Stiff neck or torticollis
Symptoms of stiff neck or wry neck stiffness
Stiff neck, torticollis, or wry neck, or kink in the neck – it is all the same thing: a condition in which neck pain and muscle spasm is so intense that the stiffness makes it impossible to move the neck normally; the neck stiffness can be so rigid and locked in a defensive posture that it refuses to straighten or move in spite of all deliberate efforts. As a result, the individual must turn the entire body to look around, as opposed to the natural neck movement when the neck freely rotates 180 degrees from side to side and just about as far up and down, all the while mincing with the deep ice-pick jabs of sharp pain that come from a broad area of the neck.
A crick in the neck is characterized by intensely sharp and deep pain coming from an area of neck muscle spasm that is also very tender to the touch; areas of the neck, upper chest, shoulder and base of the skull fell bruised even though no traumatic impact was received. The neck muscles are classically held tight in a state of defensive spasm that acts as a protective mechanism to prevent movement of the cervical spine; the neck muscles severely deny neck rotation and flexion by keeping the head tilted down in one direction in an effort to protect the nerve system in this vulnerable and critically important structure. The muscles involved in a stiff neck are primarily those supplied by the spinal accessory cranial nerve.
Stiff neck and related complaints
It is common for a stiff neck or torticollis to be accompanied by a headache, shoulder pain and/or arm pain on the same side as the neck pain. Typically the headache will localize at the base of the skull or behind the ear, at the mastoid bone, and be very sensitive to even light touch. At the height of the neck pain and stiffness, one or both eyes will be sensitive to light (photophobia).
Torticollis will usually last for at least a few days up to a week, and only regress slowly and gradually. During this time the pain associated with the stiff neck can range from mildly painful and annoying to extremely painful and incapacitating. Sometimes the pain will be nearly constant to constant, but always very painful if movement is attempted.
In a relatively rare situation neck stiffness can be a strong indicator of a serious medical condition involving infection and inflammation of the protective layers of the brain and spinal cord, known as the meninges. When the meninges are so inflamed by bacterial infection it is known as meningitis. And so a stiff neck that occurs in concert with a headache, high fever, nausea or vomiting, and sleepiness may indicate meningitis – contagious and very serious medical emergency. Other bacterial infections, such as meningococcal disease, an infection in the cervical spine, can cause stiff neck symptoms to develop rapidly. Any time a stiff neck is accompanied by even a low fever it is advisable to seek emergency medical attention.
The majority of episodes of acute neck stiffness or pain recover rapidly because they involve only an acute episode or aggravation of a chronic problem of the musculoskeletal system that is fundamentally durable and capable of good recuperation.
Medical attention is always warranted if the neck pain and stiffness symptoms do not subside after a one week or so, or it neck stiffness and pain is noted after a traumatic injury.
Stiff neck causes
- Muscle strain or sprainMost commonly a stiff neck will be caused by simple muscle strain or sprain of the neck muscles, particularly the levator scapulae muscle that connects the scapula (shoulder blade) to the cervical spine (neck), and the trapezius and sternocleidomastoideus muscles. Examples of common daily activities that can stress the neck muscles and lead to torticollis:
- Automobile accident in which the head suddenly moves forward or backward
- Sleeping in an awkward or unusual position
- Sport or work injuries
- Wearing a heavy helmet
- Repeatedly turning the head from side to side (watching a tennis match, swimming or dancing)
- Chronic bad posture while standing, sitting, working
- Keeping head tipped or turned in one direction while working on computer or looking overhead
- Exposure to a cool draft of air as when sitting by an open window on a windy day or a moving automobile
- Effect of continued physical or emotional stress leading to tense neck muscles
- Holding the neck in an unusual and stressful posture while talking on the phone, keeping the phone between the ear and shoulder
- Cervical spine disorders
Structural and mechanical problems of the neck vertebrae can act as an underlying disorder to stress the neck and result in neck stiffness. For example, a cervical herniated disc, arthritis or vertebral bone spur can lead to a wry neck because a mechanical problem can alter function, resulting in abnormal use and overuse, irritation of joints, muscles and nerves, eventually resulting in protective muscle spasm and guarding.
Chronic soft tissue disorder commonly associated with painful and tense muscles and joints, leading to prolonged muscle contraction and splinting and a stiff neck.
- Vertebrae misalignment (subluxation)
Trauma or back posture in the neck and upper back can cause sudden muscle contraction. After a short while the vertebral subluxation begins to irritate nerve tissue and this can result in widespread neck muscle spasm and torticollis.
Stiff neck treatment and remedies
Correct and effective treatment will depend on the cause of a stiff neck. When due to strained muscles or ligaments, initial treatment may include:
- Try sleeping without a pillow
- Neck brace or cervical collar to limit neck movement to prevent additional tissue stress, and allow over-excited muscle tissue to rest
- Ice/heat applications – cold for the first 48-72 hours, followed by alternating cold/heat applications
- Gentle soft tissue stretching – simple gentle stretches like moving the head up and down, from side to side, in a figure-8 pattern, or allowing ht head to drop down so the ear comes closer to the shoulder of the same side, all done slowly and stopping at the first sign of discomfort.
- Gentle massage of involved area
- Acupuncture or acupressure can be extremely effective for neck pain, torticollis and headaches
- Stiff neck exercises to relieve pain and increase healing rate
- Brief and limited non-steroidal anti-inflammatory drugs like NSAIDs ( aspirin or ibuprofen)
If a stiff neck worsens or does not show signs of improvement after a week, inform our doctor or chiropractor. Most cases of torticollis resolve in a few weeks, but others take a bit longer depending on underlying condition of the neck soft tissue and spine. Your doctor can advise if additional time or specialized care is needed to hasten recovery.