Display Patient Information Leaflets

Date issued: June 2024

Review date: June 2026

Ref: C-573/ZSF/Physiotherapy/Miami J Collar

PDF:  Miami J collar.pdf [pdf] 289KB

Patient Information

Please keep this patient handbook for reference, you may need to read this again. Please bring this information leaflet with you to any follow-up hospital/ healthcare appointments after your discharge home. If you have any further questions or concerns regarding the collar i.e., correct fit, please contact the department that fitted it.

PATIENT NAME:………………………………

DATE:……………………………………………

DEPARTMENT/WARD:………………………..

Introduction

The purpose of a cervical collar is to support the neck during the healing process after trauma or surgery.

Your consultant has recommended wearing the Miami J collar to aid in your recovery and rehabilitation. These instructions identify the steps you need to take and what you need to be aware of while wearing the collar.

Adhering to these steps and following the instructions provided by your healthcare provider will help ensure safe and effective care of you and the collar, the length of time of use and daily wearing regimen.

Purpose of the Collar

• To support the spinal column and supporting structures such as the ligaments and muscles from the loads and stresses that can cause movement and pain in the neck.

• It helps maintain the bone alignment and limits the movement in your neck whilst the bones, ligaments and muscles heal. The Miami J collar can be fitted in either lying or upright sitting. The position that is most appropriate will be advised by the issuing Consultant or healthcare professional.

Patient Notes

How long should the collar be worn?

6 weeks                                         

3 months                                        

Other: Please state:…………………………..

The collar should be worn:

Continuously                                  

When sat upright/sat out/mobilising 

Other: Please state:…………………………

The collar should be applied/ removed:

In lying                                           

In sitting                                         

The collar care is to be undertaken:

With assistance of 2 people (spinal precautions required)   

With assistance of 1                                                           

Independently                                                                    

The following is recommended:

Skin checks must be performed at least once a day            

Pads must be checked/changed at least once a day           

Other: Please state:……………………

The collar should be worn:

Continuously                                  

When sat upright/sat out/mobilising 

Other: Please state:…………………….

It is very important to wear your collar as advised.

Fitting of Miami J Collar in Sitting                  

1. The patient to sit up straight on a firm chair. Ask them to keep their head and neck in a neutral position (nose in line with belly button, chin level) and DO NOT bend your neck forward, backward or sideways. Minimise distractions. Flare the front panel outwards. Position the collar chin piece directly flush under the chin. Bring the sides of the front panel up and over the shoulders towards their ears. Ensure the padding extends beyond the edge of the plastic.

1. Whilst holding the front of the collar with one hand. Centre the back panel and attach both straps to the sides. The patient can hold the front piece in place while the straps are initially loosely attached.

1. While holding the front panel in place with one hand, pull the back panel outward and forwards to secure the back panel straps directly on top of the velcro on the front of the collar, in the same alignment. Repeating alternately on each side as required for a snug, symmetrical fit.

1. The velcro straps must be aligned symmetrically and oriented “blue-on-blue” to the velcro on the Front

You should only be able to get no more than two fingers between the patient’s neck and collar behind the ear on each side. If the patient can slip their chin inside the collar it is too loose.

Starting position for change in lying

The patient needs to lie on their bed, keeping their head in a neutral position (not turned to the side) and looking straight up. The patient needs to place their arms by their sides and keep their legs uncrossed. Please minimise distractions before starting. Check the Collar Application and Fitting record to see if any pillows/towels are needed to achieve alignment.

If you have been advised that you need a ‘head hold’ you will need a second person to assist you.

Fitting the Miami J in lying

Ensure patient is in the Starting Position and head hold is being performed if required.

1. Back Panel: Check the arrows are pointing up towards the top of the patient’s head. Slide the back piece behind the patients head and centre it. Remember to push the collar into the bed in order to prevent the patients head from moving.

1. Front Panel: Flare the sides of the front panel out. Slide it up the chest wall and scoop it up underneath the chin.

1. Angle: Angle the sides of the collar up towards the ears. This prevents skin trapping on top of their shoulders and allows the collar to wrap snugly around their neck.

1. Sides: While holding the front securely, curl the sides snugly around the patient’s neck. Apply the Velcro strap and secure the opposite side of the collar in the same fashion. Tighten the straps alternately on each side until they are the same length.

1. Final Checks: Velcro straps must be aligned symmetrically and orientated “blue-on-blue” to the front Velcro adhesive sections. There should be equal amounts of excess Velcro overhanging at the front.

When tight enough, you should be able to fit one finger only between the collar and the patients head behind their ear.

Final checklist:

• Chin is centered comfortably in the chin piece.

• Collar velcro straps oriented blue-on-blue, both tabs the same length.

• Front of collar angled up toward ears. The lower plastic edge should not be resting on clavicles or digging into shoulder.

• Sides of the Back overlap the sides of the Front.

• No plastic touching the skin. Blue pads extend beyond all plastic edges.

• No slack or gaps in any of the straps (except Assist Strap).

• The large front and back openings are centered on the neck

Collar Care/ Washing

• When you leave hospital you will have at least one complete hard collar and two sets of soft collar linings.

• You will need to change the soft collar linings ideally every day.

