Torticollis

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Your neck muscles are part of a complex musculoskeletal system that connects the base of your skull to your torso. Muscles contain fibers that contract, allowing you to perform many different movements. Your neck muscles help you do everything from chewing and swallowing to even nodding your head. The muscles inside your neck are skeletal muscles, meaning they are attached to bones by tendons. They’re voluntary muscles, therefore, so you control how they move and work. Other types of muscles in your body (cardiac and smooth) are involuntary, which means they work without you having to think about it.

Torticollis (also known as wry neck or loxia) is one of the disorders that exhibit flexion, extension, or twisting of muscles of the neck beyond their regular position. The Latin definition of torticollis means “twisted neck”. In torticollis, the neck tends to twist to one side, causing head tilt. The condition can either develop slowly if you have a family history of the disorder, acutely from trauma, or as an adverse reaction to medications.

Bending or twisting your neck too far can lead to acute torticollis. This condition appears with few symptoms, although often you will appear uncomfortable and will hold your head straight or rotated to one side. It will hurt to move your head to the opposite side, and you will have a limited range of motion. Your neck muscles on the affected side that hurts often are tender to the touch. That is why during a diagnosis for this condition, your doctor will have to check your nerve and motor function to help rule out spinal cord injury.

Additionally, there is another condition that is similar to torticollis and affects infants, called Benign paroxysmal torticollis (BPTI). This is a rare medical disorder in infants characterized by recurrent episodes (or attacks) of tilting of the head to one side.

Causes & Symptoms

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There are several types of torticollis in which depend on their causes, such as the two of the following below:

 

Congenital torticollis

Congenital torticollis occurs in approximately 2% of all births and happens due to the shortening of one of the muscles called sternocleidomastoid muscles (SCMs). The SCMs are two large muscles in the neck that connect the back of your skull to your breastbone (sternum) and clavicle. While most experts aren’t sure exactly why some babies are born with a single SCM, they suspect it may be due to crowding within the uterus during pregnancy, primary myopathy (muscle disease) of the SCM, or abnormal development of this muscle.

Acquired torticollis

Acquired torticollis can develop as a consequence of a chronically strained neck position or damage to the muscles that move the neck. Vision problems are a common cause of acquired torticollis. This type is usually called ocular torticollis. Another known type known as gastroesophageal reflux disease (GERD) can cause acquired torticollis in babies. Acquired torticollis can also occur due to scar tissue, neck arthritis, inflammation, or injury to the muscle involved in shoulder and neck movements (sternocleidomastoid or the trapezius). This muscle injury or inflammation can result from trauma or from an infection of the throat or neck lymph nodes.

 

In adults, many different conditions can cause acute torticollis. Trauma to the neck or spine can lead to torticollis. Injuries to the cervical spine or neck muscles often result in spasm of the muscles, leading to the twisting of the head, a characteristic of torticollis. Other causes include infection of the head or neck.

These infections can cause inflammatory torticollis secondary to inflamed glands. Torticollis may be associated with abscesses of the throat, the retropharyngeal space, and the upper airway, and those situations can be life-threatening. Other infections of the sinuses, ears, mastoids, jaw, teeth, or scalp may also lead to torticollis.

Certain medications of abuse such as ketamine and amphetamines as well as commonly prescribed neuroleptic drugs such as compazine, haldol, and thorazine can cause acute dystonia or dystonic reaction (a sudden lack of regular muscle control). This is a condition involving the sudden onset of involuntary contractions of the muscles of the face, neck, or back. Because torticollis is an abnormal contraction of the muscle in one side of the neck, people may appear with their heads turned to one side.

Neck muscles and those in between the neck and shoulder will be tense and tender, causing neck pain. Deviation of the eyes (ocular torticollis) where the eyes involuntarily look upward and protrusion of the tongue where the tongue sticks out involuntarily may also occur.

Other symptoms of torticollis include:

  • Back pain
  • Headache
  • Neck cramps
  • Muscle tightness
  • Muscle pain
  • Burning sensations
  • Vomiting
  • Drowsiness
  • Irritability

Who gets Torticollis?

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Several risk factors for torticollis include:

  • Age – In cases of spasmodic torticollis, it most commonly begins after the age of 30. As for acquired torticollis and ocular torticollis, it is more common in children, especially babies who are recently born.
  • Gender – Torticollis can affect both men and women.
  • Family history – If a close family member has torticollis or some other type of this condition, you are at a higher risk of developing the disorder.

How Does it Affect You? How Serious is it?

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Torticollis caused by a minor injury or illness is likely temporary and treatable. However, congenital and more severe forms of torticollis can cause long-term problems. Chronic torticollis may cause complications, including:

  • Swollen neck muscles.
  • Chronic pain.
  • Neurological symptoms from compressed nerves.
  • Inability to drive properly.
  • Difficulty socializing with others.
  • Episodes of depression.
  • Difficulty performing routine tasks.

