Waking up with a stiff neck – or acute torticollis – is one of the worst ways to start the day. The word torticollis comes from two Latin roots: torti (twisted) and collis (neck). It’s the condition often called a “cricked neck” or “wry neck,” and almost everyone has experienced waking up unable to turn their neck because of painful muscle spasm.

For most people, acute torticollis is temporary and resolves within one to two weeks. In some cases, though, it persists and can contribute to abnormal movement patterns and chronic pain. Here’s a look at the causes, symptoms, and treatment of acute torticollis.

Causes of Acute Torticollis

There are several types of torticollis, and identifying which one you’re dealing with helps explain the cause:

Congenital torticollis is usually caused by tight adhesions in the sternocleidomastoid (SCM) muscle and is recognized at or shortly after birth, sometimes related to muscular trauma during delivery or vertebral deformities.
Acquired torticollis arises in response to a nearby inflammatory process or injury – conditions such as osteomyelitis, lymphadenitis, pharyngitis, tonsillitis, a cervical abscess, tumor, or rheumatoid arthritis can trigger it.
Spasmodic torticollis (cervical dystonia) is a neurologic movement disorder of unknown cause, marked by painful, progressive, involuntary contraction of the SCM. It may have a genetic component.
Acute torticollis is a common, benign condition affecting younger and middle-aged people. Onset is typically sudden, often noticed upon waking, and it’s the most common form of a “crick in the neck.”

Most clinicians believe acute torticollis results from a cervical facet joint restriction that sets off a cycle of pain, inflammation, and further restriction. Trigger points in the SCM, scalene, or trapezius muscles are also often involved. It’s commonly associated with minor insults such as sleeping in an awkward position, sleeping under a draft, or a sudden movement.

Symptoms of Acute Torticollis

Torticollis is characterized by a painful, fixed head posture – typically tilted to one side (lateral flexion) and rotated toward the other (contralateral rotation). The spasm is most likely related to inflammation around a particular joint in the neck, though muscle, ligament, or tendon injury can also be involved. People often hold the head bent forward because lifting it increases the pain, and nearly any movement can be painful. Common symptoms include:

Neck pain immediately upon waking
Muscle pain that radiates down the neck and into the mid back
An inability to turn the head, or having to hold it in a fixed posture
Spasm and tightness of the neck muscles

Treating Acute Torticollis

Before any treatment, it’s important to rule out serious underlying causes. Even though most cases are self-limiting, watch for these “red flag” symptoms that warrant prompt medical evaluation: fever, swollen lymph nodes, significant headache, difficulty breathing, swallowing, or speaking, loss of coordination (ataxia), weakness, numbness or tingling in the limbs, or changes in bowel or bladder function.

Once anything serious is ruled out, the focus shifts to reducing spasm and restoring range of motion. Notably, a spinal adjustment alone often won’t bring immediate relief at first. Passive approaches such as ice, heat, continuous ultrasound, muscle stimulation, or cervical traction can help, as can myofascial release of the SCM, trapezius, levator scapulae, and related muscles. Spinal manipulation, when not contraindicated, can be introduced as soon as it’s tolerable.

Once red flags are ruled out, the following contract-relax stretches may help. For each, gently contract against your hand’s resistance for about seven seconds, then relax and ease a little deeper into the stretch.

Levator Stretch

While sitting, grasp the seat of your chair with your left hand. Rotate your head to the right and look down toward the floor. Place your right hand over the top of your head and gently pull down and diagonally in the direction you’re looking. Contract against your hand for seven seconds, then relax and gently pull a little further. Perform three contract-relax cycles on each side, twice per day or as directed.

SCM Stretch

Sitting, to stretch the right SCM, extend your head, rotate to the right, and tip your head left so your left ear moves toward your left shoulder. Place your left hand on your left cheek and jaw, and try to rotate your head left against the resistance for seven seconds. Relax and increase the stretch by rotating further right and tipping further left. Repeat three contract-relax cycles per side, twice daily or as directed.

Trapezius Stretch

While sitting, reach down with your right arm and grasp the bottom of the chair for stability. Looking straight ahead, place your left hand on top of your head and gently pull it toward the left. Try to bring your right ear and right shoulder together against the resistance for seven seconds, then relax and stretch a little further left. Repeat three contract-relax cycles per side, twice daily or as directed.

Summary

Waking up with severe neck pain can be alarming, but most cases of acute torticollis resolve within a few days to a couple of weeks. If your neck pain becomes chronic or doesn’t improve within two weeks, it’s worth getting evaluated, since lingering restriction can contribute to arthritis and nerve irritation over time. After a thorough exam to rule out other causes, chiropractic care typically combines manual therapy, myofascial release, and neck and upper-back adjustments to restore proper joint movement.