How long should I keep wearing a neck collar?

Key points in 30 seconds

1. On neck collars after an accident, the answer is unusually clear. No trial has found that wearing a collar and resting did better.
2. In a large trial that split 458 people three ways, the results after 1 year were the same for a collar, for living as usual, and for active exercise.
3. The muscles and ligaments injured in whiplash are tissues that heal through movement. If you keep them immobilized for a long time, the reason for the pain switches from the injury to stiffness.
4. That doesn't mean a collar has no place at all. The problem is wearing it with no "until when."
5. If your arm feels weak or tingles, it isn't a question of whether to take the collar off. Ruling out fractures and nerve damage comes first.

What we often hear

• "The ER put it on me, but nobody said when to take it off."
• "I feel secure with it on, and somehow uneasy without it."
• "I'm worried I'll hurt myself more if I take it off."
• "But my neck seems to be getting stiffer and stiffer."

People who come in the day after an accident are often still wearing the collar the ER put on them. And they almost all ask the same question: how long do I need to keep this on?

The problem is that nobody told them. The ER is a place for sorting out urgent problems, so it doesn't set the schedule for what comes after. So people keep wearing it without ever hearing that it's okay to take it off. It feels secure with it on, somehow uneasy without it, and there's the worry of getting hurt worse by taking it off for no reason. Two weeks go by, then three. Meanwhile, the neck seems to get stiffer and stiffer.

On this question, the answer is unusually clear.

There are several clinical trials that compared people who wore a collar and rested after an accident with people who started moving their neck early. The results point one way. No trial has found that wearing a collar and resting did better. Some trials found that moving early did better, and in a large trial that split 458 people three ways, the results after 1 year were the same for the collar group, the group that lived as usual, and the group that exercised actively. In other words, immobilizing the neck didn't add any benefit of its own. There's no evidence that immobilization speeds up recovery.

The reason is that what gets injured in whiplash is muscles and ligaments. These tissues heal through movement. Moving them the right amount keeps the blood flowing, guides the direction of healing, and keeps the joints from stiffening. On the other hand, if you keep them strapped in for a long time, the reason for the pain changes. At first it hurts because it was injured; later it hurts because it's stiff. That feeling of a neck getting stiffer after wearing a collar for a long time may not be just in your head.

Isn't this the opposite of what you said about back braces?

If you read the earlier post Should my parents stop wearing their back brace?, this may give you pause. In that post I said there was no evidence that wearing a back brace for a long time weakens the muscles. So why is a neck collar the opposite?

Because they're different conditions.

The back brace story was about spinal stenosis, a condition where the canal the nerves pass through narrows and walking becomes hard. The neck collar story is about whiplash injury, a soft tissue injury that heals through movement. Just because both are called braces doesn't mean the answer is the same. That's why, whether it's a brace or acupuncture, we confirm the name of the condition first before telling you anything.

So should I never use one at all?

That's not right either.

When the pain is severe for the first few days, when you have to ride in a car for a long time, for a short while during sleep. Using it like this, with set situations and a set period, is a matter of judgment. The problem is wearing it with no "until when." So if you come in wearing a collar, that's the first thing we decide at your first visit: whether to keep wearing it, and when and how to cut back.

Of course, there's an order to things. If your arm feels weak or tingles, or the middle of your neck hurt badly right after the accident, it isn't a question of whether to take the collar off. Fractures and nerve damage have to be ruled out first. When we see signs like these, we too put a check at the radiology clinic on the 2nd floor of the same building, or a referral to the care you need, ahead of treatment.

Once those are ruled out, the next step is a process of handing back to the neck the job the collar was doing. We work on pain and inflammation with acupuncture and pharmacopuncture so you can move, use Chuna (Korean manual therapy) to ease the misalignment and stiff movement, and little by little increase neck exercises within a range that doesn't hurt. We write down your pain score and how far your neck turns, and compare them later. This is to check your track within the first 3 months, when recovery is most active. For car accident care, Korean auto insurance covers acupuncture, pharmacopuncture, Chuna and herbal medicine. The process is laid out in Car accident aftercare.

The day will come when you back into a parking space without a collar. The day will come when taking it off doesn't make you uneasy. But that day doesn't come from wearing the collar for a long time. It comes from your neck getting its own strength back. How long it takes varies from person to person, depending on how bad the injury is and how severe the pain was at first. Only the direction is the same: from immobilization to movement.

If you've been wearing a neck collar for a few weeks and nobody has ever told you until when, you're welcome to come in just to settle that answer first.

For questions or appointments, message us in English through the messenger at the bottom right of the page, or call +82-53-716-1175.

The original references for the clinical trials comparing rest and early activity are in the director's column After a car accident: your tests are normal, but it hurts.