Wry Neck

Wry Neck

Article by J.Miller, S.Armfield

What is Wry Neck?

Wry neck is a complaint where you develop neck pain and stiffness, which is often accompanied by spasm of the surrounding neck muscles. This protective response causes neck pain and an inability to turn your neck through its full range of motion.

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

Wry neck is a prevalent condition, which can be quite disabling as the sufferer experiences constant severe pain with simple neck movements. Luckily wry neck treatment usually is very successful in a short period!

What Causes Wry Neck?

Wry neck can have several causes. However, it is the thought that the pain and reduction in the range of motion result mainly from two mechanisms. Either Facet Wry Neck caused by a locked facet joint or Discogenic Wry Neck caused by a cervical disc injury.

What is Facet Wry Neck?

wry neck

The most common cause of acute wry neck is a locked facet joint.

Your facet joints allow, guide and limit the movements of your neck. Your facet joints allow smooth gliding movements between the adjacent vertebra. Occasionally your facet joints can become either stiff through traumatic injury or arthritis or simply get stuck at extreme of motion.

A commonly reported history for the wry neck patient is to wake with a stiff and painful neck.  The onset of the wry neck is usually sudden. The cause may have included a restless night sleep, uncomfortable pillow, waking suddenly in the night (e.g. a noise) or merely unknown. Let’s face it, who knows what we exactly get up to in our sleep!

Wry neck pain is due to the numerous nerve endings located in the facet joint itself and the tissues adjacent to the facet joint. Facet wry neck is most common in younger populations, ranging from young children to people in their thirties. Older facet wry neck sufferers tend to have a more gradual onset with the facet joints becoming “rusty” over time.

Signs and Symptoms of Facet Wry Neck

Pain – generally located in the middle or side of the neck that is affected. The onset of pain is sudden. The pain experienced does not extend beyond the shoulder joint.

Loss of Movement – your neck locks in an abnormal position – most commonly flexed forward and rotated away from the side of pain. All movements aggravate the pain, as the stuck joint and movement trigger irritation to the joint and thus pain.

Muscle Spasm – this is a tightening of the associated neck muscles that further limit movement.

What is Discogenic Wry Neck?

An injury may also cause an acute wry neck to your intervertebral disc. This condition is known as Discogenic Wry Neck. Usually, the injured disc protrudes posteriorly and presses against surrounding structures and nerves.

Signs and Symptoms of Discogenic Wry Neck

  • Sufferers generally experience a gradual onset of dull, diffuse pain.
  • Pain is usually felt in the lower neck, shoulder or upper chest.
  • Pain may radiate down into the arms.
  • Your neck is fixed and difficult to move. You will usually be holding your head and neck away from the painful side because of pain. However, this is painfully-limited movement, rather than a mechanical block as in the facet wry neck.
  • Muscle Spasm
  • Occasionally, you’ll experience pins and needles, numbness or weakness in your arms or legs. If this is the cases, seek prompt medical assessment.

How Do You Treat Wry Neck?

Wry neck treatment varies depending upon whether you have a facet or discogenic wry neck. Therefore it is crucial to seek the advice of your trusted neck healthcare practitioner such as your physiotherapist.

Wry Neck Treatment

After your physiotherapist has assessed your neck and confirms which joint or joints are locked, they will utilise a range of low-risk joint treatment techniques and soft tissue massage to normalise your facet joint function.

While your wry neck joint can almost always be immediately unlocked, you will have some residual muscle spasm and swelling in the region due to the trauma. Think how a sprained ankle swells! Neck joints will also expand, but it won’t be as visible.

Facet Wry Neck Treatment Aims

  • Confirm your diagnosis
  • Unlock your locked facet joint: facet joint techniques
  • Normalise joint range of motion: joint techniques
  • Relax muscle spasm: massage, gentle stretches, acupuncture or dry needling
  • Normalise your muscle length-tension ratio: massage stretches and home exercises
  • Check and normalise your deep neck and superficial muscle strength
  • Ensure healthy cervical posture and function.

If you need more specific advice, please consult your physiotherapist who has a particular interest in acute wry neck rehabilitation.

Physiotherapy Treatment for Discogenic Wry Neck?

In most cases, Discogenic Wry Neck is successfully managed with a steadily progressed physiotherapy intervention. Discogenic wry neck does not typically respond as quickly as facet wry neck treatment.  This slower is due to the more severe injury that involves the intervertebral disc.