• The set of soft lining pads that are taken off can be washed in warm soapy water and left to air dry.

• Wipe the white plastic collar shell clean with mild soap and water

• The collar can be worn in the bath or shower, and then the wet pads replaced with the dry set once you have finished, using method as taught.

• If you have a beard, it can cause friction therefore it is recommended to shave regularly whilst wearing the collar.

• By getting into a daily routine, you will avoid getting any sore areas of skin around your neck, and the collar will feel more comfortable.

Miami J pad changing

All the pads are different sizes so replace one at a time to start with until you get used to it. The furry side should go to the Velcro, shiny towards the skin.

The pads must cover all edges of the plastic to avoid touching skin.

Pressure areas:

Key areas at risk of rubbing or pinching include:

• Chin                    
• Jaw                    
• Collar Bone         
• Breastbone         
• Top of Shoulders 
• Back of Head      
• Ear                     

It is known that cervical collars can cause pressure areas. Wearing a collar increases your local skin temperature and can cause excess skin perspiration in and around the area. Constant moisture can cause skin breakdown. In patients with moist skin, skin breakdown is increased four-fold, compared to those with dry skin.

To prevent pressure areas the following precautions, need to be taken: 

• Keep the skin clean, dry and cool.

• Remove the collar, inspect the skin at least once a day, particularly at the bony prominences. The usual pressure points are chin, collar bone, ear lobes and back of the head.

• Maintain hygiene under the collar.

• Clean the skin under the collar daily, wash with warm soapy water and dry thoroughly.

• Do not apply powder or lotions.

• Change pads if they become wet.

What happens if a pressure ulcer develops?

Simple grade 1 pressure ulcers (redness, intact skin) or grade 2 ulcers (partial thickness loss of skin, shallow open blister) can be managed by your community nurse/ GP surgery with a skin protector or dressing. They will also be responsible for contacting your neurosurgical team should there be no improvement in the pressure areas or if they worsen. It may mean your collar needs adjusting or refitting.

What other complications are associated with collars?

Very rarely temporary facial numbness/ weakness and swallowing difficulties, new pain or weakness in the arms have been known. This may require review by the neurosurgical team it occurs. Some find eating and swallowing more uncomfortable due to the position of head and neck. We will try to minimise this as much as possible. 

Patients may experience discomfort due to tight straps, complaints of confinement, increased perspiration because of wearing the collar. However, a well fitted, snug collar is usually more comfortable than a loose collar that may rub.

How long will I need to wear the collar?

This will vary depending on your personal situation and the reason why you require a collar. You will probably be given an expected duration of treatment when the collar is first fitted but this can change depending on how your injury heals.

How to prevent neck stiffness when the collar comes off?

Contractures, muscle wasting, and muscle weakness are possible with long term collar use but are rarely a problem. This can be overcome by muscle strengthening and stretching exercises after the removal of the collar if required. If you have any concerns, then contact your GP for referral to see a physiotherapist.

What if my bone does not heal?

Treatment in a collar is sufficient in the majority of fractures, however after a period of time the surgeon may decide on a surgical option if there is no evidence of bone healing.

What adaptations will I need to make whilst wearing the collar?

• Using an arm chair may be easier to stand/ sit down and will put less strain on your neck but is not essential.

• The collar will restrict your ability to move freely and see your feet. Take care when walking and when going down the stairs.

• Remove things that may cause you to fall, such as rugs and electrical cords. Use non-slip bathmats, grab rails and a shower chair in your bathroom if feel necessary. Arrange handy items so they are easy to access, everything else tidy away.

• When moving from a lying to standing position, roll on to your side then use your arm and leg towards the edge of the bed to keep your body in alignment. Follow advice from your physiotherapist about exercise.

• You should postpone sexual activity until your follow up appointment unless your surgeon specifies otherwise.

• You should not drive a car until out of the collar. Avoid sitting in the front seat with an airbag.

• It is advised that you wear loose fitting clothing that is easy to put on and take off such button up shirts or blouses to help avoid putting clothing over your head.

When should I call for help?

If you experience any of the following, please seek medical help.

• Severe neck pain.

• Weakness, tingling or loss of feeling in your face, arms or legs.

• New loss of bowel or bladder function.

• Broken skin areas/ pressure sores.

• If the collar breaks or is damaged in any way.

Who should I call for help?

In the first instance please call your GP regarding any problems in relation to your collar.

For patients who are under Neurosurgical team care contact Erme Ward, Tel: 01752 438114 Bleep 81483 (8.30am to 4.30pm).

In an emergency please attend your local Emergency Department.

Further Information:

Before you leave the ward, we will ensure you are able to complete your own collar care or instruct somebody who will be able to help you at home.

Any further queries should be directed to your own GP in the first instance.

Your questions may even be answered by reading through this information leaflet, or by reading the instructions contained with your collar packaging.

Collar Care Videos

There are several videos demonstrating application of both collar types. Watch Collar Care Videos.

Tutorial for changing in sitting online:

Watch Miami J user fitting tutorial

Find further patient information about physiotherapy

Replacement Collars:

If you require a replacement collar or pads, please contact your GP who will refer you to your local orthotics department.

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