Torticollis is the stiffening of the neck as a result of muscle spasms. It is also known as loxia or wry neck and it involves the lateral flexion contracture of the muscles in the cervical spine leading to the tilting of the head to one side. The muscles affected in torticollis are those supplied by the spinal accessory nerve.
All of these facts about torticollis are essential to provide the most appropriate treatment plan for patients. Torticollis is a treatable condition wherein the main goal for torticollis treatment is to restore the mobility of the neck and reduce pain, tingling sensations and numbness on the cervical spine. However, the universal symptom of torticollis is neck pain so this is the main direction of treatment options for the condition.
Prior to the treatments, physicians utilize one or more diagnostic tests to determine the root cause of the condition. These may include electromyogram or EMG to detect the muscles affected, CT scan of the neck and even MRI scan of the brain to detect damages in the nervous system.
Torticollis can be managed using conservative as well as aggressive treatments depending on the severity of the condition.
Conservative Treatment Options for Torticollis
Conservative approaches are usually employed initially among all patients. These include:
- Passive stretching and positioning
This treatment option is used among infants and children wherein there are no chronic spasms in the muscles. The aim of this treatment is to stretch the shortened neck muscles in younger children. This treatment often corrects the tilted neck when it is started within 3 months of birth. For adults, stretching exercises can be passively or actively done with the assistance of physical therapy.
- Use of neck braces
Neck braces may also be used among patients to support the neck and promote the normal anatomic position of the cervical spine and prevent further lateral flexion contracture.
Traction is also employed to some patients to create a tension that will pull the head to the opposite side. Traction is carefully used to prevent nerve damages on the neck as a result of too heavy weight or incorrect positioning of the traction device.
- Application of heat and massage
For temporary relief of neck pain, heat application and massage helps relax the spastic muscles for pain relief.
- Medication use
Anticholinergic medications are also used to promote muscle relaxation to limit pain and neck muscle spasms.
- Chiropractic care
Torticollis can also be managed through chiropractic care wherein vertebral subluxations are corrected to relieve nerve impingements in the neck. Chiropractic care is usually successful and most patients would not require surgery after this treatment.
Aggressive Treatment Options for Torticollis
Botulinum toxin injection is used to temporarily relieve torticollis and the pain associated with it. The aim of botulinum toxin is to paralyze the affected muscles and prevent spasms. Since the effect is only temporary, repeat injections are needed every 3 months.
Surgery is often the last treatment modality for torticollis especially when other treatment options have failed. In children, surgery may be done during the preschool years or even after the child’s preschool years when the deformity has not been resolved using conservative approaches. In adults who suffered torticollis after a vertebral dislocation, surgery may also used. The surgery involves the destruction of the nerves in the neck to provide a permanent relief from the condition.
Torticollis is usually debilitating as a result of severe neck pain and muscle spasms. Treatment options usually help patients gain better mobility and be free from discomforts.