Torticollis in Adults: How Long Does it Last?

You have a wry neck, pain in your neck with the sensation that it is locked, and you’re wondering how long does it last? It’s a very common reaction when experiencing torticollis, whether it’s the first time or not.

As a physical therapist, I address the most frequently asked questions from internet users regarding the duration of a stiff neck: how long, on average, does the pain decrease? Should you be concerned? What is recommended to do? What are the usual durations for taking time off work?

To provide the most reliable and precise answers to these questions, I rely on:

• My experience as a physical therapist since 2009.
• My extensive research and readings in international medical literature (all sources at the end of the article).

If you have any further questions, comments, or personal experiences to share, please feel free to leave a comment 🙂.

Happy reading!

Different types of torticollis and neck pain

Over the decades, the classification of neck pain has evolved. Today, two main types of neck pain are distinguished:

1. Non-specific cervical pain (also known as “common” neck pain): Torticollis (or “wry neck”) falls into this category. This article will focus on these types of neck pain. Often, we refer to non-specific cervical pain in general rather than specifically mentioning torticollis, as it is difficult to make a specific diagnosis of torticollis (the criteria for objective diagnosis are not necessarily agreed upon and are not very reproducible).
2. Specific cervical pain: There is another underlying issue. Torticollis does not fall into this category.

The terms cervicalgia, neck pain, and pain in the neck all refer to the same thing. The term “acute” is often added, indicating that it is a pain that has recently appeared and has been present for only a few days, weeks, or months, and not for years.

In infants, there are also congenital torticollis cases.

In this article, I’m only talking about torticollis in adults.

Torticollis is considered an acute form of cervical pain, characterized by sudden onset.

How can you be sure it’s a torticollis and not something else?

You need to consider the problems you are experiencing: is it “just” neck pain and discomfort? Or do you have other symptoms such as:

• Fever
• Unexplained weight loss
• Arm paralysis
• Recent and debilitating migraines (headaches), etc.?

If you consult a healthcare professional, they will specifically ensure that you do not have any other issues besides the “simple” neck pain and discomfort. These additional problems could indicate the presence of another condition where cervicalgia is one of the consequences. In that case, it would be worth investigating further and possibly conducting other examinations.

This will also depend on how the pain occurred: suddenly without any specific activity, during a major car accident (whiplash?), etc.

However, if your healthcare provider did not deem it necessary to perform an X-ray, MRI, CT scan, blood test, or other examinations, it means they believe you do not have any other indicative signs of something more serious. Therefore, it is likely a “simple” non-specific cervicalgia, such as torticollis or similar.

It is easy to forget, but getting an X-ray or a scan is not without risks. Repeated exposure to radiation throughout one’s life is not the healthiest option, not to mention the time spent obtaining and conducting these tests instead of returning to a normal life as much as possible.

What characterizes torticollis compared to other types of non-specific cervical pain is often:

• Contraction (or tension) of one or more neck muscles, such as the trapezius or sternocleidomastoid (SCOM) muscles.
• Head tilted and rotated to one side.
• Difficulty in turning the head (sometimes even an inability to turn the head).

However, in practice, this distinction is not of significant importance because the management will follow the same general principles for all non-specific neck pain.

We can never be 100% certain of a torticollis diagnosis (although we would like to be!), but it is simply the most likely option if you do not have any indicative signs of something else.

How do we determine the average duration of a torticollis?

There are several ways to get an idea of how long an acute episode of torticollis typically lasts:

1. Asking friends or family members who have experienced it before how long it lasted for them.
2. Seeking the opinion of a doctor or physiotherapist and asking them how long it typically lasts for their patients (or relying on one’s own professional healthcare experience if applicable).
3. Looking at the results of clinical studies that follow hundreds or thousands of individuals with or without cervicalgia issues over the course of several years, tracking the progression of their neck pain when it occurs.

Upon reading these suggestions, you will likely realize that the third option is likely to provide the most reliable approximation. Here’s why:

• Your friends or family members may not remember the exact evolution of their symptoms accurately. Moreover, their experience may not be representative of cervicalgia as a whole. The experience of one or two individuals is not a large enough sample size to form a precise understanding of the duration of a health problem.
• Healthcare professionals have access to a broader network of individuals, which is already better. However, not all people who seek treatment necessarily follow up when they feel better! This can introduce biases into the estimation of the progression. Additionally, depending on the professional’s practice style, they may not attract the same type of individuals, resulting in a non-representative sample.
• Studies help mitigate these biases, although they are never perfect.

That’s why I will now rely primarily on studies. As neck pain/torticollis is a very common issue, we are fortunate to have a lot of data on its progression!

How long does torticollis last?

First, let’s clarify what recovery time we are referring to. Are we talking about the recovery time of:

• Pain
• Difficulty turning or moving the head
• Sensation of stiffness
• All of the above

Before going into further detail, here are some optimistic points: intense pain diminishes very quickly, within a few hours or at most a few days. Sometimes it may take 3 to 7 days to see improvement, but the pain will decrease regardless of what you do.

