What is the treatment for cervical strain?

Treatment for Cervical Strain

The treatment for cervical strain should include rest, physical therapy, and short-term use of muscle relaxants such as cyclobenzaprine for up to 2-3 weeks as an adjunct to physical therapy for relief of muscle spasm. 1, 2

Initial Management

• Cervical strain refers to injury to structures of the neck leading to neck pain, stiffness, weakness, and persistent headache (often occipital/suboccipital in location) 2
• Activity modification and neck immobilization with a cervical collar are appropriate initial conservative management strategies for mild symptoms and axial neck pain 3
• Avoid prolonged immobilization as most episodes of acute neck pain will resolve with or without treatment, though nearly 50% of individuals will continue to experience some degree of pain or frequent occurrences 4

Pharmacological Management

• Cyclobenzaprine is FDA-approved as an adjunct to rest and physical therapy for relief of muscle spasm associated with acute, painful musculoskeletal conditions 1
• Cyclobenzaprine should only be used for short periods (up to 2-3 weeks) as adequate evidence for more prolonged use is not available 1
• NSAIDs may be used for pain management, though research suggests there is little benefit to routinely adding cyclobenzaprine to NSAIDs for emergency department patients with acute cervical strain 5
• Muscle relaxants may be beneficial in acute neck pain associated with muscle spasm 4

Physical Therapy and Exercise

• Exercise treatment appears to be beneficial in patients with neck pain 4
• Neck and shoulder exercises should be included in the treatment regimen 6
• Physical therapy should focus on:
  • Restoring normal cervical range of motion 7
  • Strengthening neck and upper back muscles 6
  • Improving posture and ergonomics 3

Duration of Treatment

• The average length of treatment for cervical strain is approximately 7.4 weeks 6
• Patients should be encouraged to resume their usual work and other activities as tolerated 6
• For cervical strain associated with concussion, nonoperative therapy (including immobilization in a stiff cervical collar, "low-risk" activity modification, and anti-inflammatory medications) may be appropriate for up to 3 years 2

Prognostic Factors

• The presence of interscapular or upper back pain may indicate a less favorable prognosis 6
• There is no correlation between X-ray findings of flattening or reversal of the cervical lordotic curve and the degree of recovery 6
• Age does not appear to significantly impact recovery, with older patients recovering as well as younger patients 6

When to Consider Advanced Interventions

• If symptoms persist despite conservative management for more than 6 weeks, consider:
  • MRI imaging to evaluate for focal neurologic symptoms or pain refractory to conventional treatment 4
  • Referral to a specialist for consideration of interventional treatments 4
• In patients with radiculopathy or myelopathy, surgery appears to be more effective than nonsurgical therapy in the short term but not in the long term for most people 4

Common Pitfalls to Avoid

• Overuse of cervical collars leading to muscle deconditioning 6
• Prolonged use of muscle relaxants beyond 2-3 weeks 1
• Failure to encourage early return to normal activities 6
• Overreliance on imaging findings, as MRI is characterized by a high prevalence of abnormal findings in asymptomatic individuals 4