What are the risk factors for cervical strain?

Risk Factors for Cervical Strain

The primary risk factors for cervical strain include concussion, whiplash-associated injuries, pre-existing cervical spine conditions, and participation in high-impact or repetitive motion activities that place stress on the neck. 1, 2

Mechanism-Related Risk Factors

• Trauma-related factors:

  • Whiplash injuries from motor vehicle accidents 1
  • Falls from greater than standing height 1
  • Sports-related impacts, especially in contact and collision sports 3
  • Concussion-associated injuries (cervical strain often co-occurs with concussion) 1

• Biomechanical factors:

  • Rapid acceleration-deceleration forces applied to the head and neck 1
  • Repetitive neck movements in occupational settings 2
  • Improper technique in sports activities (e.g., incorrect landing technique in high jumping) 4
  • High rate of impact during trauma (faster impacts increase injury risk) 5

Patient-Specific Risk Factors

• Age-related factors:

  • Age ≥65 years (increased vulnerability to cervical injury) 1, 6
  • Children <8 years (unique vulnerability due to incomplete ossification, unfused synchondroses, ligamentous laxity, and large head-to-body ratio) 1

• Pre-existing conditions:

  • History of previous neck injuries 1
  • Cervical spinal stenosis (significantly increases risk of injury with even minor trauma) 5
  • Congenital disorders with ligamentous laxity (e.g., Down syndrome) 1
  • Pre-existing headache conditions (increases risk of post-injury headaches) 1
  • Systemic conditions affecting spine stability:
    • Ankylosing spondylitis 6
    • Rheumatoid arthritis 6
    • Previous cervical surgery 6

Activity-Related Risk Factors

• Sports-specific risks:

  • High-impact sports (football, rugby, hockey) 3
  • Activities with repetitive neck movements (gymnastics, diving) 3
  • Combat sports with risk of neck trauma 3
  • High jumping with improper landing technique 4

• Occupational factors:

  • Jobs requiring repetitive neck movements 2
  • Occupations with sustained awkward neck postures 2
  • Professions with exposure to vibration affecting the cervical spine 2

Clinical Considerations

• Cervical strain often presents with neck pain, neck stiffness, weakness, and persistent headache (typically occipital/suboccipital) 1
• The injury can lead to somatosensory dysfunction affecting cervical afferent pathways 1
• Patients may exhibit clinical signs including:
  • Pain/tenderness in cervical spine (midline, paraspinal, and suboccipital)
  • Weakness with paracervical strength testing
  • Limitation of cervical motion
  • Pain with cervical motion
  • Paresthesia/weakness in upper extremities 1

Special Populations

• In children, the risk of cervical injury varies by age group, with younger children (<8 years) more susceptible to upper cervical spine injuries 1
• Children have higher risk of spinal cord injury without radiological abnormality (SCIWORA) 1
• Elderly patients have increased vulnerability to cervical injury even with relatively minor trauma 6

Understanding these risk factors is crucial for proper assessment, early identification, and appropriate management of cervical strain to prevent chronic issues and neurological complications.