Neck Pain Due to Torticollis

Torticollis means 'twisted neck'. The most common cause is acute torticollis, often called 'wry neck'. This is a common cause of neck pain and stiffness. It is common to wake up with a 'wry neck'. It usually goes away on its own over a few days, sometimes longer. Painkillers may ease the pain. Gentle neck exercises are usually advised. There are various other less common causes of torticollis which are briefly discussed below.

What is torticollis?

Torticollis means 'twisted neck'. The neck becomes twisted to one side. The most common cause of torticollis is acute torticollis, also known as 'wry neck'. Most of this leaflet is about the common acute torticollis. Other less common causes of torticollis are mentioned briefly later in the leaflet.

What are the symptoms of 'wry neck' (acute torticollis)?

'Acute' means that the symptoms have developed quickly, over a period of hours, or often overnight. The twisting of the neck (torticollis) occurs when the muscles supporting the neck on one side are painful.

The cause of acute torticollis is often not known. It can happen in people with no previous neck symptoms. It is a common cause of neck pain in young people. There is usually no obvious injury.

However, it may be due to a minor sprain or irritation of a muscle or ligament in the neck. Some reasons for this include:

  • Sitting or sleeping in an unusual position without adequate neck support
  • Poor posture when looking at a computer screen.
  • Carrying heavy unbalanced loads (for example, a briefcase or shopping bag).
  • Allowing certain muscles of the neck to be exposed to cold ('sleeping in a draught').

It is common for people to go to bed feeling fine and to wake up the next morning with an acute torticollis.

The pain is usually on one side of the neck and stiffness of the muscles in that area twists the neck to one side. Attempts to straighten the neck are difficult due to pain. Occasionally, the pain is in the middle of the neck.

The pain may spread to the back of the head or the shoulder. The muscles of the affected side may be tender. Pressure on certain areas may trigger a 'spasm' of the muscle. Movement of the neck is restricted, particularly on one side.

Do I need any tests?

Not usually. The diagnosis of a twisted neck which comes on suddenly (acute torticollis) is made from the typical symptoms, and an examination of the neck by a doctor. The examination can usually confirm the diagnosis and usually exclude the rarer causes of torticollis. Tests such as an X-ray are not usually needed unless a condition other than acute torticollis is suspected.

What is the outlook (prognosis) for acute torticollis?

The outlook is good. It often improves within 24-48 hours. However, it may take up to a week for the symptoms to go completely. Occasionally, the symptoms last longer or come back (recur) at a later time for no apparent reason.

What is the treatment for acute torticollis?

The aims of treatment are to relieve the pain and try to reduce the stiffness in the muscles. The following may be advised:

Exercise your neck and keep active

Aim to keep your neck moving as normally as possible. At first the pain may be quite bad, and you may need to rest for a day or so. However, gently exercise the neck as soon as you are able. You should not let it stiffen up.

Gradually try to increase the range of the neck movements. Every few hours gently move the neck in each direction. Do this several times a day. As far as possible, continue with normal activities. You will not cause damage to your neck by moving it.

Medicines

Painkillers are often helpful.

  • Paracetamol at full strength is often sufficient. For an adult this is two 500 mg tablets, four times a day.
  • Anti-inflammatory painkillers. Some people find that these work better than paracetamol. They can be used alone or combined with paracetamol. They include ibuprofen which you can buy at pharmacies or get on prescription. Other types such as diclofenac or naproxen need a prescription. Some people with stomach ulcers, asthma, high blood pressure, kidney failure, or heart failure may not be able to take anti-inflammatory painkillers.
  • A stronger painkiller such as codeine is an option if anti-inflammatories do not suit or do not work well. Codeine is often taken in addition to paracetamol. Constipation is a common side-effect from codeine. To prevent constipation, have lots to drink and eat foods with plenty of fibre.
  • A muscle relaxant such as diazepam is occasionally prescribed for a few days if the stiffness in your neck muscles is severe.

Other treatments

Some other treatments which may be advised include:

  • A good posture may help. Check that your sitting position at work or at the computer is not poor (that is, not with your head flexed forward with a stooped back). Sit upright. Yoga, pilates, and the Alexander technique all improve neck posture, but their value in treating neck pain is uncertain.
  • A firm supporting pillow seems to help some people when sleeping. Try not to use more than one pillow.
  • Heat packs which can help relax the stiffness in the affected muscles are useful for some people.

What are the other causes of torticollis?

Cervical dystonia

Cervical dystonia (also known as spasmodic torticollis) is a problem where abnormal movements develop in the muscles of the neck. It most often occurs in people over the age of 40.

You cannot control the contraction of the neck muscles which produce abnormal movements and postures of the neck and head. These can be either twisting (torticollis), being pulled forwards (antecollis), backwards (retrocollis), or sideways (laterocollis).

Cervical dystonia can range from being mild to severe. There is no cure. However, regular injections of botulinum toxin, which paralyse the affected muscles, are the most effective treatment.

Other less common causes

More rarely, torticollis in the neck occurs as a result of other conditions. These include:

  • Infections of the throat or upper airways. These can cause swelling in the lymph glands in the neck or infections in the skin and underlying tissues. The inflammation can trigger a spasm in the neck muscles.
  • Any abnormality or injury of the neck (cervical spine). For example, cervical spine tumours or blood vessel abnormalities.
  • As a side-effect of certain medicines - for example, phenothiazines.

The treatment of these depends on the cause.