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Wry neck

What is a wry neck?

An acute wry neck is the sudden onset of neck pain and stiffness, often associated with muscular spasm. It can be quite alarming to patients, who often describe waking with symptoms with no clear warning.

Patients with an acute wry neck typically experience severe one-sided neck pain, and movement to the side of pain is often painful and restricted. This can result in temporary postural deformity due to pain.

There are commonly two distinct types of wry neck:

  1. Acute facet joint wry neck. An acute facet wry neck is more common in younger patients (12-30 years of age), whilst they appear more gradually in older patients due to degeneration of the facet joints of the spine. Locking of these facet joints is thought to be caused by inflammation; muscle spasm follows this which creates difficulty in moving the neck.

  2. Discogenic wry neck. Commonly this is more of a gradual presentation as a result of a cervical disc injury. Typically the injured disc protrudes and contacts surrounding muscles and nerves, which can radiate pain/tingling/numbness down the shoulder blade and arm.

Although it is commonly a sudden injury, there are several risk factors that can predispose you to this condition:

  • Inadequate posture.
  • Inadequate sleeping posture (often tummy sleepers are prone!)
  • Inappropriate choice of pillow.
  • Inadequate workstation set up.
  • Inadequate deep neck muscle strength and endurance.
  • Poor muscle strength and endurance of the muscles surrounding the shoulder blades.

Signs and symptoms:

Patients with wry neck commonly report the following symptoms:

  • Pain which is usually on one side of the neck but can also be in the middle. Pain can also radiate between the shoulder blades, but usually does not go past the shoulder.
  • Restricted movement associated with pain, typically to the side of the pain.
  • Deformity which can present as rotation and/or tilting of the head away from the side that is painful.
  • Muscle spasm.
  • Headaches.

Most cases of wry neck resolve quickly over a period of 2-3 days, with some residual symptoms lasting up to a week. Discogenic neck pain can often take a little longer to resolve, but also responds well to physiotherapy.

Treatment commonly includes:

  • Joint mobilisations to improve joint function and reduce pain.
  • Soft tissue massage to help relieve muscle spasm.
  • Dry needling to relieve pain and muscle spasm.
  • Heat.
  • Taping to offload the neck and shoulder blades.
  • Advice re: non-steroidal anti-flammatories (NSAIDs) and pain killers if required.
  • Home exercises including range of motion (ROM) exercises and targeted strengthening of the neck and shoulder blade muscles.

It is also important to address any of the underlying issues which may have contributed to your wry neck, such postural advice, ergonomic modifications, and recommendations on appropriate pillow choice.

Wry neck which is left to resolve on its own may result in a stiffened segment or increased muscle tension, which can result in recurrent episodes.

Diana Emmerson
Physiotherapist

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