Wearing a cervical hard collar: ‘Miami J’ - a guide to collar care for patients, relatives and carers

This leaflet is intended to provide an overview about what to expect if you have injured your neck and have been advised by your doctor to wear a ‘Miami-J’ hard collar while it heals.

Contents

• The collar
• Collar care
• Removing and reapplying the collar
• General advice after injury
• Follow up
• Frequently asked questions
• Contacts/ Further information

The collar

What is a cervical hard collar?

A collar has been supplied to you in order to support, protect and limit the movement of your neck as you have sustained an injury to it. There are multiple different causes of this, but most commonly, it is due to a cervical spine fracture. This is a break to one of the bones in your neck.

Most fractures (or other injuries) of the neck are treated ‘conservatively’ (ie allowed to heal without the need for an operation), and the hard collar will aid the healing process by:

• maintaining your neck in correct alignment whilst it is healing
• reducing the movement of the bones in your neck
• supporting the bones, muscles and soft tissues in your neck to hold the weight of your head
• minimising further damage or injury through sudden movements of your neck
• minimising pain and discomfort

Occasionally, surgery may be required to manage an injury to your neck, and sometimes the doctors will want you to wear a hard collar after your surgery to promote healing. It is important that you discuss your specific injury, its severity and what this means for you, with your doctor.

How long do I need to wear the collar?

Your doctor will have explained to you about your specific injury and for how long you must wear the collar. For most patients who have injured or undergone an operation on their neck, this is approximately 12 weeks from the date of injury/surgery. However, this may vary according to the severity of the injury.

The Miami-J hard collar is a two-piece collar, with a separate front and back, which fasten together with Velcro. The doctor or nurse who is caring for you will have adjusted this to ensure that it correctly fits you – please do not touch the adjustment button following your discharge. It should be tight enough to restrict your movement (for example: you should not be able to nod ‘yes’ nor shake your head ‘no’) but must not restrict things such as breathing or swallowing.

It is important that you wear your cervical hard collar at all times so as to ensure maximum effect and minimise further injury (unless your doctor tells you otherwise). Please seek advice and support from your doctor or nurse if you are not completely comfortable wearing your collar.

Collar care

Skin care

Wearing a cervical hard collar can cause the skin underneath to become hot and excessively sweaty, which can lead to skin breakdown from moisture damage. The collar itself puts pressure on the skin, which can also lead to skin damage.

We recommend that you:

• Keep your skin clean and dry.
• Avoid using creams, lotions or oily substances on your skin under the collar.
• Remove the collar once a day (usually whilst washing and dressing) to wash and check the skin (see below).
• Contact your GP, practice nurse or specialist nurse for assessment if you notice any signs of skin discolouration, redness and/or pain underneath the collar.

Cleaning your collar

It’s important to ensure that you clean your collar if it is visibly dirty or smells. This helps to prevent skin irritation. You should have been provided with a spare set of collar pads (please ask for some if you have not been provided with these).

If your collar becomes dirty:

1. Remove collar (see below).
2. Remove Velcro pads from collar.
3. Clean plastic areas with mild soap and water and ensure they are completely dry.
4. Attach clean pads and re-apply collar.
5. Wash dirty pads with mild soap and warm water only.
6. Air dry pads on a flat surface (this usually takes approximately one hour).

Note: To reattach pads, the light grey side attaches to the Velcro on the inside plastic part of the collar.

Please ensure all plastic edges of the collar are covered by the pad.

Removing and reapplying the collar

Method 1: Lying down (one or two assistants required)

1. Lie down flat on your back without a pillow.
2. Do not move your head or neck (extra assistant can support head, if required).
3. Note the position of the Velcro straps (you could take a photo to help with this) at each side, before the assistant removes them.
4. Assistant removes front piece of collar (leaving back piece in place).
5. Ask the assistant to change the pads of the front piece (as described below) and clean/check the skin at the front of the neck.
6. Place the front piece back on – scoop upwards from your chest – ensure it fits centrally and snugly, with your chin near the edge of the chin rest.
7. The assistant slides back panel of collar sideways from underneath you (extra assistant can support keeping head still, if required).
8. Ask the assistant to change the pads of the back panel (as described below) and clean/check the skin at the back of the neck – (use a mirror to help, if required).
9. The assistant slides the back panel sideways underneath your neck – ensuring a central position.
10. Bring the Velcro straps forward evenly and reattach in the same position noted before removal. The grey pads on the back panel overlap the plastic sides of the front piece. The straps should be the same length on both sides.
11. Ensure that the collar feels in the same position as it was prior to removal, and tighten the straps evenly on each side if necessary.

