From the Guidelines
Cervical strain is primarily caused by sudden, forceful movements of the neck that stretch or tear the muscles and tendons, with whiplash injury from motor vehicle accidents being a common cause, as well as sports injuries, falls, poor posture, repetitive neck movements, and improper ergonomics at workstations. The etiology of cervical strain can be multifactorial, involving both physical and psychological factors. Physical factors that increase the risk of cervical strain include weak neck muscles, previous neck injuries, and degenerative conditions like cervical spondylosis 1. Psychological stress can also contribute to cervical strain by increasing muscle tension in the neck and shoulders.
Key Factors Contributing to Cervical Strain
- Sudden, forceful movements of the neck
- Whiplash injury from motor vehicle accidents
- Sports injuries
- Falls
- Poor posture, especially prolonged forward head posture while using electronic devices
- Repetitive neck movements
- Improper ergonomics at workstations
- Weak neck muscles
- Previous neck injuries
- Degenerative conditions like cervical spondylosis
- Psychological stress
The pathophysiology of cervical strain involves microscopic tears in muscle fibers and tendons, leading to inflammation, pain, and protective muscle spasm. These injuries typically affect the sternocleidomastoid, trapezius, levator scapulae, and deep cervical flexor muscles. Understanding the causes of cervical strain is crucial for both prevention strategies and appropriate treatment approaches, which typically include rest, pain management, gentle stretching, and gradual strengthening exercises. According to recent studies, nearly 50% of patients with cervical or neck pain may continue to have residual or recurrent episodes of pain up to 1 year after initial presentation 1, 2.
Prevention and Treatment Approaches
- Rest
- Pain management
- Gentle stretching
- Gradual strengthening exercises
- Improving ergonomics at workstations
- Avoiding repetitive neck movements
- Maintaining good posture
- Managing psychological stress
It is essential to consider the patient's medical history and the presence of any "red flags" when evaluating cervical strain, as certain conditions may require immediate medical attention 2. The differential diagnosis of cervical or neck pain includes consideration of acute versus chronic, neuropathic versus nonneuropathic, and musculoskeletal versus nonmusculoskeletal processes. Mechanical pain associated with facet joints, intervertebral discs, muscles, or fascia represents the majority of nontraumatic cervical or neck pain. Cervical neuropathic pain most commonly includes radicular symptoms from a herniated disc or osteophyte. Additional etiologies include tumor, infection, inflammation, and vascular causes; therefore, consideration of the patient's medical history is critical to accurately guide imaging.
From the Research
Cervical Strain Etiology
- Cervical strain, also known as cervical radiculopathy, describes pain in one or both of the upper extremities, often in the setting of neck pain, secondary to compression or irritation of nerve roots in the cervical spine 3
- The most common cause of cervical radiculopathy is degenerative disease in the cervical spine 3
- Cervical strain can also be caused by trauma, such as motor vehicle collisions or falls 4
- The condition is most prevalent in persons 50 to 54 years of age 3
Risk Factors
- Age: cervical radiculopathy is most prevalent in persons 50 to 54 years of age 3
- Trauma: motor vehicle collisions or falls can cause cervical strain 4
- Degenerative disease: degenerative disease in the cervical spine is the most common cause of cervical radiculopathy 3
Diagnosis
- The diagnosis of cervical radiculopathy is based on a combination of clinical findings, including painful neck movements, muscle spasm, and diminished deep tendon reflexes 3
- Imaging studies, such as MRI, may be necessary to confirm the diagnosis and rule out other conditions 3
- Electrodiagnostic testing, such as EMG, may also be used to confirm the diagnosis 3
Treatment
- Nonoperative treatment, including physical therapy, nonsteroidal anti-inflammatory drugs, muscle relaxants, and massage, is often effective in managing cervical radiculopathy 3
- Intermittent cervical traction may also be used to relieve neck pain 5
- Epidural steroid injections may be helpful in some cases, but have higher risks of serious complications 3
- Combination therapy with cyclobenzaprine and ibuprofen may not be superior to cyclobenzaprine alone in adult patients with acute neck and back pain with muscle spasm 6