Acute torticollis Dr.P.T.Kenny..

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Presentation transcript:

Acute torticollis Dr.P.T.Kenny.

Torticollis (= acute wry neck). This means a lateral deformity of the neck. This is usually a transient self-limiting acutely painful disorder with associated muscle spasm of variable intensity.

The typical features include: age of patient between 12 and 30 years patient usually awakes with the problem pain usually confined to neck but may radiate deformity of lateral flexion and slight flexion/rotation deformity usually away from the painful side loss of extension mid-cervical spine (C2-C3, C3-C4, C4-C5) any segment between C2 and C7 can cause torticollis usually no neurological symptoms or signs

The cause... The exact cause of this condition is uncertain, but both an acute disc lesion and apophyseal joint lesion are implicated, with the latter the more likely cause. Management by mobilisation and muscle energy therapy is very effective.

Muscle energy therapy… This amazingly effective therapy relies on the basic physiological principle that the contracting and stretching of muscles lead to automatic relaxation of agonist and antagonist muscles. Lateral flexion or rotation or a combination of movements can be used but treatment in rotation is preferred. The direction of contraction can be away from the painful side (preferred) or towards the painful side, whichever is most comfortable for the patient.

Method … 1. Explain the method to the patient, with reassurance that it is not painful. 2. Rotate the patient's head passively and gently towards the painful side to the limit of pain (the motion barrier). 3. Place your hand against the head on the side opposite the painful one. The other (free) hand can be used to steady the painful level, usually C3-C4.

Method continued… 4. Request the patient to push the head (in rotation) as firmly as possible against the resistance of your hand. The patient should therefore be producing a strong isometric contraction of the neck in rotation away from the painful side (Fig. A). Your counterforce (towards the painful side) should be firm and moderate (never forceful) and should not 'break' through the patient's resistance. 5. After 5-10 seconds (average 7 seconds) ask the patient to relax; then passively stretch the neck gently towards the patient's painful side (Fig. B).

Method continued… 6. The patient will now be able to turn the head a little further towards the painful side. 7. This sequence is repeated at the new improved motion barrier. Repeat 3 to 5 times until the full range of movement returns. 8. Ask the patient to return the following day for treatment although the neck may be almost normal. [The patient can be taught self-treatment at home using this method.]

B = reduced motion barrier A = motion barrier B = reduced motion barrier Muscle energy therapy for acute torticollis: (A) isometric contraction phase for problem on the left side; (B) relaxation phase towards the affected (left) side.