Outline:   
Either direct violence or indirect violence, which makes the neck suddenly turn about or excessively flex forwards or extend backwards, leads to sudden contraction or over traction of cervical muscle, and hence injury of cervical muscles. For example, when a person is riding a bus that is suddenly slowed down, his head vigorously rushes forwards; or a sportsman in ball games suddenly faces upwards when he is running very quickly, it may cause neck sprain. And contusion caused by direct strike on the neck by blunt object is less to be seen than sprain.

Major points for diagnosis  
1. There is a definite traumatic history of the neck.
 
2. Patient with sprain usually complains of pain on one side of his neck. The head deviates toward the sick side. The activity of neck is restricted. The spasm of muscle can be palpated. Patient with contusion may have local swelling with marked tenderness. Sometimes, the pain may radiate to the upper limb.
 
3. If necessary, X-ray film may be taken to rule out fracture and dislocation of cervical vertebrae.

4. It should be clinically differentiated from stiff neck, subluxation of cervical vertebrae, cervical spondylopathy and concussion of brain.


Treatment  
Tendon-smoothing manipulation:  
The patient sits erectly and the operator stands behind him. The operator first presses with his thumbs the painful Points and acupoints Fengchi (GB20) and Tianzhu (BL10), then presses, rubs, grasps and pinches the painful parts with his thumb, index and middle fingers from the lower to the upper. Finally, he rolls with his hypothenar and palmoulnar dorsum on the sick part up and down and to and fro for 3 to 4 times.

Herbal therapy  
Internal treatment based on syndrome differentiation  
(1) Syndrome of qi and blood stagnation
Main symptoms and signs:
Serious pain and obvious swelling in the neck, difficulty in turning the head, or ecchymoses on the tongue, stringy or choppy pulse.
 
Therapeutic methods:
Promoting blood flow to remove the stasis, activating qi flow to stop pain.

Recipe and herbs:
Modified Taohong Siwu Decoction. The herbs see the treatment of syndrome of stagnant blood blockage in injury of collateral ligament of knee joint.

Modification:
For the case of serious swelling, add Zexie (Rhizoma Alismatis)10 g and Cheqiancao (Herba Plantaginis)10 g; for the case complicated by headache and dizziness, add Fangfeng (Radix Ledebouriellae Divaricatae )10 g and Chuanxiong ( Rhizoma Ligustici Chuanxiong )10 g.
 
 (2) Syndrome of collateral disharmony
Main symptoms and signs:
Aching and dull pain in the neck, rigidity and weakness of the neck, pale tongue and thready pulse.

Therapeutic methods:
Relaxing tendons and activating collaterals.
 
Recipe and herbs:
Modified Huoxue Shujin Decoction. Specifically, Qianghuo (Rhizoma seu Radix Notopterygii )6 g, Jingjie ( Herba Schizonepetae )6 g, Honghua ( Flos Carthmi)6 g, Zhike ( Fructus Citri Aurantii)6 g, Duhuo (Radix Angelicae Pubescentis )9 g, Fangfeng (Radix Ledebouriellae Divaricatae)9 g, Wujiapi ( Cortex Acanthopanacis )9 g, Duzhong ( Cortex Eucommiaeulmoidis )9 g, Gegen ( Radix Puerariae )9 g, Danggui (Radix Angelicae Sinensis)10 g, Xuduan (Radix Dipsaci)12 g, Qingpi (Pericarpium Citri Reticulatae Viride )5 g and Gancao (Radix Glycyrrhizae )3 g.

External therapy:   
Jiejing Zhentong Tincture or Zhenggu Liquor may be externally applied, or Shexiang Zhuifeng Plaster is externally applied.

Fixation:     
For the case of serious injury with sharp pain, a neck support or leathery neckband may be used for fixation. One-week bed-rest is needed. Or cervical traction may be applied for relieving muscular spasm.
 
Functional exercise:     
In the middle and late stages, the patient with no serious pain should be asked to relax his muscles of the neck attentively, and to try his best to keep his neck in normal position. At the same time, exercises on flexion, extension and rotation of neck should be done.

Acupuncture therapy:    
Fengchi (GB20), Dazhui (GV14), Hegu (LI4), Kunlun (BL60) and Ashi points are selected. The needle is inserted in the contralateral side or bilateral sides. The reducing technique is used in manipulation with no needle retained.