Cervical Strain and Sprain (Whiplash)

with Rehab

ExitCare ImageCervical strain and sprains are injuries that commonly occur with "whiplash" injuries. Whiplash occurs when the neck is forcefully whipped backward or forward, such as during a motor vehicle accident. The muscles, ligaments, tendons, discs and nerves of the neck are susceptible to injury when this occurs.

SYMPTOMS

  • Pain or stiffness in the front and/or back of neck

  • Symptoms may present immediately or up to 24 hours after injury.

  • Dizziness, headache, nausea and vomiting.

  • Muscle spasm with soreness and stiffness in the neck.

  • Tenderness and swelling at the injury site.

CAUSES

Whiplash injuries often occur during contact sports or motor vehicle accidents.

RISK INCREASES WITH:

  • Osteoarthritis of the spine.

  • Situations that make head or neck accidents or trauma more likely.

  • High-risk sports (football, rugby, wrestling, hockey, auto racing, gymnastics, diving, contact karate or boxing).

  • Poor strength and flexibility of the neck.

  • Previous neck injury.

  • Poor tackling technique.

  • Improperly fitted or padded equipment.

PREVENTION

  • Learn and use proper technique (avoid tackling with the head, spearing and head-butting; use proper falling techniques to avoid landing on the head).

  • Warm up and stretch properly before activity.

  • Maintain physical fitness:

  • Strength, flexibility and endurance.

  • Cardiovascular fitness.

  • Wear properly fitted and padded protective equipment, such as padded soft collars, for participation in contact sports.

PROGNOSIS

Recovery for cervical strain and sprain injuries is dependent on the extent of the injury. These injuries are usually curable in 1 week to 3 months with appropriate treatment.

RELATED COMPLICATIONS

  • Temporary numbness and weakness may occur if the nerve roots are damaged, and this may persist until the nerve has completely healed.

  • Chronic pain due to frequent recurrence of symptoms.

  • Prolonged healing, especially if activity is resumed too soon (before complete recovery).

TREATMENT

Treatment initially involves the use of ice and medication to help reduce pain and inflammation. It is also important to perform strengthening and stretching exercises and modify activities that worsen symptoms so the injury does not get worse. These exercises may be performed at home or with a therapist. For patients who experience severe symptoms, a soft padded collar may be recommended to be worn around the neck.

Improving your posture may help reduce symptoms. Posture improvement includes pulling your chin and abdomen in while sitting or standing. If you are sitting, sit in a firm chair with your buttocks against the back of the chair. While sleeping, try replacing your pillow with a small towel rolled to 2 inches in diameter, or use a cervical pillow or soft cervical collar. Poor sleeping positions delay healing.

For patients with nerve root damage, which causes numbness or weakness, the use of a cervical traction apparatus may be recommended. Surgery is rarely necessary for these injuries. However, cervical strain and sprains that are present at birth (congenital) may require surgery.

MEDICATION

  • If pain medication is necessary, nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended.

  • Do not take pain medication for 7 days before surgery.

  • Prescription pain relievers may be given if deemed necessary by your caregiver. Use only as directed and only as much as you need.

HEAT AND COLD:

  • Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat treatment may be used prior to performing the stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or a warm soak.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 2 weeks despite treatment.

  • New, unexplained symptoms develop (drugs used in treatment may produce side effects).

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Cervical Strain and Sprain

These exercises may help you when beginning to rehabilitate your injury. In order to successfully resolve your symptoms, you must improve your posture. These exercises are designed to help reduce the forward-head and rounded-shoulder posture which contributes to this condition. Your symptoms may resolve with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 20 seconds, although you may need to begin with shorter hold times for comfort.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

ExitCare Image STRETCH- Axial Extensors

  • Lie on your back on the floor. You may bend your knees for comfort. Place a rolled up hand towel or dish towel, about 2 inches in diameter, under the part of your head that makes contact with the floor.

  • Gently tuck your chin, as if trying to make a "double chin," until you feel a gentle stretch at the base of your head.

  • Hold __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRETECH - Axial Extension

  • Stand or sit on a firm surface. Assume a good posture: chest up, shoulders drawn back, abdominal muscles slightly tense, knees unlocked (if standing) and feet hip width apart.

  • Slowly retract your chin so your head slides back and your chin slightly lowers.Continue to look straight ahead.

  • You should feel a gentle stretch in the back of your head. Be certain not to feel an aggressive stretch since this can cause headaches later.

  • Hold for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRETCH – Cervical Side Bend

  • Stand or sit on a firm surface. Assume a good posture: chest up, shoulders drawn back, abdominal muscles slightly tense, knees unlocked (if standing) and feet hip width apart.

  • Without letting your nose or shoulders move, slowly tip your right / left ear to your shoulder until your feel a gentle stretch in the muscles on the opposite side of your neck.

  • Hold __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRETCH – Cervical Rotators

  • Stand or sit on a firm surface. Assume a good posture: chest up, shoulders drawn back, abdominal muscles slightly tense, knees unlocked (if standing) and feet hip width apart.

  • Keeping your eyes level with the ground, slowly turn your head until you feel a gentle stretch along the back and opposite side of your neck.

