The term torticollis comes from the Latin words tortus (twisted) and collum (neck). Torticollis is also called “wry neck” and is caused by an involuntary contraction of the neck muscles, particularly the sternocleidomastoid and trapezius. This protective splinting tilts the neck to one side and also rotates the neck.

The four primary forms of torticollis are: 

  1. Congenital torticollis– a condition recognized at birth caused by tight fibrotic adhesions in the sternocleidomastoid muscle. This is usually due to muscular trauma during delivery or vertebral deformities like Klippel-Feil or hemi-vertebra. (1) 
  2. Acquired torticollis – this arises after trauma or in response to an adjacent inflammatory process. Osteomyelitis, lymphadenitis, pharyngitis, tonsillitis, cervical abscess, tumor and rheumatoid arthritis can all trigger acquired torticollis. Acquired torticollis may also be from partial dislocation of C1 on C2. 
  3. Spasmodic torticollis – is sometimes called Cervical Dystonia. It is characterized by a painful progressive involuntary contraction (spasm) of the sternocleidomastoid (SCM) muscle. It is a neurologic movement disorder that is thought to be a “faulty guarding mechanism”.  
  4. Acute torticollis – usually affects younger and middle-aged patients. It comes on suddenly and shows up when getting up from bed in the morning. Symptoms can self-resolve in days to weeks. This article will focus on acute torticollis.

Causes of acute neck torticollis 

There is no known cause of this form of torticollis and so the theories of origin are hypothetical and recommendations are anecdotal. It is thought that it arises from a cervical spine facet joint restriction generating the cycle of pain, inflammation, and restriction. It could also be from the formation of trigger points in the SCM or trapezius. Usually there is a minor traumatic incident like sleeping in an awkward position or sleeping under an open window or fan. Another possible cause is starting an unusual or strenuous activity the day before, i.e. new exercises, travel, prolonged head rotation during a movie, etc.  

Common symptoms of acute neck torticollis 

The common symptom of torticollis is a painful, fixed posture of the neck. The spasm doesn’t allow for movement of the contorted neck. The neck may be shifted forward or shifted to the side. It may also be rotated or compressed on one side. Movement is painful or unbearable. Sleep is usually disturbed. There may also be pain in the shoulder and upper back.

How to evaluate acute neck torticollis 

Usually torticollis is obvious based on the position of the neck. The position of the neck also doesn’t allow much range of motion. Especially looking up and moving the neck to the opposite side. Orthopedic tests such as lateral foraminal compression/ Spurlings tests may be positive for local pain. Touching the neck will reveal spasm or extreme tightness in the following muscles: SCM, trapezius and levator. If there is a history of trauma that preceded torticollis imaging may be necessary. The challenge will be positioning the patients because of the posture. Torticollis refers to the position and is thereby a description of what is seen and is not a diagnosis. It is a sign of something else going on. The cause of torticollis could be infections that cause lymph gland inflammation and reactive muscular spasm (osteomyelitis, meningitis, pharyngitis, sinusitis, etc) or fracture, neoplasm, atlanto-axial instability (common in Down’s syndrome). Some drugs can cause torticollis (dopamine blockers, ketamine, amphetamines, cocaine, compazine, haldol and thorazine) (2).

Upper cervical chiropractic for acute neck torticollis 

Once it is determined that it is acute torticollis caused by muscle spasm and there is not another cause then reduction of spasm is warranted. This can be achieved by ice, heat, continuous ultrasound, estim and/ or cervical traction. (4,5) Myofascial release can be used to reduce tension in the SCM, trapezius, levator and any other associated paraspinal muscles. Stretching can make things worse unless it is a contract-relax traction stretch.  Assisted shoulder blade retraction can also be used to assist in the treatment of torticollis. (4).

Gentle upper cervical adjustments, light force, or instrument adjusting will speed up resolution. Once the condition is improving stretching may be added for the SCM, trapezius, levator and any other involved muscles.

Exercises to help heal acute neck torticollis



If acute torticollis is a common part of your life and you are looking for an answer then I can help. I can help figure out what the cause of the neck pain is. Use chiropractic adjustments and massage to get you out of pain and teach you the exercises you will need in order to build a resilient neck that is immune to pain. If you are ready to try this approach schedule with me today. Still looking for more information? Check out my eBook on Chronic Neck Pain.


 1. Cincinnati Children’s Hospital. Therapy Management of Congenital Muscular Torticollis. Evidence-Based Care Guideline for Management of Congenital Muscular Torticollis in children age 0 to 36 months. Health Policy & Clinical Effectiveness Program, Guideline 33.
2., April 2013
3. Cerf J. Adult Torticollis. Dynamic Chiropractic Canada, April 2013.
4. Desai NA, Khatri SM, Agarwal AB. Immediate effect of scapular repositioning with active cervical rotation in acute spasmodic torticollis. J Manipulative Physiol Ther. 2013 Sep;36(7):412-7. 
5. Brunker P, Kahn K. Clinical Sports Medicine. Sydney: McGraw-Hill Book Co.; 2001, p240.