An acute wry neck is a condition characterised by sudden onset of severe neck pain accompanied by an involuntary contraction of the neck muscles which leads to an abnormal head posture being maintained. The abnormal posture or torticollis is a symptom of the underlying process and can have a number of causes, but the cause discussed in this article is acute mechanical neck pain leading to an acquired torticollis. A common presentation for a patient is acute neck pain and torticollis on waking in the morning, often interpreted as the result of having slept in an awkward position at some point overnight.
People with acute wry neck complain of severe neck pain and neck muscle spasms which prevent them from bringing their head back into the central line. This usually resolves in several days or up to fourteen and normal treatment consists of painkilling medication, a collar if necessary, physiotherapy such as neck exercises, massage and neck stretching. Examination of a patient will discover the head flexed towards the pain and rotated away from the pain. Patients report that the pain came on with a sudden neck movement or by towelling their hair and that they have neck stiffness, reduced movement and pain.
The first thing a person is aware of is the sudden pain on one side of the neck, often severe and lower in the neck. There may be pain radiating also down over the scapula and out over the shoulder. If a considerable amount of arm pain is present then this should raise the suspicion of a lesion of one of the cervical nerve roots. Nerve root problems are usually somewhat slower in onset but if the symptoms presented on waking this could be the diagnosis. The outcome is very likely to be just as good as the muscle or joint strain which is more common, but recovery typically takes longer over a period of weeks.
Examination of the patient by a physiotherapist will show a patient who is in some distress from their pain and may find sleeping difficult. They may hold the head carefully to guard against sudden movements of the painful structures. The head posture will be typically abnormal and efforts to restore the posture to normal are rewarded with strong increases in pain levels. The physio will record the neck position and the ranges of movement the patient can perform, with the results in terms of pain. The history will also be taken, to include any previous episodes and what precipitated this event, whether known or not.
Any thoracic, shoulder blade, shoulder or arm pain will also be recorded. The physio may decide to test the reflexes of the biceps and triceps muscles to check if the C6 or C7 nerve roots are involved should the symptoms indicate the possibility. The sensibility of the skin to light touch can also be investigated for similar reasons. The physiotherapist is less likely to choose to test the muscle power in the shoulders and arms as this would cause an increase in pain and not reflect the patient's true muscle strength. The usual questioning to exclude potentially serious underlying causes or complicating medical conditions will be undertaken.
Physiotherapists follow the same management principles for acute wry neck as for all soft tissue damage. The inflammation and pain of the injury are the first targets of physiotherapy so as to reduce spasm in the muscles which is maintaining the pain. Drugs such as pain killers and anti-inflammatories are employed as the target of treatment is the pain itself and not a specific anatomical lesion. Physio management consists of non-vigorous manual traction to relax the neck musculature, wearing of a collar if required (especially at night) and the pain reduction following ice treatment.
Progression on to further therapy techniques is planned once the pain is under control such as neck massage, gentle muscle neck stretches for muscle tightness and mobilisation of the joints. The patient is asked to perform active movements within reasonable pain limits. On restoration of more normal neck ranges of motion and head position the next stage of physiotherapy is to increase the neck muscle strength and endurance so that the person can return to normal.
