Can Cervical Collars Cause Neck Muscle Soreness?
Yes, both hard and semi-rigid cervical collars commonly cause neck muscle soreness and discomfort in adult patients, with pain developing particularly after prolonged use beyond 48-72 hours. 1
Mechanism of Collar-Related Neck Pain
Cervical collars restrict normal neck movement, which leads to several pain-generating mechanisms:
- Muscle spasm and stiffness develop from forced immobilization, as collars limit flexion by 17-59%, extension, and rotation depending on collar type 2, 3
- Paraspinal muscle strain occurs from maintaining static positioning against the collar's resistance 1
- Pressure-related discomfort develops at contact points between the collar and neck structures 1
- Pain increases with duration of use, with healthy young adults showing significant pain score increases after just 1 hour of rigid collar wear 4
Evidence on Collar-Related Complications
Prolonged collar use beyond 48-72 hours causes significant attributable morbidity that escalates rapidly: 1
- Pressure sores are common and may require skin grafting, serving as sources of sepsis 1
- Increased intracranial pressure worsens outcomes in patients with co-existing head injury 1, 5
- Airway complications can be life-threatening 1
- Failed enteral nutrition and gastrostasis promote aspiration and ventilator-associated pneumonia 1
- Thromboembolic events occur in 7-100% of immobilized patients with inadequate prophylaxis 1
Clinical Context: When Collar Pain Occurs
The American Heart Association recommends against routine cervical collar application by first aid providers due to documented harms that outweigh potential benefits. 1, 5
For trauma patients with persistent neck pain while in a collar:
- Whiplash-associated disorders (WAD) are the most common cause of ongoing symptoms after negative imaging, involving paraspinal muscles, facets, disks, and ligaments 1
- Imaging has limited value in WAD diagnosis, which relies primarily on clinical factors 1
- MRI findings show weak or no correlation with WAD symptoms, with no discernible differences between patients with and without WAD 1
Collar Effectiveness and Paradoxical Effects
Rigid collars paradoxically may not effectively restrict movement of unstable cervical injuries, particularly at the craniocervical and cervicothoracic junctions—ironically the two most common injury sites. 1, 6
- Soft collars reduce neck movement by only 17.4% on average 3
- Rigid collars reduce movement by 62.9% but still allow substantial motion 3
- Adjacent vertebrae may experience paradoxical movement when collars are applied 1
Critical Clinical Pitfalls
Do not keep patients in collars beyond 72 hours without definitive surgical planning, as complications accumulate rapidly and often exceed the risks of missed injury. 1, 5, 6, 7
- Each pressure ulcer costs approximately $30,000 to treat with prolonged healing time 1, 5
- Respiratory complications from prolonged immobilization are a principal cause of death in elderly patients with cervical spine injuries (26.8% mortality) 1
- The documented harms of prolonged collar use often exceed the risks of the injury itself when definitive stabilization is not performed 6
Management Approach
For patients complaining of neck soreness while wearing a collar:
- Evaluate for pressure points causing direct tissue injury, particularly after 48-72 hours 1
- Reassess the need for continued immobilization using high-quality CT (sensitivity 98% for clinically significant injuries) 1, 7
- Consider collar removal if imaging adequately excludes unstable injury, as exercise and mobilization are effective for reducing acute and chronic neck pain 1
- If collar must continue, ensure proper fit and consider alternating collar types, though this does not eliminate soreness risk 4
The soreness patients experience is a direct consequence of the collar itself—both from mechanical restriction causing muscle strain and from pressure effects—not an indication of underlying cervical pathology in most cases. 2, 4, 3