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Cervical Strain Follow-up

  • Author: Warren Magnus, DO; Chief Editor: Trevor John Mills, MD, MPH  more...
Updated: Oct 15, 2015

Further Outpatient Care

Follow-up with a primary care physician is strongly recommended in cervical strain injuries to facilitate further care. For patients involved in occupational injuries, appropriate referral for follow-up is particularly important.

Recent literature, such as the cohort study by Pape et al in the European JournalofPain, suggests that initial conservative management is associated with a better long-term outcome than overly aggressive, multidisciplinary approaches.[12] Therefore, limiting follow-up to primary care referral only and avoiding other interventions such as chiropractic care my be most appropriate.

If additional treatments are to be considered, therapeutic massage appears to have little benefit in the management of strain injuries.[13] Therapeutic exercises can, however, be of benefit in the management of neck pain, especially in an athletic population.[14] Stain/counterstain manual medicine techniques have been shown to relieve pain in cervical injuries when compared with sham techniques and may be adjunctive in the management of cervical strain.[15, 16]

Regardless of whether the patient is referred, vigilance for decreased function secondary to disuse or long-standing injury should be maintained to prevent long-term sequelae from the strain injury.


Inpatient & Outpatient Medications

Outpatient medications should include acetaminophen or an NSAID.

Muscle relaxant medications may be considered adjunctive care.



Avoidance of unusual postures (eg, painting overhead, sitting in the front row at the movies) for extended periods can prevent acute low-speed strain injuries.

Avoidance of chronic straining (eg, using the neck to hold the telephone, other malposition syndromes) or repetitive motion of neck muscles and/or ergonomic planning and regular breaks can assist in avoiding a significant number of cervical strain injuries.



Long-term complications of strain injuries are typically related to decreased function secondary to disuse.

Patients who fail to recover experience diffuse somatic, musculoskeletal, and anxiety symptoms. An awareness of these factors can assist in identifying and planning appropriate treatment for these individuals.[17]



Patients with cervical strain injuries who are compliant with recommended therapy, including rest, ice, and physical therapy or exercise programs, often make full, rapid recoveries.


Patient Education

Prior to discharge from the ED, patients should be made aware of the potential for long-term injury due to noncompliance.

Patients should be advised of the benefits of ice versus heat in acute injuries.

Patient education in basic exercises can enhance mobility and minimize discomfort during the recovery period.

During follow-up visits, referral to a physical therapist for patients with markedly decreased range of motion or long-standing injury prior to presentation can be significantly beneficial in regaining range of motion as well as strengthening cervical musculature.[18]

For excellent patient education resources, visit eMedicineHealth's First Aid and Injuries Center. Also, see eMedicineHealth's patient education articles Neck Strain and Whiplash.

Contributor Information and Disclosures

Warren Magnus, DO Center Medical Director, Concentra

Warren Magnus, DO is a member of the following medical societies: American Osteopathic Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Eric L Legome, MD Chief, Department of Emergency Medicine, Kings County Hospital Center; Professor Clinical, Department of Emergency Medicine, State University of New York Downstate College of Medicine

Eric L Legome, MD is a member of the following medical societies: Alpha Omega Alpha, Council of Emergency Medicine Residency Directors, American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Trevor John Mills, MD, MPH Chief of Emergency Medicine, Veterans Affairs Northern California Health Care System; Professor of Emergency Medicine, Department of Emergency Medicine, University of California, Davis, School of Medicine

Trevor John Mills, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.


The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Natalie T Shum, MD, to the development and writing of this article.

  1. Spitzer WO, Skovron ML, Salmi LR, et al. Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: redefining "whiplash" and its management. Spine. 1995 Apr 15. 20(8 Suppl):1S-73S. [Medline].

  2. Conforti M, Fachinetti GP. High power laser therapy treatment compared to simple segmental physical rehabilitation in whiplash injuries (1° and 2° grade of the Quebec Task Force classification) involving muscles and ligaments. Muscles Ligaments Tendons J. 2013 Apr. 3(2):106-11. [Medline]. [Full Text].

  3. Blackmore CC, Mann FA, Wilson AJ. Helical CT in the primary trauma evaluation of the cervical spine: an evidence-based approach. Skeletal Radiol. 2000 Nov. 29(11):632-9. [Medline].

