Wry neck, or acute torticollis, is a condition characterized by an abnormal, asymmetrical head or neck position. The head tilts to one side, and the chin often points to the opposite side. The condition can be categorized into congenital and acquired forms, each with distinct causes and management strategies. Although there are two main types of wry neck, congenital wry neck which is present at birth, and acquired wry neck that can develop at any age, in our physiotherapy clinic we typically see the latter, an Acute Acquired Wry Neck.
Causes/Risk Factors of Acute Acquired Wry Neck
Acute wry neck is usually caused by the facet joints in the spine jamming up or locking accompanied by muscle spasm. Facet joints are located in the back of the vertebrae and are responsible for the movement of one vertebra over another which is the key to correct movement in the neck. Locking of these facet joints is thought to be caused by irritation, inflammation and muscle spasm which creates further difficulty with moving the neck. Although it is usually a sudden injury there are several causative factors which may predispose one to a wry neck.
- Muscle Strain or Injury: Acquired wry neck can be triggered by muscle strain, injury or spasms because of overuse or trauma seen often with heavy lifting or repetitive movements. (Pillai et al., 2019).
- Infections: Infections affecting the neck area, such as lymphadenitis or cervical spine infections, can cause inflammation and muscle contraction, leading to wry neck (Kumar et al., 2021).
- Neurological Disorders: Certain disorders involve involuntary muscle movements that can affect neck positioning (Ganos et al., 2022).
- Poor Posture and Ergonomic Issues: Chronic poor posture, such as prolonged periods of sitting with improper ergonomics, can contribute to muscle imbalances and strain, increasing the risk of developing acquired wry neck (Kumar et al., 2021).
- Trauma: Trauma to the head or neck, such as from a car accident or sports injury, can cause acute wry neck by directly affecting the neck muscles or cervical spine (Pillai et al., 2019).
Signs and Symptoms
- Typically, a sudden onset of symptoms, including neck pain, stiffness and reduced movement
- Abnormal Head Position: The head tilts to one side and the chin often points to the opposite side of the tilt.
- Restricted Range of Motion: Difficulty moving the neck normally, particularly rotation and lateral flexion
- Muscle Spasms. Particularly the in the sternocleidomastoid muscle, and overactivity in the upper trapezius and levator scapulae
- Cervicogenic headaches may also be present due to muscle tension or strain.
Diagnosis
Diagnosis is typically made following a subjective history and physical examination, which can be performed by a physiotherapist. The main clinical features include the altered head position, muscle spasm and guarding, restricted cervical movement and specific joint hypomobility and tenderness on palpation. Postural changes may be noted, such as an increase in thoracic kyphosis, head forward posture or altered scapula positioning, and scapula dyskinesis on movement.
Current Evidence
Current evidence supports physiotherapy interventions in the treatment of neck pain and dysfunction. It is shown that joint mobilisations of the cervical spine can have a significant effect on neck pain, disability, range of motion and muscle endurance (Faroq et al., 2017). It is also apparent that physiotherapy treatment can lead to improvements in neck movement and cervical spine motor control within two weeks (Meisingset et al., 2016)
How does Physio Help?
Physiotherapy plays a crucial role in managing acute wry neck, particularly in improving neck mobility, reducing pain, and addressing muscle imbalances. Physiotherapy can be started immediately aiming to help improve movement and reduce symptoms. Treatment often includes:
- Manual therapy techniques including soft tissue massage which can relieve muscle spasm, tension and muscle overactivity; and joint mobilisations can improve facet joint gliding to improve cervical movement.
- Stretching Exercises can improve flexibility and lengthen the affected muscles. Gentle stretching of the sternocleidomastoid (SCM) muscle, trapezius and levator scapulae as well as other neck muscles is commonly used (Pillai et al., 2019).
- Strengthening of the neck muscles to support improved posture and alignment and may focus on the muscles that counteract the abnormal head position.
- Gentle range of motion exercises can help to promote and maintain movement following manual therapy.
Heat Therapy can help to relax tight muscles and increase blood flow by applying warm compresses or a heating pad (Kumar et al., 2021).
Physiotherapy treatment may also include:
- Postural retraining Exercises to improve overall posture and reduce the tendency to adopt compensatory postures.
- Ergonomic Adjustments: Educate on correct posture and ergonomics to prevent further strain. This will include advice on workstation setup and body mechanics (Ganos et al., 2022). Education on the use of devices such as smart phones, laptops and tablets is also imperative to take stress off the neck.
- Activity Modification: Education on modifying daily activities to avoid exacerbating symptoms. This may involve changes in movement patterns or avoiding positions that worsen the condition (Hershey et al., 2020).
Exercise
Upper trapezius Stretch:
Aim: To improve length, tone and reduce overactivity in the upper trapezius
How: Gently grasp side of head, reaching behind back with other hand. Tilt head away pulling your ear towards your opposite shoulder until a stretch is felt.
Deep Neck Flexor training:
Aim: Improve activation, endurance, and contraction of the deep cervical flexors.
How: Simply lye on your back with head on a flat pillow or folded towel so the head is in a neutral position. Gently and slowly nod the head as if saying “yes”, but only moving a small amount. Hold 5 seconds for 10 reps. It should feel very subtle and the big muscles in your neck should not contract.
High Kneeling row on the reformer:
Aim: Improve core and postural strength training your rhomboids and lower traps.
How: In high kneeling on the reformer engage your core muscles. Place your hands in the straps starting at your midline and then “row” pulling the straps towards you training your upper back muscles and improving your posture. Adjust springs to change level of difficulty.
If you or someone you care for has an injury, a flare up, requires some rehabilitation or experiences an increase in pain, give the clinic a call on 9713 2455 or book online.