What is it?
A strain or sprain is an injury to a muscle or ligament.  There are many parts of the neck that can be injured, such as the muscles, ligaments, bones, discs, and nerves.  A cervical strain or sprain is a neck injury that involves the muscles or ligaments of the neck. This type of injury can happen in any sport when there is a collision between two athletes, a fall, or contact with impact to the head.   In some collisions or falls, the neck may not be directly injured, but the force of the injury may cause a whiplash of the neck and cause a sprain or strain.  This can occur in many sports, but more often in football, ice hockey, lacrosse, wrestling, and soccer. 

Symptoms
The athlete may start to feel symptoms immediately after the injury, or may slowly feel worsening pain over the course of a few days.  He or she may feel soreness or stiffness in the neck muscles.  It may be difficult to move the neck in certain directions.  The athlete may also feel a spasm or tightness in the neck muscles.  This type of neck injury does not typically involve the bones, nerves, or discs of the neck.  The athlete should not have any numbness, tingling, or weakness in the arms from a true cervical strain or sprain.

Sports Medicine Evaluation/Treatment
 A sports medicine physician will perform a thorough physical examination in order to rule out a more serious neck injury, such as an injury to the spinal cord.  If there are any worrisome signs at the time of the injury, the athlete may be referred for evaluation at the emergency department.  The physical examination includes evaluation of neck movement, location of the pain, and evaluation for muscle spasm.  The athlete can expect a neurological exam to make sure there is no injury to a nerve in the neck.  Sometimes, an x-ray will be ordered to rule out a more serious neck injury.

The treatment of this condition depends on the severity of the injury.  The healthcare provider may prescribe medications to help with the pain or spasm, such as anti-inflammatory medications or mild muscle relaxers.  If the pain is mild, the athlete may be able to do exercises at home to regain full range of motion of his or her neck.  If the pain is worse, the provider may have the athlete work with the athletic trainer if available, or refer the athlete to a physical therapist.  If the athlete is not improving with these treatments over time, an MRI might be ordered to look for a disc or nerve injury.

Injury Prevention
In any collision sport such as football, it is important to play with proper form.  This includes keeping the head up for any collisions or tackles, and not leading with the helmet or head.  Athletes should be taught the proper form for tackling at practice by their coaches, and avoid tackling other athletes until proper technique has been demonstrated.

Return to play
For a cervical sprain or strain that does not include any other worrisome signs, the athlete can return to play once the pain is controlled and he/she has regained full range of motion and strength of the neck.

AMSSM Author: Kris Fayock, MD

Reference:

Decker, JE, Hergenroeder, AC. Overview of musculoskeletal injuries in the young athlete. In: UpToDate, Chorley, J, Bachur, RG (Ed), UpToDate, Waltham, MA, 2014