Cervical Dystonia/Torticollis

When I was researching standard treatment for cervical dystonia, mostly what I found was that there was no cure and the usual treatment is Botox injections. The Botox is generally injected into the “overworked” SCM and Splenius Capitus. This may provide some temporary relief of symptoms but certainly is no cure. What is not explored much in the literature are the motor control issues associated with this condition. Clearly the brain is sending dysfunctional signals to the muscles of the neck. But what can be done to change that?

There are four basic patterns associated with this condition. The first is a rotation of the head to one side. The second is a lateral side bending of the head to one side. The third is forward flexion. The fourth is extension. What is commonly seen is a combination of these patterns. The most frequent of these would be rotation of the head with contralateral side bending. Let’s examine each of these and the possible treatment protocols. With rotation of the head to the left, the most active muscles would be the right SCM and the left Splenius Capitus. First test the “connectivity” of the left SCM and the right Splenius Capitus. Does inhibiting the right SCM and the left Splenius Capitus facilitate the other two muscles? This would be an example of a functional correction. Of course there are many more muscles/functions involved in turning the head to the left. The left longus colli, scalenes, and the suboccipital muscles must also be examined. Testing for right thoracic rotation and left lumbar rotation is also crucial. These would be the most common compensatory rotations for a left cervical rotation. Re-firing the muscles that create left thoracic rotation and right lumbar rotation will greatly improve your treatment.

In lateral side bending of the neck the ipsilateral upper trapezius dominates with help from the levator scapula and the posterior scalene. The ipsilateral longus colli and neck extensor group must also be considered. The implications for a kinetic chain start with the latissimus dorsi, obliques, hip abductors, and peroneals. Testing the contralateral kinetic chain for inhibition and making corrections again will greatly enhance your outcomes.

In flexion of the neck, the SCMs,longus colli, suprahyoid muscles, and neck extensors must all be thoroughly examined. Check the kinetic chain from the pectoral muscles, the diaphragm, the abdominals, the hip flexors, the knee extensors, and the ankle extensors. These may be inhibiting the muscles involved in the extension kinetic chain.

In extension of the neck, the same muscles that are involved in the flexion pattern must be resolved but with the opposite emphasis. Check the kinetic chain from the trapezius, levator scapula, rhomboids, Multifidi, quadratus lumborum, gluteals, hamstrings, calf muscles, and the muscles of the sole of the foot.

With a combination pattern of rotation and side bending you must mix and match the most active muscles along with their associated kinetic chains. This requires a great deal of assessment, testing, and treatment, but the results will be worth it.

Client compliance is crucial in resolving cervical dystonia. Exercises which emphasize stretching the overworked muscles followed by strengthening the inhibited muscles produce excellent results. There are many other options such as eye tracking exercises. One of my clients when looking down always turns his head to the left. Retraining of that pattern is crucial in the resolution of this condition.

In conclusion, the treatment of cervical dystonia is a complicated assessment and treatment process that requires strict client compliance with assigned exercises. Therapies which reconfigure dysfunctional motor programs in the cerebellum are likely to be the most successful.