LIVING WITH TORTICOLLIS (WRY NECK)...
Wry neck caused by a minor injury or illness is likely temporary and treatable. However, congenital and more severe forms of wry neck can cause long-term problems to your health.
Chronic wry neck can result in complications such as:
- swollen neck muscles
- neurological symptoms from compressed nerves
- chronic pain
- difficulty in performing routine tasks
- inability to drive
- difficulty in socializing
It is easier to correct wry neck in infants and young children.
You wake up one morning, try to get out of bed, and find that your neck is very painful and stiff. You look in the mirror and notice that your neck is tilted to one side and your chin twisted to the other side. As you try to straighten it, you experience a sharp, knife-like electrical pain in the back of your neck. You quickly return it to its tilted position to alleviate the pain.
This is the typical case of the neck pain often referred to as "torticollis". It is a rather common occurrence; everyone at one time or another has experienced it to some degree. When severe, torticollis can be very disabling. Normal activities such as getting dressed, driving a car, or trying to sleep can become very uncomfortable. Headaches at the back of the neck are not uncommon with torticollis. Extreme stiffness, on one side or the other, will usually develop as torticollis persists. The stiffness of torticollis can be so intense that muscle spasm can be felt to the touch at the back and side of the neck.
WHAT CAUSES TORTICOLLIS
Neck pain of this type usually develops suddenly and for no apparent reason. Typically, the individual will wake up with the neck painful and stiff. The head can be tilted and/or twisted to one side, with the chin tilted towards the opposite side.
There are, however, some definite causes for this condition. Sleeping in an awkward position with the head elevated too high can cause torticollis. A cool draft from air conditioning can trigger its onset, Working in an awkward position for a prolonged period can also bring on torticollis working under a car, for example, or reaching to hang curtains,
Poor posture can also cause torticollis. The secretary's habit of holding the phone by raising the shoulder to the ear is a common factor. Watching television while lying on the stomach and supporting the chin with both hands is also a likely candidate.
Wry neck can be inherited. It can also develop in the womb. This may happen if the fetus’ head is in the wrong position. It can also be caused by damage to the muscles or blood supply to the neck.
Anyone can develop wry neck after a muscle or nervous system injury. However, most of the time, the cause of wry neck is not known. This is called idiopathic torticollis.
Torticollis is a painfully twisted and tilted neck. The head is generally tilted to one side and the chin to the other. It is also known as "wry" neck. This condition can be congenital (present at birth). It can also be caused by damage to the neck muscles or blood supply. Wry neck sometimes goes away on its own. However, there is a chance of relapse.
Chronic wry neck can cause debilitating pain and difficulty performing daily tasks. Fortunately, medications and therapies can help to relieve pain and stiffness if all else fails with natural and painless non-surgical interventions incorporating chiropractic techniques, physiotherapy, low level laser therapy, and specific stretching and neck strengthening exercises. Surgery, if warranted, may be the last resort to sometimes correct this condition. Treatment is most successful when begun early, especially for children.
THE UNDERLYING 'MECHANICAL' CAUSE
Awareness of the anatomy of the neck is helpful in better understanding the cause of this condition.
The neck or cervical spine consists of seven movable bones called vertebrae. Each, except for the first, are separated by spinal discs which allow for flexibility and also act as cushions or shock absorbers. Between each two cervical vertebrae, a pair of spinal nerves exit. These nerves supply the tissues of the neck, arms and other internal organs. They exit from the neck through openings formed between the vertebrae that are separated by spinal discs. The neck is also draped with numerous ligaments to provide stability, and muscles to provide a means of movement.
In the case of torticollis, two distinct events occur. One or more of the neck vertebrae become ‘fixed’ and possibly out of normal spinal alignment, leading to abnormal spinal mechanics and movement. The nerves exiting at that level become irritated, producing pain and altered neurological impulses to the muscles and tissues these nerves normally supply. Secondly, the muscles of the neck go into extreme spasms. The muscle spasm accounts for the stiffness the individual experiences. These muscle spasms can also affect the circulation in the immediate area of involvement, possibly leading to soft-tissue swelling (edema). The sharp pain is due to the nerve irritation caused by the cervical vertebra, which is not moving or ‘fixed’ out of their proper position.
