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Journal Articles

from the Pro Physical Therapy Staff

The Acute Wry Neck

Acute wry neck is the sudden onset of severe neck pain accompanied by spasms of the neck muscles. These spasms cause the neck to bend or twist away from the painful side. This common deformity, which usually occurs on one side of the neck, is a protective reaction of the body to safeguard the neck.

The cervical spine consists of seven vertebrae (C1-C7), which are separated from one another by intervertebral discs. The discs allow the spine to move freely and act as shock absorbers during weight bearing activities. There are also 36 joints in the neck, mostly small swivel joints called facet joints. The facet joints are small joints on either side of the spine which connect between the vertebra. Within the facet joint there is a small cartilage which helps to move the joint smoothly, and give the neck good flexibility. Ligaments of the neck are also present to support the joints of the spine as are several different muscles that attach to this area of the spine.

The exact cause of wry neck is not precisely known, however, it is usually due to one of two mechanisms. Acute wry neck due to facet joint dysfunction is generally caused by a sudden movement, usually rotation. Wry neck due to intervertebral disc injury is of a more gradual onset and pain may be felt upon waking from sleep. It is important to distinguish the symptoms of the mechanism of pain in order to treat the dysfunction correctly.

Symptoms

Acute Wry Neck due to facet joint dysfunction:

  • Sudden onset of sharp, unilateral neck pain that is localized.

  • Can be severe pain, however, it doesn’t usually extend below the shoulder.

  • Fixed neck deformity, usually holding the head bent to the side and turned away from the painful side, this is unable to be corrected due to joint being “locked”.

  • Neck movement triggers the pain.

  • Tender and tense musculature, usually the sternocleidomastoid and scaleni muscles.

Acute Wry Neck due to intervertebral disc injury:

  • Gradual onset of dull, less localized pain.

  • Usually felt lower in the cervical region or the upper thoracic region.

  • Pain may radiate down the arm.

  • Head and neck may be held away from the painful side; however, this movement is only limited by pain, not mechanically blocked.

  • Neck movement triggers the pain.

  • Tense and tight musculature.

A diagnosis of wry neck is usually confirmed by your doctor with a complete medical history and physical examination. Anti inflammatory and pain medication may be prescribed, as well as Physical Therapy.

Treatment

Physical Therapy can help facilitate the reduction of pain and the restoration of normal functional movement. Segmental palpation will confirm the level most affected. Usually, the levels are in the mid-cervical region on the affected side, the levels above and below on the opposite side are also stiff and can be treated as well.

Modalities are effective in helping to reduce pain and relax the affected muscles. Moist heat, ice, electric muscle stimulation, ultrasound and massage are all very useful in the acute phase of wry neck. Gentle stretching exercises along with gentle mobilization techniques are used to increase range of motion in the cervical spine. Spinal manipulation is inadvisable because of protective muscle spasms, thus increasing neck pain if attempted.

The Physical Therapist must also identify any contributing factors of the wry neck. Postures in activities of daily living must be examined. For example, sleeping positions, work tasks and leisure activities must be addressed and retraining must happen if necessary. To prevent recurrence, the therapist must incorporate postural and scapular training. Poor patterns of neuromuscular control can create painful dysfunction in the cervical spine. Posture should be corrected from the pelvis upward and include attaining an optimal position of both the lumbar and thoracic curves with good scapular control. Particular attention needs to be paid to the mid and lower trapezius and serratus anterior muscles. Training of the scapular stabilizers should be low load and in pain free range of motion.

While the acute wry neck is usually self-limiting and of short duration, the contributing factors may be long standing. These factors should be addressed in the treatment setting. This will help to prevent the possibility of recurrence and more serious pathology in the long term.

 

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