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Torticollis

There are a number of different types of torticollis. The most common in adults is an acute torticollis, which is sometimes termed wry neck or an acquired torticollis. An acute torticollis is when the head becomes twisted to one side and it is very painful to move the head back to a straight position. The cause of acute primary torticollis is often not known. However, it may be due to a minor strain or sprain to a muscle or ligament in the neck. When this happens the side of the neck feels painful and is stiff because the muscles are in spasm. Some cases may be due to certain muscles of the neck being exposed to cold ('sleeping in a draught') and others may be activity or posture induced, such as sitting or sleeping in an awkward position without adequate neck support. It is not uncommon for people to go to bed feeling fine and to wake up the next morning with an acute torticollis.

With acute torticollis, the pain is usually on the same side of the neck as the muscle spasm. However it may present in the middle of the neck or even spread to the back of the head and shoulder of the affected side. Any attempt to straighten the neck is very difficult and painful in the initial period of spasm. The most commonly involved muscle is the sternocleidomastoid muscle. This muscle runs down the side of the neck from its attachment to the occipital bone of the skull. The other end of this muscle splits, with one end attaching to the clavicle (collarbone) and the other to the top of the sternum (breastbone). The second most commonly involved muscle is the trapezius muscle.

torticollisIf you are concerned, seek advice from your GP for treatment options, and to rule out the possibility of any serious underlying causes. Generally episodes of acute torticollis resolve within 24-48 hours. However if symptoms persist, treatment from a manual therapist can help with this problem. Manual therapy aims to reduce the muscle spasm, restore range of motion and relieve the pain. Chiropractors, Osteopaths and Physiotherapists are all manual therapists who can provide advice and treatment for this condition.

General self help advice for acute torticollis:

  • Gentle exercise within the comfort zone
  • Intermittent heat or a cold pack to help reduce pain and spasm
  • Sleeping on a low firm pillow
  • Maintaining a good posture.

More rarely, torticollis in the neck occurs as a result of other conditions, such as:

  • Infections of the throat or upper airways resulting in swelling in the lymph glands of the neck or infections in the skin and underlying tissues. The inflammation can irritate the nerves and trigger the muscles of the neck to spasm. Many of these infections can be treated with antibiotics.
  • Trauma to the neck can cause the two vertebrae closest to the skull to slide with respect to each other, tearing or straining the stabilising ligaments. As a result the muscles of the neck spasm to provide support and stability to the neck. This condition is treated with traction or manipulation to reduce the muscular spasm and ligament strain as well as the subluxation of the joints. In rare cases, bracing may be used to support the neck until the ligamentous injury heals.
  • Tumours of the skull base (posterior fossa tumours) can compress the nerve supply to the neck and cause torticollis. These problems must be treated surgically.
  • Torticollis can be a side-effect of certain medicines, for example, phenothiazines.

By Shelley Doole DC MChiro

References

Dressler D, Benecke R (November 2005). Diagnosis and management of acute movement disorders. J. Neurol. 252 (11): 1299–306.
Neck pain - acute torticollis, Clinical Knowledge Summaries (January 2009).