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

  • Luca RicciardiEmail author
  • Vito Stifano
  • Sonia D’Arrigo
  • Filippo Maria Polli
  • Alessandro Olivi
  • Carmelo Lucio Sturiale
Review Article



Whiplash injury (WI) represents a common diagnosis at every emergency department. Several investigations have been conducted to compare the different medical managements for non-surgical cases. However, the role of the immobilization with a non-rigid cervical collar (nRCC) for pain management and range of motion (RoM) preservation has not been completely clarified.


We performed a systematic review of the randomized control trials (RCTs) and a pooled analysis in order to investigate the role of the nRCC for pain management, scored through the visual analogue scale (VAS) and the RoM, by comparing the use of a nRCC (for 1–2 weeks) with a non-immobilization protocols, regardless of the association with physical therapy (PhT). Only patients with whiplash-associated disorders grade I–II were included. Due to a certain heterogeneity across the RCTs, follow-up period time range resetting was necessary in order to pool the data.


A total of 141 papers were reviewed; 6 of them matched the inclusion criteria and were admitted to the final study. Pooled analysis showed that nRCC does not improve the outcome in terms of VAS score and RoM trends along the follow-up. Moreover, VAS and RoM trends seem to further improve at long-term follow-up in non-immobilization associated with PhT group.


This pooled analysis of the available RCTs shows the absence of an advantage of the immobilization protocol with a nRCC after a WI. On the contrary, non-immobilization protocols show an overall better trend of pain relief and neck mobility recovery, regardless of the association of PhT.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.


Cervical collar Whiplash Cervical spine Trauma Pain management 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

586_2019_6035_MOESM1_ESM.pptx (161 kb)
Supplementary material 1 (PPTX 161 kb)
586_2019_6035_MOESM2_ESM.docx (18 kb)
Supplementary material 2 (DOCX 18 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Departments of NeurosurgeryFondazione Policlinico Universitario Agostino Gemelli - IRCCSRomeItaly
  2. 2.Departments of Anaesthesiology and Intensive CareFondazione Policlinico Universitario Agostino Gemelli - IRCCSRomeItaly
  3. 3.Department of NeurosurgeryUniversità Cattolica del Sacro CuoreRomeItaly

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