Head & neck
Acute Torticollis (Wry Neck)
Waking with a painfully stiff neck stuck to one side. Common in teens and young adults; usually settles within a week or two.
Common symptoms
- Sudden neck pain on waking, usually on one side
- Head held tilted or turned away from the painful side
- Sharp pain when trying to turn or straighten the head
- Hard, tender muscle on the painful side of the neck
- Pain that may spread into the shoulder or upper back on the same side
- Headache in some cases
Overview
Acute torticollis, often called wry neck, is a sudden episode of neck pain and spasm that leaves the head tilted or turned to one side. Most people wake up with it: they went to bed fine and in the morning cannot turn their head without sharp pain. In Chinese it is known as "falling off the pillow", which captures how it usually starts.
The exact cause is not always clear. The most likely explanation is that a small joint or ligament in the neck is irritated, possibly by an awkward sleeping position or a sudden movement, and the surrounding muscles go into protective spasm. The spasm itself then becomes the main source of pain and stiffness.
It is very common in teenagers and young adults and is not usually a sign of anything serious. Most episodes ease noticeably within a few days and resolve within one to two weeks. Treatment aims to make that period more comfortable and reduce the chance of it happening again.
Causes and risk factors
- Sleeping in an awkward position, on an unfamiliar pillow or on a sofa
- A sudden or unguarded neck movement, such as turning quickly
- Sitting in a cold draught, for example from air conditioning on the neck
- A prolonged period of poor neck posture the day before, such as a long study session
- In children and teenagers, a recent throat or ear infection can be linked to wry neck; this should be checked by a doctor first
- A previous episode of wry neck
How we may be able to help
We first check that this is a simple mechanical episode and not something that needs medical attention, such as an infection or a nerve problem. For straightforward wry neck, assessment is quick and treatment can usually start the same visit.
Gentle hands-on techniques aim to reduce the muscle spasm and gradually restore movement. These may include soft-tissue work, gentle mobilisation and, once the acute spasm has eased, chiropractic treatment of the restricted joint. Interferential therapy may help with pain and spasm, and dry needling can target the muscles that stay tight. We also show you safe movements to keep the neck mobile, and review your pillow and sleeping position.
What you can do at home
- Apply a heat pack or warm shower to the painful side for 15 minutes several times a day
- Move the neck gently within the range you can manage; avoid forcing it
- Keep doing normal daily activities as far as pain allows
- Sleep on your back or on the unaffected side with a pillow that supports the neck
- Avoid cold draughts on the neck; a scarf can help
- Ask a pharmacist or GP about short-term pain relief if sleep is difficult
When to seek urgent help
If you have any of the following, call us straight away for an urgent same-day appointment — we can examine you and arrange fast-track X-ray or MRI through our imaging partner. If you cannot reach us, go to A&E. For loss of bladder or bowel control, numbness around the groin, chest pain, a sudden severe headache or rapidly worsening weakness, call 999 or go to A&E immediately:
- Neck stiffness with fever, headache, rash or sensitivity to light
- Difficulty swallowing, a sore throat with neck swelling, or drooling in a child
- Numbness, tingling or weakness in the arms or legs
- Wry neck following a fall, collision or other injury
- Symptoms lasting more than two weeks or getting steadily worse
Frequently asked questions
Can I get my neck 'clicked' to put it back?
Nothing is out of place, so there is nothing to put back. In the acute stage the muscles are in spasm and forceful manipulation is not usually appropriate. We use gentle techniques first; the chiropractor may treat the joint once the spasm has eased.
Should I use heat or ice?
Most people with wry neck find heat more comfortable because it helps the muscle spasm relax. If heat does not suit you, ice is also fine. Use either for about 15 minutes at a time.
How long will it last?
Most episodes improve a lot within two to three days and settle within one to two weeks. If it is not improving after a week, or keeps coming back, it is worth being assessed.
Why does it keep happening to me?
Repeated episodes are often linked to an unsupportive pillow, a stiff upper back, long hours in one position or weak neck muscles. We look at these at your assessment and give you a plan to reduce the chance of recurrence.
This page is general information, not a diagnosis. A clinician will assess you before recommending any treatment. Outcomes vary from person to person. Written with reference to NHS and other peer-reviewed guidance.
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