Recommended Treatment & Rehabilitation

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The diagnosis of torticollis typically begins with a thorough medical history. Your doctor will ask you a series of questions about when your symptoms started and whether you have associated symptoms, such as pain, fever, headache, or neurological problems, and whether there was an inciting injury or trauma.

Your doctor will then do a physical exam that is focused on your head and neck muscles and nervous system. Oftentimes, imaging tests, such as an X-ray, computed tomography (CT), or magnetic resonance imaging (MRI) scan may be ordered to rule out other conditions associated with torticollis. For further care, your doctor may refer you to physical medicine and physiatrist or orthopedist who specializes in musculoskeletal disorders and treatment for deeper rehabilitation.

Surgery is reserved only for a few selective cases of torticollis. In this treatment, some of the upper neck nerves and/or muscles are selectively severed to prevent muscle contraction. Surgical treatment often helps, but frequently the neck will return to its twisting position after several months. Rarely, deep brain stimulation is done by inserting a wire into the brain where movement is controlled and then sending electrical signals to disrupt brain signals causing torticollis.

After a diagnosis or surgery has been done, a physiotherapist will be able to work with you to design a specific treatment program that will speed your recovery, including exercises and treatments that you can perform at home. The time it takes to heal your neck pain may vary, but an individualized physiotherapy program can be effective and efficient, and help heal symptoms of torticollis in a matter of weeks. Therefore, your physiotherapist will work with you to:

 

  • Reduce pain and other symptoms – Your physiotherapist will help you understand how to avoid or modify the activities that caused the injury, so healing may begin. He or she may use different types of treatments and technologies to control and reduce your pain and symptoms. These may include gentle hands-on techniques, specific neck movements, and the use of equipment, such as electrical stimulation or traction.
  • Improve your posture – If your physiotherapist suspects that poor posture has contributed to your neck pain, he or she will teach your how to improve your posture so recovery can occur.
  • Improve your motion – Your physiotherapist will choose specific activities and treatments to help restore regular movement in any painful joints. These might include passive motion that your physiotherapist performs for you to move your spine or active exercises and stretches that you do yourself.
  • Improve your flexibility – Your physiotherapist will determine if any of the involved muscles are tight, and teach you gentle stretching exercises that you can perform at home.
  • Improve your strength – If your physiotherapist finds any weak or injured muscles, he or she will choose and teach you the correct exercises to gently restore your strength and agility. For mild cases of torticollis, core strengthening or stabilization is commonly used to restore the strength and coordination of muscles around your cervical spine.
  • Improve your endurance – Restoring your endurance is important for people with neck pain. Your physiotherapist will design a specific program of activities to help you regain the muscle endurance you had before the neck pain started.

 

Below are two main exercises that you can perform to increase strength and flexibility in the neck due to torticollis:

 

Chin tucks

Begin by standing straight while squeezing your shoulder blades together. Next, put your index finger on your chin and slightly tuck your chin. Gently push your Ching back with your finger until you feel a slight, painless stretch along the back of your neck. Hold the position for up to 20 seconds, then repeat 2-3 times a day.

Neck rolls

Start with your head straight, eyes gazing forward. Take note of any tension in the neck, shoulders, or upper back. Slowly turn your head to the left, then hold for a few seconds and roll your head back so you stare at the ceiling. Afterward, gently roll your head to the right and roll your head forward so that your chin faces down. Repeat this method 4-5 times a day.

 

Passive Stretching

For infants, passive stretching (stretches done with the assistance of a parent or caregiver) may be performed. In older babies, facilitating active movement may be helpful, for instance, using sights or sounds to get a child to turn their head in a certain direction. A physiotherapist will recommend stretches and other exercises and show you how to do them properly for your children.

Alternative & Homeopathic Treatment

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There are many homeopathic treatments that can help relieve symptoms of torticollis, such as:

  • Rest – Symptoms often disappear during sleep, so taking a break to lie on your back may provide relief. Adding a supportive pillow for your neck can increase your recovery while resting.
  • Touch the opposite side of your face – Performing this can trick your body and may help spasms stop temporarily.
  • Heat application – Heat packs or hot water bottles applied to the neck may help loosen tight muscles. In addition, having hot showers may even boost your neck recovery by increasing your blood circulation.
  • Stress-reduction techniques – Understand what causes you stress or anxiety because this can lead to tension and worsening of symptoms.
  • Anti-inflammatory medications (NSAIDs) – Non-steroidal anti-inflammatory medications help to relieve pain and discomfort related to musculoskeletal injury.

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