Choosing Cervical Pillow, Collar for Neck pain

The use of supports like cervical pillow, cervical collars and neck braces is fairly common among people with neck pain. Such orthoses function by holding the wearer’s head in a particular position, while relieving the strain from the neck, thus playing a role in the conservative management of neck pain.

We have often seen neck pain patients (across different physiotherapy clinics), enquire about such cervical orthoses. Those dealing with cervical spondylosis, neck arthritis or cervical osteoarthritis may find immediate relief with neck collars and eventually become dependent on them. Sometime patients may have to use these in cases of acute or repetitive neck injuries like whiplash or chronic stresses and strains. However, the use of these is contested.

ReLiva Physiotherapists attempt at answering these frequently asked questions about neck supports (including cervical pillow and neck collars) with a comprehensive list of orthoses available, their usage and when and to what extent they can help.

What does a cervical collar do?

A cervical collar, also known as a neck brace, is a medical device used to support a person’s neck. It is most commonly used to relieve neck during cervical spondylosis. It is also applied by emergency personnel to those who have had traumatic head or neck injuries, and can be used to treat chronic medical conditions.
Indications for recommending these include the following:

1. Pain relief
2. Mechanical unloading
3. Management of scoliosis
4. Spinal immobilization after surgery
5. Compression fracture management
6. Kinesthetic reminder to avoid certain movements

However, adequate data to encourage its regular usage is scarce. In addition, the use of these are associated with several drawbacks, which include the following:

• Discomfort
• Local Pain
• Osteopenia
• Skin Breakdown
• Muscle atrophy with prolonged use
• Increased energy expenditure with ambulation
• Psychological and physical dependency
• Increased segmental motion at ends of the orthosis
• Unsightly appearance
• Poor Patient compliance

Therefore, each cervical collar should be used depending on the requirement and only with the recommendation of an expert in the field, who is an Orthopaedic Doctor or a Physiotherapist or an Orthotist.

Do cervical collars help neck pain?

Whether one should definitely use cervical collars or supports as a form of care for cervical spondylosis is still debatable and depends largely on the seriousness and acuteness of the condition. Of course, cervical collars and supports alone will not help one get rid of the neck pain, but if recommended, it may be a good adjunct to physiotherapy, which is necessary. Here is what Mrs Mythili talks about her secret to cervical pain relief.

There are several kinds of cervical collars and supports, each of which are used depending on the severity of the ailment and for a particular requirement. Hence, they are to be used with the right kind of prescription.

Related Reading: Neck Pain: Managing at Home  ;  Cervical spondylosis Treatment

What is a cervical pillow used for?

Cervical pillows are designed to mimic the curvature of an “ideal” cervical spine in order for a patient to have improved neck postures during their sleep hours to minimise the pain with which they are likely to wake up with.

Are cervical neck pillows good for you?

Cervical pillows would have been a sure-sort good thing if everybody had similar looking spinal curvatures and that curvature could be mimicked by the pillow. The authenticity of the use of these pillows are still controversial.
Advantages of Cervical Pillow:

• Mimics normal spinal curvatures.
• Soft and comfortable.

Disadvantages of Cervical Pillow:

• Not adjustable.
• Not customizable.

How long should I wear a neck brace?

Unless otherwise indicated, you should wear a collar intermittently, meaning, every hour with a 30-minute break period for a couple of days till you can tolerate the pain without external support.

Studies suggest that for those patients with acute neck pain, who find it useful for symptom relief, a soft cervical collar for 10 days or less has not been shown to have any adverse impact.

Choose a collar only with the recommendation of a medical expert. Follow their instructions closely while using the brace.

What care needs to be taken while using cervical supports?

Here is a list of Dos and Don’ts for using cervical supports, mainly the soft collar:

DO’S for using soft collar:

• Use it only for a short-term basis unless otherwise indicated – First few hours or days.
• Wear it for only One hour at a time, again unless otherwise prescribed.
• Take a break of about 20-30 minutes after each use.
• Check with your Doctor, Physiotherapist, or Orthotist for the correct size of the collar before wearing it.
• The Velcro strap goes at the back of the neck.
• Upper edge of the collar has to be supported under the chin.
• The lower edge of the collar has to be supported above your sternal notch or the beginning of your chest wall.
• The jaw line should be resting on the collar margins.

