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Torticollis, also known as “wry neck,” refers to a condition where the neck muscles are abnormally contracted, causing the head to twist or tilt to one side. It can affect people of all ages and is categorised based on its onset (congenital or acquired) and underlying cause. The condition can lead to discomfort, restricted movement, and, in some cases, noticeable changes in posture.

Congenital Torticollis

Congenital Torticollis will present from birth or within the first few months of newborn life. The catalyst for the shortening of the Sternocleidmastoid (SCM) muscle varies from the intrauterine position, vascular disruption to SCM or birth trauma.

Newborns will present with the head laterally flexed towards the affected side and upwardly rotated in the opposite direction. The SCM may contain a pocket of fibrotic (hardened) tissue and the surrounding musculature may shorten. As a result, neck mobility is reduced which subsequently impacts on the symmetry of the craniofacial structures – often concerning for new parents.

Acquired Torticollis

Acquired Torticollis has a much greater prevalence in the adult population, with majority of people experiencing at least one episode in their lifetime. Predisposing factors include:

  • Muscle spasm or strain: Prolonged poor posture, overuse, or injury can strain the neck muscles.
  • Infections: Conditions like throat or ear infections can irritate nearby muscles or lymph nodes, leading to muscle spasm.
  • Cervical spine changes: Herniated discs, arthritis, or malalignment of the cervical vertebrae.
  • Neurological conditions: Dystonia (a movement disorder causing involuntary muscle contractions) or other nervous system issues.
  • Drug reactions: Certain medications, such as antipsychotics, may cause dystonic reactions, leading to torticollis.
  • Trauma or tumours: Burns, physical injury or growths in the neck or cervical spine.

Signs & Symptoms

  • Head tilt: The head is tilted to one side, often with the chin pointing to the opposite direction.
  • Restricted range of motion: Difficulty moving the head or neck in certain directions.
  • Neck pain or discomfort: Muscle tightness or soreness, particularly on one side of the neck.
  • Shoulder elevation: The shoulder on the affected side may appear raised.
  • Palpable muscle tightness: A firm or tight muscle, typically the sternocleidomastoid (SCM), may be noticeable.
  • Asymmetry of the face or head: In infants, prolonged torticollis can cause flattening of one side of the head (positional plagiocephaly).
  • Head tremors: In some cases, there may be small, involuntary shaking movements of the head.

Examination:

A thorough objective examination is conducted of the cervical spine and in some instances of referral, the surrounding joints. Depending on additional symptoms of dystonia or visual disturbances a thorough neurological examination is conducted. Imaging may be utilised to rule out differential diagnoses, however this is not recommended as first line intervention.

Treatment

Treatment aims to address the underlying cause, alleviate symptoms, and restore normal neck posture and movement. Physiotherapy is a cornerstone of management, particularly in congenital and muscular cases. With the application of early intervention, prognosis remains positive in reducing persistent pain, postural imbalances and permanent muscle shortening. Chronic cases or those linked to neurological conditions may require ongoing management.

Physiotherapy

  • Stretching exercises: Targeted stretches, particularly for the SCM, help lengthen tight muscles and improve range of motion.
  • Strengthening exercises: Focus on neck muscles to support improved posture and prevent reoccurrence.
  • Positioning strategies: Teaching parents how to reposition infants during play and sleep to counteract head tilt.
  • Tummy time: Encouraging supervised prone positioning in infants to strengthen neck and shoulder muscles.
  • Manual therapy: Techniques like gentle mobilisation and massage can reduce muscle tension and improve alignment.
  • Postural training: For adults, addressing ergonomic factors such as workstation setup or sleeping posture.

Other Non-Surgical Options

  • Heat therapy: Applying heat to the affected area can ease muscle tension and promote relaxation.
  • Medications: In some cases, muscle relaxants or anti-inflammatory drugs may be prescribed.
  • Botulinum toxin (Botox): For cases involving spasm or dystonia, Botox injections can temporarily relax the affected muscles.

Surgical Intervention

Surgery is rarely needed but may be considered for severe congenital torticollis when conservative treatment has failed. Options include:

  • Sternocleidomastoid release: Lengthening or cutting the SCM to allow for greater range of motion.
  • Corrective surgery for spinal issues: In cases involving structural problems in the cervical spine.

Home Management

  • Encourage active movement of the neck during daily activities.
  • Use supportive pillows or rolled towels to maintain neutral neck alignment when resting.
  • Monitor for signs of improvement or worsening, especially in children, and seek professional guidance as needed.

References:

  1. Rodríguez-Huguet, M., Rodríguez-Almagro, D., Rosety-Rodríguez, M. Á., Vinolo-Gil, M. J., Ayala-Martínez, C., & Góngora-Rodríguez, J. (2024). Effectiveness of the Treatment of Physiotherapy in the Congenital Muscular Torticollis: A Systematic Review. Children, 11(1), 8. https://doi.org/10.3390/children11010008
  2. Cunha B, Tadi P, Bragg BN. Torticollis. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539857/