  • Hold __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image RANGE OF MOTION - Neck Circles

  • Stand or sit on a firm surface. Assume a good posture: chest up, shoulders drawn back, abdominal muscles slightly tense, knees unlocked (if standing) and feet hip width apart.

  • Gently roll your head down and around from the back of one shoulder to the back of the other. The motion should never be forced or painful.

  • Repeat the motion 10-20 times, or until you feel the neck muscles relax and loosen.

Repeat __________ times. Complete the exercise __________ times per day.

STRENGTHENING EXERCISES - Cervical Strain and Sprain

These exercises may help you when beginning to rehabilitate your injury. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Progress the resistance and repetitions only as guided.

  • You may experience muscle soreness or fatigue, but the pain or discomfort you are trying to eliminate should never worsen during these exercises. If this pain does worsen, stop and make certain you are following the directions exactly. If the pain is still present after adjustments, discontinue the exercise until you can discuss the trouble with your clinician.

ExitCare Image STRENGTH – Cervical Flexors, Isometric

  • Face a wall, standing about 6 inches away. Place a small pillow, a ball about 6-8 inches in diameter, or a folded towel between your forehead and the wall.

  • Slightly tuck your chin and gently push your forehead into the soft object. Push only with mild to moderate intensity, building up tension gradually. Keep your jaw and forehead relaxed.

  • Hold 10 to 20 seconds. Keep your breathing relaxed.

  • Release the tension slowly. Relax your neck muscles completely before you start the next repetition.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH- Cervical Lateral Flexors, Isometric

  • Stand about 6 inches away from a wall. Place a small pillow, a ball about 6-8 inches in diameter, or a folded towel between the side of your head and the wall.

  • Slightly tuck your chin and gently tilt your head into the soft object. Push only with mild to moderate intensity, building up tension gradually. Keep your jaw and forehead relaxed.

  • Hold 10 to 20 seconds. Keep your breathing relaxed.

  • Release the tension slowly. Relax your neck muscles completely before you start the next repetition.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH – Cervical Extensors, Isometric

  • Stand about 6 inches away from a wall. Place a small pillow, a ball about 6-8 inches in diameter, or a folded towel between the back of your head and the wall.

  • Slightly tuck your chin and gently tilt your head back into the soft object. Push only with mild to moderate intensity, building up tension gradually. Keep your jaw and forehead relaxed.

  • Hold 10 to 20 seconds. Keep your breathing relaxed.

  • Release the tension slowly. Relax your neck muscles completely before you start the next repetition.

Repeat __________ times. Complete this exercise __________ times per day.

POSTURE AND BODY MECHANICS CONSIDERATIONS - Cervical Strain and Sprain

Keeping correct posture when sitting, standing or completing your activities will reduce the stress put on different body tissues, allowing injured tissues a chance to heal and limiting painful experiences. The following are general guidelines for improved posture. Your physician or physical therapist will provide you with any instructions specific to your needs. While reading these guidelines, remember:

  • The exercises prescribed by your provider will help you have the flexibility and strength to maintain correct postures.

  • The correct posture provides the optimal environment for your joints to work. All of your joints have less wear and tear when properly supported by a spine with good posture. This means you will experience a healthier, less painful body.

  • Correct posture must be practiced with all of your activities, especially prolonged sitting and standing. Correct posture is as important when doing repetitive low-stress activities (typing) as it is when doing a single heavy-load activity (lifting).

ExitCare Image PROLONGED STANDING WHILE SLIGHTLY LEANING FORWARD

When completing a task that requires you to lean forward while standing in one place for a long time, place either foot up on a stationary 2-4 inch high object to help maintain the best posture. When both feet are on the ground, the low back tends to lose its slight inward curve. If this curve flattens (or becomes too large), then the back and your other joints will experience too much stress, fatigue more quickly and can cause pain.

ExitCare Image RESTING POSITIONS

Consider which positions are most painful for you when choosing a resting position. If you have pain with flexion-based activities (sitting, bending, stooping, squatting), choose a position that allows you to rest in a less flexed posture. You would want to avoid curling into a fetal position on your side. If your pain worsens with extension-based activities (prolonged standing, working overhead), avoid resting in an extended position such as sleeping on your stomach. Most people will find more comfort when they rest with their spine in a more neutral position, neither too rounded nor too arched. Lying on a non-sagging bed on your side with a pillow between your knees, or on your back with a pillow under your knees will often provide some relief. Keep in mind, being in any one position for a prolonged period of time, no matter how correct your posture, can still lead to stiffness.

ExitCare Image WALKING

Walk with an upright posture. Your ears, shoulders and hips should all line-up.

OFFICE WORK

When working at a desk, create an environment that supports good, upright posture. Without extra support, muscles fatigue and lead to excessive strain on joints and other tissues.

ExitCare Image CHAIR:

  • A chair should be able to slide under your desk when your back makes contact with the back of the chair. This allows you to work closely.

  • The chair's height should allow your eyes to be level with the upper part of your monitor and your hands to be slightly lower than your elbows.

  • Body position:

  • Your feet should make contact with the floor. If this is not possible, use a foot rest.

  • Keep your ears over your shoulders. This will reduce stress on your neck and low back.