For many people, a pain from torticollis typically lasts a few days to a few weeks.

Average recovery time of torticollis / wry neck

You may be interested in knowing the precise progression of acute neck pain. I will provide you with the information.

When experiencing neck pain, the intensity of the pain will significantly decrease in the days or at most two weeks following the onset of the pain. The graph below illustrates this: you can see that the curve decreases significantly at the beginning (it descends). This curve represents the intensity of the pain as perceived by individuals with neck pain.

By looking at these curves, you might think, “Oh, but the pain doesn’t completely go away for a long time!” Indeed, these curves depict the pain progression in people who:

• Seek healthcare professional consultation for their pain
• Agree to participate in a study that monitors the progression of their condition

These two factors contribute to the data on the evolution of neck pain presenting a worse reality than what is actually experienced. This is because studies do not include individuals who do not seek medical attention, as torticollis resolves very quickly.

I have encountered several examples of this nature, as have my physiotherapist colleagues. We provide care for someone with condition X or Y (such as a knee prosthesis or stroke). This person also develops torticollis at some point. We reassure them and do nothing specific. Three days later, they no longer have any symptoms, and they did not seek specific treatment for it.

Also, consider the results of Vasseljen 2013, which, unlike others, included people who may not have consulted a healthcare professional for their neck pain. The participants in that study recover better and faster.

There is a good chance that you fall into this category of people in whom the pain disappears quickly and effectively!

Nevertheless, here are some additional findings for those people in whom the pain lingers a bit longer, such as one week, one month, or even longer.

Number of patients	Follow-up duration	Progression	Reference
888	1 year	15% experience decreasing pain over weeks (sometimes days) and it never returns	Irgens 2022
1209	1 year	24% experience fluctuating pain with an average rating of 2.7/10 for a little over 1 month (39 days)	Myhrvold 2020
448	6 months	90% show significant overall improvement in symptoms within a maximum of 6 weeks	Ailliet 2018
116	1 year	Pain rapidly decreases within the first 4 weeks	Vasseljen 2013
283	1 year	Pain and discomfort for daily activities decrease, especially in the first 6 weeks after symptom onset. Pain decreases from an average of 64/100 to 35/100. Discomfort decreases from 30 to 17/100.	Hush 2011
804	6 to 12 months	1 in 2 to 1 in 4 patients fully recover within 6 to 12 months according to studies	VerHagen 2011

Maximum recovery time of idiopathic spasmodic torticollis

During your research, you may have come across spasmodic torticollis (also known as cervical dystonia). It is a particular form of torticollis where the neck muscles contract frequently and involuntarily.

This condition can be associated with other pathologies, particularly neurological conditions, or the use of certain medications. It can also exist on its own, referred to as idiopathic spasmodic torticollis.

Idiopathic spasmodic torticollis is a rare form of torticollis, so it is highly likely that you are NOT affected by this type. Nonetheless, I will provide some data on it, although there is very limited information available in French.

Once again, the progression durations mentioned in clinical studies tend to be much more pessimistic than the reality. This is due to a simple reason: people with shorter-lasting forms of torticollis do not even seek medical attention as the pain resolves on its own within a few hours (I have several examples of such cases). People included in the studies are likely those with the longest recovery time of torticollis.

This skews the average healing and pain disappearance times, which are likely shorter in reality. However, this still provides a good reference point and can reassure individuals experiencing longer-lasting pain that they are not alone, and it eventually subsides for many people.

Number of patients	Follow-up duration	Evolution	Reference
72	7 years	20% experience complete disappearance of pain, with 87% within 3 years	Jahanshahi 1990
?	?	20% show complete regression of symptoms	Van Zandijck 1995

Is the recovery linear?

800 individuals who experienced an episode of cervical pain received text messages for one year to monitor the progression of their pain. Here’s how their pain evolved:

1. It starts off intense but gradually disappears until it is completely absent and never returns (15% of people).
2. It starts off intense but gradually disappears until it is completely absent and then returns after a few weeks or months, following the same pattern (37% of people).
3. The pain is not very intense but persists without significant reduction.
4. The pain fluctuates but never really disappears.
5. The pain remains intense for a long time without significant improvement.

The image below illustrates these different possible scenarios of progression. It may be complex to understand, but it’s important to note that the colored lines are not all straight; they frequently go up and down.

This indicates that for some individuals, the pain fluctuates: it decreases and then increases again, without it being a complication or a sign of severity.

After experiencing torticollis, for some people, the pain gradually decreases until it completely disappears and never returns (approximately 1 in 10 people). For others, the pain may fluctuate: decrease and then increase again. This is often a source of concern; however, it is a well-known progression that does not indicate severity or another problem.

Source: Irgens 2022

Prognosis for MY torticollis?

You might be thinking, “All of this is nice, but what interests me is how I will recover, not how people on average recover.” I completely understand that you’re thinking this! (And I feel the same way when I or someone close to me has a problem!)

