Physiotherapy for Torticollis

Physical Therapy for Torticollis: Treatment, Exercises, and Prognosis

Physical therapy combines advice, exercises, and—as needed—manual techniques to restore movement that has been limited by a stiff neck. Manual techniques involve movements or pressure applied with the hands. Treatment depends on the cause of the stiff neck and on activities that are difficult to perform, such as looking over your shoulder, working, or sleeping. A stiff neck upon waking can make these movements very painful. Avoid driving if you cannot turn your head enough to check traffic, as the Cambridge physical therapy department reminds us.

Acute simple torticollis develops rapidly and often improves within a few days, according to the Royal Berkshire Hospital’s clinical fact sheet. This timeframe does not apply to all cases of neck pain. In seven studies of recent neck pain with no specific cause, participants who received little or no treatment showed improvement, particularly in the early stages; however, the average pain level remained significant after twelve months.¹ An international review also highlights that neck pain can persist.² A high fever, neurological symptoms, significant trauma, or worsening symptoms require medical attention. The warning signs detailed below take precedence over the exercises.

Here's what scientific research reveals about torticollis:

• Acute torticollis is not always simply a muscle cramp: a joint, muscle, or other structure in the neck may be tender, though it is not always possible to identify the^{exact structure3, 4}
• Movement can be resumed gradually: move your neck within a tolerable range—that is, the range of motion you can manage without excessive pain—and seek an evaluation if symptoms worsen or^{persist5, 2}
• Physical therapy guides care and the return to daily activities: the evaluation assesses movements, symptoms, and signs that may require medical follow-up, and then guides a tailored treatment plan⁶

This guide explains treatments, exercises, and situations that warrant a medical consultation. In five trials involving 1,722 adults who were pain-free at the start, exercise likely reduced the risk of a new episode of neck pain within 12 months, compared with no intervention or limited interventions. About 80% of the participants worked in an office. The results varied depending on how missing data were handled; therefore, the practical implications remain uncertain.⁷ This research does not support the prevention of recurrent acute torticollis. To understand other causes of pain, see our comprehensive guide to neck pain.

Physical therapy can provide advice, movements, and exercises tailored to your specific condition.

What is torticollis?

Torticollis is an abnormal position of the head and neck, often tilted to one side and turned. It may be accompanied by pain and difficulty turning the head. The term refers to several conditions: an acute episode in adults, congenital muscular torticollis in infants, or cervical dystonia. Dystonia causes involuntary contractions of the neck muscles. These forms require different treatments.⁶

The term “torticollis” comes from the Latin tortus (twisted) and collum (neck). Symptoms vary depending on the cause and context: head position, range of motion, and the presence of pain may differ.

Several muscles can contract, including the sternocleidomastoid. This muscle connects the area behind the ear to the sternum—the bone in the middle of the chest—and to the clavicle—the bone between the chest and the shoulder. It helps turn and tilt the head.⁶ Muscle pain alone is not enough to identify the cause. A review of twenty-seven journals published in 2025 shows that certain combinations of tests help guide the diagnosis, but that few signs allow for the confident identification of a specific tissue.⁸

An acute episode begins suddenly, sometimes overnight. A persistent or recurrent case of torticollis requires further evaluation, especially if other symptoms develop. Cervical dystonia generally has a longer course than simple acute torticollis.

Now that you understand what torticollis is, let's explore the different types encountered clinically.

What are the different types of torticollis?

The term "torticollis" can refer to several conditions, including acute neck stiffness in adults, congenital torticollis in infants, and cervical dystonia. Their evaluation and management differ.

Muscular Torticollis (Adult)

In adults, acute torticollis may begin after sleeping or following an unusual movement. The muscles may contract involuntarily—this is a spasm. Joint or muscle pain may contribute to it, but the movement that precedes the pain does not prove that it is the cause.⁹ The facet joints are small joints at the back of the vertebrae, the bones of the neck. Tests of movement, strength, and tenderness help guide the examination; their results must be interpreted together.⁴ A study of 1,108 17-year-olds found no clear difference in neck pain among four different sitting posture profiles.¹⁰ Therefore, observing posture alone is not sufficient to diagnose torticollis.

