The incidence of fatal neck injuries in sports has decreased owing to better protective gear, better coaching, and rule changes, and increased awareness among the athletes. Sports injuries and whiplash injuries are some of the main causes of neck pain cervical sprains/strains.

Still, such injuries occur in contact sports like soccer, American football, rugby and non-contact sports like gymnastics and cycling.

Neck muscular pain may occur due to sprains, strains, fracture of neck bones (very rare), and so on.

Our spine is part of our axial skeleton playing an important role in providing structural support to our body. Besides, it also accommodates the spinal column that has an active role in our motor and sensory functions and connects the brain to the rest of the body.

The neck (cervical) region comprises of seven bones; the C- vertebrae (C1-C7). Each vertebrae is separated from the next by an intervertebral disc that caters to the flexibility of the cervical region and increases the range of motion.

The discs also act as shock absorbers and their function is complemented by string neck muscles, ligaments, and flexible tendons.

The cervical bones are arranged in a supportive manner. The first two vertebrae (C1 and C2) join directly to the skull bones.

Causes of neck pain muscular strain

Neck muscular pain due to sports injuries is usually due to acute cervical sprains/strains including whiplash injury.

Acute cervical sprain and strain is common condition in people who play sports. It is a neck injury involving the ligaments or muscles of the neck.

Cervical sprain and strains usually occur due to collision or contact injury. Sometimes, the head is not directly affected but the force or impact of the injury may damage causing a whiplash injury. Often encountered in games like soccer, football, ice hockey, lacrosse, and wrestling.

A muscle comprises numerous muscle fibers which in turn is made up of bundles of tiny fibers called myofibrils. The myofibrils contain the proteins (actin and myosin) that contract and relax during a movement. During a muscular strain, these small fibers tear away.

Some other causes of neck strain include;

• Overexertion of a muscle or stretching it too far during a warm up
•  Overextending cold muscles

The number of muscles torn is directly proportional to the extent of injury requiring more time to heal and recover.

The neck is supported by more than 20 muscles, all working together to support the upright position of the head and facilitating movements of the head, neck, jaw, upper back, and shoulders. Two of them are more at risk of strain and sprain. These are;

• Levator scapulae; that runs down the side of the neck, from top of the cervical spine to the shoulder blade. It functions to bend and rotate the neck to the side.  
• Trapezius; is a kite-shaped muscle that runs from the base of the skull, goes halfway down the back and out to the shoulders as well. This muscle helps facilitate a range of movements as head tilts and neck extension while looking up.

Signs and symptoms of neck pain sprain or strain

• Pain in the back of the neck that may start immediately or gradually develop over the course of few hours or days
• Pain may also occur in the back of the head, upper back, or shoulder
• Pain is aggravated by movement
• Knife-like pain may indicate severe injury
• The neck muscles feel sore
• The neck is stiff to move, typically the soreness, pain and stiffness are worse on the first day or two.
• Loss of flexibility and range of motion may also be seen depending on the severity of the injury
• Sleep disturbances and lack of focus usually accompanies the pain
• Swelling of the affected area
• Area of the affected muscle may have a dent or depression
• There is NO tingling, numbness or weakness in the arms (indicating only muscle involvement)

In case of a whiplash injury, the following signs and symptoms may accompany the muscular pain;

• Headaches and dizziness
• Ringing in the ears
• Pain, tingling, or numbness that radiates into the upper extremities

Following signs and symptoms indicate complications and that the injury is extended involving the spinal cord;

• Instability in neck
• Problems in bowel and bladder control
• Difficulty walking or maintaining balance
• Weakness in your arms and legs

Such symptoms call for an immediate emergency room visit.

Diagnosis

Before you do anything, immobilize the neck. Then ask for

• History of the presenting complaints, followed by
• Thorough physical examination to rule out any serious neck injury; check for range of motion and any associated symptoms
• Serious cases should be transferred to emergency for further evaluation; x-ray, MRI, CT-scan

A physician grades the strain after evaluating the case;

• Grade I: mild damage to muscle resulting in little loss of function and strength
• Grade II: more number of muscle fibers are torn reducing the function and strength
• Grade III: complete tear in a muscle or tendon with no muscle function

Treatment for a neck pain sprain and strain

The treatment of neck muscular pain due to strain or sprain depends on the severity of the symptoms.