While the period does vary, it is not uncommon for a discogenic wry neck to take up to six weeks to rehabilitate successfully.  In very extreme cases, spinal surgery for a significant cervical disc bulging is an option.

Physiotherapy is essential for the short and long-term management of your neck pain and restoration of its full function. Treatment includes a full neck range of movement and the stabilisation and strengthening of your neck to protect your injured disc for the remainder of your life.

You’ll find that a physiotherapist’s assessment and treatment will reduce your likelihood of a recurrence.

Discogenic Wry Neck Treatment Aims

  • Confirm your diagnosis
  • Reduce intradiscal pressure and pain: disc de-loading techniques
  • Normalise joint range of motion: joint techniques
  • Relax muscle spasm: massage, gentle stretches, acupuncture or dry needling
  • Normalise your muscle length-tension ratio via massage, stretches and home exercises
  • Normalise your deep neck and superficial muscle strength
  • Ensure standard scapular stabilisation control to reduce neck intradiscal pressure
  • Ensure healthy cervical posture and function.

If you need more specific advice, please consult your physiotherapist who has a particular interest in acute wry neck rehabilitation.

How Long Does Wry Neck Last?

Most acute wry necks can be unlocked immediately. However, the residual effects may last for up to one week. It is also important to normalise your neck muscle and joint function (e.g. strength and motion) to prevent a regular recurrence, which unfortunately commonly occurs with an inadequately rehabilitated neck injury.

What Can You Do Until You See a Physiotherapist?

At PhysioWorks, we understand that acute wry neck can be particularly disabling. Ideally, we recommend immediate treatment for the best and quickest result.

If you suspect acute wry neck, please call one of our clinics and inform them that you suspect you have an acute wry neck. They’ll do their best to fast track your appointment. Until your consultation, you may find relief from the application of ice or heat to the neck and surrounding muscles.

If you can consult with your doctor, they may prescribe muscle relaxants or other medication to assist your symptoms. A neck brace or soft collar may also help until you can seek professional advice and treatment.

Neck Pain Treatment

The best treatment for your neck pain is determined entirely by the specific reasons for WHY you are suffering neck pain. Everyone is different, but there are some common similarities.

Your physiotherapist is highly skilled at the diagnosis and treatment of mechanical neck pain and headache. Posture correction is essential, but it does depend upon the availability of enough joint and muscle flexibility to attain a good posture, plus muscle strength and endurance to maintain your proper position. Address any deficit.

We understand that your neck pain may not be solely about stiff or wobbly joints or tight/weak neck muscles. There is a whole gamut of information that your physiotherapist will analyse during your diagnostic consultation and then commence the correction of your problems. They'll also consider other systemic conditions that can cause neck pain, e.g. cancer, and direct you towards the appropriate healthcare practitioner if necessary.

Fortunately, the vast majority of neck pain does come from your neck joints and muscles. Pleasingly, researchers have shown that a combination of neck joint and muscle treatment performed by your physiotherapist and some specific strengthening exercises are an effective way to eliminate your neck pain, stiffness and headaches.

For advice specific to the diagnosis and management of your neck pain, please contact your trusted healthcare practitioner.

Common Neck Pain Treatment Options

If you are in severe neck pain or have a stiff neck, it is best to assess promptly to exclude any red flag conditions such as cancer and then commence the best neck treatment straight away.

Chronic neck pain can be a lingering problem due to habit. Research tells us that symptoms lasting longer than three months become habitual and are much harder to solve.  The sooner you get on top of your neck symptoms, the better your outcome.

Some of the neck pain treatment options available may include the following:

What's the Best Pillow for Neck Pain?


The correct pillow is also vital. If you are waking through the night or in the morning with a stiff or painful neck, it may be that it's your pillow and not your neck that is the cause.

Neck Collar?

A neck collar is not recommended for most non-traumatic injuries as the collar encourages muscle weakness. However, in severe neck spasm conditions such as wry neck or whiplash, a collar is often used in the first week to assist with muscle relaxation.

Please ask your physiotherapist for specific advice.

Will A Posture Brace Help Your Neck Pain?

Posture support braces have improved over the years with new designs being very useful in building awareness of what the correct posture is. Bracing or posture taping is excellent for teenagers, the elderly or those using computers.

There are various posture braces available. You can find more information about posture braces via our online shop.

For more advice, please consult your neck physiotherapist.