Wry Neck

Wry Neck

Article by J.Miller, S.Armfield

What is Wry Neck?

A wry neck is a complaint where you develop neck pain and stiffness, which is often accompanied by a 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?

A 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 stiff through traumatic injury or arthritis or get stuck at extreme 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 in the facet joint 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 the 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 case, 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 joints are locked, they will utilise a range of low-risk joint treatment techniques and soft tissue massage to normalise your facet joint function.

Think how a sprained ankle swells! While Your physiotherapist can immediately unlock your wry neck joint, you will have some residual muscle spasm and swelling in the region due to the trauma. Neck joints will also expand, but they 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, particularly interested 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 restoring 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, particularly interested 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 an 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 applying 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.

Article by John Miller

When Should You Be Concerned About Neck Pain?

What's Urgent?

There is one situation where there’s no need to wait several weeks before deciding if your neck pain is serious.

If you’ve had an accident with forces that may have been sufficient to fracture your spine or tear nerves, seek a medical assessment as soon as possible. In this instance, either call an ambulance or head to a hospital emergency department.

Red Flags for Neck Pain

Otherwise, the rule of thumb is to start a more thorough medical investigation only when you meet all three of these conditions.

The three general red flags for neck pain are:

  1. it’s been bothering you for more than about six weeks
  2. it’s severe and/or not improving, or getting worse
  3. there is at least one other “red flag” (see below)

Red flags are reasons to seek a professional opinion rather than to worry. Seek the advice of your physiotherapist or doctor if any of these red flags apply to you.

  • Light tapping on the spine is painful.
  • A torn artery may cause severe, throbbing or constrictive (novel pain), with a high risk of a stroke. Pain is the only symptom of some tears. Most cases are sudden, on one side, and cause neck and head pain (in the temple or back the skull), but the pain is usually strange. Any hint of other symptoms? Promptly attend a hospital emergency.
  • There are many possible signs of spinal cord trouble in the neck, with or without neck pain, mainly affecting the limbs: e.g. poor hand coordination; weakness, “heavy” feelings, and atrophy; diffuse numbness; shooting pains in the limbs (especially when bending the head forward); gait awkwardness. Sometimes patients present with both neck pain and more remote symptoms and don't realise they are related.
  • Unexplained episodes of dizziness or nausea, and vomiting may indicate a problem with the stability of the upper cervical spine.
  • Weight loss without dieting (it's a potential sign of cancer).
  • Mystery fevers or chills, especially in people with diabetes).
  • A severe headache that comes on suddenly is a “thunderclap headache”! Most are harmless, but it is always wise to investigate thoroughly.
  • Symptoms of meningitis (inflammation of the membranes covering the brain and spinal cord, caused by infection or drug side effects). The presence of a fierce headache or an inability to bend the head forward, fever, or an altered mental state.
  • The main signs that neck pain might be caused by autoimmune disease specifically include:
    • a family history of autoimmune disease,
    • gradual but progressive increase in symptoms before the age of 40,
    • marked morning stiffness,
    • pain in other joints as well as the low back,
    • rashes,
    • difficult digestion,
    • irritated eyes, and
    • discharge from the urethra (bladder).
  • Steroid use, other drug abuse, and HIV are all risk factors for a serious cause of neck pain.
  • If you feel pretty unwell in any other way, that could indicate that neck pain isn’t the only thing going on.

More info: Neck Pain


Article by John Miller

How Can You Relieve Your Neck Pain?

Neck Physiotherapy 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 depends on 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. A whole gamut of information that your physiotherapist will analyse during your diagnostic consultation and then commence correcting 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.

Please get in touch with your trusted healthcare practitioner for advice specific to the diagnosis and management of your neck pain.

Article by John Miller

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.

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.

Will A Posture Brace Help Your Neck Pain?

Posture support braces have improved over the years, with new designs beneficial in building awareness of the correct posture. 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.

Should You Wear A 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 sometimes used in a few days to assist with muscle relaxation. Rarely is a neck collar required beyond four days.

Please ask your physiotherapist for specific advice.

For more advice, please consult your neck physiotherapist.


Article by Jamie Van Beek

What Causes Neck Pain Without Injury?

Neck Pain without injury is a common complaint in the clinic. It can be frustrating to wake up without any triggering event and be stuck with neck pain.

The driver of this pain may be a muscle strain, a sprained facet joint or a bulging disc. These structures become injured due to repetitive microtrauma instead of a single event associated with injury. The microtrauma may be caused by poor posture, poor sleeping positioning or repeated movements throughout the day, which place a high load on the neck.

How Do I Fix My Posture?