The aim of the treatment is short-term and long-term goals. The short-term goals are to provide immediate relief and the long-term include preventing any recurrence and complications.

Grade I and II are usually treated with RICER.

Grade III requires complete immobilization of the muscle, often carried out with a cast. This is a rare condition.

 All the neck muscle strains are followed up with physical therapy with a specialist. The purpose is to strengthen the torn muscle and the surrounding tissue.

The doctor may prescribe a neck brace that helps to support the neck. A soft or a rigid brace can be used to provide support.

1. RICER for Neck pain strain sprain

RICE is most effective is applied soon after the injury.

Rest the injured or sore area. Stop or take a break from the activity you are currently doing.

Ice the affected part. Application of cold reduces pain and swelling instantly. Press a cold pack right away as it prevents or minimizes swelling.

Ice pack application should be continued for 10 to 20 minutes, repeated 3 or more times a day.

After two to three days, the swelling usually subsides. At this time, apply heat to the affected area.

It is important not to apply ice or heat directly to the skin. Placing a towel over the cold or heat pack before applying it to the skin helps.

Compression. (Not Applicable for Neck Injuries) Compression means wrapping the injured or sore area with an elastic bandage. It helps reduce the swelling any further.

Compression should not be done too tight as it may lead to more swelling. Signs of a tight bandage include numbness, tingling, increased pain, coolness, or swelling in the area below the bandage.

Compression requirements for more than 48-hours may indicate that the injury is complicated. Consult a doctor it happens.

Elevation. Elevate neck on pillows. Do not lie without a pillow. The purpose is to keep the head above the level of the heart so as to facilitate blood supply and cut back on swelling.

Referral. If the pain is mild, the patient may do exercises at home to regain full range of motion.  In case the pain becomes severe or worsens, an athletic trainer or physical therapist should be consulted. Such a referral helps prevent complications.

• Massage

Massage helps relieve the pain and swelling. It increases the range of motion and improves stiff muscles. Massage increases the local temperature and blood circulation of the local area, which improves tissue elasticity. An increase in tissue elasticity allows muscles to relax and tension to decrease.

Massage in case of neck pain usually makes use of acupressure, mobilisations and skin rolling.

Acupressure is the application of pressure to specific areas of the neck. Fingers and thumbs are used to break down muscular knots and increase blood flow. It results an increase in oxygen and nutrients to the muscles, thereby complementing repair and healing.

Mobilizations are an effective and specific technique during a neck massage. It involves applying pressure to the vertebrae of the cervical spine. Pressure is added and released gradually at the same time. It results in lubrication and loosening of the joint between the different vertebrae. As a result, joint stiffness is reduced. Muscles become flexible and pain is relieved.

Skin rolling is a constant technique applied during a neck massage. Fingers and thumbs are used to pick up and roll skin. It increases blood flow. It also helps to lose the fascia, a connective tissue layer under the skin layer.

A neck massage disrupts the acute pain signal sent from the skin receptors to the brain. Friction during a neck massage creates new signals. The new signal disturbs the old message of acute damage. A new signal means the nerves receive sensations of relaxation, which therefore reduces acute neck muscular pain.

• Use of heat and cold combined therapies

The general rule of thumb is to apply cold therapy for acute injuries (accompanied by swelling and inflammation), as that happens in neck muscular pain due to sports injury. Heat therapy is reserved for muscle stiffness and pain.

Heat therapy works to improve the circulation of the affected area.  Increased temperature of the area also helps soothe discomfort and pain as well as increase muscle flexibility. When the temperature is increased, the nutrient supply is also enhanced leading to a speedy recovery.

Heat therapy may be dry or moist.

Dry heat is applied via heating pads, dry heating packs, and saunas.

Moist heat or convection heat is applied via steamed towels, moist heating packs, or hot baths. Moist heat is more effective than dry heat and requires less application time for the same results.

Professional heat therapy treatments like that of heat from ultrasound are also employed.

Heat therapy can be given local, regional, or whole body. Local therapy is best for small areas of pain like neck pain due to muscular sports injuries. A steamed towels, large heating pads, or heat wraps are used for neck pain.

