Wry neck is when your neck joint gets stuck, inflamed and you’re unable to turn your neck. If you are reading this from a funny angle because you cannot move your head to face the screen, this article is for you!
Your neck can get stuck, which causes neck stiffness and often a postural deformity (to keep the neck in a position to decrease pain). We refer to this as wry neck (wry meaning distorted, lopsided, twisted or pulled out of its proper place) or an acute locked joint, which we have the key to unlock.
Each person’s case is unique and we want to address your specific needs. If you would like us to investigate or provide some insight, we invite you to contact us by clicking the link below.
What is the neck made up of?
The neck joins your head to your body. Necks come in all shapes and sizes, like a ballerina graciously moves her neck during her dance, or a weightlifter whose neck seems shorter due to the shear size of his Trapezius muscles. Even though these necks appear different, both have the same architecture, just like yours.
The vertebrae are named and counted from the top down. C1 (atlas, named after the Titan warrior condemned to carry the heavens on his shoulders by Zeus) and C2 (axis) are unique in the pivot joint that they form. This pivot joint enables rotary movement, turning your head from side to side, which comes in handy when following the ball during a tennis match.
C3 to C7 look fairly similar. The vertebral bodies have discs in between them. The rest of the vertebrae (lamina, transverse and spinous processes) fit together snugly, like lego pieces stacked on top of each other to create a tower. These “snug fits” are the facet joints (zygapophyseal joints). You have one on each side of a vertebra, where the one on top slide on the one below. A thing of beauty really, if it allows the movement is was designed for.
These facet joints work together to move the neck to look up and down or bend the ear to the shoulder, like when you squeeze your phone to your ear. All these joints need to work in harmony to allow full, pain free movement.
Between each cervical vertebra is a disc (except for C1 and C2). The disc has a fibrous outer layer (annulus fibrosus) that encloses the gel like inner part (nucleus pulposus). Almost like a few layers of onion surrounding a jelly like substance inside. The discs act as shock absorbers in the neck and allow movement.
The cervical vertebrae and neighbouring discs are connected to each other with different ligaments to aid in stability. Except for allowing movement the bony bits, discs and ligaments protect the spinal cord.
Seen from above the vertebrae have a fairly round shaped hole in which the spinal cord runs from the brain down to the lower back. From the spinal cord nerve roots exits above each vertebra, forming nerve roots C1 – C7, with the C8 nerve root exiting the spinal cord below the 7th cervical vertebra. The nerve roots then merge and divert, like rural gravel roads, to form the brachial plexus. The brachial plexus supply the arm of all the nerves needed to allow movement and relay messages of sensation to the brain.
Alongside the vertebrae important blood vessels run to supply the brain of oxygen from the heart and lungs and return deoxygenated blood to the heart. The most superficial being the external carotid where you can feel your pulse if you press your index finger just below the jaw bone.
Muscles attach in different layers to the vertebrae and skull to generate force on the bones to allow the movement desired.
How does wry neck happen?
The two most common causes for wry neck are the facet joints and intervertebral discs. Finding the cause automatically gives you the key to “unlock” the neck and give you back your freedom of movement.
Acute wry neck is most often seen in adolescents and young adults. It follows a trivial incident (like flipping your head back when blow drying your hair). It can be pain free in a resting position. The resting position is where you will be stuck. Usually turned slightly to one side. However trying to move out of this position causes sharp and sudden pain on the side that you are stuck in.
Discogenic wry neck is caused by irritation and inflammation to the disc. This can irritate or compress the nerve root. This is commonly seen in middle aged people or a young person who does a lot of repetitive actions (head banging, carry heavy loads on your shoulder). It is sore in most positions and often difficult to find a comfortable resting position. The neck is stuck slightly turned and side flexed. Your pain will be on the opposite side, and down (radiating) your shoulder and upper back. More movement is possible than with an acute wry neck.
Causes of Wry Neck
A wry neck usually occurs spontaneously upon waking in the morning or from a sudden, small, quick movement of your neck. Your neck can be predisposed to “locking” by:
- sustained poor posture (slouching, sleeping on your stomach or with too many pillows)
- repetitive or prolonged neck movements
- excessive lifting (carrying heavy load on your shoulder)
These repetitive and prolonged positions cause forces on the structures in your neck. These forces gradually stretch tissue (ligaments, capsule, discs) in the neck over time. These changes predispose the facet joint or disc to injury.
Symptoms of Wry Neck
A wry neck typically causes sharp pain on one side of the neck, especially with movement. This causes a postural deformity due to pain. The postural deformity is usually positioned with the head tilted away from the side of pain. This is the body’s way to limit the pain you experience by opening and creating space for the structures that are irritated, compressed of inflamed. Muscle spasm then forms to maintain this position.
Locked facet wry neck
- Sudden pain, on the affected side of the neck.
- Loss of Movement, your neck is locked in an abnormal position (mostly bent forward and turned away from the side of pain). All movements aggravate the pain.
- Muscle Spasm spasms around the affected joint form in an attempt to protect the joint and limit movement even further.
Discogenic wry neck
- Gradual onset of dull pain
- Pain may radiate to the shoulder blade or down into the arms (you may experience pins and needles, numbness or weakness in your arms, this necessitates a neurological evaluation)
- Your neck is stuck (usually to look away from the painful side because of pain, this is the body’s way to create space on the painful sid)
- Movement is only limited by pain, not mechanically blocked as in the facet wry neck
- Muscle Spasm
- Sit comfortably on a chair with your back supported, let your shoulder blades glide down your back.
- Now bend your neck forwards, aim your chin to your chest. Can you reach your chin to touch your chest?
- Next, aim your chin to the ceiling. How far can you look up?
