Woke up and can't turn your neck?
If you have ever woken up with neck pain which is locked to one side, it could be “wry neck”.
The neck pain and stiffness associated with a wry neck can be quite severe and cause some people to feel worried.
Good news, with early physiotherapy treatment, most people can regain movement, ease neck pan and get back to normal quite quickly.
TL;DR: Wry neck | The key takeaways
- Wry neck (torticollis) = sudden neck pain and stiffness, often from muscle spasm
- Common triggers: awkward sleep position, poor posture or neck strain
- Symptoms: sharp neck pain usually on one side, limited movement with head stuck to one side
- Usually not serious, but can be very painful and restrictive
- Physiotherapy helps relieve pain and restore movement quickly
- Treatment can include manual therapy, joint mobilisation, heat, stretching and posture correction
- Strength and posture retraining reduces the risk of recurrence
- Most people fully recovery within 1-3 weeks
- Seek further medical review if you experience numbness, weakness or fever
What is wry neck?
Wry neck (technically called torticollis) is when your head tilts or rotates involuntarily to one side, often accompanied by painful neck spasms.
Wry neck presents as follows:
- Head tilted sideways and chin pointing the other way (most common)
- Limited ability to turn or tilt the neck
- Onset is often sudden e.g. you wake up in the morning with it
Broadly speaking there are two main categories:
- Acquired/sudden-onset – often in adults
- Congenital – found in infants (less relevant for our adult patients)
What causes wry neck?
Mechanical/structural irritation
Often there is an irritation or stain to one of the neck muscles (commonly sternocleidomastoid or trapezius muscle) that leads to spasm and locking. Example: waking up after sleeping awkwardly or sitting with a twisted neck for long periods of time.
Wry neck can also be caused by irritation to the joint cartilage or cervical disks.
Poor posture or sleep setup
Poor neck positioning at your desk, on your phone or sleeping with insufficient neck support can trigger the onset of wry neck.
Less common causes
- Trauma/whiplash type event e.g. motor vehicle accident
- Infections or other neck irritation (rare)
Why early treatment matters
Many people assume that a wry neck will heal by itself, and it may. However, if left untreated:
- Muscles remain tight on one side and cause ongoing stiffness
- Compensatory movement patterns and poor posture can trigger recurring episodes
- In very rare cases, mis-diagnosis means something more serious is being missed (e.g. cervical spine issues, meningitis etc) so proper assessment is important
How physiotherapy helps wry neck
Assessment – find the underlying issues
The physiotherapist will start by:
- Taking a detailed history of your neck issue
- Conducting a range of tests to determine how your neck moves
- Palpating structures around your neck, shoulders and upper back for spasm, stiffness and knots (e.g. muscles, joints)
- Assessing posture and general muscle imbalances
Treatment – steps for full recovery
- Relieve muscle spasm and pain – heat and hands-on therapy techniques such as massage and dry needling
- Mobilise & restore movement – controlled passive and active mobility exercises to restore all restricted neck movements
- Address contributing factors – improve workstation ergonomics, use suitable pillow and reduce repetitive postures/activities
- Strengthen & postural correction – build neck and upper back stability and control so the head (~8kg) is better supported
- Prevention & self-care – Simple neck mobility drill, limit long periods of inactivity and adopt good sleep habits
Expected treatment journey
Day 1-3
Pain relief, gentle movements, monitor for red-flags (i.e. nerve signs, radiating pain, infection)
Week 1
Increase neck range of movement, start correcting postural deficits, commence light strength training
Week 2-4
Most patients see major improvement and some even completely pain-free
When to seek further medical review
While most wry neck cases are benign, these red flags mean you should get a more through medical assessment:
- Severe pain radiating into your arm or hand
- Numbness, tingling or weakness in your arms
- Onset following major trauma
- Signs of infection (fever, swelling, night pain)
- History of cancer or serious illness
If any of the above apply, it may be recommended that you be referred for medical imaging or specialist review.
How to prevent wry neck | Tips you can do right now
- Use a pillow that supports your neck curve (e.g. contoured pillow) and avoid sleeping on your stomach
- Ergonomic set up: screen at eye level, arms supported, take micro-breaks (every 30-45 minutes)
- Avoid carrying heavy bags over one shoulder for long periods
- Perform 1-2 minutes of neck mobility exercises regularly (tilt, look up, down and side-to-side)
- Be mindful of posture: keep shoulders back, chin slightly tucked and chest up (avoid slumping and rounding your shoulders forward)
