Is it common for an adult wearing a hard or semi‑rigid cervical collar to develop lateral neck muscle pain at the shoulder attachment sites?

Lateral Neck Muscle Pain with Cervical Collar Use

Yes, lateral neck muscle pain at the shoulder attachment sites is extremely common when wearing hard or semi-rigid cervical collars, typically emerging after 48–72 hours of continuous wear due to paraspinal muscle strain from maintaining static posture against the device's resistance. 1

Mechanism of Collar-Related Neck Pain

The discomfort you're experiencing is a well-documented adverse effect of cervical collar use:

• Paraspinal muscle strain develops as patients maintain a fixed posture against the collar's restriction, causing soreness in the lateral neck muscles where they attach to the shoulder 1
• Direct pressure-related discomfort occurs at contact points between the collar and neck structures, contributing to tissue irritation 1
• Rigid collars provide more immobilization than soft collars (59% vs 39% restriction in flexion), which paradoxically increases muscle strain as your body fights against the restriction 2

Prevalence and Timing

• Neck muscle soreness and discomfort frequently occur in adult patients wearing hard or semi-rigid cervical collars 1
• Pain typically emerges after more than 48–72 hours of continuous wear 1
• In one study, more than half of patients reported complications from wearing cervical collars, including pain, skin irritation, problems sleeping, and difficulty talking or swallowing 3

Escalating Complications Beyond 72 Hours

Keeping a collar in place beyond 48–72 hours markedly increases overall morbidity, with complications escalating rapidly: 1

• Pressure ulcers are common and severe cases may require skin grafting, costing approximately $30,000 per ulcer to treat 1
• The occiput experiences significantly higher interface pressures than the chin and mandibles, putting this area at increased risk 4
• Increased intracranial pressure worsens outcomes in patients with co-existing head injuries 1, 5
• Airway compromise can become life-threatening with extended collar use 1
• Thromboembolic events occur in 7%–100% of immobilized patients lacking adequate prophylaxis 1

Critical Guideline Recommendations

The American Heart Association recommends against routine cervical collar application by first-aid providers, citing documented harms that outweigh potential benefits: 1, 5

• Do not retain patients in collars beyond 72 hours without a definitive surgical plan, as the risk of complications often surpasses the risk of a missed injury 1, 6
• High-quality CT scanning has approximately 98% sensitivity for clinically significant cervical injuries 7, 1
• If imaging reliably excludes unstable injury, consider collar removal; early mobilization and therapeutic exercise are effective in reducing both acute and chronic neck pain 1

Paradoxical Ineffectiveness

Despite causing significant discomfort, cervical collars may not adequately protect you:

• Rigid collars may not adequately restrict motion of unstable cervical injuries, particularly at the craniocervical and cervicothoracic junctions 1, 5
• Application of collars can produce paradoxical movement of adjacent vertebrae, potentially compromising injury stabilization 1
• In cadaveric models, collars caused greater cervical spine movement compared to manual stabilization during certain maneuvers 5, 6

Clinical Pitfall to Avoid

The most common error is prolonged collar use when not indicated by clinical or radiographic findings: 5

• If you have negative cervical imaging and no focal neurologic deficit, continued collar use may cause more harm than benefit 3
• In one study of 45 patients discharged with collars despite negative imaging, there were no missed traumatic injuries on follow-up, but collar complications were frequent 3
• Twenty of 45 patients cleared themselves from the collar without physician order, suggesting the device was unnecessary 3

What to Do About Your Pain

Assess pressure points for tissue injury, especially after 48–72 hours of collar wear: 1

• Re-evaluate the need for continued immobilization with your healthcare provider 1
• If high-quality CT has excluded unstable injury and you have no neurologic deficits, discuss collar removal 1, 3
• The documented harms of prolonged immobilization often exceed the risks of missed injury when imaging is negative 1, 5