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.

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. This means to either call an ambulance or head to a hospital emergency department.

Red Flags for Neck Pain

Otherwise, the rule of thumb is that you should start a more thorough medical investigation only when all three of these conditions are met. 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 but not all cases are sudden, on one side, and cause both 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.
  • A fierce headache, an inability to bend the head forward, fever, or altered mental state. These are all symptoms of meningitis (inflammation of the membranes covering the brain and spinal cord, caused by infection or drug side effects).
  • 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