  4. Grogan EL, Morris JA Jr, Dittus RS, et al. Cervical spine evaluation in urban trauma centers: lowering institutional costs and complications through helical CT scan. J Am Coll Surg. 2005 Feb. 200(2):160-5. [Medline].

  5. Resnick S, Inaba K, Karamanos E, Pham M, Byerly S, Talving P, et al. Clinical relevance of magnetic resonance imaging in cervical spine clearance: a prospective study. JAMA Surg. 2014 Sep. 149 (9):934-9. [Medline].

  6. Grunau BE, Dibski D, Hall J. The daunting task of "clearing" the cervical spine. CJEM. 2012 May. 14 (3):187-92. [Medline].

  7. Khwaja SM, Minnerop M, Singer AJ. Comparison of ibuprofen, cyclobenzaprine or both in patients with acute cervical strain: a randomized controlled trial. CJEM. 2010 Jan. 12(1):39-44. [Medline].

  8. Frohna WJ. Emergency department evaluation and treatment of the neck and cervical spine injuries. Emerg Med Clin North Am. 1999 Nov. 17(4):739-91, v. [Medline].

  9. Wiangkham T, Duda J, Haque S, Madi M, Rushton A. The Effectiveness of Conservative Management for Acute Whiplash Associated Disorder (WAD) II: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. PLoS One. 2015. 10 (7):e0133415. [Medline].

  10. Borchgrevink GE, Kaasa A, McDonagh D, Stiles TC, Haraldseth O, Lereim I. Acute treatment of whiplash neck sprain injuries. A randomized trial of treatment during the first 14 days after a car accident. Spine. 1998 Jan 1. 23(1):25-31. [Medline].

  11. Kongsted A, Qerama E, Kasch H, et al. Neck collar, "act-as-usual" or active mobilization for whiplash injury? A randomized parallel-group trial. Spine. 2007 Mar 15. 32(6):618-26. [Medline].

  12. Pape E, Hagen KB, Brox JI, Natvig B, Schirmer H. Early multidisciplinary evaluation and advice was ineffective for whiplash-associated disorders. Eur J Pain. 2009 Jan 30. [Medline].

  13. Patel KC, Gross A, Graham N, Goldsmith CH, Ezzo J, Morien A, et al. Massage for mechanical neck disorders. Cochrane Database Syst Rev. 2012 Sep 12. 9:CD004871. [Medline].

  14. Durall CJ. Therapeutic exercise for athletes with nonspecific neck pain: a current concepts review. Sports Health. 2012 Jul. 4(4):293-301. [Medline]. [Full Text].

  15. Brose SW, Jennings DC, Kwok J, Stuart CL, O'Connell SM, Pauli HA, et al. Sham manual medicine protocol for cervical strain-counterstrain research. PM R. 2013 May. 5(5):400-7. [Medline].

  16. Klein R, Bareis A, Schneider A, Linde K. Strain-counterstrain to treat restrictions of the mobility of the cervical spine in patients with neck pain: a sham-controlled randomized trial. Complement Ther Med. 2013 Feb. 21(1):1-7. [Medline].

  17. Myrtveit SM, Skogen JC, Petrie KJ, Wilhelmsen I, Wenzel HG, Sivertsen B. Factors Related to Non-recovery from Whiplash. The Nord-Trøndelag Health Study (HUNT). Int J Behav Med. 2013 Sep 19. [Medline].

  18. Nieto R, Miró J, Huguet A. Pain-Related Fear of Movement and Catastrophizing in Whiplash-Associated Disorders. Rehabil Psychol. 2013 Sep 16. [Medline].

  19. Beazell JR, Magrum EM. Rehabilitation of head and neck injuries in the athlete. Clin Sports Med. 2003 Jul. 22(3):523-57. [Medline].

  20. Bourbeau R, Desjardins D, Maag U, Laberge-Nadeau C. Neck injuries among belted and unbelted occupants of the front seat of cars. J Trauma. 1993 Nov. 35(5):794-9. [Medline].

  21. Bylund PO, Bjornstig U. Sick leave and disability pension among passenger car occupants injured in urban traffic. Spine. 1998 May 1. 23(9):1023-8. [Medline].

