Acute Torticollis
1. Introduction
Torticollis, sometimes known as “acute wry neck”, is a condition that causes often quite sudden neck pain and muscle spasm. Acute torticollis (less than six weeks duration) is thought to be due to minor local irritation causing pain and spasm in the muscles that run alongside the neck. The cause of torticollis is often not known, but it may be due to issues with posture — for example, poor positioning at a computer screen, inappropriate seating, sleeping without adequate neck support or carrying heavy unbalanced loads (1, 7).
Frequently Asked Questions
- Torticollis, sometimes also referred to as “wry neck”, is a condition causing muscle spasms and associated neck pain.
- Torticollis affects less than 1% of the general population (1, 3).
- It occurs more often between the ages of 30-60 and is twice as common in women as it is in men (2).
- No.
- Acute torticollis is a common cause of neck pain and stiffness that is very rarely associated with any more concerning medical problems.
- Although it can be painful, most people with the condition do not actually need to see their doctor as simple treatment is often effective (2).
- Torticollis is twice as common in women as it is in men.
- It occurs more often between the ages of 30 and 60.
- The cause of torticollis is often not known, but it may be due to issues with posture – for example, poor positioning at a computer screen, inappropriate seating, sleeping without adequate neck support or carrying heavy unbalanced loads (3).
- Neck pain, often affecting one side more than the other.
- The pain may spread to the back of your head or down to the shoulder.
- The muscles of your affected side may be tender to touch.
- Pressure on certain areas may trigger a ‘spasm’ of these muscles.
- Movement of your neck is restricted, particularly rotation towards the painful side (4).
- Gentle exercises within a comfortable range of movement to mobilise your neck.
- Take some anti-inflammatory drugs, such as ibuprofen or aspirin; however, before taking this it is advisable to consult a medical professional to ensure this is the right choice for your case.
- Use heat for 10-15 minutes to help reduce pain and muscle spasms.
- Gentle massage with a warming gel can be soothing for some people (5).
- Torticollis often resolves within 24-48 hours in over 50% of patients.
- However, some patients may have residual discomfort that can take up to 6 weeks to fully settle.
- A very small percentage of patients may require prolonged rehabilitation beyond 6 weeks (6, 7).
We recommend consulting a musculoskeletal physiotherapist to ensure exercises are best suited to your recovery. If you are carrying out an exercise regime without consulting a healthcare professional, you do so at your own risk. Book online with us today to get a programme tailored to your specific needs.
2. Signs and Symptoms
- Sudden onset of neck pain – often upon waking in the morning – may be referred to the head or shoulder with the rotation of the neck to one side due to muscle spasm (or tightness).
- Restricted and painful neck movement, particularly rotation towards the painful side.
- Diffuse tenderness on the affected side with palpable spasm, possibly with tender points or muscle spasm (trigger points).
- No history of trauma preceding the onset of pain, but there may be a history of exposure to cold, prolonged or unusual positioning of the neck or heavy lifting (3, 4).
3. Causes
In adults, there are several reasons why torticollis may develop, though often it may be difficult for patients and clinicians to identify the exact cause (6). It can develop as a result of a relatively minor injury, such as a small car accident, or due to prolonged awkward postures including longer periods of working at a desk. The causes of acute torticollis are not usually associated with any other more worrying health condition(s).
4. Risk Factors
This is not an exhaustive list. These factors could increase the likelihood of someone developing torticollis. It does not mean everyone with these risk factors will develop symptoms.
- Adults between the ages of 30-60 seem to be the most likely to be affected.
- Torticollis is twice as common in women as it is in men.
- Having a trauma to the neck, such as a sports injury or minor car accident.
- Having a recent infection, such as a dental infection or abscess (4).
5. Prevalence
In the general population, torticollis affects less than 1% of people (4). The most common onset is between people aged between 30-60, with the majority in this group being aged 40-50 at the time of onset.
6. Assessment & Diagnosis
Musculoskeletal physiotherapists and other appropriately qualified healthcare professionals can provide you with a diagnosis by obtaining a detailed history of your symptoms. A series of physical tests might be performed as part of your assessment to rule out other potentially involved structures and gain a greater understanding of your physical abilities to help facilitate an accurate working diagnosis (4).
Your treating clinician will want to know how your condition affects you day-to-day so that treatment can be tailored to your needs and personalised goals can be established. Intermittent reassessment will ascertain if you are making progress towards your goals and will allow appropriate adjustments to your treatment to be made (5,7).
