What is the treatment for acute torticollis?
The aims of treatment for sudden-onset wry neck (acute torticollis) are to relieve the pain and try 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 are able to. 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 obtain 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.
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.
What is the outlook for acute torticollis?
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.
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