A C4–C5 spine sprain occurs when the ligaments that hold together the fourth and fifth cervical vertebrae in your neck are stretched beyond their normal limit or torn. These ligaments include the anterior longitudinal ligament, posterior longitudinal ligament, ligamentum flavum, interspinous ligaments, and the capsular ligaments of the C4–C5 facet joints. A sprain at this level can cause pain, stiffness, and even nerve irritation if nearby structures are affected Medscape Health.
Anatomy of the C4–C5 Segment
Structure & Location:
The C4 and C5 vertebrae sit in the middle of the cervical spine, just below the C3–C4 joint and above C5–C6. Each vertebra has a bony body, two pedicles, two laminae, a spinous process (the bony knob you can feel at the back of your neck), and two transverse processes with holes (foramina) that let the vertebral arteries pass through TeachMeAnatomy.
Origin & Insertion (Ligaments):
The anterior longitudinal ligament (ALL) runs along the front surfaces of the vertebral bodies from C1 down to the sacrum, attaching firmly to each vertebra.
The posterior longitudinal ligament (PLL) runs inside the spinal canal along the back of the vertebral bodies from C2 to the sacrum.
The ligamentum flavum connects the laminae of adjacent vertebrae on the inside of the spinal canal.
Interspinous ligaments run between each spinous process.
Capsular ligaments of the facet joints wrap around the joint surfaces that link the C4 and C5 vertebrae TeachMeAnatomy.
Blood Supply:
Small branches of the vertebral arteries and ascending cervical arteries supply blood to the C4–C5 vertebrae, discs, and nearby ligaments. These vessels send tiny radicular arteries into the spinal canal and around the facet joints to nourish the ligaments and joint capsules Kenhub.
Nerve Supply:
Sensory fibers from the medial branches of the dorsal rami (branches of the spinal nerves at C4 and C5) innervate the facet joint capsules. Pain fibers from the ligamentum flavum and longitudinal ligaments also travel with small branches of the dorsal rami Medscape.
Key Functions:
Support the head’s weight to keep your head balanced above your spine.
Protect the spinal cord and nerve roots that pass through the spinal canal.
Allow controlled flexion and extension (bending forward and backward) of the neck.
Permit lateral flexion (side bending) and rotation (turning) at that segment.
Provide shock absorption through the intervertebral disc between C4 and C5.
Maintain spinal stability by limiting excessive movement through ligament tension Physio-pedia.
Types of C4–C5 Spine Sprain
Sprains are graded by how much ligament damage has occurred:
Grade I Sprain: Ligaments are stretched but not torn; mild pain and stiffness without joint instability. Medscape
Grade II Sprain: Partial tearing of ligament fibers; moderate pain, swelling, and reduced range of motion. Medscape
Grade III Sprain: Complete ligament tear; severe pain, marked instability of the C4–C5 joint, and possible neurological signs. Medscape
Causes of C4–C5 Spine Sprain
Motor vehicle collisions (whiplash): Sudden back-and-forth neck motion can overstretch C4–C5 ligaments Medscape.
Contact sports injuries: Direct blows in football or rugby can sprain cervical ligaments Verywell Health.
Falls onto the head or shoulders: Impact transmits force to the neck, injuring C4–C5 ligaments Medscape.
Repetitive overhead motions: Activities like weightlifting strain cervical joints over time Medscape.
Sudden deceleration in theme-park rides: Rapid stops can whip the neck, causing sprain Medscape.
Physical assault (punches or chokes): Violent force to the neck may sprain C4–C5 ligaments Health.
Poor posture: Chronic forward head posture increases stress on cervical ligaments Verywell Health.
Sleeping in awkward positions: Prolonged neck twisting can strain the C4–C5 area Verywell Health.
Rapid head rotation: Turning the head quickly beyond normal range can overstretch ligaments Medscape.
Workplace accidents: Lifting heavy objects overhead without support can cause sprains Medscape.
Sports like gymnastics: Extreme neck extension or flexion during routines risks sprain Verywell Health.
Seismic jolts (e.g., in military vehicles): Road shocks can injure cervical ligaments Medscape.
Diving into shallow water: Neck hyperextension on impact can sprain C4–C5 TeachMeAnatomy.
Cycling crashes: Falls on handlebars transmit force to the neck Verywell Health.
Equestrian falls: Horse-related falls can whip the head and neck Verywell Health.
