What is the treatment for cervical strain?

Treatment for Cervical Strain

Initial conservative management with activity modification, cervical collar immobilization, and physical therapy focused on posture and ergonomics is the appropriate first-line treatment for cervical strain, with most patients improving within 7-8 weeks. 1

Initial Conservative Management

• Activity modification and neck immobilization with a cervical collar are appropriate initial strategies for mild symptoms and axial neck pain, as recommended by the American Academy of Neurology 1
• Treatment duration typically averages 7.4 weeks for soft tissue neck injuries, with exercises being the mainstay of therapy 2
• 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 1

Physical Therapy and Exercise

• Physical therapy should focus on improving posture and ergonomics as the primary rehabilitation strategy 1
• Neck and shoulder exercises are the cornerstone of treatment, with cervical collars used for immobilization rather than as the sole treatment modality 2
• Patients should be encouraged to resume usual work and activities as tolerated during the recovery period 2

Pharmacologic Management

• Cyclobenzaprine (muscle relaxant) is FDA-approved as an adjunct to rest and physical therapy for relief of muscle spasm associated with acute, painful musculoskeletal conditions, but should only be used for short periods (up to 2-3 weeks) 3
• However, cyclobenzaprine 5 mg three times daily provides no additional benefit over NSAIDs alone for acute cervical strain in emergency department patients 4
• Low-dose cyclobenzaprine monotherapy (5 mg TID) is as effective as combination therapy with ibuprofen (400 mg or 800 mg TID), with 88% of patients reporting at least mild improvement after 3 days and 93% after 7 days 5
• There is scant evidence for the use of paracetamol, NSAIDs, and neuropathic pain medications (gabapentin, pregabalin, tricyclic antidepressants) for radicular pain 6

Expected Outcomes and Prognostic Factors

• Approximately 37% of patients become asymptomatic with conservative treatment, while 16% show no significant recovery 2
• The presence of interscapular or upper back pain is associated with less favorable outcomes 2
• Age does not significantly affect recovery rates, and X-ray findings of cervical lordotic curve changes do not correlate with degree of recovery 2
• Approximately 30-50% of patients with axial neck pain develop chronic symptoms lasting more than a year 7

Critical Pitfalls to Avoid

• Do not routinely add cyclobenzaprine to NSAIDs for acute cervical strain, as combination therapy offers no advantage over monotherapy 4, 5
• Avoid prolonged use of muscle relaxants beyond 2-3 weeks, as adequate evidence of effectiveness for more prolonged use is not available 3
• Do not rely on cervical collars as the sole treatment; they should be used as an adjunct to active exercise programs 2
• Ensure the diagnosis is truly cervical strain and not cervical radiculopathy, which presents with arm pain, sensory dysfunction, and motor loss requiring different management 8