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Automobile insurance companies have put a lot of effort into classifying the various degrees of soft tissue injuries to the neck and back. For each degree, one to four, they also have a statistical estimation of the time course of the stages of the injury as well as the most effective interventions at the individual stage.

Degree 2: Neck and Back Strain

In a Family Physician's Office the most common degree of injury is 2. This is an injury that has resulted from an accident or impact or force that is adequate to cause vehicle damage. There is pain localized to one or more areas of the vertebral column and there are physical signs including restriction in motion and local tenderness of bone or muscle groups attached to the spinal column. There are no broken bones or evidence of serious nerve injury.

The first 3 days:

Immediately after the accident there is a huge adrenalin rush in which the patient may be very excited about damage to car, passengers or other fears ( Mom's car). It may be minutes or hours later that they note pain or stiffness in the neck or back. This discomfort gets progressively worse over the next 48 hours and typically reaches the maximum in stiffness and reduction in range of movement on the second day after the trauma. The best management for this period is to take anti-inflammatory medication immediately and for the next week or more. In the first 24 hours apply ice packs to the most tender areas. After 24 hours soak in hot water frequently. Avoid heavy lifting and other activities that may further damage weakened tissues. Try to rest and heal and do gentle stretching movements and activities to preserve your range of movement.

The first week:

It is important to evaluate the injury (damage) about one week after the trauma. In most cases the worst of the discomfort is reached 2 to 3 days after the accident and some slight improvement can be described by the end of the first week. However, new sites of pain may develop (typically in the shoulders) or more bruises may become evident. One week is a suitable time to make decisions an how to return to previous levels of activities or what type of exercise or rehabilitation program is best. Aggressive efforts to return to previous activities are the most effective for this degree (2) of injury. Swimming and then liberal soaking in a hot tub are activities that the individual can control. This is also the time to begin self directed stretch exercises.


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