. Nerve fibers travel in bundles, with smaller bundles branching off main bundles to innervate more distant parts of the body. The nerves responsible for transmitting information to and from the arm leave the spinal canal between the vertebrae (spinal bones) in the neck. They group together into a network called the brachial plexus that branches out under the collarbone before travelling into the shoulder, and then down the arm and into the hand and fingers.

    Causes:
    A burner or stinger injury can happen in two ways. If, as often happens during contact or collision sports, a tackle or fall results in the head of the athlete being forced down and sideways, the neck is bent and the nerves running from the spinal canal to the shoulder can be stretched. The other mechanism is that the head is forced backwards and sideways, which compresses the nerves on that side. Whether by stretching or compression, damage to the brachial nerve plexus produces the electric shock-like symptoms for which this injury is named.

    Nearly two-thirds of college football players suffer a burner or stinger during their time playing at college. It is an injury primarily associated with contact sports, particularly football, although it can be caused by any situation where the brachial plexus is damaged.

    It has been found that people with naturally occurring narrower spinal canals, a condition called spinal stenosis, are at greater risk for sustaining a burner or stinger.

    Symptoms:
    The injury is named for the main symptoms that it produces. These symptoms can last for a varying length of time: anywhere from a few seconds to, rarely, several days or longer.

    Symptoms are confined to one arm. Commonly experienced symptoms are:
    • Immediate and intensely painful burning or stinging sensation, similar to an electric shock, that travels from the neck down the arm to the fingers.
    • Weakness and numbness in the arm immediately after the injury that may or may not be long lasting. The injury typically affects the ability to bend the elbow, grip or abduct the arm (lift it away from the body).
    • Sensation of heat
    Diagnosis:
    The athletic coach, team doctor or physical therapist is likely to be the first person to assess the condition of the athlete after sustaining an injury of this kind. Neck, nerve function, arm muscle strength, and reflexes will be examined and tested. More serious spinal injuries need to be ruled out. In some cases, a burner or stinger injury is accompanied by a dislocation, fracture, ligament damage, or spinal cord injury, so evaluation of the condition will be careful and thorough.

    It is extremely important for the athlete to report having had a stinger or burner, even if the symptoms rapidly disappeared. Failure to do so can result in permanent nerve damage.

    Imaging tests such as X-ray, CT (computerized tomography) and MRI (magnetic resonance imaging), or nerve conduction tests, are usually not needed, unless other conditions are suspected or symptoms are persistent or recurrent.

    Treatment:
    The primary treatment for a burner or stinger injury is rest, in order to allow the damaged nerves to heal. Because this is almost always a sporting injury, the athlete must refrain from sporting activity until all feeling and strength has returned to the neck, shoulder, and arm; the range of motion of the neck, shoulder, and arm is normal; and reflexes are regular. If the injury was mild, the athlete may be able to return to sports after a few moments. In other cases he or she may have to wait a few hours, a few days, or even longer.

    Along with rest, the neck can be regularly iced, for as long as is comfortable, several times a day, for the first 48 hours. After that time, heat should be applied to the neck and shoulder in order to promote greater blood flow to the injured area.

    NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen (Advil), naproxen (Aleve) or aspirin can be taken, according to directions, to relieve swelling and pain. If there is muscle spasm present, a muscle relaxant may be prescribed.

    It might be helpful to temporarily wear a cervical collar, to prevent the brachial plexus nerves being further damaged. Cervical traction (gentle stretching), administered by a physical therapist, can relieve pressure on the nerve root.

    To prevent recurrent injury, special shoulder pads or a neck roll should be worn during sports. Subsequent burner and stinger injuries tend to become more severe each time and can result in permanent nerve damage.

    Physical therapy should include exercises to strengthen the neck and shoulder muscles, and to promote full range of motion.

    Follow-up evaluations should happen regularly until the athlete has completely recovered.

    If symptoms do not disappear with time and the treatments described above, the doctor may administer a corticosteroid injection into the damaged nerve root area. This is known as a nerve root block and can significantly reduce inflammation of the nerve.

    Surgery is rarely necessary. It might be performed if a herniated (bulging) vertebral disc or a bone spur is compressing the nerve root. If required, the surgeon would discuss the available options with the patient, taking into consideration all the factors relating to the case. Following surgery, rehabilitation would consist of physical therapy to restore range of motion and strength, and correct any postural abnormalities that might contribute to further injury.

