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    Acute Torticollis

    What is acute torticollis?

    • Torticollis, sometimes also referred to as “wry neck”, is a condition causing muscle spasms and associated neck pain.

    How common is acute torticollis?

    • 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).

    Should I worry?

    • 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).

    Who is the most likely to suffer from acute torticollis?

    • 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).

    What are the common symptoms?

    • 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).

    What can I do?

    • 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).

    How long will it take to recover?

    • 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).
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    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).

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    2. Signs & Symptoms

    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).

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    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.

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    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.

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    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

    Early Plan

    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).

    Early Plan - Rating

    Intermediate Plan

    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.

    Intermediate Plan - Rating
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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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    Book an Appointment

    Please book an appointment with one of our physiotherapists if you think you are suffering from this condition and would like to find out more.

    We have Pure Physiotherapy clinics across the country including Norwich, Great Yarmouth, Sheffield, Barnsley, Manchester, Stockport and Rochdale. Please view our clinics to find the closest physiotherapy clinic for you.

    References

    1. 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.
    2. 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
    3. Binder, A. (2007b) The diagnosis and treatment of nonspecific neck pain and whiplash. Europa Medicophysica 43(1), 79-89
    4. 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
    5. Gross, A. et al. (2015b) Exercises for mechanical neck disorders. John Wiley & Sons Ltd. http://www.cochranelibrary.com [Free Full-text]
    6. 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.
    7. BMJ (2018b) Acquired torticollis. BMJ Best Practice. http://www.bestpractice.bjm.com
    Other Conditions in Neck, Shoulders

    Whiplash Disorders

    An injury which typically occurs following a road traffic collision, often affecting the soft tissues of the neck.

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    Neck Pain

    Pain or discomfort in the neck and/or shoulder girdle, with or without pain referred to the arms.

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    Thoracic Outlet Syndrome

    A condition presenting with pain in the arm as a result of compression of structures around the neck/shoulder.

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    Cervical Disc Dysfunction

    Disk/joint-related issues that can cause pain, weakness and altered sensation in the neck and arms.

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