Know that research teams are also trying to answer this question: What factors contribute to a faster recovery (Walton 2013)? A better recovery? By doing so, we could personalize recovery prognosis better.

However, there are several issues:

• We struggle to identify these factors.
• Even if we manage to identify some factors (such as initial pain intensity), it doesn’t mean that everyone with these factors will recover well or poorly. Consequently, we might unnecessarily alert people without reason.
• These factors are not necessarily modifiable. It can be frustrating to fall into the category of people who are more “at risk” and not be able to do anything about it.

In my practice, I only provide detailed information on this point if my patients explicitly ask for frank and precise prognosis. If they are more vague about it, I simply state the average duration of recovery. It’s up to you to decide what approach you want to take, whether as a patient or a clinician!

Therefore, you don’t need to feel guilty if your pain takes longer to dissipate. It’s not because you did something wrong or didn’t do something you should have done; it’s just a matter of bad luck.

What can be done to shorten the recovery of a torticollis?

How to speed up the recovery of a torticollis? Despite decades of studies on this subject, it is challenging to identify treatments or tricks that have a significant chance of accelerating recovery (at least more than any placebo would).

What international guidelines say on torticollis

Among the 20 practice guideline manuals on nonspecific cervical pain for healthcare professionals, the recommendations vary greatly (Parikh 2019). Experts struggle to agree on what to do for diagnosing, preventing, and treating acute neck pain.

These guidelines, whether from France or other countries, are written by doctors, physiotherapists, or chiropractors.

Here’s what a publication attempting to synthesize these 20 guidelines (Parikh 2019) says about what to do in case of cervical pain:

• ✅ All guidelines (except one) state that active exercises are beneficial (regardless of which specific exercises, as long as they are active. There is no ONE or even a few “magical” exercises that should be applied to ensure recovery).
• All guidelines (except two) recommend manipulation and mobilization. The majority of guidelines recommend informing/educating patients about the importance of not resting for more than 3 days and staying active; however, four guidelines state that education is not beneficial.
• Half of the guidelines recommend using medications, alone or in combination with other treatments (NSAIDs, paracetamol, and opioids are the most commonly mentioned).
• ❌ The majority are against soft cervical collars (“neck braces”). Cervical collars are not recommended for torticollis. If you feel relief wearing one, gradually reduce the time spent wearing it.

Regarding other treatments often performed by physiotherapists, the guidelines have very different opinions (some say it is entirely useless, others say it is beneficial), and there is even less consensus about them: applying heat or cold, using ultrasound therapy, or Transcutaneous Electrical Nerve Stimulation (TENS) therapy, specific manual therapy techniques, massage, etc.

What has the most consensus in the recommendations for torticollis and wry neck: engaging in active exercises and movement.

My interpretation as a physical therapist of these recommendations

As you may know if you read me from time to time, I always prioritize treatments that have:

• maximum effectiveness (theoretical/empirical);
• minimum side effects;
• minimum cost (in terms of time, energy, money);
• minimum reliance on a third person or equipment.

Taking these four criteria into account, along with the recommendations from expert guidelines, the three best things you can do, in my opinion, are:

• Believe in your own self-healing abilities, no matter what you do.
• Continue engaging in physical activities that you can handle (walking, household chores, DIY projects, gardening, etc.), as long as the pain remains tolerable during these activities. These activities will naturally move your neck, regardless of any specific neck exercises you may perform (make sure to fit them into your routine 😉).
• Consult a doctor or a physiotherapist if you need assistance and don’t feel confident in dealing with it alone. If you require personalized information and exercises.

How long is the recommended time off work for a torticollis?

There is no standard duration for work leave regardless of the pathology. It is not the health condition itself that determines whether or not you can take time off work, but its impact on your physical or mental abilities. And of course, the nature of your professional activity.

Some individuals with torticollis:

• may not require any work leave (which is the majority based on my experience);
• may take one or two days off work;
• may have several days or weeks of work leave; may become disabled after several years (a minority).

The French Health Insurance recommends standard durations of work leave for certain health problems, but torticollis is not included.

I could not find statistics in any countries regarding the average duration of work leave after torticollis. However, I came across these small pieces of information: in Ontario (United States), out of 5,761 workers from the late 2000s who took work leave due to cervicalgia, the median duration of work leave was 13 days. This means that half of the individuals were on leave for 0 to 13 days, while the other half took more than 13 days (Van Eerd 2011).

The duration of work leave for torticollis is often between 0 and 3 days. In rarer cases, it can be longer, extending to several months if the pain becomes chronic.

Can it be dangerous if torticollis lasts a long time?

You may be worried because your pain is lasting for a long time: more than a week, a month, or even months… People don’t necessarily become concerned at the same threshold. However, please be aware that the duration of neck pain itself is not a sign of concern.

A lingering pain is certainly bothersome, and of course, we would prefer it to be otherwise. Nevertheless, it does not necessarily mean that there is an underlying serious illness or problem.

To suspect something serious that may require further examination and treatment, there need to be other symptoms accompanying the neck pain and discomfort.