Cervical Strain Follow-up
- Author: Warren Magnus, DO; Chief Editor: Trevor John Mills, MD, MPH more...
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. 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. Therapeutic exercises can, however, be of benefit in the management of neck pain, especially in an athletic population. 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.
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.
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.
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