A crick in the neck: understanding and overcoming your unexpected stiff neck (called a Wry Neck)By Marine Pfeiffer

If you have ever woken up with your head tilted to one side and found it difficult, or even painful, to move, you’ve likely experienced what’s known as wry neck. A wry neck is the description of a neck condition where there is a sharp, intolerable pain when you try to move your neck to one side, and is often accompanied by muscle spasms. There is a marked emotional element of alarm and distress from the inability to move your neck freely. The head is usually stuck in an abnormal position, often tilted, or rotated away from the painful side, as the body tries to protect the irritated joint by limiting motion.

In medical terms, a wry neck is referred to as torticollis or cervical dystonia, and it happens when a small joint between the vertebrae of the neck, known as a facet joint, becomes so stiff that all movement is restricted and this can be described as ‘locked’. Alternatively, a cervical disc can herniate or the muscles on one side of the neck, usually the sternocleidomastoid (SCM), tighten or go into a severe spasm that limits all movement in the area. This imbalance pulls the head into an abnormal position, often causing discomfort and restricted movement (Cunha, 2023; Jankovic, Tsui and Bergeron, 2007).

Neck pain is a very common complaint amongst the general population, ranking second only to lower back pain as the most common complaint of musculoskeletal pain (Ferrari and Russel, 2003). There are various different causes of neck pain, but today we will be looking at wry neck as one of these causes.

How Common Is Wry Neck?

The prevalence of wry neck is not yet clearly known. It can occur at any age, but most adult cases are seen between the ages of 30 and 40 (Medscape, 2024). Congenital muscular torticollis affects less than 0.4% of newborns (Rodriguez-Huguet et al., 2023).

What Causes It?

The exact cause isn’t always clear. However, possible causes and contributing factors include previous neck trauma, genetic predisposition in adults, and, for children, positioning in the womb or trauma during birth that impacts muscle development. The underlying problem usually involves an imbalance or overactivity of muscles on one side of the neck (Cunha, 2023).

Signs and Symptoms

Wry neck can present in several ways, with common symptoms including:

• The head tilting or rotating to one side (with the chin pointing toward the shoulder).

• Muscle spasms or jerky, involuntary movements.

• Neck pain and stiffness that may limit range of motion.

• Difficulty maintaining normal posture.

• Occasionally, dizziness, or a sense of imbalance due to changes in the neck’s relationship with the vestibular system.

How It’s Assessed

A physiotherapist will usually start with a detailed history and physical examination, including postural observation, range of motion testing for the neck and shoulders, palpation for muscle tightness or tenderness, and neurological screening to exclude other causes.

Prognosis

The outlook for wry neck depends on the underlying cause, but symptoms usually improve significantly with early treatment by a physiotherapist. Some cases resolve completely, while others may require longer-term management (Medscape, 2024).

Treatment and Management

Physiotherapy is often the main form of treatment and can be highly effective, especially when started early. Management may include gentle stretching, mobility and strengthening exercises to correct muscle imbalances, heat therapy, soft tissue release, manual therapy, postural education, and ergonomic advice to prevent recurrence. In more persistent or severe cases, medication or botulinum toxin (Botox) injections may be used alongside physiotherapy (Rodriguez-Huguet et al., 2023).

Wry neck can be painful and frustrating, but with proper assessment and management, most people recover well. Early intervention is key, so if your neck suddenly becomes stiff and painful, don’t ignore it. A physiotherapist can help identify the cause, ease your pain, and guide you through safe exercises to get your neck moving again.

References

Cunha, B. (2023) 'Torticollis', StatPearls, 7 August. Available at: https://www.ncbi.nlm.nih.gov/books/NBK539857/ (Accessed: 29 October 2025).

Ferrari, R. and Russel, A.S. (2003) 'Regional musculoskeletal conditions: neck pain', Best Practice & Research Clinical Rheumatology, 17(1), pp. 57-70.

Galway Physio (2025) 'How Physiotherapy Helps Treat Acute Wry Neck'. Available at: https://galwayphysio.com/title-how-physiotherapy-helps-treat-acute-wry-neck-fast-relief-for-sudden-neck-pain/ (Accessed: 29 October 2025).

Jankovic, J., Tsui, J. and Bergeron, C. (2007) 'Prevalence of cervical dystonia and spasmodic torticollis in the United States general population', Parkinsonism & Related Disorders, 13(7), pp. 441-416.

Medscape (2024) 'Torticollis: Background, Pathophysiology, Etiology', 15 January. Available at: https://emedicine.medscape.com/article/1152543-overview (Accessed: 29 October 2025).

Rodriguez-Huguet, M. et al. (2023) 'Effectiveness of the treatment of physiotherapy in the congenital muscular torticollis: a systematic review', Children, 11(1), p. 8. doi: 10.3390/children11010008.