Torticollis

Spinal Column Radio Torticollis Podcast[originally published in KCN, March 2010]

Torticollis. While it might sound like a strange Italian dish, it’s not.  Imagine waking up one morning with your ear pressed to your shoulder as if cradling a telephone receiver.  The only problem is, there is no telephone to be found  — only an unrelenting, painful neck spasm with absolutely no ability to bring your head back to any semblance of socially accepted posture.  Most would agree, it’s a pretty disturbing situation to find yourself in.  Thankfully, in most cases, the “fix” for torticollis can be as simple as a visit to your local chiropractor.

Sometimes referred to as “wry” neck (as in “gone awry”), “torticollis” is a hefty Latin word that simply means “twisted neck” — and therein lies some of the confusion.  Torticollis is really more of a description than a diagnosis.  Many things can cause a neck to stay in an unsightly, twisted position:  everything from fractures, tumors, and herniated discs to infections, neuro-ocular problems, and certain medication side effects.  Thankfully, these causes are relatively uncommon.  Nevertheless, they must all be considered when a patient is evaluated for torticollis.  Fortunately, the majority of torticollis cases involve cervical subluxation — something we chiropractors work on everyday.

Most of the time, a mechanical locking of the joints in the neck with a displacement of the center-most disc material has occurred.  This in turn causes the tissues of the joint to become painfully inflamed and for the muscles of the neck (mainly the sternocleidomastoid muscle) to clamp down in a state of prolonged spasm.

Many schools of thought put the blame on the muscle spasm itself.  And while this might be the case in certain situations, focusing treatment efforts on the muscle alone fails to address the underlying mechanical disorder that is spurning on the shortened muscle in the first place.  So, in other words, trying to massage and stretch out the spastic muscle will not remedy this problem.  On the other hand, a carefully administered adjustment aimed at rectifying the mechanical dysfunction by a chiropractor with torticollis experience will often bring about relief and correction in short order.

The cause of torticollis (minus the oddball situations mentioned above) is open for debate and, for the most part, “unknown.”  What we tend to see, however, is that many patients have been subjected to some sort of disproportionate “neck chill” from a draft of, say, an open window or fan.  Or the patients have had an occupational activity that put their neck in a prolonged twisted position — for example, the tractor-driving farmer who frequently looks over his shoulder while plowing.  Still, in other cases, there has been trauma involved — whether it be whiplash, sports injury, heavy lifting, or even fetal delivery.  This later, potentially traumatic event is often the cause of what doctors tag as “congenital torticollis” and is seen when infants constantly favor turning their heads to one side.  Failure to address this can lead to facial asymmetry from malformed cranial development, not to mention difficulty nursing on the unfavored side.  Again, chiropractic can be very effective at treating this.

Many who are afflicted with torticollis were “primed and ready” for the event because of longstanding spinal curve issues (eg. reversed neck curve or scoliosis).

Beyond the stretching and massage to the spastic muscle mentioned above, other medical approaches tend to focus on the muscle in a much more invasive way.   These treatment methods range from temporarily paralyzing the involved muscle for several months with Botox injections to selectively severing the nerves that go to the involved muscle.  In extreme cases of congenital torticollis, surgeons will actually attempt to “lengthen” the shortened muscle.

Even though solid scientific literature is scant on the topic of torticollis for both medicine and chiropractic, what we do know is that chiropractors have helped many with this posturally frightening condition.   And while some may need the extreme measures of medicine, most would do well to at least try chiropractic first.

____________

Source used for this article:
Barge. Torticollis: the cervical slipped disc syndrome.  Bawden Bros., Inc.  Davenport, Iowa.  1984.
Bolton.  Torticollis:  a  review of etiology, pathology, diagnosis, and treatment.  Journal of Manipulative and Physiological Therapeutics. 8 (1): 29-31.  1985.
Cornella, et. al.  Botulinum toxin injection for spasmodic torticollis:  increased magnitude of benefit with electromyographic assistance.  Neurology.  42: 878-88.  1992.
Davis, et. al.  Selective peripheral denervation for torticollis:  preliminary results.  Mayo Clin Proc 66: 365-71.  1991.
Desy.  A pain in the neck – acute torticollis. About.com:  Holistic Healing.   (last viewed on 02/15/10)
Duvoisin.  Spasmodic torticollis:  the role of surgical denervation [editorial].  Mayo Clin Proc.  66:  433-35. 1991.
Greene, et. al.  Double-blind, placebo-controlled trial of botulinum toxin injections for the treatment of spasmodic torticollis.  Neurology.  40:  1213-18.  1990.
Fysh.  Acquired torticollis. Dynamic Chiropractic.  10(07).  1992.
Hains, et. al.  Spasmodic torticollis:  a case study.  The Journal of the Canadian Chiropractic Association.  36(3):  146-51.  1992.
Kahn, et. al.  Acquired torticollis in children.  Orhopaedic Review.  20(8):  667-74.  1991.
Kaufman.  Comanagement and collaborative care of a 20-year-old female with acute viral torticollis. Journal of Manipulative and Physiological Therapeutics.  32(02):  160-165.  2009.
McWilliams, et. al.  Chiropractic care of a six-year old child with congenital torticollis. Journal of Chiropractic Medicine. 5(2): 65-68.  2006.
Stone-McCoy.  Reduction of congenital torticollis in a four month old child with vertebral subluxation:  a case report and review of the literature. Journal of Vertebral Subluxation Research.  pp. 1-8.  January 7, 2008.
Tim, et. al.  Botulinum toxin therapy for neurologic disorders.  Post Graduate Medicine.  91(6):  327-32.  1992.
Tao, et. al.  Torticollis. eMedicine.  Nov. 2009.  (last viewed on 02/15/10)
Torticollis. Wikipedia.   (last viewed on 02/15/10)
Wood.  Acute torticollis:  chiropractic therapy and management.  Chiropractic Technique.  3(3):  105-8.  1991.
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