    Exercises:
    While performing these exercises, do not move the neck.
    1: Sitting, place the fingers of both hands on the forehead. Press the fingers against the head for a count of 5. Repeat 5-10 times.
    2: Sitting, place both hands on the back of the head. Press the hands against the head for a count of 5. Repeat 5-10 times.
    3: Sitting, place one hand against the side of the head, above the ear. Press the hand against the head for a count of 5. Repeat 5-10 times. Repeat exercise with the other hand.

    Repeat the above exercises, but in this sequence bend the neck downwards during exercise 1, backwards during exercise 2, and to each side, moving the ear towards the shoulder, during exercise 3.

  • Types of Cervical Collar

    Types of Cervical Collar and Why/When They’re Used

    The neck is a delicate construction of vertebrae, muscles, tendons, and ligaments, and 50–70 percent of US residents will experience neck pain at least once during their lives. The pain is usually a result of an acute trauma such as a car accident, although it may be caused by a repetitive neck injury or chronic strain.

    Cervical collars are used to restrict movement of the neck during recovery and healing following an injury or surgery. They stabilize the injured area to a degree, although often the main benefit is to remind the patient that there is a neck issue and to therefore limit the range of motion. Cervical collars are also often used as a precautionary method following an accident until the patient’s condition can be assessed.

    In general, collars should be worn for a limited time only, i.e., for a few hours or days, unless your doctor has ordered it worn for longer. Always follow your doctor’s advice. Avoiding movement of the neck can actually worsen a stiff neck, and may lead to atrophy of neck muscles, tendons, and ligaments.

    Collars come in two forms: soft or rigid. The materials used are normally elastic cotton, foam, or molded plastic.

    Soft collars come in wraparound form and are generally made from thick foam rubber, covered with cotton. They allow a close to normal range of motion and are often prescribed by physicians for mild to moderate neck pain. Many users experience a benefit from wearing a soft collar, but there is no evidence as to whether long term use is helpful.

    Rigid collars (sometimes called semi-rigid) are made from hard plastic with removable, soft inner pads. They are in two pieces (front and back) attached by Velcro straps. Common types are the Aspen, Malibu, Philadelphia, and Miami J collars. Physicians prescribe rigid collars for moderate to severe neck pain and whiplash injuries. These restrict neck movement to a greater degree than a soft collar but can also support the chin, thereby allowing the neck muscles to relax. The collar is normally worn continuously for as long as advised by the medical practitioner, except when removed for daily washing.

    There is some controversy over how long a rigid collar should be worn. The concern is that long-term use could lead to muscle, ligament, and tendon atrophy. Studies have shown that early mobilization after a whiplash injury, i.e., allowing the neck to move, resulted in lower pain and better neck mobility. It has been suggested that use of a rigid cervical collar should be limited to a maximum of ten days.

    Rigid collars are most commonly used to stabilize the cervical spine following a trauma such as a fracture or dislocation, or after surgery. Wearing a hard collar can have side effects such as limiting the degree to which the mouth can open. They are an important part of medical care, but are not usually prescribed to manage neck pain.


  • Whiplash

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    Whiplash

    Whiplash is a common injury to the soft tissues of the neck. Its name describes the motion that typically produces the painful symptoms associated with this injury. The neck is suddenly forced backwards and then forwards, stretching the muscles and ligaments of the neck beyond their normal range.

    The neck, known as the cervical spine, consists of seven vertebral bones stacked on top of each other. These begin at the base of the skull and end at the beginning of the thoracic spine. Each vertebra is cylindrical and is cushioned by a cervical disc. Their structure provides protection for the spinal cord, support for the head, and allows the head to turn from side to side as well as bend forwards and backwards. The bones are held in position and supported by ligaments, muscles, and muscle tendons. Blood vessels and nerves travel in and out of the neck. This section of the spine is strong and not easily injured, but sufficient force can damage the soft tissues that support the cervical spine.

    Causes:
    Whiplash injuries are typically caused by motor vehicle accidents. In a motor accident, the normal course of events is that a moving vehicle hits a stationary car from behind, the cervical spine is suddenly and forcefully thrust into an abnormal S shape, and supporting tissues are damaged.

    Whiplash injuries may also result from impact during contact sports such as football, although this is less common. Physical abuse such as shaking can cause whiplash, especially in the case of babies.

