Collar

Injury type: Acute

Category: Allied Health Options

Rating: Not effective

What is it?

A soft or semi-rigid collar placed around the neck to provide support and restrict movement, usually in the early stages after an injury. It may be worn either continuously or for prescribed periods throughout the day and/or night.

How does it work?

The collar immobilises the neck, allowing the injured structures of the neck to rest and thus may potentially aid in recovery.

Is it effective?

There have been several robust research studies investigating the use of collar following whiplash. The findings from these studies are consistent and do not support the use of a collar. A systematic review of existing whiplash related clinical practice guidelines¹ highlighted that all guidelines recommended against the use of cervical collars in the initial management of whiplash. This finding is supported by another two subsequently published reviews. One review² (used for revising a clinical guideline) reported a moderate level of evidence on minimising the use of a cervical collar for acute whiplash. Another rapid review³ synthesising evidence from highest level of primary studies, systematic reviews, and well-conducted clinical practice guidelines identified that immobilisation (including soft collars, beyond short term use following trauma) is not recommended.

Most recently, a systematic review⁴ was conducted to investigate the effect of non-rigid cervical collars on pain relief and functional restoration following whiplash. This review demonstrated that immobilisation with non-rigid cervical collars did not significantly improve pain relief and neck mobility recovery, compared to ‘act as usual’ (non-immobilisation protocols with or without concurrent physiotherapy).

Are there any disadvantages?

It is possible that wearing a collar may increase neck stiffness by preventing movement, therefore potentially delaying recovery and increasing the amount of time it takes to return to work after a whiplash injury.

Where do you get it?

Collars may be provided by the hospital, or by your treating therapist. Collars are available to purchase at most pharmacies/chemists.

Recommendations

The use of a collar is not recommended by research evidence as it may unnecessarily slow recovery.

References contributing to the treatment rating

2. Blanpied PR, Gross AR, Elliott JM, Devaney LL, Clewley D, Walton DM, Sparks C, Robertson EK, Altman RD, Beattie P, Boeglin E. Neck pain: revision 2017: clinical practice guidelines linked to the international classification of functioning, disability and health from the orthopaedic section of the American Physical Therapy Association. Journal of Orthopaedic & Sports Physical Therapy. 2017 Jul;47(7):A1-83.

Bonk, AD, Ferrari, R, Giebel, GD, Edelmann, M & Huser, R 2000, ‘Prospective, randomized, controlled study of activity versus collar, and the natural history for whiplash injury, in Germany’, Journal of Musculoskeletal Pain, vol. 8, no. 1-2, pp. 123-132.

Borchgrevink, GE, Kaasa, A, McDonagh, D, Stiles, TC, Haraldseth, O & Lereim, I 1998, ‘Acute treatment of whiplash neck sprain injuries: a randomized trial of treatment during the first 14 days after a car accident’, Spine, vol. 23, no. 1, pp. 25-31.

Crawford, JR, Khan, RJK & Varley, GW 2004, ‘Early management and outcome following soft tissue injuries of the neck-a randomised controlled trial’, Injury, International Journal of the Care of the Injured, vol. 35, pp. 891-895.

Dehner, C, Hartwig, E, Strobel, P, Scheich, M, Schneider, F, Elbel, M, Kinzl, L & Kramer, M 2006, ‘Comparison of the relative benefits of 2 versus 10 days of soft collar cervical immobilization after acute whiplash injury’, Archives of Physical Medicine and Rehabilitation, vol. 87, no. 11, pp. 1423-1427.

Guzman, J, Haldeman, S, Carroll, L, Carragee, E, Hurwitz, E Peloso, P, Nordin, M, Cassidy, D, Holm, L, Coˆte, P, Van der Velde, G & Hogg-Johnson, S 2008, ‘Clinical practice implications of the bone and joint decade 2000–2010 task force on neck pain and its associated disorders; from concepts and findings to recommendations’, European Spine Journal, vol. 17, no. 1, pp. 199-213.

Hurwitz, E, Carragee, E, Van der Velde, G, Carroll, L, Nordin, M, Guzman, J, Peloso, P, Holm, L, Coˆte, P, Hogg-Johnson, S, Cassidy, D & Haldeman, S 2008, ‘Treatment of neck pain: noninvasive interventions; results of the bone and joint decade 2000–2010 task force on neck pain and its associated disorders’, European Spine Journal, vol. 17, no. 1, pp. 123-152.

Kongstead, A, Qerama, E, Kasch, H, Bendix, T, Winther, F, Korsholm, L & Jensen, TS 2007, ‘Neck collar, “act-as-usual” or active mobilization for whiplash injury’, Spine, vol. 32, no. 6, pp. 618-626.

Leach, J 2007, ‘Editorial comment on “developing clinical guidelines for the physiotherapy management of whiplash associated disorder (WAD)” by C. Mercer, A. Jackson and A. Moore’, International Journal of Osteopathic Medicine, vol. 10, no. 2-3, pp. 55.

Mercer, C, Jackson, A & Moore, A 2007, ‘Developing clinical guidelines for the physiotherapy management of whiplash associated disorder (WAD)’, International Journal of Osteopathic Medicine, vol. 10, no. 2-3, pp. 50-54.

Motor Accidents Authority 2007, Your guide to whiplash recovery in the first 12 weeks after the accident, MAA, Sydney, Australia.

4. Ricciardi L, Stifano V, D’Arrigo S, Polli FM, Olivi A, Sturiale CL. The role of non-rigid cervical collar in pain relief and functional restoration after whiplash injury: a systematic review and a pooled analysis of randomized controlled trials. European spine journal. 2019 Aug 1:1-8.

Schnabel, M, Ferrari, R, Vassiliou, T & Kaluza, G 2004, ‘Randomized controlled outcome study of active mobilization compared with collar therapy for whiplash injury’, Emergency Medicine Journal, vol. 21, pp. 306-310.

3. Strudwick K, McPhee M, Bell A, Martin‐Khan M, Russell T. Best practice management of neck pain in the emergency department (part 6 of the musculoskeletal injuries rapid review series). Emergency Medicine Australasia. 2018 Dec;30(6):754-72.

Vassiliou T, Kaluza, G, Putzke, C, Wulf, H & Schnabel, M 2006, ‘Physical therapy and active exercises – An adequate treatment for prevention of late whiplash syndrome? Randomized controlled trial in 200 patients’, Pain, vol. 124, pp. 69-76.

Verhagen, A, Scholten-Peeters, G, Van Wijngaarden, S, De Bie, R & Bierma-Zeinstra, S 2007, ‘Conservative treatments for whiplash’, Cochrane Database of Systematic Reviews, Issue 2, Art. No.: CD003338. DOI: 10.1002/14651858.CD003338.pub3.

1. Wong JJ, Côté P, Shearer HM, Carroll LJ, Yu H, Varatharajan S, Southerst D, van der Velde G, Jacobs C, Taylor-Vaisey A. Clinical practice guidelines for the management of conditions related to traffic collisions: a systematic review by the OPTIMa Collaboration. Disability and rehabilitation. 2015 Mar 13;37(6):471-89.

Yadla, S, Ratliff, J & Harrop, J 2008, ‘Whiplash: diagnosis, treatment, and associated injuries’, Current Reviews in Musculoskeletal Medicine, vol. 1, pp. 65-68.