Weightlifting without neck support: Barbell drops on traps may overstretch ligaments Medscape.
Repetitive phone or computer use: Holding the head forward for long periods strains C4–C5 Verywell Health.
High-impact aerobics: Jumping exercises without proper alignment can sprain the neck Medscape.
Snowboarding or skiing falls: Forward or backward falls risk cervical sprain Verywell Health.
Trauma from equipment failure: Collapsing scaffolding or machinery impacts the neck Medscape.
Symptoms of C4–C5 Spine Sprain
Neck pain localized around the C4–C5 level, often worse with movement Medscape.
Stiffness that limits neck motion, especially bending and turning Medscape.
Muscle spasms in the shoulder and neck muscles around the injury Medscape.
Headache at the base of the skull (cervicogenic headache) Medscape.
Tenderness when pressing on the C4–C5 vertebrae or facet joints Medscape.
Swelling or bruising around the neck in more severe sprains Medscape.
Pain radiating into the shoulders or upper arms (referred pain) Verywell Health.
Tingling or numbness in the arms or hands if nerve roots are irritated Verywell Health.
Weakness in shoulder or arm muscles controlled by C5 nerve roots Cleveland Clinic.
Difficulty sleeping due to pain and stiffness Medscape.
Dizziness or lightheadedness if upper cervical motion is impaired Verywell Health.
Visual disturbances (blurred vision) from muscle tension Medscape.
Balance problems in severe cases with spinal cord irritation Spine-health.
Jaw pain or TMJ discomfort from referred muscle tension Medscape.
Ear ringing (tinnitus) due to nearby muscle spasm Medscape.
Fatigue from chronic pain and sleep disruption Medscape.
Reduced grip strength if C5 nerve irritation is significant Cleveland Clinic.
Loss of fine motor skills in the hand with persistent nerve involvement Cleveland Clinic.
Clumsiness or dropping objects due to weakness or numbness Cleveland Clinic.
Difficulty swallowing in severe cases if swelling presses on the throat Medscape.
Diagnostic Tests for C4–C5 Spine Sprain
X-rays (AP and lateral): Show bone alignment and rule out fractures Medscape.
Flexion–extension X-rays: Assess for abnormal movement between C4 and C5 Medscape.
Oblique X-rays: Highlight the facet joints to check for joint widening Medscape.
CT scan: Provides detailed images of bone and can detect small fractures ACR Acsearch.
MRI scan: Reveals soft-tissue injury to ligaments, discs, and nerve roots ACR Acsearch.
CT myelography: Outlines spinal canal if MRI is contraindicated ACR Acsearch.
Ultrasound imaging: Visualizes superficial ligaments and muscle tears TeachMeAnatomy.
Electromyography (EMG): Tests nerve function if radiculopathy is suspected AAFP.
Nerve conduction studies: Measure speed of electrical signals in peripheral nerves AAFP.
Facet joint injection (diagnostic block): Numbs the C4–C5 facet joint to confirm pain source Medscape.
Discography: Pressurizes the intervertebral disc to see if it reproduces pain Medscape.
Spurling’s test: Clinical maneuver to reproduce nerve-root pain AAFP.
Neck range-of-motion assessment: Measures degrees of flexion, extension, and rotation Medscape.
Palpation exam: Feels for point tenderness and muscle spasm Medscape.
Sensory testing: Checks for areas of numbness or altered sensation Medscape.
Strength testing: Evaluates muscle strength in C5-innervated muscles (deltoid) Cleveland Clinic.
Reflex testing: Looks at biceps reflex (C5) for decreased response Cleveland Clinic.
Lhermitte’s sign: Bending neck forward to check for electric-shock sensation down spine Medscape.
Jaw-jaw lateral thrust test: Checks facet joint pain by moving jaw sideways Medscape.
Upper limb tension test: Stretches nerves in arm to identify nerve involvement AAFP.
Non-Pharmacological Treatments
Ice therapy: Apply an ice pack to reduce swelling and pain in the first 48 hours Medscape.
Heat therapy: Use a warm compress after acute phase to relax muscles Medscape.
Soft cervical collar: Brief support reminder not to over-move the neck Medscape.
Physical therapy exercises: Tailored stretches and strengthening for deep neck muscles Medscape.
Manual therapy (mobilization): Gentle joint movements by a therapist to restore mobility JOSPT.
