What is torticollis?
Torticollis is also referred to as “Wry Neck”. There are three types of torticollis; the first is congenital muscular torticollis, the second is spasmodic torticollis and the third is acquired torticollis. The third type, acquired torticollis, is the most common and often occurs very suddenly with symptoms and injury being very similar to a cervical facet sprain. Torticollis means “twisted neck” and that is exactly how a sufferer looks and feels. Often the sudden onset will occur over night and will be felt on waking in the morning. The most distinct symptom is that one side of the neck is in an intense spasm, so much so that the head is completely tilted towards the shoulder. Neck, upper back, arm pain and stiffness often accompany the intense neck spasm. These symptoms are normally short lived and start to ease after 24 - 48 hours.
Congenital muscular torticollis
Congenital is uncommon affecting only 0.3-2% of the population. Congenital Muscular torticollis normally occurs at birth or is noticed in infancy. It normally occurs from injury to the sternocleidomastoid muscle in the neck, either from an awkward position in the womb, injury during child birth or sometimes related to a tumour growth at the site. After any tumour or related condition is ruled out infants are normally prescribed gentle stretches and advised that heat should be applied to the area to encourage relaxation of the muscle. Many parents find that manipulative therapies such as chiropractic, osteopathy and physiotherapy help to mobilise the neck, whilst massage therapy is very helpful at loosening the muscle spasm. A small percentage of cases will not respond to these conservative treatments and in these cases surgery is advised to release the muscle spasm. In terms of results the earlier treatment is received the better chances the child has of making a full recovery.
Spasmodic torticollis
Spasmodic torticollis, also known as cervical dystonia or intermittent torticollis, is normally developed over the age of 40. It is a condition where the sternocleidomastoid muscle uncontrollably contracts causing the head to tilt to the side, front or back. These uncontrollable bouts of spasms happen repetitively. There is no known cure for spasmodic torticollis however treatment with Botox (botulinum toxin), which paralyses the affected muscle, has been found to be incredibly successful.
What does acquired torticollis feel like?
There is a sudden onset of pain which is almost immediate and is coupled by intense muscles spasms creating neck stiffness and dramatically tilting the head towards the shoulder of the affected side. The pain is sharp and possibly burning to begin with. In some cases the sharp pain continues and in others it is replaced by an intense dull ache for a day or two after the onset. Most commonly the symptoms are only felt on one side of the neck. However due to compensation the other side is usually also affected with milder levels of discomfort. The sharp pain may radiate down the side of the neck and into the tops of the shoulders, down into the upper back and also in some cases down the arm of the affected side. Symptoms are aggravated by sudden movements, such as trying to tilt the head forward, rotating the head to the side and especially by trying to look up.
Why and when does acquired torticollis occur?
The injury mechanism for acquired torticollis is not always known and often affects people who have no previous history of neck problems. It is understood that certain poor postures or sleeping positions can trigger the onset, as well as sitting in a draft or lifting weights too heavy or one-sided. The injury is suspected to be very similar to that of a Cervical Facet sprain where the ligaments surrounding the joints in the neck are over stretched, causing the surrounding muscle to spasm in protection. Acquired Torticollis can happen at any age.
How long does acquired torticollis take to heal?
The initial severe symptoms of torticollis can recover as quickly as 48 hours. However often patients are left with remnant levels of discomfort for a further week or two.
How will acquired torticollis be diagnosed?
The symptoms of acquired torticollis are very conclusive so your GP or therapist should be able to diagnose you by both listening to your history and carrying out a full orthopedic and neurologic examination. X-rays or further investigative tests should not be needed to confirm diagnosis unless they feel it is important to rule out the alternative types of torticollis.
What treatment is there for torticollis?
Your GP may prescribe a short course of anti-inflammatory painkillers to reduce and control the painful inflammation. In more severe cases a muscle relaxant may be prescribed. Repetitively applying a heat pack to the area may also significantly hasten the healing process by helping to relax the painful muscle spasm. Avoiding all aggravating movements and postures is advisable, however complete rest is not. Try to move gently and as often as you can, as this will prevent stiffness levels from building in your neck.
Many people seek out alternative treatment to speed up the recovery process. Manipulative therapies such as chiropractic, osteopathy or physiotherapy may be helpful in alleviating any neck, shoulder and upper back stiffness. Acupuncture, massage therapy and therapies like Bowen technique are very good at alleviating and reducing the muscular spasm.
The neck will be left slightly weakened after an episode of torticollis. To prevent this weakness from progressing it is important to strengthen the muscles of the neck and upper back to avoid suffering from a recurring episode. Starting with simple stretches and progressing to strengthening exercises will counteract any stiffness and weakness that has developed. Postural therapies like Alexander Technique is effective for teaching your body how to hold a good posture, as is Pilates and Yoga for strengthening your postural muscles. Your therapist or GP will be able to advise you on appropriate exercises.