Typically they are used in three situations:. Cervical neck collars are commonly used for neck injuries, such as whiplash. Whiplash is a soft tissue injury to the neck, and is also known as a neck sprain.
After serious car accidents, victims are often placed in a neck collar for precautionary measures. A hard cervical collar is used for spine problems or injuries. It limits forward and backward movement more than a soft one does. Hard collars are usually only used after major surgery or a serious injury, such as a broken neck. You may get a hard cervical collar after you've used a halo brace. A halo brace attaches to your head. It provides very stiff support of your neck.
A hard cervical collar fits from your chin to your breastbone sternum. It extends from the base of your head down to the top of your back. Sometimes, the top of the collar fits tightly around the lower jaw. Your doctor can make sure that your cervical collar is the right size and fit. This will provide the best support for your spine.
Some types of cervical braces cover more of your body. These braces limit your neck movement even more. It's important to wear your neck brace or collar correctly. Dehner et al. The patients in this study, presented within 24 h of whiplash injury WAD grade 2 to an emergency department.
They were randomized to two therapy groups; 2-days vs. After 7 days, all patients started a standardized physical therapy program, 2—3 times a week for up to 6 weeks. At both 2 and 6 months, there was no statistically significant difference between the groups for all measured outcomes pain, disability, or ROM. The authors concluded that for patients with WAD grade 2 whiplash injury there is no difference between 2 and 10 days of immobilization with a soft cervical collar.
Therefore, there does not seem to be any significant benefit to extending the duration of collar usage. However, for those patients with acute neck pain, who prefer the use of a collar, it may be helpful, and at least for the first 10 days, it has not been found to be harmful. Cervical radiculopathy is a pathologic process involving the nerve root, arising from disk herniation, spondylosis, tumor, or trauma causing nerve root avulsion.
Cervical radiculopathy may also occur in a setting in which no definite cause can be determined. The typical clinical picture is pain, paresthesia, weakness, or a combination of these symptoms [ 32 ]. In most studies, the pain is present in the upper limb more frequently than in the neck, although it is usually present in both the areas [ 33 ].
Cervical radiculopathy can usually be treated without surgery [ 34 ]. Although most studies discussing cervical collars for the management of pain have focused on whiplash patients, there have been a few that have studied patients with radicular pain.
Saal et al. All patients were treated with ice, rest, a hard cervical collar worn for up to 2 weeks, NSAIDs, traction, and strengthening exercises. More aggressive interventions were used i. The patients were followed for a 1-year period. Data analyzed included symptom level, activity and function level, medication and ongoing medical care, job status, and satisfaction. None of the patients had progressive neurological loss, and all patients with motor loss reached neurologic improvement.
The authors concluded that many cervical disk herniations, which are commonly referred for surgery, can be successfully managed with aggressive nonsurgical treatment. In this study, there were no control or comparison groups.
Therefore, no conclusion can be made about the efficacy of surgery versus nonsurgical interventions. Additionally, we cannot conclude which specific nonsurgical interventions should be implemented.
Therefore, although this study may suggest that a rigid cervical collar plays a role in treating cervical radiculopathy, there remains no clear evidence for or against the use of cervical collars. Persson et al. The patients were randomly allocated to surgery, individually adapted physiotherapy, or a rigid cervical collar. Based on the above studies, no clear conclusion can be drawn as to the role of hard cervical collars for radicular pain.
At best, these studies suggest that collars may be helpful when combined with other non-operative interventions. Most trauma patients in the US arrive at the hospital immobilized [ 36 ].
Routinely, this immobilization includes a hard spine board, a cervical collar, and a means to prevent rotation of the head. A hard cervical collar and a firm mattress are the standard means of immobilizing patients with documented unstable injuries in the ED or ICU before application of traction or definitive stabilization.
They determined that only patients with midline neck tenderness, focal neurologic deficits, altered mental status, intoxication, or a painful distracting injury require radiographs to exclude spinal injury. These criteria were Therefore, if the patient is neurologically intact, alert, without neck tenderness, they can be cleared from the precautions clinically, without obtaining a radiograph.
Cervical collars have been found to be helpful in the management of spinal stabilization for atlantoaxial rotatory subluxation AARS and various cervical spine fractures. A study by Subach et al. All the patients had presented with torticollis and symptoms of neck pain and decreased cervical motion for a mean of Five patients were initially treated with a rigid cervical collar and anti-inflamatory agents.
A total of 15 patients were treated with cervical traction. All the patients were immobilized post-reduction for approximately 12 weeks. Four of the five patients in the collar group reduced spontaneously, whereas the fifth required cervical traction and eventual fusion for recurrence. Of the 16 patients treated with traction, normal atlantoaxial alignment was restored in We see from this study that rigid cervical collars may play a role successfully managing AARS.
Kontautas et al. Additionally, in a retrospective review of cervical spine injuries, the authors concluded that generally, vertical C2 body fractures are amenable to nonoperative treatment [ 40 ].
The C2 fractures in the study were immobilized with either a Minerva jacket, halo, or a rigid cervical collar. However, given the retrospective nature of the study and small sample size, recommendations regarding a specific device for external mobilization, cannot be made with certainty. In whiplash patients, most studies suggest that early mobilization and activity is superior to immobilization and soft cervical collar use.
However, more recent studies have not found any long-term benefits of early aggressive treatment as compared to immobilization. Therefore, no definite conclusion can be drawn about the efficacy of cervical collars in this population. Our conclusions are that cervical collars should not be universally recommended to all whiplash patients. However, for patients who find it useful for symptom relief, a soft cervical collar for 10 days or less has not been shown to have any adverse impact.
Rigid cervical collars have a well-established role in the acute management of trauma patients to prevent instability of the cervical spine. They also may play a role in the conservative treatment of certain types of cervical fractures such as nondisplaced axis fractures and C2 body fractures.
However, since most of the studies done in patients with fractures, were case series and lacked an adequate control group, no specific recommendations can be made in this population.
Several studies suggest that hard cervical collars may play a role in the conservative management of cervical radiculopathy. However, sufficient evidence is lacking to advocate its routine usage. Further studies are needed for patients with non-traumatic axial neck pain, and radicular pain with or without trauma to understand the role that cervical collars may play in their management.
National Center for Biotechnology Information , U. Curr Rev Musculoskelet Med. Published online Dec Author information Copyright and License information Disclaimer. Stefan Muzin, Email: gro. Corresponding author. This article has been cited by other articles in PMC.
Abstract Neck pain is one of the most prevalent and costly health problems in the United States. Introduction Neck pain is one of the most prevalent and costly health problems in the United States [ 1 ].
Table 1 Normal cervical motion from occiput to first thoracic vertebra and the effects of cervical orthoses. Open in a separate window. Whiplash patients Whiplash is currently defined as a traumatic injury to the soft tissue structures in the region of the cervical spine caused by hyperflexion, hyperextension, or rotation injury in the absence of fractures, dislocations or intervertebral disk herniations [ 17 ].
Radicular neck pain Cervical radiculopathy is a pathologic process involving the nerve root, arising from disk herniation, spondylosis, tumor, or trauma causing nerve root avulsion. Cervical collars for spine stabilization Most trauma patients in the US arrive at the hospital immobilized [ 36 ]. Conclusion In whiplash patients, most studies suggest that early mobilization and activity is superior to immobilization and soft cervical collar use. References 1. National Ambulatory Medical Care Survey: summary.
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