Neck Injury Process, Clues To Damaged Soft Tissues, Their Pain Patterns And Healing
Any neck injury, such as whiplash should be fully evaluated by a health care provider. It is not within the scope of neck solutions to discuss complications of significant forces.
In general, injuries involving soft tissues, are similar to a cut on your finger. When a tissue, such as a muscle, is involved in a neck injury, it tears and bleeds. When the bleeding stops a scab is formed. After the scab falls off a scar is left. Scar tissue is weaker, less elastic and more pain sensitive than normal tissue.
During the initial tear of a muscle in a neck injury, there is inflammation present often for the first few days, so it is important not to use heat for neck pain relief which would cause more inflammation. Cold applications are appropriate until any swelling and inflammation is gone along with a soft type of neck brace to help limit further tearing and prevent sudden temperature changes.
It is important to remember that muscles will start to weaken just a few days after motion is restricted. It is important to minmize inflammation so that motion can be restored thus minimizing scar tissue formation and muscle imbalance to limit chronic neck pain.
Muscles have a good blood supply and respond faster to a neck injury than ligaments, tendons or joint cartilage. When the inflammation is gone heat can be used along with massage and motion ranging from normal activity to neck exercises. I like to use the neck massager early in this stage for a more passive motion, progressing to neck exercises, deep massage and address neck posture problems. This process tends to minimize scar tissue problems following injury.
Muscles have certain patterns of pain related to areas of muscle strain. Nerves also have patterns of pain as illustrated in the front and back diagrams below. Additionally, patterns of pain from the neck joints can be seen to the right. This may give a clue to the tissues involved. In a neck injury there may be more than one type of tissue involved and may exhibit an overlap of pain distribution.
Healing A Neck Injury
Muscles tend to heal fast because they are richly innervated with blood vessels. These blood vessels running throughout the muscle can be torn as well and that is how some muscle pulls can be associated with black and blue discoloration at the site of injury. Pulled muscles generally take about 3 weeks to heal. Healing time may take longer if there is extensive tearing or if the muscle is re-injured before it is fully healed
Bones heal reletively quick as they have a good blood supply and blood cells are formed within the marrow. A simple fracture can heal in 5-6 weks.
Ligaments and tendons are made with thick fibrous tissue and do not have a large blood supply. When injured, they heal more slowly than bones or muscles and may take 6-8 weeks to heal. If ligaments or tendons are severley overstretched or torn, they may take musch longer to heal and may require intervention.
Cartilage and discs can take a longer time to heal and repeated damage can further lengthen the healing time. Extensive damage may require surgery, however, a reasonable estimate would be 3-6 months.
An interesting article from Spine 2003 Nov 15; 28(22), gives some perspective on how to handle a neck injury. In this case, whiplash injury patients were given active intervention carried out as simple home neck exercises. This was found to be more effective in reducing pain intensity and sick leave, and in retaining and/or regaining total range of motion than a standard intervention. The initial phase given to all patients including information, posture training, and neck rotation exercises.
Patients were instructed to perform gentle, active neck rotational movements from the neutral or straight forward position. Rotational movements are turning the head towards the shoulder and this was performed 10 times in one direction and 10 times in the opposite direction. Rotation neck movements were performed to maximum comfortable range every waking hour. Patients were instructed to perform neck exercises in the sitting position if tolerated. The unloaded, supine position (lying on the back) was recommended if the sitting position proved too painful. If rotation exercises were not tolerated, intervention was not discontinued but adjusted by either reducing the amount of rotation of the movements, reducing the number of movements, or both. If problems were still encountered, they were treated on the principles discussed in our neck pain article using the neck exercises and strecthes described.
In this study, the active intervention addressed both the organic and the functional aspects of neck injury, reducing neck pain and the need for sick leave and restoring impaired range of motion compared to standard treatment. It appears that upper arm pain and paresthesia (altered sensations) in patients with neck injury may arise from nerve tissue. The neck rotation addresses this involvement by mobilizing (moving) the nerve structures on the opposite side of rotation, thus preventing scar tissue from forming adhesions that will later cause dysfunction by sticking to nerves and pulling on them during movements causing pain and inflammation. Rotation avoids stress sensitive structures in the neck which may be caused by flexion (bending the head forward) and lateral flexion (bending the head sideways) which are often involved as the direction of injury in whiplash.
There are many factors involved with a neck injury. This is a small review of the process of healing, pain patterns of specific tissues involved and a suggestion for early mobilization where appropriate. To monitor an injury or other neck problem and the effect it has on the ability to manage everyday life, I like to use the neck pain symptoms questionnaire or the neck pain disability questionnaire. Either or both of these can help determine how healing is progressing and monitor the level of dysfuntion and disability.