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Understanding Torticollis and Differentiating It from Stiff Neck. A guide for massage therapists.

Updated: Jun 28, 2023


Torticollis, also known as a wry neck, is a condition characterised by the abnormal positioning or posture of the head and neck. It can cause discomfort and a limited range of motion, affecting individuals of all ages. In this blog post, we will delve into the topic of torticollis, specifically focusing on sleep torticollis. Furthermore, we will clarify the distinctions between torticollis and stiff neck, shedding light on their unique characteristics.

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Torticollis: A Brief Overview

Torticollis is a condition that causes the head to tilt to one side and the chin to rotate towards the opposite side. This abnormal positioning may result from several factors, such as muscle spasms, abnormalities in the neck bones or muscles, nerve problems, or injury. While congenital torticollis is present at birth, acquired torticollis can develop later in life due to trauma, muscle strain, or underlying medical conditions.

Sleep Torticollis: Understanding the Role of Sleep Positioning

Sleep torticollis, also referred to as "positional torticollis," occurs when an individual assumes a specific sleeping position that triggers the development or exacerbation of torticollis symptoms. While the exact cause of sleep torticollis is not fully understood, it is believed to result from sustained pressure on certain neck structures, including muscles, nerves, or blood vessels, during sleep.

During sleep, the neck is vulnerable to prolonged stress if it remains in an awkward or strained position for an extended period. This sustained pressure can lead to muscle imbalances, spasms, and discomfort upon waking up. Individuals with sleep torticollis often report experiencing stiffness, pain, and restricted mobility in the neck area after sleeping in specific positions.

Distinguishing Torticollis from Stiff Neck

While torticollis and stiff neck may share some common symptoms, it is crucial to recognize their distinct features to facilitate accurate diagnosis and appropriate treatment. Here are the key differences between the two conditions:


  • Involves abnormal head positioning, characterised by tilting and rotation.

  • May be present from birth (congenital) or develop later in life (acquired).

  • Can result from various causes, including muscle spasms, skeletal abnormalities, nerve issues, or injuries.

  • The head and neck remain fixed in an abnormal position even when attempting to move them.

Stiff Neck:

  • Presents as neck pain and limited range of motion without abnormal head positioning.

  • Typically caused by muscle strain, tension, or inflammation.

  • Often arises from poor posture, sleeping in an awkward position, or sudden movements.

  • The neck may be difficult to move, but the head remains centred without tilting or rotation.

Healthcare professionals evaluate the range of motion, muscle strength, and overall function of the neck and surrounding structures. Some commonly used orthopedic tests for torticollis include:

Passive Range of Motion (PROM) Assessment: Gently move the patient's neck through various planes of motion, such as flexion, extension, rotation, and lateral bending. Restricted movement or pain during specific movements may indicate torticollis.

Spurling's Test: This test is performed to assess for nerve root compression in the cervical spine. The therapist applies pressure on the patient's head while it is tilted and rotated to the affected side, looking for symptoms such as pain, tingling, or numbness radiating down the arm. (read more)

Cervical Compression Test: In this test, the therapist puts downward pressure on the patient's head while it is in a neutral position. The test aims to reproduce symptoms such as pain or discomfort, indicating possible cervical spine involvement.

Upper Limb Tension Test: This test evaluates the tension and mobility of the nerves in the upper limb. The therapist gently stretches the nerves of the affected arm while observing for pain or abnormal sensations.



  • Cyriax, J. H. (2013). Textbook of Orthopaedic Medicine: Diagnosis of Soft Tissue Lesions (8th ed.). Elsevier Health Sciences.

  • Magee, D. J. (2013). Orthopedic Physical Assessment (6th ed.). Elsevier Health Sciences.

  • Singh, M. P., Singh, R. K., & Balain, B. (2021). Torticollis. In StatPearls [Internet]. StatPearls Publishing. Retrieved from

Disclaimer: This blog post is intended for educational purposes only and should not be used as a substitute for professional medical advice.

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