Congenital Torticollis (Infant)

Congenital muscular torticollis appears at birth or within the first few weeks. A shorter or stiffer sternocleidomastoid muscle can tilt the head toward that side and turn the chin toward the other side. The baby may always prefer the same head position. Several factors are being studied, including muscle development during pregnancy and events surrounding birth; however, these factors do not allow each case to be attributed to a single cause.¹¹

An early evaluation also assesses movement, development, and the shape of the skull. Appropriate stretching exercises and movement activities taught to parents can improve neck mobility. A review of six studies reported, in particular, greater gains in rotation with passive stretching than with assisted movements in one trial; methods and follow-up periods varied.¹¹ The exercises for adults described below are not intended as a program for infants.

Spasmodic Torticollis (Cervical Dystonia)

Cervical dystonia causes involuntary contractions that turn or tilt the head, sometimes accompanied by pain or tremors. Your doctor may recommend botulinum toxin, an injectable treatment used to reduce these contractions. Type A is the treatment of choice.¹² Physical therapy combined with injections may reduce pain more effectively than injections alone: a 2024 review pooled the results of two studies for this comparison. The programs differed; no specific type of physical therapy was identified as the best.¹³

Type B has also been studied. Four trials involving 441 adults showed a 10% to 20% improvement in symptom severity after a course of injections compared with a placebo—an injection without an active ingredient; dry mouth and difficulty swallowing were more common.¹⁴

The terms used to describe torticollis do not, by themselves, determine the treatment. The evaluation focuses on symptoms, associated signs, function, and context.

What Causes Torticollis in Adults?

Torticollis in adults can result from a muscle, joint, or movement control disorder; an infection or a side effect of medication can also cause an abnormal neck position.⁶ After a night’s sleep, the exact cause often remains unknown. Trauma or new symptoms warrant a medical evaluation.

A condition sometimes reported after sleep

An unusual sleeping position or uneven weight distribution may precede an acute episode. The Royal Berkshire Hospital fact sheet describes these possible circumstances, while noting that the cause often remains unknown. Adjusting head support or redistributing weight may improve comfort.

A work position can become uncomfortable when maintained for a long time. It makes sense to vary your positions based on comfort, without singling out any particular posture as the cause of neck stiffness.

Keeping your head tilted can become uncomfortable. The data on posture remain mixed: among 17-year-olds, four sitting postures were not associated with clear differences in pain.¹⁰ A 2019 review found an association between forward head posture and pain in adults; most studies of adolescents did not show this link.¹⁵ These studies do not prove that a particular posture causes neck pain.

Possible joint tenderness

The facet joints allow the vertebrae in the neck to move relative to one another. A sensitive joint can contribute to pain during certain movements. See our overview of neck anatomy to locate these structures.

Symptoms may involve several affected tissues. The evaluation focuses primarily on movements that alter the symptoms and signs that warrant medical follow-up¹⁶.

Symptoms That May Warrant a Neurological Evaluation

Irritation or compression of a nerve root—the part of a nerve near the spine—can cause pain that radiates down the arm. A herniated disc may be the cause: a portion of a disc—the cushion between two vertebrae—protrudes beyond its normal boundaries. Numbness, tingling, or weakness require evaluation; these symptoms alone do not confirm a herniated disc.

Signs that may indicate a throat or neck infection

An infection of the throat or neck tissues may be accompanied by a fever and pain when swallowing. A fever accompanied by difficulty swallowing and breathing requires urgent medical attention. These symptoms require medical evaluation before exercising.¹⁷

The physical therapist evaluates your symptoms and range of motion to determine the appropriate treatment or refer you to a doctor.

How Does Physiotherapy Treat Torticollis?

Physical therapy treats issues related to torticollis through gradual movements, strength exercises, and guidance on resuming activities. Manual techniques may complement this program. The initial assessment checks for signs that require medical evaluation. For neck pain in general, approaches focused on returning to activities are better supported by evidence than treatments that lack this active component.²

Thorough Initial Assessment

A physiotherapy assessment for torticollis includes:

• History of symptoms: The physical therapist will ask you about how the stiff neck began, your pain, activities that are difficult for you, your medical history, and any recent changes in your medications.
• Postural assessment: The physical therapist observes the position and tilt of your head, as well as the range of motion when you turn it.
• Movements you perform: You turn your head, tilt it, and look down or up while the physical therapist observes these movements.
• Manual examination: The physical therapist checks for tender areas in the sternocleidomastoid muscle, the trapezius—the large muscle between the neck and shoulder—and the small muscles at the base of the skull.
• Passive mobilization: The physical therapist guides the movements of your neck and observes their effect on your symptoms, without attempting to identify a locked joint.
• Nerve examination: The physical therapist checks muscle strength, sensation, and reflexes—the automatic responses of the muscles to a light tap with a hammer.

