Waking up with a stiff neck or acute torticollis is the worst way to start your day.

Torticollis comes from two Latin words: torti (twisted) and collis (neck).

Acute torticollis is a condition that we often refer to as “cricked neck” or “wry neck”. Almost everyone has experienced a time in their life where they woke up and couldn't turn their neck because of painful muscle spasms or severe neck pain.

For most of the population, acute torticollis is a temporary condition that should resolve within one to two weeks. However, in some people, the problem persists and can contribute to abnormal movement patterns that result in chronic pain.

In this article, we're going to dive into acute torticollis by describing the symptoms, causes and treatments to get you better, faster.

Causes of Acute Torticollis

There are many causes of acute torticollis or a “cricked neck”.

To understand what is specifically causing your torticollis, it would help to narrow down the type of torticollis you're experiencing.

There are four basic forms of torticollis:

  1. Congenital torticollis is usually caused by tight adhesions in the sternocleidomastoid muscle (SCM). The condition is recognized at birth or shortly thereafter. This may be related to muscular trauma during delivery. Congenital torticollis may also result from vertebral deformities.
  2. Acquired torticollis arises in response to an adjacent inflammatory process or unrelated injury. Osteomyelitis, lymphadenitis, pharyngitis, tonsillitis, cervical abscess, tumor and RA can trigger acquired torticollis.
  3. Spasmodic torticollis, also called Cervical Dystonia, is of unknown etiology and is characterized by a painful progressive involuntary contraction of the SCM. This spasm may be sustained or recurrent. Cervical dystonia is a neurologic movement disorder that may have a genetic link and is thought to be a “faulty guarding mechanism”.
  4. Acute torticollis is a common benign condition, affecting younger and middle aged patients. Onset is typically sudden, often presenting upon arising or waking up. This is the most common form of neck pain or a “crick in the neck”.

Most doctors and scientists theorize that acute torticollis is a condition that results from a cervical spine facet joint restriction, which then generates a cycle of pain, inflammation and more restriction.

Trigger points in the SCM, cervical scalene or trapezius muscles are also to blame.

The condition is thought to also be associated with minor traumatic insults such as sleeping in an awkward position, or sleeping under a draft from an open window or fan, sudden movements that cause injury.

Symptoms of Acute Torticollis

Torticollis is defined by a characteristically painful, fixed posture of lateral flexion (tilting your head to the left or right) and contralateral rotation (turning your head to the left or right).

The spasm itself is most likely related to inflammation of nerves around a particular joint in the neck. In some cases, it could also be due to muscle, ligament or tendon injuries as well.

Usually, you'll also see people bending their head forward because pain is increased when they attempt to life their head up. Any amount of movement is likely going to be painful or even unbearable.

The most common symptoms of torticollis will include:

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

Treating Acute Torticollis

Before any treatment, it's important to rule out any potential serious causes of torticollis. This means that even though most cases are self-limiting or will resolve on their own, it's still a good idea to rule out serious medical conditions.

“Red flag” symptoms for torticollis include: fever, swollen lymph nodes, significant headache, difficulty breathing, swallowing or speaking, ataxia, weakness, numbness or paresthesia in the extremities, and change in bowel or bladder function.

After ensuring that nothing serious is causing it, the next step is to focus on reducing spasm and improving your range of motion. This means getting a chiropractic adjustment is most likely not going to help you to feel better right away.

Instead, passive modalities including: ice, heat, continuous ultrasound, muscle stimulation or cervical traction may be useful. [1, 2]

Myofascial release of the SCM, trapezius, levator scapulae and other related muscles will also help before chiropractic adjustments.

Spinal manipulation or chiropractic adjustments, when not contraindicated, should be implemented as soon as tolerable.

Stretches that can be done as soon as you rule out “red flags” include:

Levator Stretch

While sitting, grasp the seat of your chair with your left hand. Rotate your head toward the right and look downward toward the floor. Place your right hand over the top of your head and gently pull down and diagonally in the direction you are looking. Against the resistance of your hand, contract your neck in an attempt to push your head backward/diagonally from the direction you are looking for seven seconds. Relax and gently pull your head further toward the floor to increase the stretch. Lock into this new position, and make sure that you continue to keep your head rotated in the direction that you are pulling. Perform three contract/relax cycles on each side twice per day or as directed.

SCM Stretch

Begin in a seated position. To stretch the right SCM, extend your head, rotate toward the right, and tip your head toward the left so that your left ear moves toward your left shoulder. Place your left hand on your left cheek and jaw. Against the resistance of your hand, attempt to rotate your head toward the left for seven seconds. Relax and slowly increase the stretch by rotating further toward the right and laterally flexing toward the left. “Lock in” to this new position and repeat three contract/relax cycles twice per day on each side or as directed.

Trapezius Stretch

While sitting, reach down with your right arm, grasping the bottom of a chair for stability. While looking straight ahead, place your left hand on top of your head, and gently pull your head sideways toward the left. Against the resistance of your arms, attempt to bring your right ear and right shoulder together for seven seconds. Relax and stretch further toward the left. “Lock-in” to each new position, and do not allow any slack. Repeat three contract/relax cycles on each side twice per day or as directed.

Acute Torticollis Summary

While the experience of waking up with excruciating neck pain can be scary and cause for alarm, most cases will get resolved within 24-48 hours. For the great majority of people with acute torticollis, the condition goes away in several days to a few weeks.

However, if you have chronic neck pain or pain that doesn't go away within two weeks, complications can develop that lead to spine arthritis, nerve inflammation and impingement.

The good news is that torticollis is easily treated through chiropractic care.

After a chiropractor performs a thorough exam to rule out any other underlying causes, the care usually consists of manual therapy, myofascial release and neck and upper back adjustments to ensure proper joint movement.