Traction therapy: Intermittent mechanical cervical traction to relieve pressure on ligaments JOSPT.
Massage therapy: Soft-tissue work to ease muscle tension and improve circulation Medscape.
Ultrasound therapy: Uses sound waves to promote ligament healing and reduce inflammation JOSPT.
Transcutaneous electrical nerve stimulation (TENS): Electrical pulses to block pain signals JOSPT.
Acupuncture: Needle insertion at specific points can relieve short-term neck pain NCBI.
Dry needling: Targeted needling of tight muscle bands to reduce spasm NCBI.
Chiropractic adjustment: Gentle spinal manipulations to improve alignment Physio-pedia.
Yoga stretches: Gentle neck and shoulder poses to enhance flexibility Physio-pedia.
Pilates: Core and neck stability exercises to support cervical spine Physio-pedia.
Ergonomic assessment: Adjusting workstation height, monitor position, and chair support Physio-pedia.
Postural training: Teaching proper head-over-shoulder alignment during daily activities Physio-pedia.
Cognitive behavioral therapy: Address pain-related anxiety that can worsen muscle tension Physio-pedia.
Mindfulness meditation: Reduces stress and muscle guarding in chronic neck pain Physio-pedia.
Relaxation techniques: Deep breathing and guided imagery to ease muscle spasm Physio-pedia.
Ergonomic pillows: Use cervical-support pillows to maintain neutral neck position during sleep Health.
Soft-tissue mobilization: Therapist-guided massage to break up adhesions Medscape.
Scar tissue massage: If minor surgery has been done, massage to prevent tightness Medscape.
Hydrotherapy: Warm water exercises to gently mobilize neck joints JOSPT.
Laser therapy: Low-level laser to reduce inflammation and promote healing JOSPT.
Kinesio taping: Tape applied to support cervical ligaments and reduce muscle load JOSPT.
Proprioceptive training: Balance and head-movement exercises to improve joint awareness JOSPT.
Biofeedback: Teaches control of muscle tension to reduce spasm JOSPT.
Activity modification: Avoiding heavy lifting or overhead tasks until healed Medscape.
Gradual return to sport/work: A supervised program to safely rebuild neck strength Medscape.
Education on body mechanics: Learning safe ways to lift and move to protect the neck Physio-pedia.
Pharmacological Treatments (Drugs)
Ibuprofen (NSAID): Reduces inflammation and pain AAFP.
Naproxen (NSAID): Longer-acting anti-inflammatory for sustained relief AAFP.
Diclofenac (NSAID): Potent topical or oral option for pain control AAFP.
Ketorolac (NSAID): Short-term injectable for severe acute pain AAFP.
Acetaminophen: Pain relief when NSAIDs are contraindicated AAFP.
Cyclobenzaprine (muscle relaxant): Relieves muscle spasm in the neck Medscape.
Tizanidine (muscle relaxant): Short-acting spasm relief Medscape.
Baclofen (muscle relaxant): Reduces muscle hyperactivity in severe spasm Medscape.
Methocarbamol (muscle relaxant): Adjunct for moderate to severe spasm Medscape.
Gabapentin: Nerve pain relief if radicular symptoms are present AAFP.
Pregabalin: Similar to gabapentin for neuropathic pain AAFP.
Amitriptyline (tricyclic antidepressant): Low-dose chronic pain control AAFP.
Duloxetine (SNRI): For chronic musculoskeletal pain and mood improvement AAFP.
Lidocaine patch: Topical numbing for localized neck pain AAFP.
Capsaicin cream: Depletes pain-signaling substance P in the skin AAFP.
Methylprednisolone (oral steroid): Short-term high-dose for severe inflammation AAFP.
Prednisone (oral steroid): Tapered course for acute flare with marked swelling AAFP.
Corticosteroid injection: Direct injection around facet joints for severe pain Medscape.
Opioids (e.g., tramadol): Reserved for short-term severe pain under close supervision AAFP.
NSAID–muscle relaxant combination: Fixed-dose pills to simplify regimen Medscape.
Surgical Options
Anterior cervical discectomy and fusion (ACDF): Removes damaged disc, fuses C4–C5 for stability Medscape.
Posterior cervical fusion: Stabilizes the back of the C4–C5 segment with plates and screws Medscape.
Cervical disc arthroplasty: Artificial disc replacement to preserve motion Medscape.