This assessment helps identify movements that trigger or relieve symptoms and recognize signs that warrant medical follow-up.

An Approach Tailored to Evaluation

Physical therapists select interventions based on symptoms, tolerated movements, and the goals established during the evaluation:

• Pain and Limited Mobility → Recommendations, movements, or exercises selected based on the assessment and the individual’s tolerance
• Muscle symptoms → Active or manual strategies selected based on the goals, without assuming a single cause
• Symptoms in the arm or signs of concern → Further evaluation and medical referral as needed

The goal is to reduce barriers to movement and gradually resume activities, without assuming that a single mechanical problem caused the symptoms.

Personalized Preventive Program

After the episode, the program may focus on limited range of motion, neck strength, or the endurance required for work. The data on prevention primarily concern new episodes of neck pain in adults who initially had no pain; they do not guarantee that a new case of torticollis will not occur.⁷ For infants, advice for parents and activities are tailored to the child’s developmental stage.¹⁸

A study followed 118 women from two exercise groups in a trial on chronic neck pain. The improvements in pain, functional activity, strength, and mobility observed after one year were largely maintained at three years. The three-year follow-up did not include a non-exercise group. Therefore, it does not demonstrate that strength training prevents acute torticollis.¹⁹

Let's now explore the specific techniques used in physiotherapy to treat stiff neck.

What physiotherapy techniques are used for stiff neck?

Techniques used to treat torticollis include mobility and strength exercises, guided mobilizations, and certain types of massage. The choice depends on the cause, the specific challenges, and your preferences. Manual techniques support the restoration of movement; they do not replace the assessment of warning signs.

Manual therapy

Depending on your symptoms and preferences, certain manual therapy techniques may be recommended:

• Massage of the sternocleidomastoid muscle: Massage can be tried for temporary relief, without claiming to relax a specific structure
• Progressive manual stretching: gentle neck movements performed within the patient's tolerance, without assuming that a muscle has lost its normal length
• Massage of the surrounding muscles: Appropriate pressure can be applied as comfortable, without claiming to repair tissue or correct a single cause.

The results of massage depend on the nature and duration of the pain. A 2024 Cochrane review, which included 33 trials, focused on pain that had been present for several weeks or months. Compared with sham massage, the difference in pain was small or nonexistent for up to about twelve weeks; the certainty of this finding is low. Some people reported a slight overall improvement, and a subgroup receiving more frequent and longer sessions had a more favorable outcome.²⁰ The findings regarding activities and quality of life also remained uncertain, with little or no difference according to the review’s conclusions. These data do not allow us to predict the effect on very recent torticollis. A sham massage replicates certain treatment maneuvers to allow for comparison.

Cervical Mobilizations

These are therapeutic movements applied to the cervical vertebrae:

• Passive mobilization: The physical therapist moves the stiff joint himself, gently at first, then a little further as the neck allows.
• Active-assisted movements: The patient participates in the movement while the physical therapist adjusts it based on the patient’s symptoms and tolerance.
• Manipulations: A brief, rapid movement may be performed in certain cases. The practitioner explains the expected benefits, risks, and other options before obtaining your consent. A manipulation does not put a “displaced” vertebra back into place.

Guided movements can help restore mobility and relieve certain types of neck pain.²¹ A 2013 review specifically supports certain short-term upper-back manipulations for recent neck pain. For persistent pain, exercises—either alone or combined with manual techniques—yielded better long-term results than manual techniques alone.²² These results do not prove that any specific technique accelerates the resolution of acute torticollis.

Electrotherapeutic Modalities

• TENS: This device delivers an electrical current through electrodes attached to the skin. A 2019 Cochrane review included seven trials involving 651 people with chronic neck pain. The data do not allow for a confident conclusion regarding its effects.²³ Physioactif emphasizes education, movement, and exercises.
• Therapeutic ultrasound: A device transmits sound waves to the tissues. A review of twelve trials examined various types of neck pain, with widely varying protocols and results.²⁴ It does not establish a treatment program for acute torticollis. Physioactif does not promote this modality.
• Therapeutic laser: This device uses light on a specific area of the body. A review of eight trials on various types of neck pain concludes that the evidence remains inconclusive, with significant differences between the studies.²⁵ These results do not support the claim that laser therapy has an effect on torticollis.

These passive methods are no substitute for education, gradual movement, and appropriate exercises.

