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Cervical Spine Protocol


This section applies to all patients. 

  • No NSAIDS such as Advil, Motrin, ibuprofen, Naprosyn, and Aleve x 2 weeks.

  • Pain: Tylenol for mild pain and if needed use mild narcotic provided.

  • Bracing: If recommended, use sling during sleep the first 2 nights if able. Sleep is more important so if you cannot sleep and use the sling, feel free to remove it.

  • Driving restrictions: No driving until you can safely shift and steer the vehicle and safely look over your shoulder.

  • Work restrictions: Depends on duration of lifting restrictions.

  • Exercise restrictions: 2 weeks relative rest then 4 weeks progressive PT.

The following may not apply to all patients. Your provider will complete this section, depending on your needs. 

☐ Use soft collar for ____days, coming out for range of motion (without deep stretch) twice daily

☐ Avoid Rotation and Extension (looking up) and side bending at the neck for 2 days.

☐ Begin active stretching of scalene and trap by day 3 post injection

☐ NO ACTIVE lifting with arms above shoulder height x 3 days; may do PASSIVE RANGE OF

☐ MOTION with shoulder and neck after day 2

☐ Sleep with cervical neck support lying on back as much as possible for 3-5 days.

☐ f/u for PT in 4-7 days

Activities: In general, with all exercise and activities, keep pain level below 4/10.

First 2 Weeks:

  • Strengthening/Motion: Isometrics and range of motion are good for muscles and pain control. PT will help with range of motion and home exercise plan.

  • Walking: No restrictions.

  • Cycling: May do gentle ride on stationary bike for 10-15 minutes without looking up, such as at a TV screen, then 30 minutes after week 1.

  • Swimming: No swimming for the first 2 weeks.

  • Throwing/rock climbing/tennis: None of these the first 2 weeks.

Weeks 2-4:

  • Strengthening/Motion: Start gentle low load concentric/eccentrics with PT. Work on progressive motion and strengthening of shoulder and thoracic spine.

  • Cycling: No restrictions except would stay on exercise bike until 4 weeks.

  • Swimming: May begin gentle kicking and pool walking.

  • Throwing/rock climbing/tennis: No rock climbing until after 6 weeks. Throwing can begin at 4 weeks

Weeks 4-6:

  • Strengthening/Motion: Progress to moderate loading and progressive strengthening. Work on maintaining or regaining full range of motion by 4-6 weeks.

  • Cycling: May do gentle road biking and trail biking; avoid mtn biking until 6 weeks.

  • Swimming: May try some gentle breaststroke for a few laps. Use buoy for rest.

  • Throwing/rock climbing: Can begin some pre-climbing/throwing exercises with PT. Anticipate return to gentle climbing and return to throwing program at 6 weeks.