People walking into the clinic with an acute onset of neck pain and stiffness is a relatively common occurrence here at Sport and Spinal Physiotherapy. I would like to take the opportunity to explain a common pillow and sleep related condition we see: acute wry neck. While this article specifically covers how to fix a wry neck, other articles such as thoracic mobility, headaches, workstation setup, and sleep are also gems of information.

This article will answer:

1. What is wry neck?
2. The cause of wry neck?
3. What are the main signs and symptoms of wry neck?
4. What contributes to a wry neck?
5. How to fix a wry neck?
6. How to prevent a wry neck…

So what is wry neck?

Wry neck is a relatively common complaint where you develop neck pain and stiffness, which is often accompanied by spasm of the related neck muscles. This causes pain and makes it hard to move your neck through a normal range of motion.

Wry neck can also be referred to as an acute wry neck since the onset is abrupt – or acute!

I often hear the story of someone having a busy week at work, being extremely tired, and then waking up the next day unable to move their head/neck in a certain direction. Clients will often come into the clinic holding their head at a weird angle – as at the time this is the most comfortable position!

The cause of wry neck?

Wry neck researchers tell us that it can have several causes. However from a clinical perspective, there are two main anatomical causes: facet-related wry neck or discogenic-related wry neck.

Facet:

The most common cause of acute wry neck is due to an issue with a facet joint.

Facet joints are located towards the back of your spinal column. There are two facet joints at each level of your spine, one on each side. These facet joints allow, guide and constrain the movements of your neck. Sometimes something simple such as sleeping in an awkward position or a rapid, jerky movement of the neck can cause the tissues of this joint to become irritated, or ‘stuck’. Facet wry neck is most common in younger populations, generally ranging from young kids to people in their thirties.

Occasionally your facet joints can also become stiff through traumatic injury or arthritis. Wry neck pain is due to the numerous nerve endings that are located in the facet joint itself and in the tissues around the facet joint.

Discogenic:

In some cases acute wry neck may also be caused by an injury to an intervertebral disc. This is known as Discogenic Wry Neck. The injured disc promotes inflammatory chemicals to the area, which affects surrounding structures and nerves, or may protrude posteriorly and press against surrounding structures and nerves.

The spinal disc is a load absorbing structure which sits between the vertebrae of the neck. The disc can sometimes bulge under stress or tear, like a small sprain, and the resulting swelling can irritate the nearby tissue and nerves. Movement is not actually blocked as in facet acute wry neck but because there are is a lot of nerve endings around the spine a small injury can feel extremely painful.

What are the main signs and symptoms?

In an acute facet wry neck:

• pain is generally located in the middle and side of the neck
• Sudden onset of pain
• Generally no pain beyond the shoulder
• Movement is restricted, and your head/neck can be ‘stuck’ in a weird position – frequently flexed forward and away from the painful side
• Further spasm of surrounding muscle can restrict movement also

In discogenic wry neck:

• There is generally a gradual onset of dull, diffuse pain
• Pain usually located in the lower neck, into the shoulder, and sometimes into the upper chest
• There can be pain radiating into the arm, and there can be pins and needles
• Movement is restricted – but due to pain, rather than a mechanical ‘block’ as in facet wry neck
• I find patients often tend to hold their head away from the painful side
• Muscle spasm
• Sometimes there can numbness, or even weakness in your arms, and into the legs – further medical assessment may be required!

Headaches are also a common presentation in both facet and discogenic related wry neck.

What contributes to a wry neck?

I find that a wry neck usually occurs either upon waking in the morning or from a sudden, quick movement involving the neck. Sometimes in the lead up to having a wry neck, the patient’s history involves:

• Prolonged poor posture/slouching
• Recurring or sustained neck movements
• Heavy lifting
• Sleeping in different posture
  • With an unsupportive pillow in side-lie
  • Too many pillows on the back
  • Or on stomach with head turned uncomfortably

There can be many contributors to the onset of an acute wry neck. These can include:

• • Poor ergonomic or workplace setup
  • Stiff joints – particularly of the neck/upper back
  • Lack of daily exercise/movement
  • Reduced core control
  • Muscle weakness – particularly of neck control muscles
  • Muscle tightness
  • Poor lifting technique
  • Limited recovery time after strenuous activity
  • Having the wrong type of pillow

How to fix a wry neck?

As with most musculoskeletal problems, the most important part of managing a wry neck is to get a clear diagnosis so the appropriate rehab can start straight away. Establishing a correct diagnosis directs the care plan for your pain.

Your physiotherapist can assess your neck and diagnose the problem, and will also be able to tell the vertebral level/s that is/are involved.

From there, a plan will be put in place to take the pain away, get the neck moving, and aim to prevent it from happening again!

During treatment a range of modalities can be used, and include:

• • Home exercise programme – initially stretching, and then strengthening
  • Soft tissue massage
  • Joint mobilisation
  • Heat or ice as indicated
  • Dry needling – Research suggests this an effective treatment
  • Taping to assist in muscle relief and posture
  • Pillow fitting
  • Ergonomic advice and assessment
  • Postural control and strengthening
  • Sporting/recreational advice and assessment
  • Gym strengthening

Facet-related wry neck will generally recover faster than discogenic wry neck. Whereas a general timeframe for recovery from facet wry neck can be a few days to 2-3 weeks, discogenic wry neck will involve a longer recovery time, generally around 6 weeks.

How to prevent wry neck from occurring?

Prevention of wry neck developing or reoccurring generally involves looking at the possible contributing factors as mentioned above.

Identifying the contributing factors and problems is the easy part, making changes and finding solutions can sometimes be tricky. Your physiotherapist will be able to help you identify and then implement the necessary changes.