Torticollis in Adults
- Introduction
- Causes
- Epidemiology
- Symptoms
- Diagnosis
- Treatment
- Prevention
- Real-life Cases or Personal Experiences
- Conclusion
1. Introduction
Torticollis is a condition where the neck tilts to one side and is accompanied by pain. When attempting to straighten the neck, pain occurs. It is a common condition, and in adults, it is typically characterized by slight neck discomfort upon waking up in the morning. The pain may worsen with hot showers or prolonged periods of sitting in one position, gradually causing the neck to tilt to one side.
2. Causes
In our neck, we have seven cervical vertebrae, allowing for a total of 90 degrees of rotation. Of this range, approximately 50 degrees occur at the C1/2 level, leaving the remaining five vertebrae with a total of 40 degrees. This means that each cervical vertebra can contribute to about 8 degrees of rotation. If one of these vertebrae is unable to move properly due to certain reasons, it can place excessive stress on the vertebrae above and below it, eventually leading to damage. Most cases of torticollis occur in the lower cervical spine. This often happens when the upper thoracic spine is unable to move correctly, affecting the lower cervical spine. When a specific area of our spine fails to move properly, it can result in damage to other joints.
There are instances when torticollis originates in the upper cervical spine, but from personal experience, it seems to vary based on the patient’s occupation. In some cases, the issue arises in the upper cervical spine, while in others, it’s in the lower cervical spine. Additionally, in the case of women washing hair before sleep, sleeping with their head in an unnatural position to avoid wet hair can lead to stress on the joints, which give high chance of torticollis the next day. So there are a lot of causes for torticollis.
3. Epidemiology
The incidence of torticollis in adults is reported to be approximately 0.5% per 1,000 individuals. It is considered a relatively rare condition. There is generally no significant gender difference in the occurrence of torticollis. The incidence is relatively equal between males and females.
According to this article, that 90% of us will have torticollis at least once
As personal opinion, I noticed that the incident differs with patients’ occupations. People who move their neck frequently at work, such as truck drivers don’t usually get torticollis. But people like office workers or baristas who don’t move their head or look down for prolonged period of time tend to get torticollis often.
4. Symptoms
Both sharp and dull pain in the neck is the main symptom. In severe cases, the head can be tilted to one side, this is because the facet joint is inflamed and swollen and it causes sharp pain when the patient tries to straighten the neck, muscle spasms can occure in some cases like these. Range of motion is also limited due to sharp pain when moving. In rare cases, headache is accompanied, these headaches are usually cervicogenic headaches which are coming from the tight muscles in the neck. cervicogenic headaches disappear as the muscles loosen.
5. Diagnosis
Torticollis in adults are quite easy to diagnose. Kemp’s test determines whether the patient has inflammation in the facet joint or not. There is one more important thing to rule out which is the cervical disc injuries. In order to rule the disc pathology out, do practitioner will do compression test of the cervical spine and see whether the pain is reproduced by flexion or extension of the cervical spine.
6. Treatment
As mentioned in another post, chiropractic aims to make the stiff joints move. If we move the stiff joints that are locked up, it will lessen the compensation that is being put into the damaged torticollic joints. So we adjust stiff joints and release the muscles. Some chiropractors may do different therapies to try and reduce the inflammation such as ultrasound or other therapies, but in chiropractic, we assume the cause of torticollis is the joints that are not moving.
7. Prevention
Torticollis cannot be prevented in cases resulting from traumatic causes. However, it can be prevented by engaging in exercises that maintain normal joint movement in the upper body, depending on one’s profession. For example, office workers who spend long hours sitting at a desk can prevent it by incorporating regular upper body stretching or maintaining a habit of keeping their shoulders back. Drivers who occasionally look back and excessively turn their neck may also prevent it by performing exercises that involve squeezing the scapula. By squeezing the scapula, our upper back goes into extension and upper thoracic spine flexibility reduces compensations to the neck.
8. Real-life Cases
The chiropractor in the video adjusts the neck into right rotation first which makes the movement easier in the right rotation and lateral flexion. Although it is painful, he does the left rotation adjustment as well in what looks like a upper cervical segment. After that, patient walks around a little bit and the chiro does thoracic adjustments, which is what chiropractors typically do for torticollis. The pain doesn’t compelety go away but this is because we cannot get rid of inflammation straight away, but if the joint movements are restored, the body will do the healing automatically and in about 2~3 days the pain will fully subside. This depends on the body’s recovery speed (patients’ age, fitness etc) and sometimes the pain doesn’t fully disappear until 2 weeks.
Some patients have extremely stiff upper thoracics and in those cases, recovery takes longer.
9. Conclusion
Torticollis is an inflammation of the facet joints in the neck. It hurts if we try to straighten our neck because it puts pressure on the swollen facet joint. Chiropractic can help fix it by allowing better neck and upper back movement.