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Physiotherapy Management of Acute Wry Neck

Tuesday, 11th February 2025

Acute wry neck is a common musculoskeletal condition characterized by sudden and severe neck pain, often accompanied by abnormal head positioning and muscle spasms. It usually occurs abruptly, with athletes often reporting an inability to move their neck freely, often tilting the head to one side. Understanding the anatomy involved and the physiotherapy management options is essential in treating this condition and helping our athletes to recover effectively.

The neck consists of seven cervical vertebrae and numerous muscles, ligaments, and tendons that provide support and allow a wide range of motion. When an individual experiences acute wry neck, it’s often due to a problem in one of the cervical muscles or joints. The primary muscles involved are:

Sternocleidomastoid (SCM):

This muscle plays a critical role in head movement. When it contracts on one side, it causes the head to tilt toward that side while rotating the face away.

Trapezius:

Located in the upper back and neck, this muscle aids in stabilizing the head and neck. Tightness or spasm in the trapezius can contribute to discomfort and limited mobility.

Levator Scapulae:

This muscle helps elevate the scapula and assists in neck movement. Tension in the levator scapulae can exacerbate neck stiffness and pain.

In acute wry neck, it is often the sternocleidomastoid or other nearby muscles that experience spasm or tightness. The result is a lateral tilt of the head (toward the affected side) and rotation of the chin (away from the affected side). This altered posture can lead to significant discomfort and even difficulty in performing daily activities, such as driving or reading.

Causes of Acute Wry Neck

The exact cause of acute wry neck can vary, but it is commonly associated with:

Muscle strain or spasm:

A sudden movement or poor posture can trigger muscle spasms in the neck.

Joint dysfunction:

Sometimes, a misalignment or mechanical dysfunction of the cervical spine joints can irritate the surrounding muscles, causing a wry neck.

Injury:

A trauma, such as whiplash or an awkward sleeping position, can contribute to the development of acute wry neck.

Infections or inflammatory conditions:

In rare cases, infections like meningitis or inflammatory conditions like rheumatoid arthritis can result in a wry neck.

Physiotherapy Management of Acute Wry Neck

The management of acute wry neck focuses on relieving pain, restoring normal range of motion, and preventing recurrence. Physiotherapists play a crucial role in guiding patients through these recovery steps, often using a combination of manual therapy, exercises, and education.

1. Pain Relief and Initial Management

In the acute phase, physiotherapists prioritize reducing pain and muscle spasm. Methods such as:

Heat or cold therapy: Ice packs or heat pads can be used to reduce inflammation or promote muscle relaxation.
Gentle stretching: Instructing the patient to gently stretch the affected muscles can help reduce tightness and improve movement.
Soft tissue massage: Gentle massage of the neck muscles helps alleviate muscle tension.

2. Manual Therapy

Manual therapy is commonly used by physiotherapists to mobilize the cervical spine and relieve pain. Techniques such as joint mobilizations and soft tissue manipulation target tight or restricted joints, improving mobility and reducing discomfort.

3. Exercise Rehabilitation

Once pain and inflammation are under control, physiotherapists guide patients through a tailored exercise program. This may include:

Stretching exercises: To improve flexibility and prevent muscle stiffness.
Strengthening exercises: Focused on the deep cervical flexors and extensors, these exercises help stabilize the cervical spine and support posture.

Postural training: Educating the patient on proper posture during activities of daily living, such as sitting, driving, or using a computer, can help prevent future episodes.

4. Ergonomics and Lifestyle Modifications

Patients are often educated on proper ergonomic practices to prevent recurrence. This may involve adjustments to workstation setups and techniques for lifting and carrying objects.

Acute wry neck is a painful and debilitating condition, but with the appropriate physiotherapy management, most individuals can recover fully. By addressing muscle spasms, improving joint mobility, and strengthening the cervical muscles, physiotherapists help patients regain their neck function and prevent future episodes. Early intervention, combined with lifestyle and ergonomic modifications, is key to a successful recovery and long-term neck health. If you have been experiencing neck pain, book in with one of our PEAK coaches here.

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