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Interview with Dr. George Frey
Editor: Does Colorado Comprehensive Spine treat many patients with neck sprains and strains?
Certainly, we see a steady stream of patients with neck pain; it is one of the most common complaints. Although neck pain may be caused by spinal stenosis, a herniated disc, or other more serious conditions, strains and sprains are the most frequent diagnosis. The pain can be severe and even temporarily disabling to the patient's everyday activities.
The frequency of this condition is closely related to our lifestyles. For example, awkward positions such as cradling the phone between the ear and shoulder, sitting in a chair that offers no support, or working at an ill-designed computer station can contribute to neck strain. Another example is whiplash, which is a type of neck strain. It may develop after an automobile accident when the head is suddenly and quickly forced forward and backward (excessive flexion and extension) during a rear-end collision. Other causes of whiplash include injuries during sports or biking.
Although, the initial neck pain may be so severe that the patient fears they have "broken" their neck, the good news is that most neck strains and sprains are easily treated and do not require spine surgery.
Editor: Please help us understand what happens when a patient strains or sprains his neck.
Well, first of all we need to briefly look at the anatomy of the neck (the cervical spine). Remarkably, only 7 small vertebrae and an intricate system of soft tissues (muscles, tendons and ligaments) support the head and enable it to move in a wide range. The cervical spine is the most mobile segment of the spine, but this mobility also makes it susceptible to strain and injury.
Cervical spine with muscles, tendons, and ligaments
Sprains and strains are soft tissue injuries. A strain affects muscles and tendons, while sprains affect ligaments. While these soft tissues provide reinforcement of the cervical vertebrae, they can be stressed and forced to the point of injury. Excessive flexion (bending forward) and extension (stretching out) activities, especially when combined with poor posture and movement mechanics, will lead to injury.
Editor: How would I know I might have strained or sprained my neck?
The typical symptoms of cervical strain and sprain include sharp pain, stiffness and difficulty when moving, and swelling. Whiplash shares these symptoms and may include headache, dizziness, difficulty swallowing and chewing, burning sensations, and shoulder discomfort.
Although these symptoms might exist, it does not necessarily mean that the patient has a sprain or strain. To make a correct diagnosis, doctors at CCSI take several steps. First, we will take a detailed patient history, asking for information about when the pain started, what makes the pain worse, and so forth.
Following this step, we will conduct a physical and neurological examination. The physical exam will include palpation, during which the physician feels the patient's spine to detect muscle spasm and areas of inflammation. The range of motion examination helps to measure the degree of injury. For example, can the patient turn his or her head from side to side comfortably or bend the neck forward and backward without pain? The neurological segment of the exam tests the patient's reflexes and sensory responses. For example, are there areas of tingling or numbness in the shoulders, arms or hands?
Finally, it is possible that physician will order an x-ray to rule out fracture. Seldom is further diagnostic testing initially required.
Editor: OK, so after this diagnostic process, what are my treatment options?
As I mentioned earlier, most sprains and strains do not require surgery. Treatment options thus focus on non-operative techniques.
The majority of patients will be prescribed medications to relieve pain and muscle spasm. Medications may include an anti-inflammatory, a muscle relaxant, and either narcotic or non-narcotic medications for pain. A narcotic is only prescribed when a non-narcotic medication is insufficient to relieve pain.
Some patients will be instructed to wear a soft cervical collar. This is a removable, padded, adjustable collar worn about the neck that serves to gently lift some of the head's weight off tender and painful neck tissues. A cervical collar is a short-term treatment (two to three weeks) to help the patient manage muscle spasm, neck fatigue, and pain.
Finally, there is physical therapy. Therapeutic exercise programs begin slowly to acclimate the patient to stretching and strengthening routines. The patient is usually provided with a home exercise program to continue on a regular basis. A strong and agile spine is one step toward preventing future injury.
In addition, physical therapy incorporates "hands on therapies" such as ultrasound, massage, heat or ice packs, and electrical stimulation. These therapies work to increase neck mobility and decrease inflammation, muscle spasm and pain. Manual therapies of this type also increase circulation to the site of injury and facilitate healing. Chiropractic care can provide good results for patients with strains and sprains.
What pleases me most about the PT programs at CCSI is the attention we give to prevention of future injuries. All of the medical staff at CCSI is trained to give patients careful instruction regarding how to prevent future injury. Many of the sprains and strains we see could have been prevented if the patient had been better educated about such issues as correct posture, good body mechanics, diet and exercise.
Editor: Do you have any final thoughts about neck sprains and strains?
Yes, don't be a hero! By that I mean if you have some of the symptoms described in this article, do not try to diagnose yourself! Visit a doctor at CCSI who is an expert at diagnosing such conditions, and at identifying other more serious conditions with similar symptoms. We'll help you on the road to a speedy recovery.
Editor: Thank you Dr. Frey for your time and insights.