Sports Medicine
Sports Injury Prevention & Rehabilitation

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Facet Wry Neck

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)
Note - 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. 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 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, 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.

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 usually performed activities that involve sustained poor posture, slouching, excessive or repetitive 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.

Signs and symptoms of a wry neck
Patients with a wry neck typically experience severe one sided sharp neck pain which is most common in the lower neck region. 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 held away from the side of pain with the patient unable to correct this due to muscle spasm and pain.
In some cases, symptoms may be felt centrally or on both sides of the neck. The symptoms associated with a wry neck are sometimes accompanied with pain radiating down the arm or into the shoulder blade region, or in some cases, headaches. Muscle spasm, pins and needles, numbness or weakness may also be present.
Patients with this condition often first notice their symptoms upon waking in the morning. Occasionally there may be a sudden onset of pain during the causative activity. Some patients may notice no identifiable reason as to why the symptoms have started, although a thorough history and examination from the treating physical therapist will usually be able to identify the likely cause.
The symptoms associated with this condition are often worse with sustained postures such as reading, driving, sitting at a computer or watching television. Symptoms may also be exacerbated by activities using the arms in front of the body, prolonged sitting (especially if slouched), heavy lifting and certain neck movements involving rotation, side bending, bending forwards or backwards. Sneezing may also aggravate symptoms. Patients with a wry neck will often experience pain that is worse first thing in the morning.

Diagnosis of a wry neck

A thorough subjective and objective examination from a physician is usually sufficient to diagnose a wry neck. Investigations such as an MRI or CT scan may be required to confirm diagnosis.

Treatment for a wry neck

Most patients with this condition heal quickly and have a full recovery with appropriate physical therapy. The initial goal of treatment is to relocate the bulging disc back into its original position and then keep it there so the torn connective tissue at the back of the disc can heal.
The time it takes to push the disc back into its original position varies from person to person depending on their activities and compliance with physical therapy advice. Since certain activities push the disc out and others push the disc back in, the balance of these activities dictates recovery time. If there are more activities pushing the disc out than in, these injuries will get worse and will only improve once activities pushing the disc in exceed the activities pushing the disc out. Activities typically pushing the disc out include: bending the neck forward or slouching, activities whereby the shoulders or arms are forward of the body (e.g. cooking, cleaning etc), lifting, and sneezing. Activities which help to push the disc back in include: lying, standing and walking with good posture, and certain exercises determined by a physical therapist (commonly chin tucks, shoulder blade squeezes or neck arches).
Generally, sitting for prolonged periods should be avoided. However, if inevitable, optimal sitting posture is vital to minimize stress on the disc. Sitting slouched should be avoided as it places your lower neck into considerable bend, this will rapidly aggravate a wry neck. Optimal sitting posture can be obtained by sitting tall on an appropriate chair, with your bottom in the back of the chair and a lumbar support (or a pillow / rolled up towel) in the small of your back. A lumbar roll can significantly help to improve your whole spinal posture.
Patients should follow RICE in the initial phase of injury. RICE is beneficial in the first 72 hours following injury or when inflammatory signs are present (i.e. morning pain or pain with rest). RICE for a wry neck primarily involves resting from aggravating activities and regular icing. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation. When inflammation has settled, heat treatment may be beneficial to reduce muscle spasm and pain associated with this condition.
Once the disc is back in its original position, patients should perform pain free flexibility, strengthening and postural exercises to prevent stiffness and weakness from developing and to ensure the neck is functioning correctly. Clinical Pilates exercises are also often recommended. The treating physical therapist can advise which exercises are most appropriate and when they should be commenced.

Prognosis of a wry neck

In patients who receive appropriate treatment and maintain the perfect balance of activities, the injured disc may be pushed back into position in as little as three days. Typically, however, patients will take approximately 2 to 3 weeks to push their disc back 'in'. Once the disc is 'in', the patient should be pain free and have full movement. However, the torn connective tissue at the back of the disc continues to heal from this point. It takes approximately six weeks of consistently keeping the disc 'in' to allow the torn tissue to heal to an adequate level before resumption of full activities can take place. Care must therefore be taken when returning to activity during this period.

Contributing factors to the development of a wry neck
Several factors may contribute to the development of a wry neck. These need to be assessed and, where possible, corrected with direction from the treating physical therapist. They may include:
  • poor posture
  • poor core stability
  • a sedentary lifestyle
  • muscle tightness
  • muscle weakness
  • joint stiffness
  • poor lifting technique
  • a lifestyle or occupation involving large amounts of sitting (particularly at a computer or driving), excessive neck movements (such as bending forwards), slouching, shoulders forwards activities or heavy lifting

Physical therapy for a wry neck
Physical therapy treatment for patients with this condition is vital to hasten healing, ensure an optimal outcome and prevent recurrence. Treatment may comprise:
  • soft tissue massage
  • joint mobilization
  • traction
  • electrotherapy (e.g. ultrasound)
  • postural taping
  • postural bracing
  • dry needling
  • the use of a cervical collar
  • the use of a lumbar support for sitting
  • exercises to push the disc back 'in' and to improve strength, core stability, flexibility and posture
  • education
  • activity modification advice
  • ergonomic advice
  • clinical Pilates

Other intervention for a wry neck

Despite appropriate physical therapy management, a small percentage of patients with a wry neck fail to improve and may require other intervention. This may include further investigations such as an X-ray, CT scan or MRI, pharmaceutical intervention, assessment from a specialist or sometimes surgery. The treating physical therapist can advise if this is required and will refer to the appropriate medical authority if it is warranted clinically. In cases of persisting or worsening neurological symptoms (pins and needles, numbness and weakness), surgery may be indicated.