 Minor pain is often relieved with 15 to 20 minutes of heat therapy.

Heat therapy is contraindicated if the neck injury is associated with an open wound, swelling, or bruising.

Cold therapy or cryotherapy works by reducing blood flow to a particular area. Cutting back the blood supply reduces the inflammation and swelling especially if it is around a joint or a tendon. Cold therapy suppresses nerve activity, a process that relieves pain.

Cold therapy is applied via ice packs or frozen gel packs, coolant sprays, ice massage, and ice baths.

Some professional modes of treatment include cryostretching (cold to reduce muscle spasms during stretching), cryokinetics (combines cold treatment and active exercise for ligament sprains).

Cold therapy should not be applied on stiff muscles or joints. Conditions with sensory disturbances or circulatory impairment as it happens in diabetes are also contraindicated for cold therapy on muscular neck pains.

Cold therapy should be applied for 10-15 mins and not more than 20 minutes.

Cold and heat therapy can be used alternatively. Apply heat for 15 to 20 minutes. After few hours, use cold therapy for 10 to 15 minutes. Contraindications should be kept in mind while using both therapies alternatively.

• TENS

Transcutaneous electrical nerve stimulation is a passive and non-invasive method of relieving muscle strain.

Using a device, the process involves sending a painless electrical current to specific nerves. The electrical current is mild and generates heat that helps relieve muscle stiffness, improve mobility, and relieve pain.

As the neck pain affect the muscles that are attached to the shoulder bones and the upper back, TENS may help in alleviating muscle strain in these areas.

TENS should not be used on the neck area directly specifically the front of the neck.

• Use of K-tape for Neck pain strain sprain

Kinesiology tape is a therapeutic tool that is applied strategically to the body. It helps provide support, lessen pain, and reduce swelling. It works by decompressing the pressure points where injury may have occurred.

When the tape is applied to the body, it recoils and gently lifts your skin. This helps to create a microscopic space between your skin and the tissues underneath it.

The result is perceived as decompression by the sensory nervous system. It decreases the pain associated with muscular pain. The tape also improves circulation helping repair and healing.

K-tape is usually used as part of another physiotherapy along with other treatment modules. In case of a muscular strain of the neck, it helps improve the posture by realigning the muscles to their original position. It improves the stiffness of the neck muscles.

A physical therapist usually applies the tape in the pattern that suits the specific problem. Tape is applied in an X, Y, I, or fan pattern.

Here is how to apply the K-tape to relieve neck strain;

• The area should thoroughly clean and dry.
• Trim any hair.
• Round off the k-tape at the ends using scissors.
• Cut 5cm-wide kinesiology tape. The tape should be long enough to extend from the patient’s upper back going all the way up between the shoulder blades, reaching up the neck, below the hairline.
• Start at one end. Split the strip of kinesiology tape right down the center Leaving a 5cm unsplit tab at the other end.
• Stick the unsplit end to the patient’s upper back. Place the tape directly over the spine, at the level of the top of the shoulder blades or just below. Stick the tape without any tension.
• The patient should sit in an upright position with the head lowered and chin resting on their chest.
• Take the two split ends of the k-tape and stick them up the back and neck, running on either side of the spine. Stick the tape with no or minimal tension.
• Now apply a strip of kinesiology tape across the back of the neck, at the shoulder level in horizontal direction. This part of the tape should be placed with maximum stretch.

• Medicine for Neck pain strain sprain

Over-the-counter pain relievers work well with all the other measures. These include ibuprofen (Advil, Motrin IB), naproxen sodium (Aleve), and acetaminophen (Tylenol).

Medicines that numb the pain like lidocaine injections can relieve the pain in severe cases. Some severe cases may require corticosteroid injections.

Opioid medications (codeine, morphine, oxycodone, and fentanyl) are prescribed for neck pain not relieved by NSAIDs. They have a strong tendency to cause addiction so proper follow-up and monitoring is required. Often a combination medicine with aspirin or acetaminophen is suggested.

Muscle relaxants as valium are prescribed for short-term management of pain and stiffness.

Some neuropathic and nerve blocking formulas may also be indicated for severe cases. Antidepressants (paroxetine), anticonvulsants (gabapentin), and nerve blockers (lidocaine) are included.

