Neck pain is a common public health concern that has been studied extensively in adults. Minimal studies have been done on neck pain in children and/or adolescents. The World Health Organisation (WHO) Global Burden of Disease data showed that neck pain is the 8th highest reason for most years lived with disability among adolescents between the ages of 15 and 19 years. This is higher than the common health problems in youth such as asthma, alcohol & drug usage and road injury.
What does the research say:
A study was done in 2017 on 207 children and adolescents with non-specific neck pain. The results revealed that the majority of neck pain (87%) in children and adolescents was caused by musculoskeletal dysfunction with associated muscle spasm. All of these children reported faulty neck positions while studying and/or using mobile devices. Twenty-one percent (21%) of them had associated visual symptoms such as difficulty focusing, blurry vision, and pain behind the eyes. The parents of 82% of them reported changes in their children’s psychological and social behaviours as a result of neck pain.
Technology can also play a role…
Another study done in 2009 highlighted that lengthy periods of sitting in fixed postures, such as when using computers or smartphones, results in high prevalence of neck pain and headaches in adolescents. Girls commonly complains of headaches. Neck pain and headache is also associated with negative effects on their mental wellbeing and social interaction. The concerning association between neck pain and long hours of computing among the youth emphasises the need for education about appropriate ergonomics and postural health.
A very recent study done in 2021 indicated that the prevalence of neck pain in the paediatric population is on the rise as a result of technological advances. The progressive and inappropriate use of computers and mobile devices is linked with the development of what is referred to as “Text Neck Syndrome”. Frequently bending forward to look down at screens put repeated stress on the neck that causes progressive degeneration. Children and adolescents with persistent neck pain have a high risk of developing chronic pain as adults.
The weight of your head on your spine considerably increases when you bend your head/neck forward. Full grown heads weigh about 5kg in a neutral neck position. The more the head is flexed forward, the more force and stress there is on the neck. At 15° of forward flexion, the weight of the head is increased to 12kg. At 60°, it increases massively to more than 27kg!
What can parents do?
Early treatment and diagnosing of non-specific neck pain is crucial to prevent progressive spinal degeneration, postural adaptations, the development of chronic pain, other more concerning symptoms (such as neurological or eye problems) and disability.
Neck stiffness without other symptoms may simply be caused by minor muscles strain such as sleeping in an unusual position or looking down at a screen for a long time. A stiff neck can be easily treated by applying heat and taking basic pain reliever medication. However, if the pain persists, take your child to a physiotherapist who can assess the possible cause of your child’s pain and help manage it.
Neck pain and stiffness with any of the following factors calls for immediate medical attention as it may indicate a more serious cause: recent injury, tick bite, fever (or low temperature in babies), severe tiredness or drowsiness, mood changes, persisting headache, nausea and/or vomiting, or flu-like symptoms.
Common Neck Conditions in Infants, Children and Adolescents:
Torticollis is the Latin word for “twisted neck”, where the child’s head is tilted to one side and rotated to the opposite side. It is a postural abnormality of the neck leading to an atypical head position It can occur in people of all ages but is more common in infants where there is muscle tightness on one side of the neck. The position of the baby in their mother’s womb, or complications during childbirth can cause this abnormality.
Signs of torticollis in infants include:
- They prefer to turn their head to one side only
- They may tilt their head to one side, bringing that side’s ear closer to the shoulder
- Their head may be flatter on one side
- Their face may seem asymmetrical e.g. one cheek may appear fuller, one eye may appear more open, or their jaw may be uneven when they open their mouth
- They may become irritable when they try to look to the other side, when you change the position of their head or when they are placed on their tummy
- You may have trouble breastfeeding on one side
Most infants with torticollis will not feel pain. However, if the abnormal neck and head position is left untreated, they may develop postural deformities, changes in the shape of their head and uneven facial appearance. Untreated torticollis will affect your child’s development because it changes the way your child plays, uses their hands, and explores their surroundings. The earlier your child receives treatment, the better their recovery.
Torticollis can be congenital or acquired.
Congenital Muscular Torticollis is the most common. It usually develops by 6 weeks of age but may take up to 3 months. Physiotherapy can treat this condition be very successfully, by manually releasing the tight muscles. We also teach you positioning techniques and specific exercises you must do at home. Follow the home exercise and stretching program for a few weeks. Severe conditions may take a few months.
