Cervical Collar

Cervical collars fall broadly into two groups. Soft collars, made of foam, provide comfort and a gentle reminder to limit movement, but do little to truly immobilise the neck. Rigid collars, made of firm plastic with padded supports, restrict movement much more and are used when firmer immobilisation is needed. In the injury setting a rigid collar limits bending, extension and rotation of the neck, helping to protect the cervical spine. Collars are fitted and sized carefully, because a poorly fitting collar is both less effective and more likely to cause skin problems.

A cervical collar may be used to immobilise the neck after trauma while injuries are assessed, and to treat certain stable cervical fractures non-operatively. It is also sometimes used for symptom relief in conditions such as whiplash, though for that purpose prolonged immobilisation is generally discouraged in favour of gentle early movement. The decision to brace, and the type of collar, depends on the injury, its stability, and the individual. Unstable fractures, or those threatening the spinal cord, need firmer immobilisation such as a halo, or surgery.

The evidence highlights both value and limits. For soft-tissue neck injuries like whiplash, reviews suggest that early movement generally does better than prolonged collar use. For immobilisation after trauma, collars are widely used but are increasingly applied thoughtfully, because prolonged rigid collar wear carries recognised drawbacks — including pressure injuries to the skin, discomfort, and complications in frail or elderly patients. Systematic reviews have examined soft versus rigid collars and the adverse effects of prolonged hard-collar use, prompting more selective, time-limited use. The honest position is that a collar is a useful tool for the right injury and the right duration, but not something to be left on longer than necessary.

Where a collar is used for a stable fracture, it is generally worn for a defined period, with review and imaging to confirm healing before it is weaned off. Careful attention is paid to fit, skin care and hygiene under the collar, and to keeping the duration as short as the injury allows. As healing progresses, the collar is gradually discontinued and gentle neck movement and rehabilitation are encouraged. The right type of collar and the right duration depend on the individual injury and are decided with the treating team.

• —Pandor A, et al. Cervical spine immobilisation following blunt trauma in pre-hospital and emergency care: a systematic review. PLoS One 2024. (PMID 38662734)
• —Bäcker HC, et al. Cervical immobilisation: soft collars better than rigid collars? A systematic review and meta-analysis. Eur Spine J 2022. (PMID 36181555)
• —Brannigan JFM, et al. Adverse events relating to prolonged hard collar immobilisation: a systematic review and meta-analysis. Global Spine J 2022. (PMID 35333123)
• —Ricciardi L, et al. Non-rigid cervical collar in pain relief after whiplash injury: a systematic review and pooled analysis of RCTs. Eur Spine J 2019. (PMID 31214856)
• —Maschmann C, et al. New clinical guidelines on spinal stabilisation of adult trauma patients. Scand J Trauma Resusc Emerg Med 2019. (PMID 31426850)