RAPHAEL et al. (1994) - Effects of the cervical collar on cerebrospinal fluid pressure

Hi friends,

A doctor told me that a collar to limit the head movements might result in a poorer flow of CSF. Trying to find evidence for that I came across the following study. But there should be another one with healthy participants, too…


We investigated the hypothesis that cervical collars might compress the internal jugular veins and raise intracranial pressure in head-injured patients. In a randomised, single-blind, crossover study of nine patients scheduled for elective spinal anaesthesia the cerebrospinal fluid pressure in the lumbar subarachnoid space was measured with and without a ‘Stifneck’ cervical collar applied. There was a significant elevation of cerebrospinal fluid pressure in seven of the patients studied when the cervical collar was applied (p < 0.01). This preliminary study raises the possibility that immobilisation of the cervical spine with the ‘Stifneck’ cervical collar may, by raising the intracranial pressure, contribute to secondary neurological injury in head-injured patients in whom intracranial compliance is already reduced.


I have not read the whole study (just the abstract) but wonder if the study took into account the different types of neck Collars. I know Stifneck’ cervical collar can compress the jugular vein since it has much compressive force but Soft neck collar was a life saver for me. Even pressing your neck with your hand can collapse the thin-walled jugular vein but I hope this study does not scare away folks who can benefit from soft neck collar to keep their chin up.

There was one case in here (below) that was able to reduce pain and diamox as result of wearing soft neck collar.


This is really interesting and helpful, thanks! I have been using a hard collar for a few years while travelling in a vehicle because I have a hypermobile neck/CCI. This helps tremendously with the impact of travelling in a car. However! It also results in feeling weird and suffocated. Now that I have a diagnosis of stylo-jugular syndrome (vascular eagles), this makes sense. I was wondering about the impact of he collar on my IJVs and this article confirms my experience and suspicion.
The problem remains - how to stabilize and protect my craniocervical region without IJV impact!?
Is a soft collar a good compromise? Is it enough to stabilize the head/neck when in a vehicle? I’m also thinking about trying to sleep with a soft collar as I’m thinking it might help with keeping my neck/head in a more neutral position, maximizing IJV flow during sleep.

Would love other thoughts on this!

i don’t have my full ES diagnosis yet but because my neck hurts when i turn right i thought i would buy a collar to keep me from doing it, hoping i can improve my hurting neck muscle. i was using it for a couple of hours a day for a week and had to stop, i felt i feel worse. thank you for sharing this.


@JR71 We’ve had a few members w/ ICA compression try a soft collar to try to stabilize their necks & keep their necks in a more neutral position. Haven’t heard anything from those who’ve tried it. My gut feeling is a soft collar would be more helpful than no collar as it will still give neck support just not as completely as a stiff-neck type collar.

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@Bozena - Were you using a stiff collar or a soft collar?

is soft the one made of sponge like material??? this is the one i have Raphael

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