Neck pain is one of the most common musculoskeletal complaints with up to 80% of the population experiencing an episode of neck pain in their lifespan. Wry neck is an acute episode of neck pain, where the neck temporarily becomes stiff and painful. This typically presents with pain down one side of the neck and difficulty straightening, bending, or rotating the neck.
The most common wry neck presentation involves inflammation of one or more cervical facet joints. These often respond quickly to treatment and recovery is expected with in a couple of weeks.
There can be a more stubborn version, involving discogenic inflammation, which initially presents quite similar. Recovery, however, tends to be slower with more gradual symptom reduction, often taking a couple of months to regain full function. A Range Physiotherapist can typically diagnose the tissues affected and provide and accurate prognosis and recommended treatment to achieve recovery in a safe and timely manner.
It is very common for a wry neck to develop overnight, with symptoms first noticed when waking up. In these cases, an appropriate pillow and fit can be an essential part of management and prevention of future episodes.
Applying the 5 stages of rehabilitation to wry neck:
- Reduce Pain and symptoms – Wry neck presentations are often quite painful with significant activity limitations in the early stages. Physiotherapy treatment can start from the onset of neck pain and work effectively to reduce the pain and dysfunction. Self-treatment strategies include using a heat pack, hot water bottle/shower, gentle massage, supportive pillow, and gentle exercises including deep neck flexor activation and rotations.
- Restore range of motion – Restricted range of motion is one of the defining features of wry neck. As pain and tissue irritability settles management can focus on restoring full range of motion. Gentle stretches and self-mobilizations can assist through this stage. Chi ball rotations and rumble roller self-release are often prescribed as home exercises.
- Motor control – Following a wry neck episode restoring full function of the deep neck flexors and postural support muscles is a key step along the way of regaining neck strength. Strength exercises implemented too early often results in strengthening the movement dysfunction and leaving tissues vulnerable to injury recurrence. Chi ball, postural control and foam roller exercises are often prescribed when retraining control.
- Strengthening – After good control and muscle activation is achieved there is a good opportunity to strengthen the neck, shoulders, and upper back to ensure the body can handle many of the loads life chooses to throw at it. Supervised exercise (Clinical Exercise or Functional Strength Classes) provide a safe and effective environment to complete strengthening exercises, along with improving exercise adherence, technique and compliance.
- Maintain – the recurrence rate of wry neck presentations is quite high, around 50%! Maintaining range of motion, posture and strength gains is key to ensuring wry neck pain doesn’t return.
For more general information on neck pain and wry neck see https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/neck-pain