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Cervical Spine Sprain/Strain Injuries Follow-up

  • Author: Gerard A Malanga, MD; Chief Editor: Sherwin SW Ho, MD  more...
Updated: Jan 21, 2016

Return to Play

Criteria for the patient's return to unrestricted competition include the following[24, 25] :

  • Minimal or no tenderness
  • Full AROM
  • Neck strength versus resistance without pain is within normal limits (WNL)
  • Posture is WNL
  • Neurologic examination is WNL
  • Absence of neurologic symptoms

The likelihood of a recurring injury is extremely high if the player returns to action before pain, tenderness, and ROM have returned to normal.



Long-term complications that may develop from cervical injuries include chronic pain, headaches, depression, permanent loss of cervical ROM, and disability. In patients with chronic symptoms that are unresponsive to a progressive rehabilitation approach, diagnostic zygapophyseal joint injections may help to identify a potentially treatable process, which may respond to radiofrequency denervation treatment in a properly selected patient group.



For participants in football or wrestling, strengthening of the muscle groups supporting the cervical spine is imperative.[1, 2, 3] To guarantee adequate development of strength, power, and endurance, strengthening routines need to include a variety of isometric and isotonic exercises. Emphasis must be placed on strengthening not only the large cervical flexors and extensors, but also the smaller paravertebral muscle groups because they offer the final resistance to forces that may cause dislocation of the vertebrae. Sport-specific drills with emphasis on cervicothoracic spine stability should be included in the athlete’s exercise regimen.

Athletes are advised to add a minimum of 1 cm to their neck circumference. Warm-up of the neck and the cervical spine should be emphasized, especially in contact sports. By performing several repetitions of cervical flexion, cervical extension, lateral bending, and rotation, the athlete can sufficiently warm up the neck. After workouts, while the muscles are warm, stretching to maintain or increase the AROM should be completed. In all AROM, the cervical muscles should be stretched to their limits and held in the stretched position for 30-60 seconds.

In football, a proper shoulder pad should encompass many of the characteristics of a proper cervicothoracic orthosis. Important characteristics of a proper shoulder pad include a modified A-frame shape that fits the athlete's chest and prevents the shoulder pad from rolling during contact.[1, 2] Firm, circumferential fixation to the chest is important. Proper fit to the chest is important in evenly distributing the shock to the shoulders over the pad and to the thorax. Better plastics in the outer shell of the pad and improved resistive padding absorb the shock and allow the use of the shoulder in proper blocking and tackling techniques. Improved shoulder protection should allow the player to de-emphasize the use of the head as a blocking and tackling instrument.

After fixing the chest, fix the neck to the chest by the fit of the shoulder pad at the base of the neck. Thick, stiff, comfortable pads at the base of the neck are the key considerations. This lateral support at the base of the neck offers fixation to the cervical spine.



The prognosis for athletic cervical spine sprains and strains is believed to be excellent.



Proper head and neck positioning should be emphasized in all sports. Football players must be taught proper blocking and tackling techniques to avoid the head-first block or tackle, such as spearing, and the use of the head as an offensive weapon, which can increase the potential of severe cervical injury.[1, 2] Wrestlers should be instructed to avoid the maneuver of bulling the neck into a hyperextended position while attempting or blocking a takedown because this appears to be associated with the greatest number of neck injuries in wrestling.[3]

Contributor Information and Disclosures

Gerard A Malanga, MD Founder and Partner, New Jersey Sports Medicine, LLC and New Jersey Regenerative Institute; Director of Research, Atlantic Health; Clinical Professor, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey-New Jersey Medical School; Fellow, American College of Sports Medicine

Gerard A Malanga, MD is a member of the following medical societies: Alpha Omega Alpha, American Institute of Ultrasound in Medicine, North American Spine Society, International Spine Intervention Society, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine

Disclosure: Received honoraria from Cephalon for speaking and teaching; Received honoraria from Endo for speaking and teaching; Received honoraria from Genzyme for speaking and teaching; Received honoraria from Prostakan for speaking and teaching; Received consulting fee from Pfizer for speaking and teaching.


Daniel Kim, MD Staff Physician, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey

Daniel Kim, MD is a member of the following medical societies: American Medical Association

Disclosure: Nothing to disclose.

Michael J Mehnert, MD Volunteer Faculty, Department of Physical Medicine & Rehabilitation, Thomas Jefferson Medical School; Associate Physiatrist, Rothman Institute Orthopedics

Michael J Mehnert, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, Physiatric Association of Spine, Sports and Occupational Rehabilitation, International Spine Intervention Society

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.

Russell D White, MD Clinical Professor of Medicine, Clinical Professor of Orthopedic Surgery, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center-Lakewood

Russell D White, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Family Physicians, American Association of Clinical Endocrinologists, American College of Sports Medicine, American Diabetes Association, American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, Herodicus Society, American Orthopaedic Society for Sports Medicine

Disclosure: Received consulting fee from Biomet, Inc. for speaking and teaching; Received grant/research funds from Smith and Nephew for fellowship funding; Received grant/research funds from DJ Ortho for course funding; Received grant/research funds from Athletico Physical Therapy for course, research funding; Received royalty from Biomet, Inc. for consulting.

Additional Contributors

Janos P Ertl, MD Assistant Professor, Department of Orthopedic Surgery, Indiana University School of Medicine; Chief of Orthopedic Surgery, Wishard Hospital; Chief, Sports Medicine and Arthroscopy, Indiana University School of Medicine

Janos P Ertl, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, Hungarian Medical Association of America, Sierra Sacramento Valley Medical Society

Disclosure: Nothing to disclose.

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Bony framework of head and neck.
Cervical vertebrae, the atlas and the axis.
Cervical vertebrae.
External craniocervical ligaments.
Internal craniocervical ligaments.
Atlantooccipital junction.
Lateral view of the muscles of the neck.
Anterior view of the muscles of the neck.
Infrahyoid and suprahyoid muscles.
Scalene and prevertebral muscles.
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