What is discogenic wry neck, and why do you need to treat it differently to acute wry neck?

Wry neck

Patients with acute wry neck will have a very different presentation, prognosis and treatment to discogenic wry neck. Patients with a wry neck will present with neck pain, restriction of movement and unilateral or asymmetrical symptoms.

Discogenic wry neck

The features of discogenic wry neck include discogenic neck pain with nerve root symptoms, in 35–60 year olds. Prior to onset, patients will often have stiffness or limitation of movement prior to onset, with a less sudden onset than acute wry neck.

Symptoms and objective findings in discogenic wry neck

Symptoms of “discy” wry neck include local neck with or without shoulder pain. They often cannot find a comfortable position, are usually able to perform some contralateral rotation and lateral flexion, and can usually reach midline with their movements. The mid to low cervical spine is often implicated in their symptoms and treatment will often target this area.

Treatment

Without treatment, discogenic wry neck may progress to nerve root irritation or compression. Overall this will respond slower to treatment than acute wry neck, and may require a lot more and regular treatment. You can incorporate rotation, lateral flexion movements or passive physiological intervertebral mobilisation (PPIVM’s) may be used.

Manual therapy such as PAIVM’s can also be used in your treatment, as opposed to acute wry neck where this may aggravate it. Cervical spine manipulation would not be your first line treatment in any wry neck, or to be honest in many conditions, as manipulation should really be considered a progression of treatment following a positive response to mobilisation with more end range discomfort.