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Cervical Torticollis

Cervical torticollis is a painful condition in which your neck muscles contract involuntarily, causing your head to twist or turn to one side. Cervical torticollis can also cause your head to uncontrollably tilt forward or backward. A rare disorder that can occur at any age, cervical torticollis most often occurs in middle-aged people, women more than men.


  • Cervical torticollis is sometimes linked to head, neck or shoulder injuries.
  • In most cases of cervical torticollis, the cause is unknown. Some people who have cervical torticollis have a family history of the disorder, so a genetic component may be a factor.


Symptoms generally begin gradually and then reach a point where they don’t get substantially worse.The muscle contractions involved in cervical torticollis can cause your head to twist in a variety of directions, including:

  • Chin toward shoulder
  • Ear toward shoulder
  • Chin straight up
  • Chin straight down

The most common type of twisting associated with cervical torticollis is when your chin is pulled toward your shoulder. Some people experience a combination of abnormal head postures. A jerking motion of the head also may occur. Many people who have cervical torticollis also experience neck pain that can radiate into the shoulders. The disorder also can cause headaches. In some people, the pain from cervical torticollis can be exhausting and disabling.


There is no cure for cervical torticollis. The disorder sometimes resolves without treatment, but sustained remissions are uncommon. Injecting botulinum toxin into the affected muscles often reduces the signs and symptoms of cervical torticollis. Surgery may be appropriate in a few cases.

Physical Therapy Interventions

Physical Therapists are professionals, educated and trained to administer interventions. As stated in The Guide to Physical Therapist Practice interventions are the skilled and purposeful use of physical therapy methods and techniques to produce changes consistent with the diagnosis, prognosis, and the goals of the patient or client. Common interventions in the treatment of cervical torticollis include:

  • Manual Therapeutic Technique (MTT): hands on care, including soft tissue massage, and joint mobilization by a physical therapist to modulate pain and reduce any soft tissue or tendon irritation.
  • Therapeutic Exercises (TE) including strengthening exercises to improve strength of the muscles in the head and neck, and increase stability.
  • Neuromuscular Reeducation (NMR) to restore stability, begin retraining the neck, improve proximal joint stability and improve movement technique and mechanics in daily use of the head and neck.
  • Modalities that can include the use of ultrasound, electrical stimulation, ice, cold laser and others to decrease pain and inflammation at the neck and head.
  • Home program that includes strengthening, stretching and stabilization exercises as well as instructions to help the person perform daily tasks and advance to the next functional level.

Medical Interventions

Procedures that your physician may recommend and perform in addition to physical therapy.

  • REST and ICE
  • The use of NSAIDS (Non Steroidal Anti-Inflammatory Drugs)
  • Steroidal Injections to reduce inflammation
  • Pain medication to reduce the discomfort and allow the patient to perform the recommended exercises


  • Botulinum toxin, a paralyzing agent often used to smooth facial wrinkles, can be injected directly into the neck muscles affected by cervical torticollis. Examples of botulinum toxin drugs include Botox, Dysport, Xeomin and Myobloc.
  • Most people with cervical torticollis see an improvement with these injections, which usually must be repeated every three to four months.
  • To improve results or to help reduce the dosage and frequency of botulinum toxin injections, your doctor might also suggest oral medications that have a muscle-relaxing effect.