TYPES OF TORTICOLLIS:
1. Temporary Torticollis: This type of wry neck usually disappears after one or two days. It can be caused by:
- swollen lymph nodes
- an ear infection
- a cold
- an injury to the head and neck that causes swelling
2. Fixed Torticollis: Fixed torticollis is also called acute torticollis or permanent torticollis. It is usually due to a problem with muscle or bone structure.
3. Muscular Torticollis: This is the most common type of fixed torticollis. It is caused by scarring or tight muscles on one side of the neck.
4. Klippel-Feil Syndrome: This is a congenital form of wry neck. It occurs when the bones in an infant’s neck have formed incorrectly. Children born with this condition may have difficulty with hearing and vision.
5. Cervical Dystonia: This rare disorder is sometimes referred to as spasmodic torticollis. It causes neck muscles to contract in spasms. If you have cervical dystonia, your head twists or turns painfully to one side. It may also tilt forward or backward. Cervical dystonia sometimes goes away without treatment. However, there is a risk of recurrence. This type of wry neck can happen to anyone. However, it is most commonly diagnosed in middle age. It affects more women than men.
CHIROPRACTIC TREATMENT FOR TORTICOLLIS
Chiropractors specialize in the examination and treatment of such neck disorders, especially "acquired" torticollis. A complete and thorough history consultation and examination of the patient will disclose the exact cause and severity of this condition. Be sure to tell your chiropractor of any injuries to the neck or upper body. Depending upon examination findings, imaging tests such as X-rays and MRI scans can also be used to find structural problems that might be causing your symptoms. Also, an electromyogram (EMG) may be requisitioned which measures electrical activity in your muscles and may help to determine which muscles are affected. Only after a complete evaluation of the neck and upper body will the chiropractic physician recommend a treatment program.
The chiropractic physician is specifically trained to effectively restore normal function to the fixed spinal areas. Following a series of special stretching maneuvers, manipulative therapy or an 'adjustment' is gently administered to restore normal mobility to the restricted vertebrae and improve mechanical spinal stability. Special attention is also given to the intense muscle spasm which accompanies the condition. Once the neck has been restored to normal mechanical function, the chiropractic physician may advise the patient about exercise, sleeping posture, the use of special orthopaedic cervical pillows, lifestyle adjustment and other significant factors related to the proper care of the neck.
OTHER TREATMENTS FOR TORTICOLLIS
Currently, there is no way to prevent wry neck. However, getting treatment quickly can keep it from becoming worse.
Congenital forms of wry neck can be improved by stretching the neck muscles. If started within a few months of birth, this treatment can be very successful. If this or other treatments don’t work, surgery can sometimes correct the problem.
Acquired wry neck is treated according to the cause, if known.
Treatments for wry neck include:
- chiropractic techniques
- heat applications
- physical therapy
- stretching exercises
- neck braces.
Types of surgery may include:
- fusing abnormal cervical spinal vertebrae
- lengthening neck muscles
- cutting nerves or muscles
- deep brain stimulation to interrupt nerve signals - this is used only in the most severe cases of cervical dystonia.
Medications may include:
- muscle relaxants
- medications used to treat the tremors of Parkinson's disease
- botulinum toxin (injections are repeated every few months)
- pain medications.
If your wry neck is not treatable, consider seeking out a support group. Many people with chronic conditions find them both comforting and informative. Your chiropractor, physician or local hospital may be able to give you information about groups that meet in your area. You may also be able to find a supportive community online. Communicating with others who have wry neck or similar conditions can help you cope.
If you or anyone else you know is suffering from torticollis (wry neck),
please call Dr. Pisarek now at Advanced Healthcare, (416) 633-3000, to
schedule an appointment to treat, correct this condition... and find relief!