Laminectomy: Removes the lamina to decompress spinal cord if ligament rupture causes pressure Medscape.
Laminoplasty: Reopens the spinal canal by reshaping the lamina Medscape.
Foraminotomy: Enlarges the nerve root exit canal if sprain is compressing a nerve Medscape.
Posterior instrumentation and fusion: Uses rods and screws to stabilize multi-level sprains Medscape.
Facet joint fusion: Surgical fusion of the C4–C5 facet joints to stop painful motion Medscape.
Anterior plating: Metal plate and screws applied after ACDF for added support Medscape.
Minimally invasive cervical decompression: Uses small incisions and tubular retractors to relieve pressure Medscape.
Prevention Strategies
Proper headrest adjustment in cars: Keeps neck aligned to prevent whiplash Health.
Wear helmets in sports: Protects against direct neck trauma Verywell Health.
Practice good posture: Keep ears over shoulders to reduce ligament stress Verywell Health.
Ergonomic workstations: Screen at eye level and chair support to maintain neutral spine Physio-pedia.
Strengthening exercises: Build deep neck muscle support around C4–C5 Physio-pedia.
Warm-up before sports: Gentle neck stretches to prepare ligaments for activity Physio-pedia.
Avoid sudden head turns: Move your trunk, not just your neck, when looking around Medscape.
Use hands-free devices: Reduces twisting when on the phone Verywell Health.
Sleep on supportive pillows: Keeps neck in neutral alignment overnight Health.
Regular breaks from screen time: Prevents sustained forward head posture Physio-pedia.
When to See a Doctor
Seek medical attention if you experience:
Severe neck pain that does not improve with rest or over-the-counter medications.
Numbness, tingling, or weakness in your arms or hands.
Loss of bladder or bowel control (a sign of possible spinal cord involvement).
High-impact trauma such as a car crash or fall from height.
Persistent headache at the base of the skull with neck injury AAFP Medscape.
Frequently Asked Questions
What is a C4–C5 spine sprain?
It’s an injury to the ligaments that connect the fourth and fifth cervical vertebrae. Ligaments are bands of tissue that keep bones in place, and when they stretch or tear, you feel pain and stiffness Medscape.How is a sprain different from a strain?
A sprain affects ligaments (bone to bone), while a strain affects muscles or tendons (muscle to bone) Medscape.Can a C4–C5 sprain heal on its own?
Mild (grade I) sprains often heal with rest, ice, and gentle movement over a few weeks. More severe sprains may need physical therapy or other treatments Medscape.How long does recovery take?
Grade I may heal in 2–4 weeks; grade II in 4–8 weeks; grade III may take several months and sometimes require surgery Medscape.Will I need surgery?
Most sprains don’t need surgery. Surgery is reserved for severe tears (grade III) with instability or neurological symptoms Medscape.How can I manage pain at home?
Use ice for 48 hours, then heat; take NSAIDs like ibuprofen; and do gentle neck stretches as guided by a therapist Medscape.Is wearing a cervical collar helpful?
A soft collar can remind you to limit motion but should not be worn more than a few days to avoid muscle weakening Medscape.What exercises help a C4–C5 sprain?
Chin tucks, neck isometrics, and gentle side-to-side stretches strengthen deep neck muscles without overstretching ligaments Medscape.Can I drive with a neck sprain?
Avoid driving if pain or stiffness limits your ability to turn your head safely. Get cleared by a doctor first AAFP.Does posture really matter?
Yes—keeping your head directly over your shoulders reduces strain on ligaments between C4 and C5 Physio-pedia.Are there long-term risks?
Chronic instability or untreated grade III sprains can lead to ongoing pain, arthritis of the facet joints, or neck deformity Medscape.What workplace changes help?
Adjust monitor height, use supportive chairs, take frequent breaks, and avoid heavy overhead lifting Physio-pedia.Is massage safe after a sprain?
Yes—once acute pain and swelling have eased, gentle massage can reduce muscle tension around C4–C5 Medscape.Can acupuncture help?
Evidence shows acupuncture may relieve short-term neck pain but is less proven for long-term disability relief NCBI.How can I prevent re-injury?
Build neck strength, practice good posture, use proper head restraints, and avoid sudden jerking motions Health.
Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.
The article is written by Team Rxharun and reviewed by the Rx Editorial Board Members
Last Updated: May 04, 2025.
