Wry Neck (Facet)
(Also known as Acute Wry Neck, Neck Sprain, Facet Joint Sprain, Apophyseal Joint Sprain, Apophyseal Wry Neck, Locked Apophyseal Joint, Zygaphophyseal Joint Sprain, Sprained Facet Joint)
N.B. Although a wry neck may originate from either the discs or facet joints of the neck, the term ‘wry neck’ will be used in this article to describe a wry neck originating from a facet joint.
What is a wry neck?
A wry neck is a relatively common condition characterized by sudden onset pain and stiffness in the neck or upper back. The injury originates from damage and subsequent ‘locking’ of one of the facet joints of the neck and results in a noticeable limitation of movement and postural deformity.
The spine (neck) comprises of many bones known as vertebrae. Each vertebra connects with the vertebra above and below via two types of joints: the facet joints on either side of the spine and the disc centrally (figure 1). These joints are designed to support body weight and enable spinal movement.
Each facet joint comprises of strong connective tissue wrapping around the bony ends and cartilage which lies between the bony joint surfaces, cushioning the impact of one bone on another.
During certain postures or movements of the neck, stretching or compression forces are placed on the facet joint. If these forces are excessive due to too much repetition or high force, or are sustained for too long, injury to the facet joint may occur. This may involve damage to the cartilage or tearing to the connective tissue surrounding the joint. When this occurs and results in a loss of range of movement and postural deformity of the neck, the condition is known as a wry neck.
A wry neck most commonly occurs in younger individuals from adolescence to the age of 30.
Causes of a wry neck
A wry neck usually occurs either upon waking in the morning or from a sudden, quick movement involving the neck. In the lead up to injury the patient has typically performed activities that involve sustained poor posture, slouching, excessive, repetitive or prolonged neck movements or excessive lifting. These repetitive or prolonged forces gradually stretch tissue in the neck over time, predisposing the facet joint to injury. A wry neck may also occur due to sleeping in poor posture in side lying (figure 2), on your back (with too many pillows) or on your stomach with your neck turned excessively.
Signs and symptoms of a wry neck
Patients with a wry neck typically experience one sided sharp neck pain. There is usually an inability to turn the head to the painful side and often a resultant postural deformity due to pain. The postural deformity is usually positioned with the head tilted away from the side of pain with the patient unable to correct this due to muscle spasm and pain. Occasionally pain may be referred into the shoulder blade, upper back or arm on the affected side. Symptoms are generally exacerbated with activities that involve turning the head to the painful side, bending forwards or sideways, heavy lifting, arching the neck backwards or slouching for prolonged periods (e.g. when sitting – figure 3). Patients may also experience an ache in the neck that is particularly prominent at night or first thing in the morning.
Patients with a wry neck often first notice their symptoms upon waking in the morning. Sometimes there may be no identifiable reason as to why the symptoms have started, although a thorough history and examination from the treating physiotherapist will usually be able to identify the contributing factors.
Diagnosis of a wry neck
A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose a wry neck. Investigations such as an X-ray, MRI or CT scan may be required to confirm diagnosis.
Treatment for a wry neck
Prognosis of a wry neck
The recovery time following a wry neck may vary from patient to patient depending on compliance with physiotherapy. Usually the acute symptoms will settle within 2-5 days with appropriate management. With ideal treatment, patients may be pain free in as little as a couple of days, although this may take 2 – 3 weeks. Physiotherapy treatment, however, may be required for a longer period to ensure a full recovery and address any contributing factors such as joint stiffness.
Contributing factors to the development of a wry neck
There are several factors that may contribute to the development of a wry neck. These factors need to be assessed and corrected with direction from a physiotherapist and may include:
- poor posture
- poor ergonomic set-up
- joint stiffness (particularly the neck or upper back)
- a sedentary lifestyle
- poor core stability
- muscle weakness (particularly the deep neck flexors)
- muscle tightness
- inappropriate lifting technique
- a lifestyle or occupation involving large amounts of sitting (particularly at a computer or driving), bending, slouching or heavy lifting
- Inadequate recovery periods from repetitive or prolonged neck movements (such as bending, slouching or twisting of the neck)
- Use of an inappropriate pillow during sleep
Physiotherapy for a wry neck
Physiotherapy treatment for patients with this condition is vital to hasten the healing process, ensure an optimal outcome and reduce the likelihood of recurrence. Treatment may comprise:
- soft tissue massage
- joint mobilization
- ice or heat treatment
- electrotherapy (e.g. ultrasound)
- joint manipulation
- dry needling
- postural taping
- postural bracing
- the use of a lumbar roll for sitting
- the use of an appropriate pillow for sleeping
- activity modification advice
- ergonomic advice
- clinical Pilates
- exercises to improve flexibility, strength, posture and core stability
Other intervention for a wry neck
Despite appropriate physiotherapy management, a small percentage of patients with this condition fail to improve and may require other intervention. This may include investigations such as an X-ray, CT scan or MRI, pharmaceutical intervention, corticosteroid injection or referral to appropriate medical authorities who can advise on any procedures that may be appropriate to improve the condition.
Exercises for a wry neck
The following exercises are commonly prescribed to patients with this condition. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, the initial and intermediate exercises should be performed 3 – 5 times daily, whilst the advanced exercises should be performed twice daily. All exercises should only be performed provided they do not cause or increase symptoms.
Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to the intermediate and advanced exercises. As a general rule, addition of exercises or progression to more advanced exercises should take place provided there is no increase in symptoms.
Begin sitting with your back and neck straight and your shoulders back slightly. Turn your head looking over one shoulder as far as you can go without pain and provided you feel no more than a mild to moderate stretch (figure 5). Then repeat the exercise turning your neck in the opposite direction. Keep your neck straight and don’t allow your head to poke forwards during the movement. Repeat 10 times to each side provided the exercise is pain free. Repeat 3 – 5 times daily.
Begin sitting or standing tall with your back and neck straight, shoulders should be back slightly (figure 6). Tuck your chin in as far as you can go without pain and provided you feel no more than a mild to moderate stretch. Keep your eyes and nose facing forwards. Hold for 2 seconds and repeat 10 times provided the exercise is pain free. Repeat 3 – 5 times daily.
Shoulder Blade Squeezes
Begin sitting or standing tall with your back and neck straight (figure 7). Squeeze your shoulder blades together as far as you can go without pain and provided you feel no more than a mild to moderate stretch. Hold for 5 seconds and repeat 10 times provided the exercise is pain free. Repeat 3 – 5 times daily.
Rehabilitation Protocol for a wry neck
Physiotherapy products for a wry neck
Some of the most commonly recommended products by physiotherapists to hasten healing and speed recovery in patients with this condition include:
OPPO – Posture Aid / Clavicle Brace (OPP2075)
Premium Strapping Tape 38mm (Victor)
AllCare Pro-TENS Machine
AllCare Spikey Massage Ball
AllCare Instant Cold Pack (15 x 25cm)
AllCare Foam Roller Round
McKenzie Treat Your Own Neck Book
Dentons Impressions Classic Memory Foam Therapeutic Pillow
To purchase physiotherapy products for a wry neck click on one of the above links or visit the PhysioAdvisor Shop.
Find a physiotherapist in your local area who can treat this condition.
- View more Neck Flexibility Exercises.
- View Beginner Pilates Exercises to improve your core stability and posture.
- View detailed information on improving your Posture
- View detailed information on Postural Taping.
- View detailed information on improving your Ergonomic Computer Setup.
- View detailed information on when to use Ice or Heat.
- View detailed information on initial injury management and the R.I.C.E. Regime.
- Read our Neck Diagnosis Guide.
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