Handy hints

• The words ‘Miami-J’ should be readable to ensure back panel is the right way up.
• You should be able to fit two fingers between your collar and your neck.
• Always ensure the back panel is replaced sideways, not vertically.
• Push the back panel into the mattress if you are struggling to slide underneath.
• Ensure that any long hair is outside of the collar before reattaching.

Method 2: Sitting (one assistant required)

Note: It is only safe to remove the collar in a sitting position if your medical team have advised that it is safe to do so, and you are confident that you (or the person you are helping) can keep your/their neck completely still throughout the process.

1. Sit in a stable position, ideally in front of a mirror. Do not move your head or neck.
2. Note the position of the Velcro straps at each side, before removing them.
3. Remove the front (and then back) of the collar – ask an assistant to help you, if possible.
4. Ask the assistant to change the pads (as described below) and clean/check the skin of the neck (use a mirror to help if required)
5. Replace the front piece of the collar so that your chin is resting on the chin rest. Use one hand to hold it in place.
6. Assistant to replace the back panel of the collar centrally.
7. Adjust and tighten the straps one at a time, until they are in the same position as prior to removal. The grey pads on the back panel overlap the plastic sides of the front piece. The straps should be the same length on both sides.
8. Ensure that the collar feels in the same position as it was prior to removal, and tighten the straps evenly on each side if necessary.

Useful videos

Please note that these videos are produced for health professionals, and provide a useful guide for the management of the collar. However, they should not be used independently without the guidance of a therapist or a nurse. Please do not press the adjustment button without discussing with your medical team.

YouTube video of Miami J - User Fitting Tutorial (opens in a new tab)

YouTube video of Miami J - Care Instructions (opens in a new tab)

General advice after injury

Pain management

You are likely to experience mild to moderate neck pain following your injury. If you have sustained a cervical spine fracture, you may find that the pain worsens initially, but you should experience a gradual improvement over the next six to eight weeks. You should then notice a significant improvement by 12 weeks after injury. Regular simple analgesia (such as paracetamol and ibuprofen) usually helps with this, and should be taken as per package instructions.

If you experience severe pain in your neck (particularly if this is new), or if you find the pain is significantly worsening, please contact your doctor, a specialist nurse or call 111 for advice.

Activity

Whilst you must wear your collar at all times, we encourage you to slowly increase your activity level after your injury.

• Walking is encouraged – slowly try to increase walking distances.
• It is important to keep your arms and legs moving to improve blood flow, and prevent them from becoming stiff or developing blood clots.
• Take regular rest, and let your comfort be your guide on what is safe.
• Take extra care if you are at risk of falls.

Things to avoid

• Do not drive – your collar will restrict your field of vision, and you will not be covered by the DVLA or your insurance company.
• Do not carry out heavy lifting (more than 2kg in each hand).
• Do not lie or sleep on your stomach.
• Do not carry out activities which might put you at risk of sudden movements in your neck.
• Do not perform any heavy housework, heavy exercise or contact sports (for example lawn mowing, running, shovelling, vacuuming).
• Do not carry out activities which involve pushing or pulling, or twisting/bending of the neck.

Follow up

Your doctor will arrange a follow up appointment for you with the correct team.

If you have sustained a cervical spinal fracture, this is usually within the Spinal Fracture Clinic. This appointment is usually a telephone appointment, and typically held 12 weeks after injury, but will depend on the severity of your injury. An x-ray is sometimes, but not always required before this appointment to monitor the healing process. Your doctor will have told you if this is the case.

At your appointment, a clinician will assess your symptoms and discuss the continuing treatment plan for your care and whether a face-to-face appointment or further imaging is required.

Please contact the neurosurgical clinical nurse specialists with any queries.

