A PAIN IN THE NECK: Wry Neck Pain

 AUTHOR: JACK RAYMENT, BOUNCEREHAB PHYSIOTHERAPIST
CO-AUTHOR: MATTHEW CRAIG, PHYSIOTHERAPIST BOUNCEREHAB DIRECTOR  

Have you woken up with a neck pain and stiffness on one side, resulting in difficulty in turning your neck? You might have what we physiotherapists refer to as an Acute Wry neck pain!

It often occurs from sleeping awkwardly and results in stiff joints, tight muscles and neck pain. At bounceREHAB, our team of experienced physiotherapists can facilitate accurate assessment and treatment to ensure optimal recovery.

 

What is a Wry Neck ?

An Acute episode of Wry Neck pain is a relatively common pathology relating to neck pain  in children and adults. It is characterised by a sudden onset of sharp neck pain and neck stiffness and results in a protective lack in range of movement. The injury typically occurs after either a prolonged abnormal posture such as sleeping in a harmful position, or after a sudden, quick movement of the head on the neck. Due to this mechanism, facet joints (Figure 2) in the neck become ‘locked’, resulting in pain limited movement and a visible postural deformity.


Figure 2. Anatomy of the Cervical Spine

Figure 1. Sections on the spine – Cervical segments make up the neck part of the spine

 

Anatomy

There are two main culprits in the cause of acute Wry Neck pain, they are:

  • Discogenic Wry Neck pain (Type 1);
  • Zyhapophyseal (facet joint) Wry Neck pain (type 2)

Our neck forms the top of our spine, a series of bones (cervical vertebrae) that form a column to shape our posture and protect essential structures including important blood supply (to and from the brain) and our spinal cord (to and from the brain). Each vertebrae attaches to the next at two contact points – The disc centrally (Type 1) and facet joints  posteriorly (at the back) (Type 2) (Figure 2). The function of the joints are to support the weight as well as to allow movement, which is particularly important in the cervical spine.

There are 36 joints in the neck, mostly facet joints, which give the neck such good flexibility

 

 

Figure 3. Facet Joint, Cervical Vertebra, Cervical Disc and Facet Capsule

In Zygapophyseal (facet joint) Wry Neck pain, the source of the pathology is the facet joints on either side of the posterior cervical spine (at the back) .

In Discogenic Wry Neck pain however, the pain comes from the more anterior (front) connection around the discs. 

Evident in Figure 4 below, a layer of cartilage helps form the facet joint and serves to provide shock absorption between layers. Connective tissue such as ligaments, muscles and the synovial capsules surrounding each facet joint, combine to reinforce the stability of each joint in our spine.

Figure 4. Cartilage lining the Facet Joint surfaces

Who is most at risk

Patients typically present:

  • After flight travelling
  • Prolonged desk work/poor posture with computers
  • Overhead lifting at personal training or the gym
  • Old or harmful pillows
  • People staying away for work or on holidays with different mattresses and pillows
  • Reduction in exercise

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bromance will likely end in tears (and neck pain) here

Bro-mance at the airport will likely end in tears (and neck pain) here

Located in Pyrmont (Sydney), BounceREHAB sees 40-60 cases of Acute Wry neck pain each week

 

quick sudden force (like high velocity chiro)

quick sudden force (like high velocity chiro really)

Poor posture when using the computer

Big week, heavy sleep rotated

Big week, heavy sleep rotated…cheers!

 

 

Pathophysiology – How it works?

As we move, the facet joints juggle a combination of complex forces and angles to provide congruent movement of the head on the neck. Sometimes the movements of the head may have a deleterious effect on the neck joints or discs, for example, if the forces are extreme (eg whiplash, trauma), or highly repetitious (eg watching tennis or a computer screen with neck rotated more in one direction), or in a sustained abnormal position (eg drunk party sleep, poor sleep position, economy flight long haul), injury is likely to occur to the connective tissues encapsulating the structure, or the cartilage lining the joint (circled in Figure 3 above).

As a result, certain actions become painful causing restriction in movement that in turn create secondary dysfunction including:

  • Deficit in muscle coordination and control
  • Focal areas of increased muscle tone (stiffness) with trigger points (taut bands on muscle fibers)
  • Changes in muscle length
  • Reduced strength and endurance of contractile structures in the neck

It is this mechanism that gives the patient the classic symptoms of Wry Neck pain


Signs & Symptoms of Wry Neck Pain

  • Inability to perform normal head movements
  • Neck stiffness
  • One shoulder more elevated than the other
  • Swollen neck muscles
  • Severe neck pain, usually on one side, that may refer to the head or shoulder
  • Headache
  • Tilting of head to one side

Treatment will include a combination of:

  1. PHYSIOTHERAPY @ bounceREHABdownload

Spinal Manual Therapy

  • Therapeutic mobilisation of facet joints aims to reduce stiffness and restore range of movement.
  • Relieve painfully tightened muscles

Education

  • How to attain anatomically correct posture sit, stand, sleep, more…
  • Self management strategies
  • Unloading strategies – postures, pillows, more…
  • Pain Education and counselling

Clinical Based Exercises and/or Clinical Pilates

  • Including motor control re-training

Dry Needling

  • Similar treatment to acupuncture to reduce pain signalling in the brain and to reduce protective muscle spasming
  • See our informative blog on dry needling v’s acupuncture!

Pillow Modification:

  • Sleep with the painful side on pillow
  • Use a firm pillow and avoid staking pillows
  • Dentons High, low, multi profile pillows ($89) – get measured up at bounceREHAB:

Dentons Pillow Support

Comfy and aligned!

Comfy and aligned!