Cervical Traction

Cervical traction applies a pulling force to the neck. A 2025 study examined a single session in 18 people with chronic pain of unknown cause and in 17 people without pain.²⁶

• Indications: mild to moderate chronic pain, excluding acute torticollis.
• Measurement: resistance of the trapezius and a scalene muscle on the side of the neck to deformation measured by ultrasound.
• Time: measurements taken during the draw and after the session.
• Limitation: This study does not measure relief from torticollis or daily activities.

A mechanical measurement taken during application is not, on its own, sufficient to recommend this treatment. Traction is not one of the approaches recommended in this guide.

Therapeutic Heat

Heat may provide temporary relief. A 2026 review identified two small trials, involving 67 participants, on the use of dry heat for neck pain of unknown cause. The studies reported reduced pain and discomfort, but their limitations prevent us from confidently recommending or advising against the use of heat for everyone.²⁷ It does not repair tissue or lengthen a muscle. Its use remains optional:

• A temporary feeling of comfort in some people
• A response that varies depending on heat sensitivity
• Use with caution to avoid burns
• An optional supplement to take before movement or exercise

Let's now move on to the exercises you can do, first under physiotherapy supervision, then at home.

What exercises can be done for torticollis?

Exercises for a stiff neck include gentle rotations, head tilts, and gradual neck strengthening. The movements should remain comfortable and appropriate for your condition. If you’ve experienced an injury or notice any warning signs, seek medical advice before beginning. The physical therapist will determine the directions, intensity, and number of repetitions based on your evaluation.

Sternocleidomastoid Muscle Stretches

First step based on tolerance and assessment :

A sternocleidomastoid stretch combines several directions. First, have someone check your form and the side you’re working on. The program from NISMAT, a sports medicine institute, describes this seated variation:

• Sit with your back supported and your shoulders relaxed.
• Gently turn your head to look over your shoulder.
• While maintaining this rotation, look up slightly, without completing the movement or pulling your head back.
• The physical therapist will adjust the duration, number of repetitions, and side based on your evaluation. The exercise should feel light.
• Breathe normally, then slowly return to the center. Stop if you feel dizzy or experience increased pain.

Next step, depending on tolerance and progress :

Once acute pain has decreased:

• Return to the center, looking straight ahead; strengthening exercises don't necessarily have to be done in a stretched position.
• Place your hand on your forehead or the side of your head, then press lightly against your hand without moving your head. This contraction, which involves no visible movement, is called isometric.
• The duration of the contraction is adjusted based on how easily the position can be maintained and on the symptoms experienced during and after the exercise
• The number of repetitions is determined based on the quality of the movement and the response of the symptoms; there is no set number of repetitions.

Exercises to Move Your Neck

These exercises help you gradually regain range of motion in areas that have become stiff. Move slowly and stop before you feel a sharp pain. The Cambridge physical therapy guides describe rotation, tilting, and flexion exercises that can be tailored to each individual.

• Gentle rotations: Turn your face to the right, return to the center, then turn to the left, within a comfortable range.
• Tilting: Gently bring one ear toward your shoulder without lifting the shoulder, then return to the center before repeating on the other side.
• Look down and up: Gently lower your chin, return to the center, and then look up slightly if this movement feels comfortable.

Start with a few slow movements. If the pain increases or remains severe after exercising, reduce the range of motion and ask for an adjustment. If you experience dizziness, new weakness, or new numbness, stop immediately and have the symptom evaluated.

Progressive Cervical Strengthening

Depending on tolerance and objectives:

• Resistance in multiple directions: Place your hand on your forehead, behind your head, or to the side. Gently push against your hand while keeping your head still. Relax between repetitions. The physical therapist determines the directions and duration, as described in the NHS Bexley exercise sheet.
• A gentle “yes” movement while lying down: Lie on your back with your head supported by a small towel. Make a slight “yes” gesture without lifting your head or pressing it into the towel. Keep your mouth relaxed and breathe. NHS South Tees recommends this exercise to work the deep muscles at the front of the neck; it should remain easy and pain-free.

Strength training can improve strength and the ability to perform daily activities. A 2021 review on neck physical therapy reports benefits of strength, endurance, and postural maintenance exercises for chronic pain, compared to no treatment or a placebo, or when added to another treatment.²¹ Endurance is the ability to sustain or repeat an effort. These findings do not provide a single, standardized program for acute torticollis.