7. Self-Management
As part of the sessions with your physiotherapist, they will help you to understand your condition and what you need to do to help the recovery from your torticollis. This may include reducing the amount or type of activity, as well as other advice aimed at reducing your pain. It is important that you try and complete the exercises you are provided as regularly as possible to help with your recovery. Rehabilitation exercises are not always a quick fix, but if done consistently over weeks and months then they will, in most cases, make a significant difference.
It should be noted that whilst most cases of torticollis settle within the first few days (5), adherence to rehabilitation exercises may need to be continued over time for people with persistent symptoms.
8. Rehabilitation
Below are rehabilitation programmes created by our specialist physiotherapists targeted at addressing torticollis. In some instances, a one-to-one assessment is appropriate to individually tailor targeted rehabilitation. However, these programmes provide an excellent starting point as well as clearly highlighting exercise progression.
9. Acute Torticollis
Rehabilitation Plans
Our team of expert musculoskeletal physiotherapist have created rehabilitation plans to enable people to manage their condition. If you have any questions or concerns about a condition, we recommend you book an consultation with one of our clinicians.
What Is the Pain Scale?
The pain scale or what some physios would call the Visual Analogue Scale (VAS), is a scale that is used to try and understand the level of pain that someone is in. The scale is intended as something that you would rate yourself on a scale of 0-10 with 0 = no pain, 10 = worst pain imaginable. You can learn more about what is pain and the pain scale here.
This programme focuses on maintaining range of movement within the neck, appropriate loading of the affected area and maintenance of strength and stability in the neck. We suggest you carry this out once a day for approximately 2-6 weeks as pain allows. You can work into pain during these exercises but ideally, this should not exceed any more than 3 out of 10 on your self-perceived pain scale (3).
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With this advanced programme mobility exercises are combined with early phase strengthening exercises of the muscles that help support and stabilise your neck. Some discomfort is expected, particularly as you begin to strengthen your muscles. Ideally, this should not exceed 4/10 on the pain scale.
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10. Return to Sport / Normal life
For patients wanting to achieve a high level of function or return to sport, we would encourage a consultation with a physiotherapist as you will likely require further progression beyond the advanced rehabilitation stage. This is particularly relevant if you have symptoms that have persisted beyond the first two weeks.
As part of a comprehensive treatment approach, your musculoskeletal physiotherapist may also use a variety of other pain-relieving treatments to support symptom relief and recovery. Whilst recovering you might benefit from further assessment to ensure you are making progress and establish the appropriate progression of treatment. Ongoing support and advice will allow you to self-manage and prevent future reoccurrence.
11. Other Treatment Options
There are also home remedies for torticollis that will help you feel better by using a series of natural products. Gently applying some form of superficial heat, such as a heat patch or hot water bottle, can help ease pain and muscle spasms. A gentle massage using arnica cream or warming rub can also be soothing for some people.
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References
- Athanassacopoulos, M. and Chiverton, N. (2016) Soft tissue problems of the neck. In: Morris, F., Wardrope, J. and Hattam, P. (Eds.) ABC of common soft tissue disorders. Wiley-Blackwell, 12-18.
- APTA (2017) Neck Pain: clinical practice guidelines linked to the international classification of functioning, disability and health from the orthopaedic section of the American Physical Therapy Association. American Physical Therapy Association. https://www.ncbi.nlm.nih.gov/pubmed/28666405
- Binder, A. (2007b) The diagnosis and treatment of nonspecific neck pain and whiplash. Europa Medicophysica 43(1), 79-89
- Cohen, S.P. and Hooten, W.M. (2017) Advances in the diagnosis and management of neck pain. British Medical Journal. https://www.bmj.com/content/358/bmj.j3221
- Gross, A. et al. (2015b) Exercises for mechanical neck disorders. John Wiley & Sons Ltd. http://www.cochranelibrary.com [Free Full-text]
- Hoy, D.G., Protani, M., De, R. and Buchbinder, R. (2010) The epidemiology of neck pain. Best Practice & Research Clinical Rheumatology 24(6), 783-792.
- BMJ (2018b) Acquired torticollis. BMJ Best Practice. http://www.bestpractice.bjm.com
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Common age related changes to the structure of the knee joint which may be associated with pain, stiffness and loss of function.