Acquired torticollis occurs in children older than 6 months. It can occur after trauma such as an injury, fracture, dislocation, or be due to awkward positioning of their head or neck. In can also occur when your child has an infection in the area of the head, neck, spine or upper chest as a secondary condition. Therefore, note any signs of infection such as fever, sore throat, increased drooling, or drowsiness and make sure to treat it early. Most uncomplicated acquired torticollis should resolve within 7 – 10 days. Heat application, massage and pain relievers are helpful. Your physiotherapist can help with manual release of tight muscles and help to encourage early movement of your child’s head and neck.
A “Wry Neck” describes a pain full stiff neck in older children and adolescents when they suddenly presents with pain, muscle spasm or locked joints in the neck. It is very common in young people especially between the ages of 12 to 30 years. They usually wake up with a sore and stiff neck that is “stuck” in one position. Attempts to move out of this “stuck” position will cause pain.
Encourage early movement, but since movement of the neck can be very painful, your physiotherapist may need to perform manual techniques to “unlock” the small joints of the neck and release the muscles. Again, early treatment (preferably within 12 hours of onset) is crucial to restore movement and prevent complications. Wry neck symptoms can resolve within 24 – 48 hours with early, effective treatment.
Stretches will lengthen the tight muscles. The focus should be on rotation of their neck toward, and a head tilt away from the affected side. If you would like guidance on the specific stretches, ask your physiotherapist to show you.
Keep in mind that neck problems may return. Therefore, strengthening the neck muscles and normalising movement is crucial for prevention of recurrence. In babies and toddlers, try “he
ad-righting reactions” such as pull-to-sit, or letting them sit on your lap and tilting them slightly to the side. This will encourage them to lift their head in the opposite direction to strengthen the muscles of the neck. In older children, encourage good posture and proper use of mobile devices and computers. Chin tuck exercises are very effective.
What can You do if your Child has Torticollis or Wry Neck?
Position your baby in such a way to encourage head and neck movements in the opposite direction toward the non-affected side. Tummy time is crucial. Place toys and other objects of interest to their unaffected, non-preferred side. When carrying your baby, hold them facing away from you with their affected side’s ear resting on your forearm. Use your arm to lift their head and stretch the affected side. Incorporate positional techniques into playtime, diaper changes or during feeds. Position your baby on their back with their head turned to the non-preferred side when sleeping. You may need to support your baby’s head and body using rolled-up towels or blankets.
Older children need more active interventions. Again, introduce activities that will encourage them to turn their heads towards the other side. Allow your child to spend time playing on the floor while sitting or lying on their tummy. Allow them to fully explore their environment with as much sensory stimulation as possible. Encourage the use of both of their hands and legs when crawling, kneeling and playing. Remove long-sleeve clothing to increase skin exposure for better sensory stimulation.
For adolescents, try encourage gradual releasing movements out of the painful position. You can try to assist their movement by letting them relax in a comfortable position and gently and passively try to move their neck out of the “stuck” position. Never force any movement. Encourage graduated, active neck movements.
Children with neck pain and/or headaches may not be able to communicate their pain or distress effectively. It is vital to learn how your child may use verbal and non-verbal ways to communicate to enable you to identify problems early.
Physiotherapists are competent at identifying movement and postural dysfunctions, as well as more serious conditions requiring medical attention. Our clinical skills and experience guides our treatment based on each individual child’s needs. We aim to work closely with you, as parents, to ensure continuous and successful treatment. Call to book an appointment today or talk to a physiotherapist in our 10 minute no-obligation Telephone consultation.
- Dietzen, A. Trovato, M. 2013. Torticollis in Children and Adolescents. Musculoskeletal Medicine. Available from http://now.aapmr.org/torticollis
- Fares, J. Fares, M. Y. Fares, Y. Surg Neurol Int. 2017; 8: 72. Published online 2017 May 10. Doi: 10.4103/sni.sni_445_16
- Smith, L. Louw, Q. Crous, L, Grimmer-Somers, K. published Feb 1 2009. Available at: PubMed, https://doi.org/10.1111/j.1468-2982.2008.01714.x
- David, D. Giannini, C. Chiarelli, F. Mohn, A. Int. J. Environ. Res. Public Health 2021, 18(4), 1565, Available at: https://doi.org/10.3390/ijerph18041565