Physiotherapy in Huntsville for Injury Care
The debate about neck collars has been going on for decades. Some surgeons never have their patients use them -- even to stabilize the neck after a fusion procedure. Others use them to provide support and security for the patient but don't consider them really necessary. And when asked in a survey at least half of the surgeons fell somewhere in between those two opinions.
The debate continues beyond just whether or not to use collars. The next question is then: soft or rigid? Studies have clearly shown that soft collars don't restrict motion at the end ranges. That means if the person really wants to turn the head all the way to one side or the other (or fully flex or extend the neck), the collar doesn't prevent it. Tests show that rigid collars don't fully restrict motion either.
In fact, many patients still have up to half their normal motion even when inside a rigid neck brace. And given the fact that rigid neck collars can be hot, cause skin rashes and sores, and restrict swallowing and breathing, they can be difficult to get used to. If they don't really do any more than a soft collar, why bother using them?
That's what the authors of this study finally concluded after comparing neck motion between soft and rigid collars. They used a special tool called an electrogoniometer to measure neck motion in 10 normal, healthy adults. The measurements included neck flexion, extension, side (lateral) bending, and rotation. Range of motion measurements were taken before and after wearing first the soft neck collar and then the rigid collar.
All participants had normal cervical spine (neck) motion. No one had a history of neck problems and there were no reports of neck pain at the time of the study. To assess functional neck motion (motion needed to do everyday activities), neck motion was measured while doing 15 different tasks.
The activities included things like standing up from a sitting position, backing up a car, tying shoelaces, walking up and down stairs, and eating. Other activities normally carried out everyday were also monitored such as shaving (men), putting on makeup (women), washing hands, and reading a magazine or book held in the lap.
A motion analysis of the data was designed to look at two things: 1) how much soft and rigid collars really restrict neck motion, and 2) the effect of these collars on functional motion. All the people who were in the study were young (in their mid-20s).
The idea was to see what a normal, healthy person could do in these collars. It was assumed that using younger subjects would give the best and fullest range of motion measurements since neck motion decreases with age. Measurements were taken for each person without a brace, with a soft collar, and with a rigid collar while performing each of the 15 tasks.
After a detailed study of all the comparative measurements, here's what they found:
- Rigid collars do restrict neck motion compared with soft collars but only for flexion, extension, and rotation. Side bending was the same for both types of collars.
- Motion during functional activities was the same for both types of collars with the exception of two activities: backing up the car and sitting down from a standing position.
- Both braces allowed much more motion than was actually ever used during any of the 15 daily activities.
- The collars don't restrict motion. They seem to regulate motion by giving the person greater proprioceptive input. Proprioception refers to the joints sense of position (and changes in position).
The conclusion made from this study was that bracing after neck surgery just isn't needed. Not only are many neck fusions held together internally with hardware like metal plates and screws but people seem able to regulate their own motion. If a collar is needed, then a soft collar will probably provide all of the extra support and proprioceptive input needed for daily tasks.
Collars may still be beneficial for patients with neck pain that goes down the arm. The collar will restrict neck motion and take the pressure off the nerve roots that are irritated or compressed causing pain.
Soft collars are more comfortable, allow necessary motion needed for daily function, and may increase patient compliance (willingness to wear the collar) after cervical spine surgery. Only one type of rigid collar was used in this study (Vista brace) so the results may not be the same with other types. Further studies are needed to compare various brace types and in other age groups with and without neck problems.
Reference: Christopher P. Miller, BA, et al. Soft and Rigid Collars Provide Similar Restriction in Cervical Range of Motion During Fifteen Activities of Daily Living. In Spine. June 1, 2010. Vol. 35. No. 13. Pp. 1271-1278.