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Suddenly can't turn your head like usual? It might be acute torticollis aka. wry neck

Have you ever woken up with your head to one side or suddenly felt a painful, restrictive spasm in your neck? Have you been unable to look both ways to cross the road? Is your neck feeling stuck?


Acute torticollis, also known as wry neck or cervical dystonia, is a common but often distressing condition that causes the head to be suddenly pulled towards one side. Torticollis can occur following an injury or after sleeping in an awkward position.



Causes


Sustaining a neck position for an extended period of time and/or a sudden, quick movement can cause irritation to a cervical facet joint (causing stiffness) or intervertebral disc (causing inflammation).


Common factors

  • Stress

  • Weakness in neck and shoulders

  • Stiffness in mid-back

  • Poor ergonomic set up

  • Non-neutral sleep position


Symptoms

  • Pain during neck movement

  • Profound reduction in range of motion

  • Swelling and inflammation

  • Stiffness

  • Spasm with sudden neck movements

  • Tenderness at the neck and upper back


Diagnosis


After a full history is taken, an assessment of the cervico-thoracic region to determine the level and location of injury is completed. This includes observing posture, active movements, passive movements, intervertebral movements and palpation of the musculature and bony prominences. This ensures an accurate diagnosis so a relevant treatment plan can be determined.



Treatment


Treatment is focused on reducing pain and gently improving the movement in the neck over the initial 24-48 hours. Education on sleep positions and work ergonomics is also introduced early in the piece.


Manipulation and mobilisation:

  • Passive stretches and mobilisation to the cervical spine and muscles of the neck

Exercise:

  • Active self-mobilisations using a strap or a towel

  • Thoracic stretching and upper quadrant strengthening

  • Neck strengthening exercises using a resistance band



Soft tissue treatment:

  • Dry-needling

  • Soft tissue massage

  • Trigger point therapy

  • Kinesio-taping


Home remedies:

  • Heat pack for 20mins at the neck

  • Upper back stretches/mobility at regular intervals through the day

Medications that treat acute torticollis include:

  • Non-steroidal anti-inflammatories (NSAIDS), such as aspirin or ibuprofen

  • Muscle relaxants

Prognosis

A well managed torticollis usually resolves within 2-7 days given minimal interference from recurring external factors listed earlier (like poor ergonomics). Physiotherapy management is crucial to an active recovery, return to full function and gym or sport in a timely manner.

Book in with one of our physiotherapists for a full physical assessment, treatment and guided return to normal activity.

References

Crowner, B.E. (2007) Cervical Dystonia: Disease Profile and Clinical Management. Physical Therapy. 7(11). 1511-1526.

https://academic.oup.com/ptj/article/87/11/1511/2742273


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