Rehabilitation Exercise for Spasmodic Torticollis

EXCERPTS FROM

The following materials are reproduced with the kind permission of Demos Medical Publishing. Thanks to the generosity of the publisher and the authors, books are available at discounted prices from NSTA, or you can buy them from the Demos Medical Publishing website or from Amazon.com. 

Chapter 1:  What is Spasmodic Torticollis?

     "You are reading this book presumably because you suffer from tremor, abnormal unwanted movements, or crooked posture of your head and neck.  This is an uncommon condition, and you may have been suspected of having a number of underlying causes for it.  A number of different medical conditions may manifest as an abnormal head and neck posture, and the term torticollis is loosely applied to many of them.  In fact, torticollis simply means "twisted neck."  This book deals specifically with the neurological condition known as spasmodic torticollis (ST), also known as cervical dystonia.  Other causes of abnormal posture will be briefly discussed to differentiate them from ST..." 

Exercise 1: Splenius Capitis, Levator Scapuli, and others

This exercise is designed to stretch and relax muscles running down the back of your neck on either side of your neck bones, as well as muscles connecting these bones to your shoulder blades.  It may be useful for individuals who have a component of rotational torticollis plus retrocollis, as in the figure below:

In the figure above, the head is turned slightly left and backwards, and the muscles in the back of the neck on the left side are most active; the exercise below illustrates stretching of these left- sided muscles.  If your head usually tends to turn toward your right and backwards as in the figure below then the muscles in the back of your neck on the right side are most active, and the procedure below needs to be reversed.

This exercise is performed in a seated position on a chair that allows you to grasp and hold underneath:

 Alternatively, it can be performed in the standing position next to object that has a handhold at approximately the mid- thigh level.

Grasp the handhold with your left hand.  Slowly lean your body forward and toward the right side, and at the same time allow your left shoulder to relax and be pulled downward while keeping your grip on the handhold.  You may feel a pulling or stretching sensation deep in your shoulder muscles.  Next turn your head about 45 degrees toward the right, and then tilt your head into a direction away from your left arm.

As you do this, feel the stretch in muscles of your shoulder and the back of your neck on the left side.  Hold this position for 30 seconds.  You may feel the sensation of stretch begin to subside.  At this point, you may actually be able to stretch a little further.  To make the stretch even more effective, reach behind for your head with your right hand and gently help pull along the direction of the stretch.  Hold this position for another 10 seconds, then slowly release and relax.

Exercise 2: Sternocleidomastoid on One Side

This next exercise is intended to provide stretch to one of the major muscles which runs diagonally across the front and side of the neck, and has attachments at the collar bone and the back of the skull.  Known as the sternocleidomastoid (SCM), it is one of the muscles most frequently involved in spasmodic torticollis.

Many people have difficulty understanding which of the two SCM they need to stretch.  Remember that if your head usually tends to rotate toward your right, as in the figure below, then it is your left SCM that is most active and needs to be stretched.

If your head usually tends to rotate toward your left, as in the figure below, then it is your right SCM that is most active and needs to be stretched. 

If still in doubt, consider that botox injections are placed in the most active muscles, and therefore the SCM that receives the injections is probably the one to stretch.

We will illustrate stretching for the left SCM.  The movements in this particular exercise are somewhat complex, and will require some patience and practice in order to be performed correctly.  The entire procedure may be reversed if you require stretching of the right SCM.

In order to stretch the left SCM, begin in a seated or standing position.  Grasp the handhold behind or underneath you with your left hand:

Now lean your body slightly so that your left shoulder is pulled downward.  If you relax your shoulder, you will find your collarbone is pulled downward.  Now slowly rotate your head toward the left side (the side being stretched).  Once your head has been rotated as far as it can comfortably go, begin tilting your head backward so that your chin moves toward the ceiling.  Now tilt your head slightly so that your right ear moves closer to your right shoulder:

As you do this, you may feel a stretching sensation from your left collarbone to the side of neck.  Hold at the point you feel stretch but not pain.  After 30 seconds, the feeling of stretch may begin to subside.  At this point, you may increase the stretch a little further by cupping the fingers of your left hand around your chin and slowly and gently pushing upwards.  As always, stop if you feel pain.  Hold this position for 10 more seconds, then slowly release and relax.

Exercise 3: Sternocleidomastoid on Both Sides

The next exercise is a simple alternative stretch for the SCM that stretches both sides at once, and may be useful for individuals with anterocollis, as in the figure below.

This is best done in a seated position in a chair with some support for the back.  Simply grasp a handhold behind or underneath you with both hands, as in the figure below.

Slowly lean your body backward to pull down your shoulders.  Allow your shoulder muscles to relax, pulling down your collarbones.  Keep your head in the neutral position facing directly ahead.  Now, slowly tilt your head backward so that your chin moves toward the ceiling, as in the figure below.

You should feel a stretching sensation in the front and side of your neck.  Do not hunch up the shoulders.  Remember to allow your shoulders to relax and be pulled downward.  Hold at the point where you feel stretch but not unusual pain.  Hold this position for 30 seconds, then slowly release and relax.