Torticollis

What is torticollis?

Torticollis, another name for having a 'twisted neck' or a 'wry neck', often happens suddenly. You go to bed without any symptoms one night and then you simply wake up the following morning with a wry neck. This is known as acute torticollis.

It is a common cause of neck pain and stiffness. Although it can be very painful when you are affected by it, most people with the condition do not actually need to see their doctor, as simple treatment such as painkillers can be very effective.

Types of torticollis

Temporary torticollis

This is the most common form of torticollis. It is often of sudden-onset (acute torticollis). It usually lasts 24-48 hours and can occur for no known reason or due to irritation of a muscle or ligament in the neck. It can also occur due to infection in the throat or upper airways. Such infections can cause swelling in the lymph glands in your neck which triggers spasm of the neck muscles. Temporary torticollis can also occur as a side-effect of certain medicines - for example, phenothiazines.

Fixed torticollis

This form of torticollis is permanent. It occurs due to a problem with the structure of the muscles, blood vessels or bones in the neck. For example, fixed torticollis that is muscular can arise due to scarring or tight muscles on one side of the neck. Fixed torticollis can also arise due to incorrect development or fusion of the vertebra (neck bones) in babies.

Cervical dystonia

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

You cannot control the contraction of the neck muscles which produce abnormal movements and postures of the neck and head. These movements 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.

What causes acute torticollis?

The cause of sudden-onset wry neck (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 occur 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)

Torticollis symptoms

Developing a wry neck (acute torticollis) occurs when the muscles supporting your neck on one side become painful. These symptoms usually come on very quickly, often overnight, so that you wake up with them:

• Stiffness of the muscles on the affected side may twist the neck.

• You may find it very difficult to straighten your neck, due to pain.

• Occasionally, the pain is in the middle of your neck.

• The pain may spread to the back of your head or to your shoulder.

• The muscles on the affected side may be tender.

• Pressure on certain areas may trigger a 'spasm' of these muscles.

• Restriction of neck movements.

Do I need any tests for torticollis?

The good news is that usually you do not need to have any tests to find out what is causing the problem. The diagnosis of sudden-onset wry neck (acute torticollis) is made from the presence of typical symptoms.

Many people with milder symptoms diagnose this on their own. Your doctor or a healthcare professional can make the diagnosis by examining your neck. The examination will also usually exclude the rarer causes of torticollis. Tests such as X-rays are generally not needed. Your doctor would only refer you for further tests if a condition other than acute torticollis is suspected.

Acute torticollis treatment

The aims of treatment for sudden-onset wry neck (acute torticollis) are to relieve the pain and to reduce the stiffness in your 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 can. You should not let it stiffen up.

Gradually try to increase the range of the neck movements. Every few hours gently move your 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.

You should avoid driving until you can move your neck freely and without any pain.

What about 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 most supermarkets. 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.

What about other treatments?

Some other treatments which may be advised include:

• A good posture. Keeping a regular check on your posture may help. Make sure that your sitting position at work or at the computer is not poor. It is important to ensure that your head is not flexed forward and also that your back is not stooped when you are sitting and working. You should make sure you sit upright. Yoga, Pilates and the Alexander Technique can all improve neck posture but their actual value in treating neck pain is uncertain.

• A firm supporting pillow. This seems to help some people when sleeping. Try not to use more than one pillow.

• Heat packs. These can help relax the stiffness in the affected muscles and are useful for some people.

Remember: soft neck collars are not recommended anymore as they can actually worsen and prolong the stiffness.

How quickly does it get better?

The outlook (prognosis) is good. A wry neck (acute torticollis) 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 at a later time for no apparent reason. Most people who have had torticollis do not have it again in the future.

Temporary torticollis

This is the most common form of torticollis. It is often of sudden-onset (acute torticollis). It usually lasts 24-48 hours and can occur for no known reason or due to irritation of a muscle or ligament in the neck. It can also occur due to infection in the throat or upper airways. Such infection can cause swelling in the lymph glands in your neck which triggers spasm of the neck muscles. Temporary torticollis can also occur as a side-effect of certain medicines - for example, phenothiazines.

Fixed torticollis

This form of torticollis is permanent. It occurs due to a problem with the structure of the muscles, blood vessels or bones in the neck. For example, fixed torticollis that is muscular can arise due to scarring or tight muscles on one side of the neck. Fixed torticollis can also arise due to incorrect development or fusion of the neck bones (vertebra) in babies.