Torticollis physical therapy

Cervical spine radiating patterns

Torticollis physical therapy concerns chiropractic care of the stiff neck.

Okay, I will admit it up front; chiropractic treatment of torticollis is not a keyword that many folk are using and so I have cheated. If you have no interest in cervical spine manipulation in the treatment of your problem, then close this page right now.

There are few more painful and debilitating conditions than a torticollis. Tears are often shed and there is no place to hide; over the counter analgesics do nothing.

There are about thirty joints in the cervical spine; each of them has many mechanoreceptors telling your brain where your head and neck are in space. When just one of them starts firing off messages to the brain extreme pain and stiffness results.

Its other name is a wry neck. You go to bed absolutely fine, wake up in the morning, stretch, and bingo you can not move your head. The pain is excruciating.

I am not a believer in rushing off to the doctor or chiropractor for every little snivel or pain, but when you know something significant has happened, then it is best not to delay. Treating conditions like this before deep seated swelling occurs makes all the difference to how long it will take to resolve.

Taking anti inflammatory medication is like treating a broken arm with painkillers. The cause of the problem must be addressed immediately.

What may be surprising is that the treatment of wry neck, and especially if it began in the last twenty four hours is not particularly painful using the artful chiropractic adjustment.

The reason for writing this blog is the response of a patient yesterday to an extremely painful neck that began that morning. After just one treatment within 24 hours she had 80 percent less pain, at her reckoning, and an almost normal range of motion.

This page was last updated by Dr Barrie Lewis on 27th August, 2019.

Torticollis physical therapy

Torticollis physical therapy is for the person with an extremely painful stuck neck.

There are many different causes of acute neck pain. A torticollis however is characterised by the lack of disc signs, no radiation to the arm and all movements are extremely limited and painful; the patient with this condition never drives themselves to the clinic.

Facet joint signs are weakly positive, but Kemp's test, the hallmark is often only mild. One expects signs of muscle spasm, but they are absent.

So what then is causing the pain?

All synovial joints are enclosed in a bag that holds the fluid that keeps the cartilage fed with nutrients and oxygen and removes the waste products of metabolism.

When a small part of this sac becomes invaginated between the plates of the superior facet of the bone below and the inferior plate of the vertebra above then you have a torticollis. It is extremely painful; any movement is likely to bring the patient to the point of tears.

Whilst it can occur at any level in the cervical spine, the second and third vertebrae are often involved.

I cannot comment on how successfully torticollis physical therapy reacts to their treatment but generally the patient responds very quickly to the chiropractic adjustment. Whether massage of the neck, or ultrasound for example and medication help and how quickly, I have no idea.

For me the treatment of choice is the chiropractic adjustment; it is astonishingly effective for the patient in extreme pain.

The lady in question had consulted me the past for headaches. As is so common with the TMJ migraine she had symptoms emanating from the both the jaw joint and the upper cervical spine where the sensory nucleus of the trigeminal nerve is found.

However, for eighteen months she had been headache free; when she had pain or a headache she was able to relieve it by doing the TMJ exercises found elsewhere on this site.

She phoned me early in the morning reporting that she had arisen with no symptoms, but on extension of her neck in the shower whilst rinsing her hair she had felt a pop; extreme pain set in immediately and she was unable to move her head in any direction. Fortunately I was able to see her that day.

All movements were extremely painful and limited but particularly right rotation and flexion. Oddly the least painful was Kemp's test, usually associated with the classical facet syndrome.

Compression and distraction tests were negative and the muscles of the neck were not particularly painful. There were no signs of nerve impingement, and she had no headache. The TMJ joints were unrestricted.

What was uncertain was the level involved; the whole cervical spine on both sides were extremely tender. As a general rule one is not concerned about pathology in a young woman with no history of recent trauma if there is sudden onset of severe pain. Radiographs were not indicated.

After prodding and poking, using a diagnostic technique called motion palpation, I decided that the joint between the third and fourth cervical vertebrae was the spoke in the wheel.

After just one adjustment of C3 on the right side using the thumb cervical technique she had immediate restoration of movement and by the next day had 80 percent less pain.

Miracles we do at once; the impossible takes a little longer.

After the third treatment today she had almost no pain, and I discharged her, but with a request to phone in a week or two and let me know how she is doing. Clearly it's still very unstable and she made need another few adjustments.

Cervical facet syndrome

Cervical facet syndrome is a common phenomenon at the chiropractic coalface; torticollis is not. Yet they are blood brothers. It's arguable that one is a subgroup of the other.

With a torticollis all ranges of motion are severely limited and the pain is extreme; provided the patient comes early in the manifestation, it usually resolves with a few days.

The cervical facet syndrome is more likely to be a chronically disabling condition from an old injury. Perhaps the poorly managed torticollis becomes a chronic facet syndrome.

It takes research looking at large groups of people to find out what is the treatment of choice, and what is to be avoided. Is it torticollis physical therapy or chiropractic?

Neck pain anatomy

Neck pain anatomy will give you a better understanding of what may be causing your torticollis; physical therapy or chiropractic, or anti inflammatory medication the treatment of choice?

Of course much is determined by what your philosophy of health is, and what armaments you have to treat conditions like a torticollis.

If you see it as an inflammatory process then NSAIDS are the first port of call. If your only treatment regiment is manipulation and you are unable to prescribed medication, then manipulation will be done. If you have a hammer in your hand, then every condition looks like a  nail.


Nursing a baby is hard work not only on the body's nutrition but on the upper back and neck. Keeping fit is part of the solution. Having a cushion under the arm supporting the feeding child also helps.

We are inclined to think that best calcium for osteoporosis applies only to the elderly; not so. The child sucks it out of you mom, and making sure you are getting plenty of calcium, omega-3 for the infants growing brain, and high quality protein is vital.

  • Anti inflammatory omega 3

Useful links

› Torticollis physical therapy.

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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I have left alone. After seven treatments his pain and stiffness is 50 percent better, and he is happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti-inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He is doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost pain-free. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he is well pleased; sixty-five percent better after three treatments.

5. Mr T is a wise man; he has taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily stroll has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift; he has a short leg.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. X-rays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65-year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88-year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done. 

10. Mr X is a 71-year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a few months ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It is a non-complicated upper cervical facet syndrome, and she is doing well.

12. Mr D is a 38-year old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he could not sleep on that shoulder.

13. Mr D, a 71-year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors should not be treating the elderly most medical sites state but that is so much bunkum.

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Interesting questions from visitors

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