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Spasmodic Torticollis.

Spasmodic Torticollis ( Cervical Distonia)

Spasmodic Tortitollis (ST) is a painful and debilitating neurological movement disorder. It is also known as "Cervical Dystonia." and is referred to by many just as "torticollis."

This movement disorder is caused by a dysfunction of the brain. The symptoms are caused by intermittent or sustained contractions of the muscles around the neck which control the position of the head. This causes the head to lean to one side, or be pulled forward or backward. The shoulders may also be uneven and some patients experience tremors in the head or arms.

ST is usually accompanied by constant and extreme pain.

ST can resemble other disorders including Parkinson's disease, epilepsy, muscular dystrophy and wry neck (an acute episode of pain and spasm in the neck that resolves itself in days or weeks.)

ST can limit a person's ability to function. As a localized disability this disorder does not directly affect other body systems. Because it can be more severe during times of anxiety or stress, ST was once thought to be a psychiatric disorder. Research has shown, however, that while ST does indeed seem to originate in the brain, it is clearly a neurological disorder rather than a psychiatric one.Signs and Symptoms

ST can occur any time in life, although the symptoms most frequently occur between 25 and 55 years of age. ST is more common in women than men. The exact cause is unknown. Onset sometimes comes after an injury to the head or neck, following an infection, or after taking certain medications. There also seems to be a genetic link, with 5 percent of patients reporting at least one relative with ST and 50 percent demonstrating a family history of tremors in the head or hands.

First symptoms generally occur slowly or intermittently and are usually noticed when a person tried to keep his or her head straight, for example, while driving. Family or friends are often the first to see the sign, asking questions like, “Why does your head look like it’s on crooked?” Within two to five years, progression of the disease reaches a plateau without further worsening. The pain associated with ST is almost always focused in one place, frequently the side of the neck or the back of the shoulders.

There are three distinct varieties of Spasmodic Torticollis:

Tonic, in which the head turns to one side, Clonic, which involves the shaking of the head, and Mixed which involves both turning and shaking.

The turning of the head is generally considered to fall into one of four categories: Rotational, in which the head turns to one side or the other, Laterocollis in which the head is pulled toward the shoulder, Retrocollis in which the head is pulled to the back, or Anterocollis in which the head is pulled forward. In fact, most people’s ST is more complex, having a combination of “pulling” from among these four categories.

Physical/ Neuromuscular therapy and Deep Tissue Massage by experienced therapists may improve pain symptoms.

The goals of the therapy include bringing the head position back toward normal, increasing the range of motion, and decreasing the pain, thereby increasing functional ability. The physical therapist may employ a variety of techniques to achieve these goals. Primarily the physical therapist will gently move the neck through its range of motion, stretching the spasming agonist muscles.

Myofascial Trigger Points Dry Needling

Dry needling is similar to acupuncture but different in that it uses western based anatomy and physiology rather than Eastern based "meridians". The term "dry needling" is purported to describe the technique of using acupuncture needles on trigger points to release tight muscles. Many of these trigger points are similar or identical to those of traditional Chinese medicine.

Dry needling means inserting needle into the muscle without the use of any substance ( Dry needle).

As relatively new therapy it has shown great potential for ST therapy as it helps relaxing muscles spasm particularly treating the Sterno-Cleido-mastoid and upper Trapezius muscles.

Spasmodic Torticollis and Exercise

You need to exercise regularly; in fact, you may need to exercise more. There are specific things that you need to address that the average person doesn’t.

Physiological Changes over Time

As you start to move into your thirties, your body is already starting to age. By the time you hit forty you lose 10% of your aerobic capacity. You begin to have decreased muscle mass, local muscular endurance and strength. That extra 100

calories per day adds up to 1 pound/ year on the scales. The ability of your tissues to heal starts to diminish.

This decline continues: between 50 and 70 years of age there is a 30% reduction in strength, 10% loss of aerobic capacity per decade and most of us get stiffer. Another statistic to be aware of: 40% of women 55-64, 45% of women 65-74 and 65% of women 75-84 are unable to lift 10 pounds.

I am an older person will I be able to start training?

Your body will respond to training as you get older just as it did when you were younger. We lose strength and the ability to move through big ranges because most of us just stop moving! The postural issues and muscle imbalances caused by ST make you more vulnerable to osteoarthritis and tendonitis and exercise can really help address these problems.

What kind of exercise do i need?

It’s important that you work on all the systems that keep your body working well. Your heart and circulation require aerobic exercise to stay healthy. That means walking, swimming, cycling, exercise classes that keep your heart rate in its target zone. At least three times a week for 30-40 minutes.

Your muscles need to stay strong.

Resistance training with weights and/or doing exercises that use your body weight as resistance e.g. a Ball class, Pilates, Yoga .

The evidence for improving strength and decreasing neck pain is well documented . Stretching will help to lengthen the muscles that ST shortens, but it will also keep your whole body moving well and allow you to bend and reach and get up and down from the floor. You can do this with specific stretching, or take a class. Yoga and Pilates can be really helpful.

In dealing with Spasmodic Torticollis, most patients and doctors think the symptoms to be pain, pulling, pressure and tremors, but they leave out a very important component: stress.

How we learn to deal and cope with stress is a very important part of the therapy, it’s a fact the symptoms of tremor are less pronounced when the patient relaxes.

Again Yoga, Meditation, Massage therapy and stress management classes would be strongly recommended.

Nutrition

There are different opinions and myths about the right diet for Torcicollis, what we would encourage is to have a good healthy diet , avoid junk foods and concentrate on more natural products.

Cut down sugars, meaning cut down your weekly alcohol intake as alcohol contain lot of sugar.

Supplements

Some supplements are recommended to improve or at least to manage ‘Cervical Distonia’

Anti-oxydants Vitamin E and Selenium to give the tissue elasticity, Calcium for healthy bones and strong , Magnesium, Zinc and Potassium for muscular contraction and Electrolite balance, Vitamin C to boost immune system and B complex to deal with stress.

In our daily clinic we offer multidisciplinary therapy, Physical and Neuromuscular therapy combine with exercises therapy and nutrition.

We do recommend ‘ Colonic Hydrotherapy ‘ as a form of ‘ de-tox ’ to give the body a new start as old matter and impactions in the digestive system may prevent absorption of nutrients.

References

· The national spasmodic torcicollis association- USA

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