Cervical retraction: moving the head backward without tilting it

Retraction involves sliding the head backward while keeping the gaze level. The OPPQ blog features a neck exercise;⁵ The variation below follows the description of the Cambridge retraction and distinguishes this movement from the slight horizontal “yes” nod.

• Sit with your back supported.
• Place your feet on the floor or choose another stable and comfortable position.
• Keep your jaw relaxed and look straight ahead.
• Gently tilt your head back, tucking your chin in slightly, without looking down or up.
• Keep your back still; the movement comes from your neck.
• Hold the position briefly as instructed, without holding your breath.
• Slowly return to the starting position.
• Adjust the number of repetitions with your physical therapist based on how you respond during and after the exercise.

Retraction works on a specific direction of movement; it should not be used to force the head into an “ideal” position. Its effectiveness is judged by the improvement in comfort, movement, and daily activities. It does not replace the small “yes” movement used to engage the deep muscles.

Important: If an exercise is new, difficult to understand, or causes your symptoms to worsen over time, ask for a demonstration and have the program adjusted.

A common question: how long does it take to recover from a stiff neck?

How long does a stiff neck last?

Acute simple torticollis often improves within a few days; some symptoms may last longer. The course of the condition described by the Royal Berkshire Hospital does not apply to congenital torticollis or dystonia. If your neck does not begin to improve after a few days, seek medical advice.

Possible course of the disease without treatment

First stage, based on symptoms and associated signs

• Intense pain and severe limitation of movement
• Significant difficulty turning the head
• Possible muscle contractions, either continuous or intermittent
• Possible self-management with local heat, gentle movements within a comfortable range

The course of the condition varies from person to person

• In a simple acute episode, improvement often occurs after a few days. Recent studies on neck pain in general also report an initial decrease in pain, but some pain persists: this population is not limited to torticollis.¹
• Movements may become easier as the pain subsides.
• Gradual return to daily activities

Future developments are uncertain; there is no guarantee that a resolution will be reached by a specific date

• Reenacting useful movements, such as looking from side to side
• Possible slight residual pain
• Variable course; if symptoms persist or worsen, a reevaluation is warranted

The progression of the condition alone does not determine whether a medical consultation is necessary. A medical consultation may be helpful when symptoms limit daily activities, persist, or worsen.

Possible improvement with physical therapy

A consultation within the first few days can help confirm the diagnosis, restore mobility, and determine relief strategies; there is no specific time frame²⁸ :

• A variable response from the very first sessions, assessed based on pain, movement, and activities
• Monitoring Changes in Mobility
• An exercise program tailored to your goals and activities

Response to treatment varies; the treatment plan is adjusted based on changes in symptoms, mobility, and activities.

Factors Related to Progress and Monitoring

• Pain and Limited Activities: In cases of neck pain in general, more severe initial pain may be associated with a more difficult recovery. Follow-up care also assesses which movements have become possible again.
• Other symptoms —such as headaches, arm pain, or signs of nerve involvement—may affect the necessary treatment and tests.
• Patient background: Previous episodes, other types of pain, and difficulties at work may be associated with a less favorable course of neck pain. Age or activity level alone are not predictive factors.²¹
• Early intervention: An early consultation may be helpful if the pain is severe, if the diagnosis is unclear, or if the symptoms are preventing you from carrying out your activities.
• Performing the exercises: Describe the movements you make, which ones are difficult, and their effects. The program can be adjusted rather than continued if your condition worsens.

Pain that does not improve after a few days, a stiff neck that lasts more than eight days, or repeated episodes require a medical evaluation within the next few days, according to the French National Health Insurance (Assurance Maladie). The warning signs listed below require a more immediate medical evaluation.

When to consult a physiotherapist for a stiff neck?

A physical therapy appointment is recommended when a stiff neck limits your movement or activities, or if it recurs frequently. Severe pain, worsening symptoms, or signs of nerve involvement also require medical attention. Any emergency should be evaluated before your physical therapy appointment.

Recommended consultation criteria

A consultation may be helpful if :

• Your stiff neck is limiting your daily activities, such as work, driving, or personal care; if you’re experiencing severe pain, you should seek medical advice first.
• Have you had a history of recurrent stiff neck over the past year?
• The pain is progressively worsening instead of improving
• Do you need advice on how to adjust your movements or activities?

