Torticollis.
What is torticollis?
Torticollis — from the Latin for "twisted neck" — is a condition in which the head is held in a tilted and rotated position due to involuntary contraction or shortening of the muscles on one side of the neck. The sternocleidomastoid (SCM) is the most commonly involved muscle, though the scalenes, upper trapezius and deeper cervical muscles may also contribute depending on the type and cause.
At Articulate Physiotherapy we treat adult presentations of torticollis. If you are looking for physiotherapy for an infant with congenital muscular torticollis, we recommend contacting a paediatric physiotherapy service with specific infant CMT experience.
Types of torticollis in adults
Adult torticollis presents across several distinct clinical patterns, each with different causes and management approaches.
Acute wry neck is the most common presentation in physiotherapy practice — a sudden onset torticollis, often on waking, involving protective muscle spasm and reflex guarding around a cervical facet joint that has been acutely irritated or locked. The head is typically held in lateral flexion and rotation away from the painful side, and any attempt to move toward neutral produces sharp pain and resistance. Most episodes occur in young to middle-aged adults and resolve rapidly with appropriate treatment — often within days.
Cervical dystonia — also called spasmodic torticollis — is a neurological movement disorder involving abnormal, involuntary sustained or repetitive contractions of the neck muscles. It is a form of focal dystonia and is distinct from musculoskeletal torticollis in both its mechanism and management. Botulinum toxin injections are the primary medical treatment for cervical dystonia, and physiotherapy plays a complementary role in managing the musculoskeletal consequences, reducing secondary pain, and optimising functional outcomes alongside medical management.
Secondary torticollis can develop from structural causes including cervical disc herniation, atlantoaxial instability, cervical lymphadenopathy, or as a response to pain from other cervical pathology. Identifying and treating the underlying cause is the primary management strategy in these cases.
What are the symptoms?
The characteristic presentation is a head and neck held in a tilted and rotated position, with pain and muscle tightness on the contracted side. Movement in the restricted direction provokes pain and guarding. In acute wry neck, onset is typically sudden — often overnight — and the restriction can be dramatic. In cervical dystonia, the abnormal posture may be intermittent or sustained, and may worsen with fatigue or stress. Secondary torticollis symptoms reflect both the head position abnormality and the underlying structural cause.
How can physiotherapy help?
For acute wry neck, manual therapy — joint mobilisation of the restricted cervical segments — is highly effective at restoring movement and reducing protective muscle spasm rapidly. Most acute wry neck presentations respond well within one to three sessions. Dry needling of the cervical and upper trapezius musculature assists with pain management and muscle relaxation in the acute phase.
For cervical dystonia, physiotherapy complements medical management by addressing the secondary musculoskeletal effects of the abnormal muscle contractions — treating the pain, stiffness and postural compensations that develop over time, and providing sensory tricks and movement strategies that can temporarily reduce dystonic activity.
For secondary torticollis from structural cervical causes, physiotherapy targets the underlying pathology — whether that is cervical disc herniation, facet joint syndrome, or atlantoaxial instability — with appropriate cervical mobilisation, deep cervical flexor retraining, and postural rehabilitation.
For all presentations, strengthening exercises address weakened or imbalanced neck muscles to improve head alignment and support proper posture, while neuromuscular re-education helps retrain the muscles and nervous system to maintain a more neutral head position. Real time ultrasound guides deep cervical stabiliser retraining. Clinical Pilates provides structured thoracic and cervical rehabilitation in the later stages of recovery.
Our physiotherapists Yulia Khasyanova and Mauricio Bara both have experience in cervical spine conditions and are members of the Australian Physiotherapy Association.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
Torticollis — from the Latin for "twisted neck" — is a condition in which the head is held in a tilted and rotated position due to involuntary contraction or shortening of the muscles on one side of the neck. The sternocleidomastoid (SCM) is the most commonly involved muscle, though the scalenes, upper trapezius and deeper cervical muscles may also contribute depending on the type and cause.
At Articulate Physiotherapy we treat adult presentations of torticollis. If you are looking for physiotherapy for an infant with congenital muscular torticollis, we recommend contacting a paediatric physiotherapy service with specific infant CMT experience.
Types of torticollis in adults
Adult torticollis presents across several distinct clinical patterns, each with different causes and management approaches.
Acute wry neck is the most common presentation in physiotherapy practice — a sudden onset torticollis, often on waking, involving protective muscle spasm and reflex guarding around a cervical facet joint that has been acutely irritated or locked. The head is typically held in lateral flexion and rotation away from the painful side, and any attempt to move toward neutral produces sharp pain and resistance. Most episodes occur in young to middle-aged adults and resolve rapidly with appropriate treatment — often within days.
Cervical dystonia — also called spasmodic torticollis — is a neurological movement disorder involving abnormal, involuntary sustained or repetitive contractions of the neck muscles. It is a form of focal dystonia and is distinct from musculoskeletal torticollis in both its mechanism and management. Botulinum toxin injections are the primary medical treatment for cervical dystonia, and physiotherapy plays a complementary role in managing the musculoskeletal consequences, reducing secondary pain, and optimising functional outcomes alongside medical management.
Secondary torticollis can develop from structural causes including cervical disc herniation, atlantoaxial instability, cervical lymphadenopathy, or as a response to pain from other cervical pathology. Identifying and treating the underlying cause is the primary management strategy in these cases.
What are the symptoms?
The characteristic presentation is a head and neck held in a tilted and rotated position, with pain and muscle tightness on the contracted side. Movement in the restricted direction provokes pain and guarding. In acute wry neck, onset is typically sudden — often overnight — and the restriction can be dramatic. In cervical dystonia, the abnormal posture may be intermittent or sustained, and may worsen with fatigue or stress. Secondary torticollis symptoms reflect both the head position abnormality and the underlying structural cause.
How can physiotherapy help?
For acute wry neck, manual therapy — joint mobilisation of the restricted cervical segments — is highly effective at restoring movement and reducing protective muscle spasm rapidly. Most acute wry neck presentations respond well within one to three sessions. Dry needling of the cervical and upper trapezius musculature assists with pain management and muscle relaxation in the acute phase.
For cervical dystonia, physiotherapy complements medical management by addressing the secondary musculoskeletal effects of the abnormal muscle contractions — treating the pain, stiffness and postural compensations that develop over time, and providing sensory tricks and movement strategies that can temporarily reduce dystonic activity.
For secondary torticollis from structural cervical causes, physiotherapy targets the underlying pathology — whether that is cervical disc herniation, facet joint syndrome, or atlantoaxial instability — with appropriate cervical mobilisation, deep cervical flexor retraining, and postural rehabilitation.
For all presentations, strengthening exercises address weakened or imbalanced neck muscles to improve head alignment and support proper posture, while neuromuscular re-education helps retrain the muscles and nervous system to maintain a more neutral head position. Real time ultrasound guides deep cervical stabiliser retraining. Clinical Pilates provides structured thoracic and cervical rehabilitation in the later stages of recovery.
Our physiotherapists Yulia Khasyanova and Mauricio Bara both have experience in cervical spine conditions and are members of the Australian Physiotherapy Association.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