DON’TS for using soft Collar:

• It should not be used constantly throughout the day – Unless specified otherwise.
• It should not be worn for years together. It has a durability of only 2-6 months.
• Do not keep the neck in an extended position with the collar on.
• Do not let the neck drop down because of the collar.
• Do not push the collar deep inside.
• Do not wear it too tight.

Want to get rid of the Cervical Collar?

Physiotherapy may help!

Which is the best cervical collar?

Research studies show that different cervical collars have different effects on neck motion².

The main kinds of Cervical Collars and supports used today, in no particular order, are detailed underneath. [ We advise you to consult a medical expert to identify if collar is needed for you; and if yes, then which one works best for you.]

1. Soft Collar

Advantages of Soft Collar:

• It is light weighted.
• Can be easily put on and taken off.
• Comfortable to wear.
• Provides warmth, psychological comfort, support to the head during acute neck pain, relief from minor muscle spasms associated with spondylosis and relief in cervical strains.

Disadvantages of Soft Collar:

• Soiled easily with long-term use.
• Restricts movement at the neck by only 5%-15%

2. Hard Collar

Advantages of Hard Collar:

• Height can be adjusted in certain designs to fit patients better.
• Easy donning.
• More durable than a soft collar with long-term use.
• Provides support to the head during acute neck pain, relief of minor muscle spasm associated with cervical spondylosis, psychological comfort and interim stability and protection during halo application.
• Better than a soft collar in motion restriction.

Disadvantages of Hard Collar:

• More rigid material.
• Less effective in restricting rotations and side bends.

3. Miami J Collar

Miami J collar is a cervical neck brace used to keep your neck and spine straight and to help healing by supporting your neck bones; most often after a neck surgery or a spinal cord injury.

Advantages of Miami J Collar:

• Has a soft washable lining.
• Easy donning and doffing.
• Available in various sizes.
• This collar can be heated and moulded to a contoured fit.
• Limits movement by 55% to 75%.
• No known drawbacks.

4. Philadelphia Collar

A Philadelphia collar is a neck brace used to prevent head and neck movement, most often after cervical spine surgeries due to severe cervical spondylosis like fusions or discectomies, fractures of the second vertebra, for suspected trauma in unconscious patients, halo removal and strains.

Advantages of Philadelphia Collar:

• It comes in various sizes.
• Patient compliance is good with this collar.
• Comfortable to wear.
• Easy to put on and take off.
• The front piece has a chin cup.
• Tracheostomy hole is available.
• Extensions can be added to increase motion restriction.
• Limits movement at the neck by 30% to 70%.

Disadvantages of Philadelphia Collar:

• It is difficult to clean.
• Becomes soiled very easily.

5. Malibu Collar

Advantages of Philadelphia Collar:

• Adjustable in many planes to adjust proper fit.
• Chin support height is adjustable too.
• Straps for tightening.
• Padding around the chin can be trimmed.
• Extensions can be added to increase support.
• Limits movement by 55% to 60%.
• Used for the same conditions as the Philadelphia and Miami J Collar.

Disadvantages of Philadelphia Collar:

• Comes in only one size.

What is the purpose of a collar?

If your pain is acute in nature and you cannot tolerate it without the collar on, as long as the brace is worn correctly, you may sleep with it in a position that is comfortable to you.

Do cervical collars help reduce neck pain?

Not directly, they do not. They serve as immobilizers and reminders to avoid aggravating factors.

Can I drive with a collar on?

You can, if you have access to a camera system to watch your back and not for more than an hour at a stretch. You would not want to cause harm to others and to yourself, if not.

Cervical pillow and cervical collars may be useful to relieve immediate strain from the neck. But one should use them more as a reminder for a condition that needs care and treatment. In most cases, a systematic physiotherapy-based treatment developed after a detailed assessment can help aid a longer-lasting recovery.

Do share this post with anyone who is using neck supports or is contemplating using the same. Scroll further and hit subscribe to receive similar updates related to health, movement and recovery directly in your inbox.

This article is based on the inputs from Dr Carol Johnson (PT). Dr Carol is a sports physiotherapist at ReLiva and is a Masters in Orthopaedics and Sports Rehabilitation.

Looking for Long Term Solution for Cervical Pain?

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