An evaluation is also recommended if :

• Your symptoms persist without any noticeable improvement
• You frequently experience painful neck episodes without having had a complete assessment
• The pain radiates from the neck down into one arm (possiblyrelated to a nerve in the neck )

Warning signs requiring URGENT consultation (emergency room)

Go to the emergency room immediately if your neck pain is accompanied by signs that could indicate a serious infection:

• High fever with neck pain, especially accompanied by chills.
• A very severe headache or one that is getting worse.
• Very stiff neck, especially with sensitivity to light; do not force your chin toward your chest to test yourself.
• Repeated vomiting.
• Unusual sensitivity to light.
• Confusion, difficulty waking the person, or unusual behavior.

Meningitis is an infection of the membranes surrounding the brain and spinal cord, the nerve cord that transmits messages between the brain and the body. The NHS reminds the public that you should not wait for all symptoms to appear or for a rash to develop before seeking help. A rash that does not fade when pressed, a first seizure, or suspected meningitis also require immediate medical attention.

Call 911 if severe neck pain is accompanied by difficulty speaking, seeing, or walking; paralysis; or signs of distress, such as sweating, dizziness, or impaired consciousness. A fever accompanied by difficulty swallowing or breathing also requires urgent medical attention. After a severe blow to the head, or following any neck injury in a person over 65, have the neck evaluated in the emergency room.¹⁷

Seek medical advice the same day if you experience heaviness or tingling in an arm, clumsiness in the hand, difficulty moving the hand, pain that wakes you up at night, or pain following even a minor injury. Do not wait for your regular appointment if weakness develops or worsens.¹⁷

In rare cases, new, unusual, and unexplained neck pain or a headache may be the only symptom of a cervical artery dissection. A dissection is a tear in the inner wall of an artery in the neck. In a hospital registry, 20 out of 245 people—or 8 percent—had pain as their only symptom. This figure comes from people who were already hospitalized and does not reflect the risk among all individuals seeking medical care for neck pain. Urgent evaluation is warranted.²⁹

Torticollis in Children

If your child has torticollis:

• Congenital torticollis : A persistent preference for a certain head position or a tilted head in an infant warrants early evaluation. The program focuses on mobility and development, with exercises taught to parents.¹¹
• Acute torticollis in children: Seek medical advice the same day, even if there are no other symptoms. Fever, trauma, altered general condition, or previous warning signs may require emergency care.¹⁷

Recurrent or Chronic Torticollis

If you suffer from recurring stiff neck:

• An evaluation can examine activities, movements, symptoms, and associated factors without attributing recurrences to a specific posture or weakness.
• A personalized program can help you work on the movements, strength, and habits relevant to your activities
• In some cases, a follow-up medical consultation may be recommended to rule out underlying conditions (osteoarthritis, which affects the joints in the neck, or excessive movement between certain vertebrae)

Let's now look at prevention strategies to avoid future episodes of torticollis.

How to prevent torticollis?

Regular exercise can reduce the risk of new episodes of neck pain; varying your posture and adjusting your work or sleep habits can also improve comfort. These strategies do not guarantee the prevention of torticollis. The five prevention trials focused primarily on office workers who were pain-free at the start, rather than on people with recurrent torticollis.⁷

Sleep Ergonomics

Pillow Selection :

• On your side, try a height that supports the space between your head and the mattress without pushing your head toward your shoulder.
• When lying on your back, make sure the pillow doesn't cause your head to tilt too far forward.
• A slight adjustment to the thickness may be all it takes; there's no one-size-fits-all height.
• General rule: When lying on your side, choose a comfortable pillow that allows you to change positions

Recommended Sleeping Positions :

• On your back: Choose a comfortable support that allows you to change positions.
• On the side: Adjust the support so you stay comfortable and can move freely.

Adjust your position if it becomes uncomfortable :

• On your stomach: This position isn't prohibited; change it if it becomes uncomfortable.
• You can use multiple pillows as long as the arrangement remains comfortable; there is no single height that prevents a stiff neck.
• Whether you're on a sofa or in an armchair, adjust the support and change your position if necessary.

Work Posture

Computer Workstation Ergonomics :

• Position the main screen in front of you so you don't have to keep your head turned throughout the task.
• Adjust the distance from the screen based on your vision, comfort, and the size of the text.
• You can try resting your forearms on the armrests if it makes you more comfortable.
• Movement breaks: Take a break from a long task to stand up, walk around a bit, or gently turn your head.

Phone Use :

• Avoid holding the phone between your ear and shoulder for long periods of time if this position becomes painful.
• Earbuds can be used for long phone calls if you find them comfortable.
• Change your position when using the phone becomes uncomfortable.

