Home Page

Date issued: December 2022  

For review:  December 2024

Ref: C-260/Physio/AE/You and your collar v8 

PDF:   You and your collar final March 2018 v7.pdf [pdf] 742KB

 

Purpose of a collar

• The purpose of a collar is to stabilise the spinal column and supporting structures, such as the ligaments and muscles, from loads and stresses that can cause pain and movement of the neck bones.

• It maintains the bone alignment and limits the movement in your neck whilst the bones and ligaments heal.

• Your Physiotherapist will attach a copy of your collar discharge plan.

It is very important to wear your collar as advised.

The collar type you have been fitted with:

Aspen Vista                    

Miami J

The position you need to change your collar in is:

Lying

Sitting

Head hold required:   

Yes                            

No

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.

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

You will have been advised on the Collar Care and Fitting Record as to whether you need any support behind your head in order to maintain neck alignment.

Lying

This is a one size fits all collar, with a yellow dial on the front panel. This is turned to adjust the height of the front panel and will be done by a trained, collar fitter; it should not be adjusted by you.

Ensure patient is in the Starting Position and

head hold being performed if required.

 

1. Curl/bend the ends of the side panels so that they are slightly curved.

 

2. Ensure it is the correct way up, then with their head in a neutral position press the back panel down onto the bed and slide it behind the patient’s neck. The Velcro straps should be

   half way between the patients ear and the top of their shoulder.

3. Hold the front panel in place, with the chin resting centrally on the chin area and attach the Velcro straps on each side, back over front.

4. To tighten, anchor your fingers in on the collar and peel back the Velcro on each side, push the back piece firmly around the neck, tighten and reattach the strap. Tighten the other side            equally and repeat as required to ensure a snug, symmetrical fit.

5. Check to see that the back of the chin piece is not pressing inward onto the throat and that the padding covers the plastic well.

6. Final Checks: Velcro straps must be aligned symmetrically and orientated  to the front Velcro adhesive sections. You may need to re-adjust the position of the collar by lifting and angling          the back ends of the side panels up towards the ear. There should be equal amounts of excess Velcro overhanging at the front. When tight enough, you should be able to fit two fingers            between the collar and the patients head behind their ear.

Aspen pad changing

Reapply the pads so grey/green colour material grips the Velcro dots.

Ensure the notch on the lower, front pad is correctly positioned. The pads must cover all edges of the plastic to avoid touching skin. Particularly on the chin and throat.

To change the back pad, push the straps through the slits in the pad, and then through the slots in the outer edge of the plastic.

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 to ensure it is the correct way up.  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.

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

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

       4. 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.

      5. 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.

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.

Fitting of any collar in sitting

1.Ensure the head is in a neutral   position, minimise distractions. Flare the front panel outwards. Position the chin piece directly under the chin. Generally the chin should not extend beyond the edge of the plastic). Push the side of the front panel up and over the shoulders.

2. 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.

3. While holding the front panel in place with one hand, pull outward then secure the back panel straps to the front of the collar. Repeating alternately on each side as required for a snug, symmetrical fit

You may be advised you can change your collar yourself in the case of very stable injuries. You will be taught how to do this.

On all collars: You should only be able to get two fingers between the patients neck and collar behind the ear on each side, if you can put more than one then the collar will need tightening.

Common areas that are at risk of rubbing or pinching include the bottom of the ear and skin on top of the shoulders, where the two halves of the collar overlap.

Collar Care

• 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.

• 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.

Pressure areas

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 ulcers 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 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 armchair 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 nonslip bath mats, 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.

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 (08.00-4.30).

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 that can be found on the website/QR code below:

http://www.peninsulatraumanetwork.nhs.uk/collar-care

See the following link for further information: https://www.plymouthhospitals.nhs.uk/physio-patient-information

Replacement Collars:

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