Stretches

  • Particularly targeting structures in order to prevent the neck regaining stiffness

 

 

Prescription of devices to enable quicker recovery and self management

  • Neck Rest ® 
  • Physio-Thumbs 
  • Heat packs

 

Home exercise program

  • Includes specifically tailored, individualised exercises to reduce the period of pain, quicken recovery and minimise recurrence (See video below for example)

Prognosis with Physiotherapy treatment

With effective treatment, symptoms of Wry Neck will usually dissipate within a few days, up to 2 weeks if it’s a really challenging presentation (eg underlying arthritis, poor posture, ongoing sitting at work, overhead weightlifting, stress, anxiety, depression, fear of pain or painful movement, low compliance to treatment). After this time, a bounceREHAB Physiotherapist may tailor an exercise or clinical pilates program to help prevent further recurrence. This program includes postural correction in sitting, standing, at work and while sleeping. Clinical Pilates is an effective tool in addressing biomechanical dysfunction associated with Wry Neck pain and a plethora of other musculoskeletal disorders.

Clinical Pilates

Clinical Pilates is your best bet for conditioning the mid to upper back posture and muscular resistance to tension.

2. Massage Therapy

Once assessed as Wry Neck pain by our physiotherapists, you may require massage therapy to alleviate secondary dysfunction including increased muscle tension and stiff joints, through deep tissue muscle release. Stuart and Colleen work with our physiotherapists all the time to reduce the recurrence of neck related pain and headaches.

blog-image-17

3. Nutrition

Nutrition is an important element when recovering from any disease or injury. Acute Wry neck pain and dysfunction can benefit from the study of nutrition which complement physiotherapy treatment well. The following supplements are recommended for use in Acute Wry neck pain:

  • Omega Trienols – Natural anti-inflammatory
  • Theractive Pain – Natural anti-inflammatory and pain killer
  • Magnesium – Relaxes the muscles, helping to reduce muscle spasms and tension
OmegaTrienols

OmegaTrienol

TherActive Pain

TherActive Pain

Ultra Muscleze – Advanced Magnesium Blend

 

 

 

 

 

 

 

 

 

 

 

 

These dietary supplements are a natural alternative to traditional pain relief and anti-inflammatory medications, and have less chance of harmful side effects such as stomach ulcers, fluid retention and kidney problems. Caroline, our in house nutritionist, can help with more information on this.

Biopsychosocial Modelblog-image-10

Neck pain is considered within a biopsychosocial model where a more holistic picture is taken of what may contribute to the disorder and potentially influence recovery, including:

  • Biological factors – Previously mentioned
  • Psychological reactions – For example: Stress, anxiety, depression and fear
  • Social factors – For example: Home or family situation, access to healthcare, occupational factors

 

Summary

An Acute Wry neck is a common condition involving mild to severe neck pain and subsequent spasm of neck muscles, causing the neck in most instances to bend away from the painful side. The neck may feel “stuck” in a position and attempts to move beyond this resistance exacerbates the feeling of pain. TRICKY thing is your Physiotherapist may request that you move in towards the direction of pain with unloaded strategies in order to keep the joints and disc gel moving in the correct direction to eventually (and more quickly) abolish your neck pain. See our blog on pain and psychology.

I hope you found my blog on Acute Wry Neck pain useful, i tried to make it informative and relevant. 

Jack Rayment  :) 2016

AUTHOR: JACK RAYMENT, BOUNCEREHAB PHYSIOTHERAPIST 
CO-AUTHOR: MATTHEW CRAIG, PHYSIOTHERAPIST BOUNCEREHAB DIRECTOR  

References:

Brukner, P., & Khan, K. (2012). Brukner & khan’s clinical sports medicine (Fourth ed.). Sydney: McGraw-Hill.

Gross, A., Kay, T. M., Paquin, J., Blanchette, S., Lalonde, P., Christie, T., … Santaguida, P. L. (2015). Exercises for mechanical neck disorders. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd004250.pub5

Meisingset, I., Stensdotter, A., Woodhouse, A., & Vasseljen, O. (2016). Neck motion, motor control, pain and disability: A longitudinal study of associations in neck pain patients in physiotherapy treatment. Manual Therapy, 22, 94-100. doi:10.1016/j.math.2015.10.013

Ravichandran, P., Karthika Ponni, H., & Antony Leo Aseer, P. (2016). Effectiveness of Ischemic Compression on Trapezius Myofascial Trigger Points in Neck Pain. International Journal of Physiotherapy, 3(2). doi:10.15621/ijphy/2016/v3i2/94883

Thompson, D., Oldham, J., & Woby, S. (2016). Does adding cognitive-behavioural physiotherapy to exercise improve outcome in patients with chronic neck pain? A randomised controlled trial. Physiotherapy, 102(2), 170-177. doi:10.1016/j.physio.2015.04.008

Vasseljen, O., & Meisingset, I. (2015). Neck pain treatment: carry on, refrain, or reappraise?Physiotherapy, 101, e1581-e1582. doi:10.1016/j.physio.2015.03.1586

Youssef, A. R. (2016). Photogrammetric Quantification of Forward Head Posture is Side Dependent in Healthy Participants and Patients with Mechanical Neck Pain.International Journal of Physiotherapy, 3(3). doi:10.15621/ijphy/2016/v3i3/100838

http://www.houstonmethodist.org/orthopedics/where-does-it-hurt/lower-back/lumbar-facet-joint-arthritis/

http://orthoinfo.aaos.org/topic.cfm?topic=A00575

http://www.spineuniverse.com/anatomy/facet-joints-spines-anatomy

http://www.ultimatephysionq.com/789-2/

https://au.pinterest.com/sydneyphysio/relevant-anatomy-of-pelvis-and-spine/

https://jdodd1122.wordpress.com/tag/posture/

https://www.bioceuticals.com.au