Cervical Dystonia: What Exactly is This?

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Cervical dystonia, also called spasmodic torticollis, is a rare neurological disorder.

According to the National Organization for Rare Disorders, approximately 60,000 individuals in the United States alone are affected by cervical dystonia.

Seeing as this is not a common diagnosis, it’s understandable that many may not have even heard of cervical dystonia.

For this reason, let’s take a closer look at what exactly cervical dystonia is, how it affects the joints and soft tissues around the neck, and how it can be managed.

What is Cervical Dystonia?

what is cervical dystonia?

Cervical dystonia occurs when involuntary muscle contractions cause abnormal movements and positions at the head and neck.

These involuntary movements, or muscle spasms, cause the head to tilt or turn to one side.

This movement disorder unfortunately will typically cause neck pain in most cases because of the compromised position the neck muscles and joints are positioned in.

While no cure has been found, there are treatment options available for people with cervical dystonia.

Causes of Cervical Dystonia

Cervical dystonia can be classified as an isolated or secondary condition.

Isolated Cervical Dystonia

An exact identifiable cause for isolated cervical dystonia has yet to be determined.

Some with isolated dystonia have a family history of this movement disorder, with some cases involving genetic mutation have even found.

Similar to most neurological disorders, it’s thought that cervical dystonia may occur from abnormal signals and messaging from the nervous system, which causes the involuntary movements.

There are usually no other abnormal symptoms associated with isolated dystonia.

Secondary Cervical Dystonia

Sometimes cervical dystonia can develop as a result of another condition, injury, or medication.

Certain drugs have been found to potentially cause cervical dystonia, such as anti-psychotic medication.

The abnormal head tilts and neck movements can occur with other degenerative brain diseases or neurological disorders.

There is also thought to be a contributing factor of cervical dystonia in cases of trauma.

Conditions That May Mimic Cervical Dystonia

It’s important to consider that certain conditions may mimic the symptoms of cervical dystonia. This tends to be the case though more often with children versus adults.

If a child has a slipped or fractured vertebrae causing instability in the neck, this could lead to an abnormal head tilt; however, the appropriate treatment would be from an orthopedic specialist versus a neurologist, such as is the case with true cervical dystonia.

Congenital infantile torticollis occurs when babies are born with a naturally shortened neck muscle. This leads to abnormal head and neck positioning.

Affected Individuals

While cervical dystonia can occur to any individual at any age, it most commonly occurs in middle age. Women tend to be most affected versus men.

It’s more uncommon to find this disorder in children, although it can still occur.

You are also considered to be at higher risk for developing spasmodic torticollis if you already have a family history of it.

Symptoms of Cervical Dystonia

Early signs of cervical dystonia symptoms usually begin gradually. Some may have periods of remission of symptoms, but it rarely ever resolves.

The most common symptoms of cervical dystonia involve abnormal head and neck postures, which can affect any of the neck muscles.

Some may also have more abrupt head movements in addition to the sustained head tilts.

Most with cervical dystonia will develop neck pain in the affected muscles and joints with these sustained postures, as well as headaches.

It’s common for cervical dystonia to worsen with increased stress.

As a result of cervical dystonia, other secondary issues can develop from the abnormal positions:

  • Cervical spine arthritis
  • Cervical stenosis
  • Cervical nerve root compression with radiating symptoms

While acute dystonia may demonstrate more mild symptoms initially, as the disorder progresses, the symptoms can become more severe and debilitating.

Head Postures Commonly Seen with Cervical Dystonia

There are certain head posture positions that can be seen with spasmodic torticollis.

  • Torticollis: Rotation of the head sideways with twisting of the chin towards one shoulder.
  • Anterocollis: Tilting of the head forward.
  • Retrocollis: Tilting of the head backward.
  • Laterocollis: Tilting of the head sideways.
  • Combination head postures

The most common dystonia head posture is torticollis, with rotational twisting of the head to one side.

Making a Diagnosis of Cervical Dystonia

Upon a physical examination by an appropriate healthcare provider, usually a neurologist, an appropriate diagnosis of cervical dystonia can be made.

The classic clinical features of cervical dystonia will be able to be identified typically from the physical exam and medical history alone, however, some may still recommend imaging studies to rule out other possible causes.

Magnetic resonance imaging, or an MRI, will show if there are any spinal or soft tissue abnormalities causing the head posture.

Blood tests may also be ordered to rule out other disorders that could mimic spasmodic torticollis symptoms.

Usually testing will show normal results if it’s truly isolated cervical dystonia that is occurring.

Medical Treatment for Cervical Dystonia

Once a diagnosis of cervical dystonia has been made, it’s important to initiate treatment for the symptoms in order to provide pain relief.

As cervical dystonia may often cause significant physical pain, it’s important to manage this immediately.

Botox

Botulinum toxin is a standard treatment method for cervical dystonia. It’s commonly given in the form of botulinum toxin injections to calm down and relax the spastic muscle contractions.

Botulinum toxin will usually be given on average every 3-4 months to maintain control over muscle spasms and pain.

