The guidelines established by the New York State Workers Compensation Board are designed to assist healthcare professionals in the application of orthotics for individuals with Neck Injuries. These directives aim to support physicians and healthcare practitioners in determining the appropriate use of orthotic devices to aid in the management and rehabilitation of neck injuries.
Healthcare professionals specializing in Neck Injuries can rely on the guidance provided by the Workers Compensation Board to make well-informed decisions about the most suitable orthotic interventions for their patients.
It is crucial to emphasize that these guidelines are not meant to replace clinical judgment or professional expertise. The ultimate decision regarding the use of orthotics for neck injuries should involve collaboration between the patient and their healthcare provider.
Orthotics for Neck Injury
The main goals and purposes of using a cervical orthosis involve: (a) managing position with control forces, (b) applying corrective forces to address abnormal curvatures, (c) assisting in spinal stability when soft tissues or osteoligamentous structures are insufficient as stabilizers, and (d) limiting movement of spinal segments following acute trauma or surgery. When dealing with traumatic cervical injuries, the top priority is safeguarding the spinal cord and nerve roots.
Cervical Collars
Soft Collars
Recommended – for certain individuals. Indications: It can be worn by patients while in bed to alleviate pain and facilitate sleep when secured with the closure in the front. Not Recommended Rationale: Although well-tolerated by most patients, soft collars don’t significantly restrict motion in any direction and are linked to delayed recovery.
There’s no proof that using them aids recovery from cervical sprain. In cases of acute strain/sprain injuries, the use of cervical collars might prolong disability, impede early mobilization, foster psychological dependence, and restrict self-activity. Some evidence suggests that patients encouraged to maintain regular activities experience less neck stiffness and headache compared to those instructed to wear cervical collars after motor vehicle accidents.
Rigid Collars, such as a Philadelphia or Miami Orthosis
Recommended – these collars can be beneficial in post-operative or emergency scenarios. They limit the motion of flexion and extension, with a somewhat lesser impact on lateral bending and rotation. The duration of wear after surgery depends on the surgeon’s assessment. Typically employed for fracture care and post-operative situations.
Posture Appliances
Not Recommended – for injuries involving sprains or strains.
Cervicothoracic Orthosis
Cervicothoracic Orthoses like Yale and sternal occipital mandibular immobilization (SOMI) type braces offer more extensive control over flexion and extension compared to the Philadelphia collar, providing better management of lateral bending and rotation. Typically used for fracture care and post-operative conditions.
Recommended – for the treatment of specific traumatic injuries.
Recommended – postoperatively as deemed clinically necessary.
Not Recommended – for injuries characterized as sprains or strains.
Halo Devices
Recommended – for the treatment of cervical fracture, dislocation, and/or post-operatively at the discretion of the treating surgeon. Please refer to Halo Immobilization in the Therapeutic Procedures: Operative section of this Guideline.
Other Orthoses, Devices, and Equipment
Special orthoses or equipment might have a role in the recovery of a cervical injury, such as those affecting a cervical nerve root leading to upper extremity weakness or a spinal cord injury with some level of paraparesis or tetraparesis.
Recommended – for specific patients within a well-structured rehabilitation program as part of a comprehensive recovery plan.