Please seek advice from your doctor or specialist nurse if:

• skin around the collar becomes damaged
• the collar itself becomes damaged
• there is an increase in tenderness, pain or discomfort around the collar
• the collar is not fitting properly
• you have run out of replacement pads

Please attend your local emergency department (ED) for assessment if you experience:

• any new difficulties with breathing or swallowing
• new weakness, numbness or pain in your arms and legs
• new visual disturbances
• new changes in bladder or bowel habit, or developing numbness in your genitals

Frequently asked questions

Do I have to wear the collar at night?

Yes – unless otherwise instructed by your doctor. If you are finding this particularly difficult, please contact your doctor or specialist nurse for further advice. You may move freely in bed, so long as you do not lay on your stomach. You may use pillows to help with your comfort, but take care that your neck remains in a stable position within the collar, and as flat as you are able to tolerate. To get out of bed, it is recommended that you roll onto one side, bring your legs to the edge of the bed, and push up with your arms.

How do I shower and wash my hair while wearing the collar?

It is safe to shower during the time that you are advised to wear the collar, but this should be done with adequate precautions in place to avoid falls, such as sitting on a shower chair with or without additional anti-slip mats, and having a friend/family member present in the room, at least initially, for help if necessary.

You must wear the collar while showering, particularly as there is a high risk of slipping/falling, or of jerking/moving your neck in response to the water. Covering the collar with a thin waterproof material (such as cling film) may help to prevent it getting wet while you are washing your hair, or you can remove, dry, and change the pads (using the methods described above) after you have finished showering.

Remember: it’s important that your collar remains completely dry for continuous wear.

Can I drive while wearing the collar?

No: as described above, your hard collar is designed to prevent the movements of your head and neck, which are required for safe driving and you will not be covered by the DVLA or your insurance company.

What clothing should I wear?

Wear clothing on the outside of your collar; the pads should be directly against your skin. Stretchy, loose clothing is recommended. Button up shirts may be easier for you to wear. Avoid pullover shirts and jumpers, as they are more difficult to get over your collar.

When can I return to work?

Returning to work will depend largely upon you and what sort of work you do. It is usually safe to resume working at a desk as soon as you feel ready to do so, but please discuss with the clinician at your follow up appointment before resuming any manual work. We can provide an initial Fitness to Work note, and further notes can be obtained from your GP if required.

Will I need physiotherapy?

Physiotherapy is not recommended until after your neck has healed. A clinician will review your condition at your follow up appointment, and recommendations or referrals can be made at this point. Most people do not routinely require physiotherapy.

The doctor will tell you when you can stop wearing the collar. The neck muscles may initially feel weak or stiff after the doctor tells you that you can stop wearing the collar, but this usually recovers naturally.

If you experience any continuing weakness or a limited ability to move your neck, a physiotherapy review might be of benefit. Please contact your GP to arrange this.

I’ve got a surgical dressing under my collar. How should I manage this?

Any wounds should be checked as part of your your daily skin checks. Recommendations for caring for this wound or stitch removal will have been given to you separately when you were discharged.

However, if you see any new discharge, redness or swelling from the wound, or find that the collar is causing irritation to the wound, please contact your doctor or specialist nurse for further advice.

Contacts/ Further Information

If you have any clinical questions in relation to your collar or injury, please contact the neurosurgical clinical nurse specialists (via the Contact Centre).

• Aimee Cooper/ Marissa Asplen (spine)
• Nicola Owen (trauma)
• Kirsty Grieve (trauma)
• Joana Ferreira (spinal cord injury)

You should receive an appointment through the post or via MyChart for a follow-up appointment. If this does not occur, or if you have queries in regards to this, please contact the neurosurgical secretaries via the Contact Centre.

If your doctor told you that you required an x-ray before your follow-up appointment, this appointment should come through the post or via MyChart. If this does not happen, or if you have queries in regards to this, please call the Outpatient X-Ray Department on 01223 216270.

References/ Sources of evidence

Promedics Manufacturers Guidelines (opens in a new tab)

National Institute for Health and Care Excellence (NICE). Spinal Injury: Assessment and Initial Management (Guideline: NG41] Published 17 February 2016.