- Next, turn your head to the unaffected side. Notice how far you can look over your shoulder. Then turn the opposite way (towards the painful side) and notice how far you look over that shoulder. Is there a big difference between the two sides?
- Next, drop your ear towards your shoulder of the unaffected side, as though you are reading the title on a book’s spine. Compare with the affected side. Is there a big difference between the two sides? If there is a big difference between the two sides (something is blocking the movement or you experience a lot of pain), you probably have a wry neck.
How bad is my wry neck?
A straightforward wry neck is easily treated to gain movement. However, if your wry neck is discogenic in origin, it is important to find out what has led to this moment in time. If we can find the contributing factors (posture, desk set up, sleeping position, underlying weakness, poor exercise techniques) we can prevent your wry neck from returning.
Diagnosis of Wry Neck
Your inability to move your neck is a diagnosis already. We can assess the different structures that are contributing to your wry neck and treat it accordingly. Under normal circumstances imaging will not be necessary. If this is a recurring problem and you have had some form of imaging done in the past, please bring it with you to your first consultation.
X-rays show only the bone, that is only the cervical vertebrae. If we suspect a problem with the vertebrae and if conservative treatment is not working, we may refer you for X-rays.
Magnetic Resonance Imaging show all the different structures in the neck. Bone, muscle, ligament, nerves, even the blood vessels. This is a very costly study and needs specialists referral.
How we test it
Physiotherapist have the ability to test the different structures to determine what is causing your wry neck. We use different techniques to assess the joints and discs. We will be able to identify the cause and level (which vertebra) of your problem. If you have any referral or pins and needles, you can expect a neurological evaluation. This includes comparing the sensation, power and reflexes of the affected and unaffected sides.
Why is my wry neck not going away?
Normal, uncomplicated locking of a facet joint should be unlocked within one/two treatment session. The following treatment will then focus on any adjacent structures (mostly residual muscle spasm) and regaining FULL movement.
Recurring wry neck is mostly due to discogenic causes. Discogenic wry neck will happen because of fraying of the annulus (the outer layer of the disc) that gets caught, causes inflammation, may compress the nerve root. The disc will heal in time. We have to determine why it is recurring. You probably have bad habits that influence the structural integrity, we have to find what they are and change them.
A big problem we see with Wry Necks these days
Manipulation is NEVER the first line of treatment for a wry neck. Manipulation describes a forceful end of range movement. An uncontrolled manipulation may cause more damage than good, if all the structures in the neck were not tested. You may feel as though a forceful “shake down” of your neck will get your spine “back in alignment” and therefor take your pain away. This is not the case. Manipulation is NEVER the chosen treatment for a discogenic wry neck. Manipulation may be considered if an acute wry neck does not respond favourably to mobilisations.
What makes Wry Neck worse
Continuously “testing” your neck to see if it is still stuck, will increase your pain.
Poor postural habits when driving or doing computer work will increase your pain.
Prolonged forward bending, like drawing, doing fine needlework, cooking ect. will increase your pain.
Sleeping on your stomach with the head turned to one side, will increase your pain. Even worse so if you use a pillow too.
Physio treatment for Wry Neck
- Our first aim will be to find the structures responsible for your wry neck. Then to “unlock” your neck ASAP. Treatment will include:
- Myofascial techniques (massage, lyno, deep dry needling) to decrease protective muscle spasm
- Joint mobilisations to decrease pain and increase movement
- Electrotherapy (ultrasound, LASER) to control pain and inflammation
- Neural mobilisations to decrease referred pain
- Strapping to immobilise the neck, restrict certain movements or support certain muscles.
Phases of Rehabilitation & Treatment
Acute Phase (week 1)
Goals of treatment:
- Regain 50% of range of motion (ROM) in first consultation
- Decrease pain
- Control inflammation
- Immobilise if necessary (strapping)
Intermediate Phase (week 2)
- Goals of treatment:
- Regain full active pain free ROM
- Control pain and inflammation
- Introduce muscle strengthening exercises
- Change contributing habits if necessary
Final Phase (week 3-4)
- Goals of treatment:
- Full active pain free ROM
- Return to hobbies/sport
The recovery time for a wry neck varies from person to person, depending on compliance with physiotherapy. Usually the acute symptoms will settle within 2-5 days with appropriate treatment. You can expect to see us 2-3 times in the first week. The more aggressive we treat you during this time, the quicker your recovery. You should be pain free in as little as a couple of days, depending on the cause of your wry neck. Thereafter we will custom your treatment plan accordingly to ensure a full recovery and address any contributing factors such as joint stiffness.
Surgery for wry neck
Surgery for a wry neck is highly unlikely. It’s the last resort.
We are first line practitioners, which means that you can consult a physiotherapist without referral. We will be able to refer you to your GP is necessary. You may need medication (analgesics, anti inflammatories or a muscle relaxant). Over the counter options should suffice, while also informing your pharmacist of any chronic medication that you are taking.
In severe cases you can consider a voltaren injection from your GP. As mentioned before, a manipulation should never be your first line of treatment for your wry neck. After treatment we want to encourage movement, therefore you should not use a soft collar for a long time, if even necessary at all.
What else could the pain be?
- Spasmodic Torticollis (cervical dystonia) is the sustained, involuntary contraction of two muscles with directly opposing functions, which causes the head and neck into a similar position as in wry neck.
- Neck muscle spasm – depending on the group of muscles that’s involved.
- Trauma (car accident/fall) may cause a fracture dislocation that may result in a similar position of the head and neck.
- Acute disc prolapse, where the nucleus is causing compression on the nerve root may result is a similar head and neck position in an attempt to decrease pressure on the structure.
- Vestibular dysfunction may result in a similar position of the head and neck with associated vertigo/dizziness and nausea.