    Symptoms:
    Whiplash symptoms often appear after the moment of injury, but usually develop within a day. Typical symptoms include the following:
    • Pain and stiffness in the neck, sometimes in the shoulder or between the shoulder blades
    • Headaches, usually at the base of the skull
    • Blurred vision
    • Dizziness
    • Tiredness
    • Prickling or burning sensation
    • Pain in the jaw
    Less common symptoms can include
    • Sleep disruption
    • Irritability
    • Ringing in the ears
    • Difficulty with memory and concentration
    Diagnosis:
    Your doctor will ask you about your medical history, including any previous injuries to your neck. You will be asked about the circumstances of your current injury, and the type and severity of your symptoms. Your neck will then be physically examined. Diagnostic tests such as X-ray, CT (computerized tomography) and MRI (magnetic resonance imaging) scans may be taken to rule out other conditions, for example, dislocation, arthritis, or bone fracture. CT and MRI scans clearly show soft tissues, so are useful in detecting injuries to nerves or the spinal cord.

    Treatment:
    Most cases of whiplash respond to treatment and the patient fully recovers. During the acute stage of the injury, which is the first few days, you may find the following therapies helpful:
    Ice: Ice, crushed in a bag and wrapped in a towel, can be applied to the neck for as long as is comfortable, several times a day. This will help to reduce swelling and pain.
    Pain medication: Acetaminophen (Tylenol) can be taken for mild or moderate cases of whiplash. NSAIDs (over-the-counter non-steroidal anti-inflammatory drugs), taken according to directions, will help relieve pain and swelling. Examples of these are ibuprofen (Advil), naproxen (Aleve) and aspirin. Your doctor may prescribe stronger pain medication if necessary.
    Muscle relaxants: Your doctor may administer an injection of lidocaine into painful muscles. This relaxes the muscles, which may have gone into spasm. Alternatively, you may be prescribed muscle relaxant medication, which can cause drowsiness, so should only be taken at bedtime.
    Physical therapy: After the acute stage, heat applied to the neck can be both soothing and healing as it brings increased blood flow to the damaged area. The blood contains nutrients and substances that will promote healing of the damaged tissues. The warmth will also help to relax your muscles. Other physical therapies may include massage, ultrasound, and traction. Traction is used to gently stretch the neck.
    Support: Foam neck collars were regularly used for whiplash injuries, but it is now believed that prolonged immobilization in a collar contributes to stiffness and loss of muscle tone and therefore delays recovery. You may find it helpful to wear a collar at night if pain is preventing you sleeping. If you do choose to wear a cervical collar, wear it for no longer than three hours at a time, and only during the acute stage of injury.
    Exercise: Following the acute stage, your doctor will recommend that you begin stretching exercises to improve your neck’s range of motion. This has been demonstrated to improve the rate of recovery. These exercises will also help to strengthen the neck muscles, reducing the chances of further injury. Exercises usually consist of rotating the head, and gently bending the neck forwards and backwards.

    Examples of exercises typically used for whiplash:
    Do not attempt these if they cause you any pain, and check with your doctor before undertaking an exercise program. Go gently and carefully.
    Range of motion 1:
    Sitting in a chair with your head held as though balancing a book on top, carefully turn your head as far to the right as you can, without causing pain. Return to a forward facing position, then turn your head as far to the left as you can. Repeat 5-10 times.
    Range of motion 2:
    Sitting or standing, carefully bend your head downwards then up again. Make sure that only your head moves, not your shoulders. Now bend your head backwards, as though you are going to look at the ceiling. Go very gently. Repeat the exercise 5-10 times.
    Range of motion 3:
    Stand with your feet shoulder-width apart. Roll your shoulders back 2-3 times. You can also do this one shoulder at a time. Slowly tilt your head to one side, ear moving towards the shoulder, then to the other side, and finally back to face forwards.
    Alignment:
    Lie on the floor with your knees bent so that they are directly above your ankles. Your feet should be flat on the floor. Gently draw in your abdominal muscles. Drop your shoulders. Turn your head so that your ear moves towards the floor. Repeat to the other side. Repeat 5-10 times.

Neck & Cervical Spine Pain & Injury

Neck injury and arthritis can be among the most debilitating orthopedic ailments. Cervical vertebrae injury and pain can leave the patient feeling especially vulnerable, since the neck protects so many of our most important nerves and is so close to the brain. For the articles above, doctors and professional medical copywriters have researched the causes of neck pain and treatments that can be used to lessen discomfort and encourage a speedy recovery. Learn on your own or read along with your sports medicine professional to choose a treatment or neck brace that’s right for your particular injury.

Whether you just need to learn how to treat neck pain or you need recommendations for dealing with a more serious, chronic condition, our resource library is a great place to start. Find your ailment above and start on the path to recovery today!

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