Wry neck is something that constantly rears its head in our clinic. People being unable to turn their head to the side or look around without a shooting pain into the head. Some people say its the worst injury of all as you just can't get comfortable and you end up looking like Beaker out of the Muppets as you sit at the desk and try to remain upright. So what can you do to avoid this condition and how is it treated effectively?
What is it?
A condition that does not allow the person to rotate the head in one direction. A sharp stabbing pain on movement and a general inability to move the head in any direction without pain.
Often associated with a constant and dull ache that can sit behind the shoulder blade or in the upper back.
Headaches that radiate from the base of the skull up and over the temporal lobe on one side often accompany this condition
How is it Caused?
There are many causes for this condition that range from overhead movements of the arm (such as working on hanging trees in the garden/painting walls etc) sitting in a compromised position for a long period of time (reading a book on a sofa) or even sleeping in a bad position.
Sometimes improper shoulder alignment can also be a big influence of this condition as racquet sports such as tennis or squash can induce poor shoulder stability and as the shoulder alignment becomes poor after exercise, this can result ina'dropped shoulder' which pulls on the entire posterior and anterior chain of neck muscles. (see previous article)
The Anatomy
Primarily with this condition we are looking at two distinct muscles. The Levator Scapulae that runs from the atlo-occipital region (base of the skull meets the top of the spinal column) to the medial (inside) point of the scapulae bone (wing bone). This long muscles runs on an oblique angle and is responsible for rotating the head and elevating the shoulder blades. It is also active in rotating the head, looking up to the left or right.
My particular favourite the Sternocleidomastoid (don't you just want to say that 10 times really fast!) is a two headed muscle (like the bicep) beginning at the mastoid process at the base of the skull and running obliquely to the top of the sternum (lateral insertion) and midway along the clavicle. This muscle is also a neck rotator and also brings the head forward of the shoulders (like a turtle) which is particularly important for those working on laptops. Looking at the screen and holding your head 'into the screen' stresses this muscle.
The scalenes are also vitally important to treat any condition to do with neck alignment. These muscles runfrom the cervical spine (lateral processes) to the top of the first rib and are active in flexion, lateral flexion and rotation to the opposite side of the neck. They can be vital for addressing stiff neck and rotational issues. They are deep muscles and require specific palpation from a trained therapist. They can provide instant relief for this condition.
How to Treat
The focus with wry neck is a tensile stretch issue. When a bone is pulled in an angle due to poor posture or alignment the muscles attached to that bone may have to elongate to accomodate the change in posture. This stretching can be called 'tensile stretch' - much like an elastic band that stretches to accomodate tension. However with a muscle, the golgi tendon organs (nerve cells) sends the message to the brain informing it that it is 'too long'. Hence the brain responds by contracting the muscle to bring it back to its desired length. HOWEVER - as the bone is pulling on the muscle, that tension remains and the muscle slowly but continually contracts, contracts, contracts, tightening and fatiguing throughout the day.
Working on the aforementioned muscles is paramount to giving relief from the spasm or contraction that is occuring to produce pain. The next focus is shifting the alignment of the skeletal areas. Getting the shoulder alignment correct through the clavicle and the scapulae is primary to ensuring long term relief. I often work on the pectoral areas and the shoulder stabilisers with this condition to ensure that the bones are in as proficient a position as possible.
I am often talking about the triangle upon which the head balances. The clavicle and scapulae form a triangular foundation that the head sits atop. If that foundation is compromised then the head can no longer balance efficiently and muscular contraction is necessary to stabilise the 4-5kg of the head. In my dancing days we used the image of a bowling ball on top of a pyramid. If the base of the pyramid tilted, the bowling ball would fall. Thus maintaining a solid base is paramount to ensuring ideal alignment and 'ease of movement' of the head and neck.
How to Avoid
Ideally ensuring that you keep your shoulders strong and in a good position is paramount. The alignment of the neck is subject to this ideal alignment. Also, avoiding positions where the head is tilted for long periods or not supported properly is important to address. The big issue here can be a sleeping posture. If you are a side sleeper, you need a thick pillow to support the distance between the should and the neck. A back sleeper needs a thinner pillow to support the space between the back of the head and the neck.
Stretching out after over head exercise work can also be important, the best one being placing your nose in your armpit and putting your hand over your head, gently allowing the weight of the arm to pull on your neck. Extending an arm away and downwards and then rotating your head in the opposite direction both upward and downward are also good ways to stretch out the neck muscles.
When in the acute phase, active bodywork can assist with the structure, but warm wet towels or flannels can provide relief. Keep it warm. Wearing a scarf and avoiding downward breezes is important. Avoiding sitting will help and a flat posture will at least provide relief to the aching musculature.
This condition is never pleasant and can be debiltating as you are unable to move, stand, sit or be comfortable in any position. It makes concentrating at work almost impossible. It is best treated early and there is no need to suffer with it. In most cases a single treatment can provide significant relief and also a good assessment of the underlying posture will prevent the condition from coming back. So don't let pain ruin your renovations! Make sure you get it sorted STRAIGHT AWAY.