Preventative strengthening exercises

Example of cervical retraction to be adapted :

The retraction described above causes the head to move backward without tilting it. It can be part of an exercise program; the exercise described on the OPPQ blog does not, on its own, prove that it prevents torticollis.⁵

Multi-directional Isometric Strengthening :

Gently pressing your head against the therapist’s hand allows you to build strength without visible movement. Alternate the directions chosen with the physical therapist, breathing normally. Gradually increase the effort based on your response; there is no single recommended intensity for acute torticollis.

Stress Management

Stress can make some people more aware of neck tension, but the exact link to an episode of torticollis has not been established³⁰. A 2016 review of studies does, however, find an association between stress and persistent neck or arm pain³¹. However, the studies varied too widely and were of low quality, so it cannot be concluded that stress causes an episode of torticollis.

Strategies that can be discussed based on your needs:

• Breathe slowly and comfortably, letting your abdomen and ribs move without shrugging your shoulders.
• Progressive relaxation: Gently tense and then release different muscle groups, taking care not to strain your sore neck.
• Regular physical activity, based on your abilities and preferences.
• The amount of sleep needed varies from person to person; there is no set amount of sleep required to prevent a stiff neck.

Gradually resume fast movements

A rapid rotation may be uncomfortable, but it does not necessarily indicate that a joint is locked.

Recommendation : Resume the movements gradually, at a pace that feels comfortable to you, without assuming that your joints are stiffer when you wake up.

It is also important to differentiate torticollis from other neck conditions that may seem similar.

What is the difference between torticollis and other neck pains?

Torticollis primarily refers to a tilted or turned head position; cervicalgia simply means neck pain; a herniated disc refers to a disc that has bulged; and a sprain refers to an injury to the ligaments. Ligaments are strong bands that connect bones. These conditions may overlap. The patient’s history and a combination of tests guide the diagnosis, although no single sign always identifies the cause.^{8, 4} Whiplash involves a sudden acceleration followed by deceleration of the head; it can cause various neck injuries.

Neck pain

Torticollis :

• Turning the head can become very difficult, often more so on one side.
• An acute episode begins suddenly, sometimes upon waking.
• Pain can limit movement in several directions.
• The head can remain tilted and turned toward a less painful position.
• A single acute episode often improves within a few days; if symptoms persist, seek medical advice.

General Neck Pain :

• The term refers to pain in the neck region, whether localized or diffuse.
• The pain may begin suddenly or gradually.
• It may be accompanied by limited movement, though this is not required.
• No specific head position is required to experience neck pain.
• The duration depends on the cause; some pain persists or recurs.

Torticollis and Cervical Disc Herniation

Torticollis :

• The pain often affects the neck and can radiate to the head or shoulder.
• Pain that radiates down the arm warrants an evaluation for possible nerve damage.
• Numbness or weakness in the hand should not automatically be attributed to torticollis.
• An examination of muscle strength, sensation, and reflexes completes the evaluation.

Cervical disc herniation :

• A herniation is the protrusion of a portion of the disc. It may be visible on an imaging study without causing any symptoms.
• If the herniated disc irritates or compresses a nerve root, it can cause pain in the arm, tingling, numbness, or weakness.
• Coughing, sneezing, or exertion can cause symptoms to change; this reaction alone does not confirm a hernia.
• An imaging study of the neck may be recommended based on the symptoms and physical examination, particularly if a serious condition is suspected. It is not automatically performed for every case of pain.
• In studies of cervical herniation with nerve root involvement, significant improvement generally occurred within four to six months. Complete recovery was reported between 24 and 36 months in approximately 83% of the study participants. This 2014 review was based on few high-quality studies; the incidence of recurrence remained unclear.³²

For more information on cervical herniation, consult our guide on cervical disc herniation.

Torticollis and Whiplash

Torticollis :

• Acute simple torticollis can occur without any accident or impact.
• Waking up in pain with the head tilted to one side is a possible presentation.
• The limitation may be more pronounced on one side.
• After an injury, it is important to check for possible injuries before concluding that it is simply a stiff neck.

Whiplash :

• A sprain is an injury to the ligaments. An accident or impact can stretch these tissues beyond their limits.
• "Whiplash" describes the movement involved in the accident; it does not, on its own, indicate which tissue is injured.
• Pain and stiffness can affect the neck and shoulders, on one side or both.
• Headaches, dizziness, or difficulties with memory or concentration following a blow to the head also require evaluation.
• Recovery varies depending on the injuries, symptoms, and the individual

To learn more about whiplash, see our guide on whiplash.

