Most of us have had the experience of waking up in the morning with a stiff neck. For some, this painful sensation is a severe and recurring problem. More than just a stiff neck, torticollis is characterized by involuntary contractions or intermittent spasms of neck muscles. Learn how valuable massage therapy can be to clients with torticollis, as well as the precautions to be aware of when approaching this condition.
Torticollis belongs to a broad category of disorders describing abnormal flexion, extension or twisting of the neck muscles. A neck twisted to one side is typical of torticollis. Although the exact cause of torticollis is uncertain, the following are potential scenarios where it may develop:
· In those with a family history of this disorder, symptoms may be present at birth or develop slowly
· As a result of some sort of trauma, torticollis can be acute
· From an adverse reaction to certain medications
When it can be traced to a genetic disorder, the condition is referred to as spasmodic torticollis. Although considered rare, spasmodic torticollis affects close to 90,000 people in the United States. Spasmodic torticollis has three variations of neuromuscular dysfunction:
1. Tonic (a sustained contraction)
2. Clonic (head shaking)
3. Mixed (both tonic and clonic)
Trauma that involves bending or twisting the neck too far can lead to acute torticollis. The acute form can also be the result of keeping the neck muscles in shortened positions for a prolonged period of time. A person who has slept in an awkward position or in a cold draft may awaken to acute torticollis.
Torticollis causes discomfort and pain, forcing many to hold their head straight or rotated to one side. Unilateral in nature, torticollis is irritated when the affected side of the neck’s muscles are activated or even touched. As a contralateral rotator, the sternocleidomastoid (SCM) muscle is most commonly involved in acute torticollis, as any position rotating the head to its opposite side for long periods may cause this condition.
A massage therapist should confirm that a physician has properly diagnosed any client with torticollis. In some cases, torticollis is mistaken for muscular dystrophy, epilepsy or Parkinson’s disease.
To assess the condition, the practitioner will be able to palpate and/or observe shortening and hypertonicity in the neck muscles. The head and neck are held in a non-neutral position, often with rotation to the opposite side. The SCM on the affected side is likely to be more prominent than on the other side. In the clonic variation of spasmodic torticollis, there will be some shaking of the head.
The cervical muscles will likely be tightened due to a local muscle spasm. In some chronic cases, the practitioner will be able to palpate fibrotic changes in the affected musculature. Active and passive motions rotating the head in the opposite direction of the contraction are likely painful and limited. There may be pain associated with further rotation to the contracted side depending on the severity of the condition and the percentage of muscle fibers recruited for the activity.
Symptoms of acute torticollis generally resolve in a couple of weeks. Western medicine’s top offering for this condition is an injection of Botox® to temporarily paralyze the muscles. For those seeking to avoid this toxic injection, the pain and contraction of torticollis responds well to massage. Considering neck muscles in either a tonic or clonic state are highly sensitive, extreme care must be used with any hands-on modality.
With a gentle approach, bodywork’s goal for torticollis is release of the contracted neck muscles. Such a release typically entails:
1. Enhancing circulation in and around the spastic musculature
2. Enlisting passive and active stretching techniques to elongate shortened muscles
While most massage modalities enhance circulation, a gentle technique must be chosen for torticollis. The increase in circulating cerebrospinal fluid accomplished through cranial-sacral therapy (CST) is an ideal match for a contracted neck. Cranial Sacral typically uses the equivalent of a dime’s weight of pressure for its maneuvers, making it an extremely gentle option. Even some of the simple cranial holds of CST can allow the contracted tissues of torticollis to unwind at their own pace. Additionally, the application of heat in a warmth-producing topical gel, heat lamp or hot pack is a non-invasive and safe way to invigorate local blood circulation.
Osteopathic medicine’s passive and active stretching techniques offer a gentle route to lengthening contracted muscles. Myotherapy techniques are ideal for increasing the range of motion that is restricted with torticollis. Additionally, some of sports massage’s stretching techniques are ideal for lengthening neck contraction. All within the realm of osteopathic medicine, some of the applicable stretches in sports massage include:
· reciprocal inhibition
· proprioceptive neuromuscular (PNF) stretching
· isometric stretching
A client with torticollis may come for a massage after receiving medical treatment from their physician. Bodyworkers need to be aware that an injection of the Botox® toxin causes motor loss and has no effect on sensory perception. Massage or early manipulation of the injection site can speed up absorption and spread the toxin. Therapists are advised to avoid the injection site to avoid paralysis of the injected as well as adjacent muscles.
The gentle techniques garnered from cranial-sacral therapy, myofascial release and sports massage stretching can be safely and effectively applied to relieve torticollis. A massage therapist familiar with the described methods and the pathology of torticollis will be successful in delivering pain relief and increased range of motion to a client who awoke with a stiff neck.