What is a Neck Strain?

A neck strain is a soft tissue injury to the neck.  This is usually multifactorial and is typically not just muscular in nature, especially if caused by a severe injury.  A severe neck strain can involve an injury to all the soft tissue structures of the neck including the muscles, ligaments, tendons, facet joint capsules, and the discs.  The mechanism and severity of the injury can vary tremendously, as patients can get a neck strain from sleeping in an awkward position, or get a severe neck strain from a high speed car accident (commonly known as “whiplash”).

The neck is the most flexible part of the spine which and supports the weight of the head. The unique anatomy of the cervical vertebrae allows free movement of the head. The neck is also composed of muscles, ligaments, and discs which all protect the spinal cord and spinal nerves. Any excessive stress on the ligaments, muscles, or discs may injure or damage them.

A strain refers to an injury to the muscles, tendons, ligaments, and/or discs when they are stretched or placed under a force that exceeds their capacity. A strain can be acute (lasting days to weeks) or be chronic (lasting weeks to months).

Some of the most common activities and movements that may cause a neck strain include lack of adequate warm up exercises prior to activity, a fall, an awkward position of the neck during sleeping, or repetitive motions of the neck.  Motor vehicle accidents usually result in severe strains also known as whiplash injuries.

Neck strain symptoms

Neck strain symptoms can include:

  • neck pain

  • stiffness

  • headaches

  • muscle tightness and knots

  • fatigue

Patients often describe their neck pain in a variety of ways including burning, tingling, numbness, stabbing, or aching.  Headaches are often present as the muscles of the neck attach at the base of the skull. Severe headaches could represent another concurrent problem such as a concussion or other brain or intracranial injury, and should be investigated thoroughly, especially if the neck strain was caused by a high energy mechanism (fall from height, car accident, etc).

How is a neck strain diagnosed?

Neck strains are diagnosed with a thorough history and physical exam.  The physical exam typically shows tenderness to touch of the muscles and soft tissues of the neck, and pain and stiffness with neck range of motion.  The physical exam is also used to rule out any problems with the nerves or spinal cord. Xrays are often obtained to rule out fractures or spinal instability, especially if the neck strain symptoms are severe or the strain was caused by a high energy mechanism.  An MRI is typically not necessary or recommended as it does not change the treatment of a neck strain, and often only shows degenerative or aging related changes of the spine that were present before the neck strain.

Neck Strain Treatment - How to treat a neck strain?

Neck strain treatment is conservative and there is no role for surgical treatment.  Minor neck strains typically resolve in several days to a few weeks and can be treated with:

  • over the counter anti-inflammatory medicines

  • regular low-impact exercise (which provides increased blood flow to the muscles and helps them heal)

  • Massage

  • heat or ice.  

  • Muscle relaxer medications can help with nighttime symptoms and help patients sleep.

Neck strain exercises include chin tucks, stretching exercises to improve neck range of motion, and additionally core and mid-back strengthening which will secondarily help with neck strength and function.  These can be done after a neck strain resolves to help prevent recurrences. Severe neck strains can take many months for the symptoms to resolve, especially if caused by a car accident.  While most neck strain treatment can be done easily at home without needing to visit a doctor, seeing a doctor is recommended if patients are concerned about their symptoms or if they have questions about how to treat a neck strain.

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