Cervical Strain

THE CLINICAL SYNDROME

Acute cervical strain is a constellation of symptoms consisting of nonradicular neck pain that radiates in a nondermatomal pattern into the shoulders and intrascapular region. Headaches often accompany the symptoms of cervical strain. The trapezius is often affected, with resultant spasm and limitation in range of motion of the cervical spine. Cervical strain is usually the result of trauma to the cervical spine and associated soft tissues but may occur without an obvious inciting incident. The pathologic lesions responsible for this clinical syndrome may emanate for the soft tissues, facet joints, and/ or intervertebral disks.

SIGNS AND SYMPTOMS

Neck pain is the hallmark of cervical strain. It may begin in the occipital region and radiate in a nondermatomal pattern into the shoulders and intrascapular region. The pain of cervical strain is often exacerbated by movement of the cervical spine and shoulders. Headaches often occur along with the aforementioned symptoms and may worsened with emotional stress. Sleep disturbance is common, as is difficulty in concentrating on simple tasks. Depression may occur with prolonged symptomatology.

Cervical strain is often caused by trauma to the cervical spine and adjacent soft tissue.

On physical examination, there is tenderness on palpation, and spasm of the paraspinous musculature and trapezius is often present. Decreased range of motion is invariably present, with pain increasing with this maneuver. The neurologic examination of the upper extremities is within normal limits despite the frequent complaint of upper extremity pain.

TREATMENT

Cervical strain is best treated with a multimodality approach. Physical therapy including heat modalities and deep sedative massage, combined with nonsteroidal anti-inflammatory drugs and skeletal muscle relaxants, represent a reasonable starting point. The addition of cervical epidural nerve blocks and occasionally cervical facet blocks is a reasonable next step. For symptomatic relief, cervical epidural block and/ or blockade of the medial branch of the dorsal ramus or intra-articular injection of the facet joint with local anesthetic and steroid has been shown to be extremely effective in the treatment of cervical strain. Underlying sleep disturbance and depression are best treated with a tricyclic antidepressant compound such as nortriptyline, which can be started at a single bedtime dose of 25 mg.

Low intensity laser therapy as well as a coordinated wellness program is also effective in treating this disorder.

Low Intensity Laser Therapy (LILT)

The low intensity Laser (LILT) sends photons (light) into the injured tissues and can penetrate two to three inches to treat affected areas. It uses a natural enhancement of the cellular machinery that can and has been dynamically measured in published studies to promote healing without burning affected tissue .Once the photons find the injured tissues, they stimulate and energize the cells to repair and strengthen at a remarkable rate. The treatment does not hurt, takes about 30 minutes and is very cost advantageous.

Wellness Program

A wellness program whichindividualizes treatment for age, performance and function has been shown in pilot studies to improve the overall health and well being of the individuals evaluated. A well conceived dietary and supplementary regimen based on scientific age–related decline in certain necessary compounds can improve quality of life, correct the ravages of hormone imbalance, balance critical neurotransmitter function without resorting to powerful drugs for depression that often have unfavorable side-effect profiles and restore vitality and youth in daily exercise routines. Furthermore, when wellness products are utilized with success, individuals often seek less costly interventions including unnecessary surgeries and narcotic options to treat pain. For more information go to www.drpwellness.com.