Treatment of Physical Limitations from Cervical Strain
Physical therapy combining electrotherapy, kinesiotherapy, and manual massage is the most effective treatment approach for cervical strain, with patients typically requiring 20 treatment sessions to achieve optimal functional recovery and return to normal activities. 1
Understanding Cervical Strain Pathophysiology
Cervical strain involves injury to neck structures causing somatosensory dysfunction and aberrant signaling along cervical afferent pathways that coordinate cervical and vestibular reflexes. 2 This dysfunction manifests as:
- Neck pain and stiffness with limitation of cervical motion 2
- Persistent headache, often occipital/suboccipital in location 2
- Upper extremity weakness or paresthesias (radicular symptoms) 2
- Pain with cervical motion and palpation of paraspinal and suboccipital muscles 2
Critical distinction: Differentiate isolated cervical strain from concomitant whiplash-associated disorder or concussion, as they share common injury mechanisms but require different management approaches. 2
Primary Treatment Algorithm
First-Line Pharmacologic Management
NSAIDs alone are sufficient for acute cervical strain—adding muscle relaxants provides no additional benefit. 3
- Ibuprofen 800 mg three times daily as needed for up to 7 days 3
- Avoid routine use of cyclobenzaprine or other muscle relaxants, as they show no significant improvement in pain scores, time to resumption of activities, or functional outcomes compared to NSAIDs alone 3
- No difference in adverse event rates between NSAID monotherapy versus combination therapy 3
Physical Therapy Protocol (Most Effective Approach)
Multimodal physical therapy is superior to any single modality. 1 The optimal combination includes:
- Electrotherapy 1
- Kinesiotherapy (active exercises) 1, 4
- Manual massage 1
- Duration: 20 treatment sessions on average 1
- Average treatment length: 7.4 weeks 4
Critical Management Principles
Avoid cervical immobilization devices in non-traumatic cervical strain:
- Do not use cervical collars routinely 2, 4
- Collars increase intracranial pressure and cause unnecessary neck movement 2
- Prolonged immobilization (>48-72 hours) causes significant complications including pressure sores, increased intracranial pressure, airway problems, and thromboembolic events 2
- Treatment excluding cervical collars and traction yields better outcomes 4
Encourage early mobilization and activity:
- Patients should resume usual work and activities immediately 4
- Active neck and shoulder exercises are the cornerstone of treatment 4
- 37% of patients become asymptomatic with this approach 4
Prognostic Factors and Expected Outcomes
Presence of interscapular or upper back pain predicts less favorable outcomes. 4
- Age does not affect recovery—older patients recover as well as younger patients 4
- X-ray findings of cervical lordotic curve changes (flattening or reversal) show no relation to degree of recovery 4
- 16% of patients show no significant recovery despite treatment 4
Common Pitfalls to Avoid
Do not over-immobilize: Prolonged cervical immobilization beyond 48-72 hours dramatically increases morbidity including pressure ulcers (requiring $30,000 per ulcer to treat), ventilator-associated pneumonia, thromboembolic events (7-100% in inadequately prophylaxed patients), and increased mortality. 2
Do not add muscle relaxants reflexively: The evidence shows cyclobenzaprine adds no benefit to NSAIDs for acute cervical strain in emergency department patients. 3
Do not rely on imaging for prognosis: Radiographic findings of cervical curve abnormalities do not correlate with clinical outcomes or recovery. 4
Special Populations
Office workers and prolonged sitters: This population has 76% prevalence among cervical strain patients and requires particular attention to ergonomic modifications and postural correction. 1
Women are disproportionately affected (64% of cases), though treatment approach remains the same. 1
When to Escalate Care
Consider neurological consultation if: