Wry neck

Wry neck, or acute torticollis, is a painful, twisted neck: the head tips to one side while the chin turns towards the other, because muscles supporting the neck have gone into spasm. “Acute” means it comes on quickly, over a few hours or often overnight, so it’s common to go to bed feeling fine and wake up with it. It is a common cause of neck pain in young people (Royal Berkshire NHS Foundation Trust, 2024).

Symptoms include a limited range of movement of the head, neck pain, stiff and sometimes swollen neck muscles, headache, and one shoulder sitting higher than the other.

What causes wry neck?

Often nobody knows. The cause frequently isn’t found, and wry neck can happen in people who have never had neck problems. When there is a trigger, it is usually a minor muscle injury or sprain from (Royal Berkshire NHS Foundation Trust, 2024):

• sitting or sleeping in an unusual position without neck support
• poor posture while looking at a computer screen
• carrying heavy or unbalanced loads

The NHS lists a neck that stiffens in an awkward position during sleep, and long periods sitting at a desk, among the most common causes of neck pain in general (NHS).

Which muscles pull the neck round depends on the type of torticollis. In cervical dystonia, the sternocleidomastoid, which runs down the side of the neck and turns and tilts the head, is the one most often affected, and the trapezius, splenius and scalene muscles can be involved too (Cunha et al., 2023).

How long does wry neck last?

Symptoms usually get better on their own after a few days, though sometimes they take a little longer. The diagnosis is normally made by examination, and an X-ray is usually only needed if the examination doesn’t explain the problem. Treatment aims to ease pain and stiffness: gentle neck exercises are usually advised, simple painkillers can make them possible, and heat packs often help with stiffness (Royal Berkshire NHS Foundation Trust, 2024).

The NHS advice for neck pain points the same way: keep the neck moving rather than wearing a collar unless a doctor advises one, use a low, firm pillow, and don’t drive or cycle if you can’t move your neck safely (NHS). The stiff neck stretches page shows one gentle exercise from the app, and stiff neck after sleeping looks at the overnight side in more detail.

Wry neck is not cervical dystonia

The word torticollis covers several different problems. Babies can be born with congenital torticollis, and torticollis can also have serious causes such as brain injury (Cunha et al., 2023). Cervical dystonia, sometimes called spasmodic torticollis, is a neurological condition that causes uncontrolled, sometimes painful muscle spasms that can twist the neck to one side, and sometimes shaking. It is usually lifelong, and one of the main treatments is botulinum toxin injections repeated about every 3 months (NHS). A neck that locks overnight and settles within days is a different, short-lived problem.

Can your desk or pillow prevent it?

No trials have tested ways to prevent wry neck. The NHS suggestions for avoiding neck pain are to sit upright, avoid staying in one position for long periods, keep your head level with your body when sleeping on a firm mattress, and avoid sleeping on your front or twisting your neck in bed (NHS). There is more in sleeping position and pillow and microbreaks.

When to see a doctor

See a GP if you have numbness or weakness in your hands or feet, severe pain or pain that spreads down your arm into your hand, or pain that isn’t improving after a few days (Royal Berkshire NHS Foundation Trust, 2024). Call 999 or go to A&E if a stiff neck comes with a headache and a very high temperature, if bright lights hurt your eyes, or if there is a rash that doesn’t fade when a glass is rolled over it (NHS). If the neck pain started after an accident or fall, see whiplash.