Botulinum toxin injections are usually given via use of guided ultrasound or EMG (electromyography) tools.

Additional Oral Medications

Cervical dystonia may also be treated with other oral medications.

The goal of these medications, similar to botulinum toxin drugs, is to relax the over-stressed, spastic muscles.

Physical Therapy

physical therapy for cervical dystonia

Physical therapy treatment can further help with controlling and relieving painful symptoms associated with cervical dystonia.

Your physical therapist will likely include a combination of exercises to address the muscle imbalances from the head postures, modalities such as heat and electrical stimulation, and manual therapy such as massage, to further relax the muscles.

Sensory tricks may also be utilized to provide a brief relief from muscle spasms. Some of these may include touching the opposite side of the face or back of the head. It may even be recommended to try a cervical collar to assist in improving head position and providing sensory stimulation.

Exercises for cervical dystonia will attempt to improve available range of motion and strength of weakened muscle groups.

We’ll look at a few examples of exercises your physical therapist may practice with you to address symptoms. These will focus on the primary issues of head and neck position, as well as posture.

1. Scapular retraction:

scapular retraction
scapular retraction
  • In a sitting or standing position, try to sit as straight as possible. Aim to position the head in as much of a forward and neutral position as possible.
  • Gently pull the shoulders back and squeeze the shoulder blades together.
  • Hold for 5 seconds, then relax.
  • Repeat 10-15 repetitions for 2-3 sets.

2. Neck range of motion:

Try to practice gently moving the head and neck in each possible direction. This will include forward bending, backward bending, side bending and rotation.

Make sure to move very gently and slowly in each direction, attempting to keep your muscles as relaxed as possible. Sometimes it can be helpful to apply a heating pad on the neck muscles during this for further relaxation.

a. Forward Bending
forward bending
  • Bend the head forward until you feel a comfortable stretch on the back of the neck.
  • Hold for 2 seconds, then return to your starting position.
  • Repeat 5-10 repetitions for 2 sets.
b. Backward bending
  • Bend the head backward. Do not push into pain.
  • Hold for 2 seconds, then return to your starting position.
  • Repeat 5-10 repetitions for 2 sets.
backward bending
c. Side Bending
side bending
side bending
  • Bend the head to one side at a time, practicing on both the left and right sides.
  • You should keep your nose pointing forward and try to move your ear towards your shoulder.
  • Really key in on turning away from the side the cervical dystonia is naturally pulling you into.
  • Hold for 2 seconds, then return to your starting position.
  • Repeat 5-10 repetitions for 2 sets.
d. Rotation
neck rotation
neck rotation
  • Turn the head one side at a time, practicing on both the left and right sides.
  • Make sure you don’t force the motion.
  • Key in on turning away from the side the cervical dystonia is naturally pulling you into.
  • Hold for 2 seconds, then return to your starting position.
  • Repeat 5-10 repetitions for 2 sets.

3. Thoracic extension in a chair:

thoracic extension in a chair.
thoracic extension in a chair.
  • Begin sitting in a chair with back support. Position your hands behind your head for support.
  • Slowly lean back into the chair, extending slightly backward.
  • Hold for 5 seconds, then return to your starting position.
  • Repeat for 10 repetitions for 2-3 sets.

One Simple Exercise to Strengthen Your Posture

Posture is an important but often overlooked component of a healthy lifestyle. Make time to do this posture exercise every day, and you will be on the road to proper posture.

This exercise can help you fight back against the forces that overcome good posture, like sitting at a desk for hours and slouching over your phone.

Surgical Procedures

In more severe cases of spasmodic torticollis, surgical procedures may be necessary.

The two most common procedures are deep brain stimulation surgery and cutting the nerves that innervate the affected muscles.

Deep brain stimulation is a procedure that usually involves placing a thin wire into the brain via a small hole in the skull. This wire is placed in the part of the brain that controls movement.

Electric pulses will travel to break up the signals causing the abnormal head movements.

Cutting the nerves is a more direct way to stop the nerves carrying messages to the overactive muscles.

Support Groups and Mental Health Counseling

Cervical dystonia can take its toll as it usually is a chronic, ongoing condition. It’s important to consider your emotional and mental health, as well as addressing the physical side of this movement disorder.

Don’t hesitate to reach out to support groups or mental health counseling to get the full support that you need.

Long-Term Management

long-term pain management of neck pain

While cervical dystonia is considered a long-term condition, it’s important to remember that it absolutely can be managed.

For this reason, it’s important to make sure you’re set up with the right medical team to address your symptoms. By doing so, you’ll be able to take a proactive approach to managing this condition and living your best life.

FAQ:

Are other treatment methods available to treat cervical dystonia?

Yes.

There are many alternative treatment options to consider, in addition to what was discussed in this article. This may include acupuncture, yoga, meditation for relaxation, and more.

Can cervical dystonia be cured?

Unfortunately, no. While temporary remissions are possible, there has been no cure found.

Can any doctor treat cervical dystonia?

A neurologist is the best specialist to consult with regarding cervical dystonia, as this is a neurological disorder.

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