Comparison Table of Available Formats

Characteristic	Torticollis	Neck pain	Cervical Hernia	Whiplash
Onset	Often rapid, sometimes upon waking	Rapid or gradual, depending on the cause	May be asymptomatic; onset of pain varies	After an injury, sometimes with delayed pain
Head Rotation	Rotation is often difficult, especially on one side	Possible restriction, without mandatory blocking	Movement is sometimes limited by pain	Possible stiffness following the injury
Pain that spreads	May extend toward the head or shoulder; arm should be evaluated	The term does not specify the path of the pain	Possible symptoms in the arm or hand if a nerve root is affected	Neck and shoulders may be affected; check for neurological signs
Progression	Often a few days for simple acute cases	May persist or recur depending on the cause	Improvement often occurs within 4 to 6 months in cases of nerve damage, according to the cited review	Varies depending on the injuries and symptoms
Neck Position	Head often tilted and turned	No mandatory characteristic position	No single position indicates a hernia	No position indicates a ligament injury

If you have concerns about your neck pain, a physical therapy evaluation can identify any worrisome signs and guide your treatment plan.

What are the next steps if you have a stiff neck?

The next steps are to check for warning signs, resume comfortable movements, and seek an evaluation if the pain persists, worsens, or limits your activities. The emergencies described above take priority over home monitoring.

Decision-Making Guidelines

First period: acceptable strategies

• Heat can be tried briefly if it provides relief; there is no one-size-fits-all dose.
• Gentle movements within a comfortable range (do not force it)
• Gradual resumption of daily activities based on symptoms and associated signs
• Before taking any medication, consult a pharmacist or doctor based on your health condition and any other treatments you are taking.

Next period: monitor developments

• If progressive improvement: continue self-management
• If the pain persists or worsens: seek medical advice; a physical therapist can then adjust your movements and activities.
• Track your range of motion daily

If symptoms persist or worsen: Consultation recommended

• If symptoms persist or worsen, a new evaluation is warranted
• A professional evaluation assesses movements, symptoms, and associated signs
• The plan is adjusted based on the response and the limited activities

Visit Physioactif

The physical therapists at Physioactif can assess neck movement, restricted activities, and symptoms that require a referral to a doctor. During your first visit, we will:

1. Let's assess your symptoms and movements, as well as any signs that warrant medical attention
2. Let's choose strategies tailored to your risk tolerance, your activities, and your goals
3. Let's teach exercises tailored to help you develop the movements and strength needed for your activities
4. Let's tailor the program to your progress and needs

The response to an initial session varies; the treatment plan is adjusted based on changes in symptoms and function.

What to Expect During Your First Consultation

Duration : Please confirm the duration when making your appointment Process :

1. History of symptoms: onset of torticollis, circumstances, activities that are difficult to perform, and other symptoms.
2. Physical examination: movements performed by you or with guidance, tender areas, and nerve testing if necessary.
3. Initial treatment: Strategies are selected based on the evaluation, tolerability, and treatment goals
4. Instruction on the exercises: demonstration and performance of the initial movements with the physical therapist.

What to Bring :

• List of Your Current Medications
• Recent test results, if you have any: X-rays or magnetic resonance imaging (MRI), a test that produces detailed images using a magnet. No new tests are required just to prepare for the appointment.
• Any questions or concerns you've noted in advance

Before Your Appointment

To make the most of your consultation:

• Note down any movements that worsen your pain (like turning your head left or right, tilting, etc.)
• Identify activities that are limited by your torticollis (such as driving, working, or sleeping)
• Observe what helps relieve your pain (like heat, a specific position, or a particular movement)
• Choose comfortable clothing if it makes it easier to examine your neck and shoulders

A Reassuring Message

Acute simple torticollis often improves within a few days. Other recent cases of neck pain with no known cause may persist: in a review of seven studies, the average intensity of the pain remained significant after one year.¹ In the absence of concerning signs, treatment focuses primarily on gradual movement, advice, and symptom relief. Pain that is persistent, recurrent, or accompanied by new symptoms warrants further evaluation.

Physical therapy can help you gradually resume your movements and activities, and then choose appropriate exercises. The best time to seek care depends on the severity, progression, and associated symptoms.

Seek medical advice if your symptoms persist, recur, worsen, or cause you concern. An evaluation can help determine the next steps, though it does not guarantee relief.

References

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