'Wry' Neck

What is a ‘wry neck’?

A ‘wry’ neck is one of the more common neck disorders that Physiotherapists see and treat. Medically, a wry neck is known as an ‘acute torticollis’ and it is characterised by a rapid onset pain that can grossly limit your range of available movement. It is usually much more painful on one side of the neck, but because of the associated involuntary muscle spasm that occurs with the condition, pain may sometimes be felt on both sides. It is very common to wake up with a wry neck and for the pain and muscle tension to then increase progressively over the course of the morning. Alternatively, some people experience them following a sudden or jerky movement of their head, and they may vary in severity between relatively mild to excruciatingly painful. Most patients with a wry neck tend to be young adults, and children may also be affected.

What causes a wry neck?

The exact cause of a wry neck may vary. In young children for instance, a common cause of the neck restriction is thought to be spasm of the sternocleidomastoid muscle which can be the result of habitual posturing of the head (such as sleeping in the same position each night), causing a shortening of the muscle. In youths and young adults, a common cause of wry neck is an entrapment of a synovial membrane within the planes of one of the neck joints, this causing the acutely painful ‘pinching’ in the neck when you move. Less commonly, one of the discs of the neck can be the source of pain.

Fortunately, wry neck is a transient and self limiting condition that can usually recover in a few days to a week or so, and more reliably with treatment. There are generally no long term complications as a result of having a wry neck, but although many are isolated ‘one off’ problems, some individuals can have re-occurrences.

Neck pain is a major contributor to disability worldwide, with about 70% of the population experiencing an episode of neck pain at some time in their lives. In fact, some statistics show that around 10-15% of the population has neck pain at any given moment!

Characteristics of Wry Neck

• A sudden onset of sharp neck pain and restriction of neck movement
• Pain can be anywhere in the neck extending to the head, shoulder and upper back, usually worse on one side.
• Difficulty tilting or turning the head to the affected side.
• The head is often tilted away from the affected side slightly and the patient is unable to correct the faulty posture themselves due to pain and muscle spasm.
• Palpable neck spasms on the affected side.
• Pain and movement restriction will usually resolve in under a week with treatment.

Making sure it is a ‘Wry Neck’...

It is very important for your Physiotherapist to accurately diagnose your specific problem, since not all neck pain will be from an acute torticollis. There are many potential sources of neck pain, and Physiotherapists are specifically trained to identify these issues and manage them appropriately. Some other sources of pain may include:

• Cervical disc protrusions
• Cervical postural syndromes
• Spinal degeneration
• ‘Whiplash’ injuries
• Spinal fracture
• Acute nerve root pain

The management of each of these conditions may vary significantly, as may the time frame of recovery. Your Physio will assess your problem and advise you on the best course of action and treatment based on their findings. Many cases of neck pain respond favourably to Physiotherapy, but under some circumstances we may need to refer you to your doctor or for X-rays/investigations to optimally treat the problem. For more information on different types of neck pain, click here.

Physiotherapy Treatment

Physiotherapy is often the treatment of choice for a wry neck. We use a variety of different techniques to help reduce your pain and restore your range of movement. In the vast majority of cases a it will respond well over 3-5 days, although some more extreme cases may take up to two weeks.

• Multi-modality treatments: In most cases, your neck pain will respond well to a combination of several approaches including manual mobilisation techniques, gentle stretching, electrotherapy, heat, soft tissue massage and graduated strengthening exercises as required. Manipulation can be effective but needs to be used cautiously and when clinically indicated.
• Proprioceptive and therapeutic exercise - aims to restore your sense of head/ neck position and encourage a return to normal active movement.
• Massage and soft tissue stretching - relaxation of tight muscles and secondary spasm induced by pain will help to ease symptoms but should be done gently and within comfort.
• Dry needling - some people find this useful for the short term relief of pain and muscle spasm.
• Simple range of movement exercises should be done every hour or so when you have a wry neck. Perform them gently and within comfort, but try to actively improve your available range with each repetition.
• Contoured heat packs are a great help at work or around home for alleviating pain and muscle spasm.