The spine is made up of three curves. A concave curve in your lower back, a convex curve in your mid-back and another concave curve in the neck. Research has shown that people with neck pain have a flattening of the curve in their neck, resulting in a forward head posture. 1

An injury to any part of the spine can cause changes to spinal alignment, which can often flow onto the neck. A flattened lower back curve is a common postural adaptation from lower back pain. This increases the postural demand of the muscles which keep the head upright. Over time, these muscles may spasm and produce pain or fail and allow the head to float forward.

This is just one possible mechanism out of many. Your physiotherapist can identify which previous injuries may be contributing to your neck pain and the influence it's having on your neck.

Forward head postures may also result from sustained positions such as looking down at a phone and looking down at laptops and gaming.  Text neck is becoming more prevalent in our community.

What Is The Consequence of a Forward Head Posture?

Each vertebral level in the neck is made up of three joints. At the front, the vertebral bodies and discs make up the joints of the spinal column. At the back, facet joints sit on either side of the spinal cord.

A forward head posture shifts the weight of the head forward, stressing the vertebral bodies and discs in the neck. A loss of this natural curve has been linked to conditions such as cervical spondylosis, bulging discs and chronic neck pain [1]

This condition has become known as Nerd Neck.

How Should I Sleep With Neck Pain?

Sleep positioning should focus on reducing strain on the front joints of the neck (the vertebral body and disc). In side-lying, this means sleeping as upright as possible in order to avoid curling up into the foetal position and encouraging a forward head posture. To achieve this, try moving your pillow a couple of inches upwards and stretching your neck up to meet it.

When sleeping on your back, it's important to find a pillow that fully supports your neck to prevent it from rotating. The pillow also shouldn’t be too thick, to prevent encouraging a forward head posture.

Sleeping on your back is not recommended due to the sustained positions the neck has to maintain all night.

Solving Your Neck Pain

Whether your neck pain is caused by sleep positioning, poor posture or repetitive movements involving the neck, your Physiotherapist is trained to identify and treat the cause. Contact your Physiotherapist for an individualised assessment.


[1] Alpayci M, İlter S. Isometric Exercise for the Cervical Extensors Can Help Restore Physiological Lordosis and Reduce Neck Pain: A Randomized Controlled Trial. Am J Phys Med Rehabil. 2017 Sep;96(9):621-626. doi: 10.1097/PHM.0000000000000698. PMID: 28118272.

Article by John Miller

What's Causes Cervicogenic Headache?

Your neck headache originates from a variety of musculoskeletal and neurovascular structures. These structures include the upper three neck joints, C2/3 disc, spinal cord coverings, and neck muscles. Dysfunction in these areas can trigger pain signals that travel to your trigeminocervical nucleus (TCN) in your brainstem. This information is then transmitted into your brain and interpreted as a headache (Bogduk 2003).

Upper Neck Joints

cervicogenic headache

The most likely source of your neck headache is a dysfunction of your upper neck joints. Your neck muscles or nerves become involved from pain signals that travel to your trigeminal nucleus in your brainstem, where you interpret the pain signals as a neck headache.

The most common cause of a neck headache is the dysfunction of your upper three neck joints. The most common neck joints involved are your:

  • atlantooccipital joint (O-C1),
  • Atlanto-axial joint (C1/2), and
  • C2/3 cervical spine joints.

In simple terms, your neck joints can cause a neck headache or pain if they are either too stiff or move too much (e.g. wobbly and unsupported by weak muscles) or locked in an abnormal joint position, e.g. a locked facet joint or poor neck posture. Once your neck joint becomes stressed and painful, the pain signals refer to the trigeminocervical nucleus in your brainstem. You start to feel a neck headache or, in some cases, face pain!

Your neck and headache physiotherapist can assess and correct neck joint dysfunctions that result in a neck headache. Their professional diagnosis and treatment are essential for neck headache sufferers.

Neck Muscles

Your neck and shoulder blade muscles that originate from your neck will cause pain if they are overworking, knotted or in spasm. Some of your neck muscles overwork when protecting injured neck joints. Other neck muscles become weak with disuse—this further demands your overworking muscles resulting in muscle fatigue-related symptoms. Your deep neck flexors are frequently weak or lack endurance. Your neck muscles work best when they have healthy resting tension, length, strength, power and endurance.

Your skilled physiotherapist assesses and helps you correct any muscle imbalances that result in a neck headache.

Cervical and Occipital Nerves

Nerves in your upper neck may become pinched by extra bony growths, e.g. arthritis, disc bulges or swelling. The results can result in nerve irritation or a reduction in the neural motion known as neuromechanosensitivity or abnormal neurodynamics. Irritation of your upper neck structures refer to pain messages along the nerves and cause your headache. In simple terms, your neck is the "switch", nerves are the "power cords", and your headache is where the "light" comes on.

Your headache physiotherapist can assess your neuromechanosensitivity.

More info:

Headache & Migraine

Neck Headache

Jaw Headache