diploma of remedial massage case studies aetiology of the head and neck n.
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Diploma of Remedial Massage Case studies Aetiology of the Head and Neck. Head and Cx. Common pathologies cont: Whiplash Wry neck / Torticollis. Whiplash. Acceleration/deceleration injury Often MVA, but may be high velocity sport or impact injury Symptoms can vary++

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head and cx
Head and Cx

Common pathologies cont:

  • Whiplash
  • Wry neck / Torticollis
  • Acceleration/deceleration injury
    • OftenMVA, but may be high velocity sport or impact injury
  • Symptoms can vary++
  • Can last up to 9/12 if not proper initial Rx
  • Acute, Sub-Acute and Chronic phases

Acute Phase:

  • 2 – 3/52 post accident
  • Hyperextension of SCM, can be torn or strained
  • Anterior longitudinal lig may be pulled out &/or annulus disc may tear away from vetebral body
  • Articular facet joints are hyperextended

Acute Phase cont.:

  • Very little pi and FROM initially
  • Gradual increase in pain & stiffness over 48 hours


  • If in doubt – refer on!!!
  • Aim to relax Cx region without becoming stiff
  • Minimal Rx, STM (no DT), gentle jt mob’s (assess ROM prior to jt movement)
  • At home: heat or ice and supported posture (collar?)
  • Keep active, normal ROM within pi limits
  • Reassess 1/52

Subacute Phase:

  • 2 – 10/52
  • General muscle guarding will reduce and allow better assessment
  • c/o deep dull ache, possible referral to head, interscapular or upper limbs
  • Complete neurological assessment should be performed
  • VBI, ULTT, Spurlings, Distraction test
  • If in doubt – refer on!!

Subacute Phase cont:


  • Aim = restore flexibility
  • STM most effective now as muscle guarding is reduced
  • Stretching and mobilisation more comfortable than previous
  • Adhesions haven’t become solid scar tissue yet
  • Care to not over stretch facet joints – swelling and deep tissue damage not visibly obvious
  • No gross passive stretching, gentle only

Chronic Phase:

  • Begins when acute healing over
  • Muscles will be shortened and fibrotic
  • Deep pi, aching & fatigue & referral to head shoulder and intrascapular region
  • Hyperactivity of ant Cx and forward head posture


  • Progress gradual – check expectations: yours & clients
  • Responds well to gentle repetitive stretching, postural education and chin tucks
acute wry neck torticollis
Acute Wry Neck / Torticollis
  • Relatively common
  • Sudden onset of sharp neck pain
  • Associated deformity and limitation of ROM
  • Occurs usually after a sudden quick movement or after waking
  • Two types
    • Discogenic
    • Apophyseal

To successfully differentiate between these two similar conditions, the key is how they presented, and the location of pain.

acute wry neck torticollis1
Acute Wry Neck / Torticollis


  • Normally occurs in the younger population < 30yrs old
  • Presents from a sudden movement, fixing the neck into a flexion, rotation and lateral flexion position away from the affected joint, resulting in sharp pain and very limited cervical mobility.
  • The pain presentation is local.
acute wry neck torticollis2
Acute Wry Neck / Torticollis



  • The initial aim of treatment is to reduce pain, with ice, TENS, or heat
  • Gentle manual techniques can provide success in releasing muscle spasm around the affected joint.
  • Joint mobilisation, or manipulation provides great success in this case. Refer to appropriate practitioner. – Never try to move the joint yourself unless you have had appropriate training.
acute wry neck torticollis3
Acute Wry Neck / Torticollis


  • Can affect all populations, although is more common in older age groups.
  • Presents gradually after the neck has been in an awkward posture for an extended period of time.
  • Pain can extend over the local affected area and into shoulder and upper thoracic areas of affected side.
acute wry neck torticollis4
Acute Wry Neck / Torticollis



  • The management of this condition is better treated by releasing the muscle spasm, and trigger points via manual techniques and dry needling.
  • The use of a collar for the initial 24 hours of presentation can provide an option to prevent further muscle spasm and control pain, also NSAID’s such as voltaren for the first few days can help.
  • Manipulation in this situation doesn’t have the successful outcome
acute wry neck torticollis5
Acute Wry Neck / Torticollis



  • This condition almost always is a secondary condition to the activation of myofascial trigger points in the cervical muscles.
  • Key muscles include Sternocleidomastiod, splenius cervicis and splenius capitus of affected side.

Practice assessment, development of Rx plan and Treatment of a client with:

  • Chronic whiplash
  • DiscogenicTorticollis