  22. Calliet R. Neck and Arm Pain. 2nd ed. FA Davis Co; 1981.

  23. Daffner RH. Controversies in cervical spine imaging in trauma patients. Emerg Radiol. 2004 Aug. 11(1):2-8. [Medline].

  24. Davis CG. Injury threshold: whiplash-associated disorders. J Manipulative Physiol Ther. 2000 Jul-Aug. 23(6):420-7. [Medline].

  25. Dickinson G, Stiell IG, Schull M, et al. Retrospective application of the NEXUS low-risk criteria for cervical spine radiography in Canadian emergency departments. Ann Emerg Med. 2004 Apr. 43(4):507-14. [Medline].

  26. Dreyer SJ, Boden SD. Laboratory evaluation in neck pain. Phys Med Rehabil Clin N Am. 2003 Aug. 14(3):589-604. [Medline].

  27. Galasko CSB, Murray P, Stephenson W. Incidence of whiplash-associated disorder. BCMJ. Jun 2002. 44(5):237-240. [Full Text].

  28. Griffiths HJ, Olson PN, Everson LI, Winemiller M. Hyperextension strain or "whiplash" injuries to the cervical spine. Skeletal Radiol. 1995 May. 24(4):263-6. [Medline].

  29. Hoffman JR, Schriger DL, Mower W, Luo JS, Zucker M. Low-risk criteria for cervical-spine radiography in blunt trauma: a prospective study. Ann Emerg Med. 1992 Dec. 21(12):1454-60. [Medline].

  30. Kappler RE. Cervical Spine. Ward RC, et al, eds. Foundations for Osteopathic Medicine. Lippincott, Williams & Wilkins; 1997. 541-546.

  31. Ladig D, DeBell LS, Hubert MK. Mosby's Complete Drug Reference 1997. Physicians GenRx. Mosby-Year Book, Inc; 1997.

  32. Martinez JA, Timberlake GA, Jones JC, et al. Factors affecting the cervical prevertebral space in the trauma patient. Am J Emerg Med. 1988 May. 6(3):268-72. [Medline].

  33. McMorland G, Suter E. Chiropractic management of mechanical neck and low-back pain: a retrospective, outcome-based analysis. J Manipulative Physiol Ther. 2000 Jun. 23(5):307-11. [Medline].

  34. McSwain NE, Martinez JA, Timberlake GA. Cervical Spine Trauma: Evaluation and Acute Management. 1989.

  35. Patel RV, DeLong W Jr, Vresilovic EJ. Evaluation and treatment of spinal injuries in the patient with polytrauma. Clin Orthop Relat Res. 2004 May. 43-54. [Medline].

  36. Richards PJ. Cervical spine clearance: a review. Injury. 2005 Feb. 36(2):248-69; discussion 270. [Medline].

  37. Shaffer MA, Doris PE. Limitation of the cross table lateral view in detecting cervical spine injuries: a retrospective analysis. Ann Emerg Med. 1981 Oct. 10(10):508-13. [Medline].

  38. Stiell IG, Clement CM, McKnight RD, et al. The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma. N Engl J Med. 2003 Dec 25. 349(26):2510-8. [Medline].

  39. Sturzenegger M, DiStefano G, Radanov BP, Schnidrig A. Presenting symptoms and signs after whiplash injury: the influence of accident mechanisms. Neurology. 1994 Apr. 44(4):688-93. [Medline].

  40. Van Goethem JW, Maes M, Ozsarlak O, van den Hauwe L, Parizel PM. Imaging in spinal trauma. Eur Radiol. 2005 Mar. 15(3):582-90. [Medline].

  41. Wang JC, Hatch JD, Sandhu HS, Delamarter RB. Cervical flexion and extension radiographs in acutely injured patients. Clin Orthop Relat Res. 1999 Aug. 111-6. [Medline].

  42. Zmurko MG, Tannoury TY, Tannoury CA, Anderson DG. Cervical sprains, disc herniations, minor fractures, and other cervical injuries in the athlete. Clin Sports Med. 2003 Jul. 22(3):513-21. [Medline].

External craniocervical ligaments.
Internal craniocervical ligaments.
Lateral view of the muscles of the neck.
Anterior view of the muscles of the neck.
Radiograph of the cervical spine shows a normal lordotic curve.
Radiograph of the cervical spine shows straightening of the lordotic curve.
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