Botulinum toxin type A (Botox) and botulinum toxin type B (Myobloc) are some of the latest options that relieve neck pain for the long term, at least four months.

Over-the-counter pepper creams and the capsaicin prescription cream called Zostrix also work in mild cases.

• Active rehabilitation for Neck pain strain sprain

Grade I and II strains generally heal on their own or with minimal intervention. Sometimes the muscular strains may not recover fully requiring rehabilitation. Recurrence can occur which may make the muscle weakness with loss of functionality.

Here are some rehabilitative exercises for strengthening the neck muscles. Stop the move if you experience any pain. 

1. Active neck rotation
2. Sit upright in a chair.
3. Keep your torso straight.
4. Turn your head to the right slowly till you are comfortable. Hold for five counts.
5. Bring it back to the starting position and do the same by moving the head to the left.
6. Repeat for a minimum of ten times.

• Active neck side bend
• Keep sitting and move your head in a tilt so that your right ear moves closer to your right shoulder.
• Count till five before bringing the head to the starting position.
• Do the same to the opposite side.
• Do not move your shoulder.
• Repeat ten times.

• Neck flexion
• Sit in a chair straight with your body upright.
• Move your head forward till it reaches the chest.
• Hold for 5 seconds and repeat 10 times.

• Neck extension
• Move to bring your head back while sitting upright in a chair.
• Your chin should point to the ceiling. 
• Repeat 10 times staring from the original position.

• Chin tuck
• Place your fingertips on your chin and make a double chin by gently pushing your head straight back.
• Look forward as your head moves back.
• Hold the chin for 5 seconds and repeat for another 5 times.

• Scalene stretch

This move stretches the neck muscles that get attached to your ribs.

• Sit in an upright position on a chair.
• Clasp both hands behind your back.
• Lower your left shoulder towards the ground while you tilt your head in the opposite direction toward the right.
• Hold for 15 to 30 seconds.
• Come back to the starting position and do it in the right side.
  You should be able to feel a stretch. Hold the position on each side for 15 to 30 seconds.
• Repeat at least 3 times on each side.

• Isometric neck flexion
• Sit tall on a chair with eyes looking straight ahead.
• Place your palm on your forehead.
• Gently push your forehead into your palm.
• Your palm is the resistance here. Hold for 5 seconds, release and do 3 sets at the least.

• Isometric neck extension
• Again sit tall with eyes straight ahead and chin level.
• Clasp your hands together.
• Place them behind your head.
• Now press back your head into your palms. Hold 5 seconds and release.
• Do 3 sets.

• Isometric neck side bend
• Sit tall on a chair.
• Eyes straight ahead and chin level.
• Now place the palm of your hand at the side of your head at the temple area.
• Press the temple into the palm of your hand. Hold 5 seconds and release.
• Do 3 sets on each side.
• Head lift: Neck curl
• Lie with your back on the ground and with your knees bent and feet firmly flat on the floor.
• Tuck your chin while lifting your head toward your chest. 
• Keep your shoulders on the floor. Hold for 5 seconds.
• Do it ten times.

1. Head lift: Neck side bend
2. Lie on your right side with your right arm extending straight out.
3. Rest your head on your arm.
4. Lift your head slowly toward the opposite, i.e. your left shoulder. Hold for 5 seconds and repeat 10 times.
5. Do the same on the left by switching sides.

1. Neck extension on hands and knees
2. Get on your hands and knees on the floor with your back straight.
3. Look down at the floor.
4. Keeping your back straight, drop your head to your chest.  
5. Lift your head and tuck your chin till your head and neck are at the level of your back.
6. Hold for five seconds and repeat.

1. Scapular squeeze
2. Lastly, stand with your arms by your sides.
3. Squeeze your shoulder blades together with a backward motion.
4. Hold for 5 seconds and repeat for five times.

Prevention of neck strains and sprains

In any collision sport, playing with proper from is important.  Here is how to do it;

• Warm up proper. Not few stretches but at least few minutes of aerobic activity to get the circulation going.
• Do wear protective head gear. The gear should be of appropriate size and fit securely.
• Do not dive in water less than twelve feet at the least.
• Keep the head up if playing a contact sport. Do not lead or tackle with helmet. Proper tackling technique should be followed.