Ligaments of the neck
- Ligaments are the primary static stabilisers
- Limit end range of motion
Muscles a
Act as dynamic stabilisers |
See cheat sheet muscles of the neck |
Strains occur due to eccentric muscle contraction due to unexpected external force |
- SCM, traps, lS , scalene, paraspinals mainly affected |
Fast twitch muscles are more likely to be strained than slow twitch |
Athletes - football, ice hockey, wrestling, skiing most affected. Whiplash injuries |
Blow to the head when the head is moving forward |
Pushing, pulling, moving heavy objects, falls |
Prolonged postures, sedentary lifestyle,poor bra support , repetitive movements, pregnancy, obesity weakened CX musculature ( deep neck flexors) |
More common in females |
Children and adults both suspectable to CX sprain/strain
children due to ligamentous laxity and immature facets/unicinate
adults due to tissue being less elastic |
Presentation
Pain occurs hours/days after injury |
Dull neck pain that becomes sharp with movement |
Relieved by rest |
Pain in CX , traps or interscapular regions but can refer to anterior neck and upper arm |
Suboccipital headaches usually occur |
Upper CX facets involvement can cause vertigo and headaches |
Facial injury = extension (SCM, Longus rectus, spinal erectors, solenoid or semispinalis) rotation/lateral flexion injury= levator, scalene, SCM, traps, solenoid |
Poorly localised pain, swelling |
Loss of ROM |
Pain on end range =ligaments |
Pain on resisted = musculature |
Paraspinal spasm |
Upper crossed features. |
Neck flexion test, DNF endurance, foraminal compression, cervical distraction |
If significant trauma, consider Canadian c spine rules. Consider head injury and CX instability |
Neurological exam unremarkable if neuro findings, consider instability or disc lesion |
Red flags
Radiograph/further investigation needed if |
Dangerous mechanism.of injury |
>65 years of age |
Radiating neuro s&s |
Midline CX tenderness |
Loss of ROM (>50%) |
HX of cancer |
Bone disease |
Systemic disease |
Inflammatory arthropathy |
Steroid use |
Immunosupression |
Fever |
CX surgery |
Suspected congenital defects or instability |
Severe, unusual or prolonged pain |
EDS/Marfan's/down syndrome |
Neck gets stuck or locked with movement |
Ddx
F# |
Infection |
Disc lesion |
Arterial dissection |
Neoplasm |
Meningitis |
Myofascial pain syndrome |
Management
Ice |
Electrical stimulation |
US |
NSAIDs (if relevant) |
ROM exercises |
Isometric strengthening |
Myofascial release and stretching of scalene, levator, pecs, scm and paraspinal muscles |
Nerve mobilisation |
Avoid SMT |
CT SMT may be more appropriate |
Then stabilisation |
DNF exercises |
Upper crossed postural training to prevent further injury |
Lx spine Strain/sprain
Mainly at L4-L5 & L5-S1 |
Posterior ligaments most affected |
Strains = eccentric muscle contraction from excessive/unexpected force |
Fall, twist, lift, push, pull, direct blow, straightening from prolonged seated/crouched |
Can lead to muscle fatigue, inflammation and microtearing |
Instability = chronic overloading and dysfunction
Cycle of: Dysfunction, stiffness and abnormal coupling |
Risk Factors
Prolonged static postures |
Repetitive movements |
Improper lifting |
Sedentary lifestyles |
Poor conditioning (muscular imbalance = weak lx paraspinals and hip abductors , tightness in hip flexors and hamstrings |
Pregnancy |
Obesity |
Movements that decrease lx lordosis |
Sustained flex causes ligamentous laxity (creep) lasts >30 minutes |
More susceptible in the morning |
Presentation
Pain begins gradually in hours/days following an injury (can occur abruptly) |
Poorly localised, constant dull pain |
Aggravated by movement (flexing, bending, twisting or lifting becomes sharp) |
Relieved by rest (can cause stiffness) |
Can refer into the thigh, buttock |
Muscular spasm common |
Swelling & loss of ROM - pain on end range PROM = ligament
Pain on RROM = muscular |
SP tenderness |
Paraspinal hypertonicity |
Altered Intersegmental mobility |
Assess for directional preference |
+ve Slump, +ve PA shear +ve Kemps +ve Yeoman |
Neurological exam unremarkable |
VAS
ROBDI
RMBDI
RAND 36
BDQ
Imaging
Not usually unless red flags: |
Rule out f# (dangerous mechanism of injury) |
Significant degeneration |
Hx of cancer |
Bone/systemic disease |
Inflammatory arthropathy |
Steroid use |
Immunosupression |
Fever |
Prior spinal surgery |
Patients who do not respond to conservative care |
DDx
Segmental joint dysfunction |
Disc lesion |
Facet syndrome |
OA |
Rheumatologic disease |
F#/compression F# |
Neoplasm |
Infection |
Spondylolysis |
SI Dysfunction |
Stenosis |
Management
Ice/Heat (Ice for first 72 hours) |
Electrical stimulation |
US |
NSAIDs |
Gentle ROM exercises |
Isometric strengthening |
SMT of Lx and SI (6-12 sessions over 2-4 weeks) |
Myofascial release/stretching of Lx erectors, QL, Gluteal muscles, Hamstrings, hip flexors/psoas, hip abductors |
Nerve mobilisation |
Postural advice, sleep advice, proper lifting mechanics |
Avoid repetitive bending, twisting, lifting especially in the morning |
Encourage to remain active |
Take breaks from workstation for 10secs every 20 mins |
Lumbar support cushion |
Brugger's relief |
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