What’s in this article:
- What wry neck is: why children sometimes wake with a stiff, twisted neck, and how long it usually lasts
- What you can do at home: simple, safe ways to ease pain and keep the neck moving
- How physiotherapy can help: when it’s worth booking in
- When to seek help: the warning signs that need the emergency department, and when to see your GP or physio
- Sore neck yourself? A short guide for parents on adult neck pain, including the role of sleep, stress and exercise
Most children who wake with a stiff, painful neck have a simple muscular “wry neck”, and it usually settles within a week or so.
What is wry neck?
Acute wry neck (also called acquired torticollis) is one of the most common causes of sudden neck pain in children. It often follows sleeping in an awkward position. Your child may wake with a stiff, sore neck, find it hard to turn their head, and hold their head tilted to one side.
In most cases, the muscles around the neck have gone into a protective spasm. This makes movement painful and can make the small joints of the neck more sensitive.
It can look quite dramatic, but uncomplicated muscular wry neck has a very good outlook. Most children can be managed with simple pain relief, and the stiffness should settle within 7 to 10 days.
What you can do at home
The aim is to keep the neck gently moving without stirring up the pain.
- Keep it moving gently. Small, comfortable movements are better than holding the neck completely still.
- Use warmth. A warm shower or heat pack can help the muscles relax. Wrap the heat pack, check the temperature first, and supervise young children to avoid burns.
- Try gentle massage around the neck and shoulders if your child finds it comforting.
- Use pain relief if needed. Paracetamol or ibuprofen can help. Give the dose for your child’s age and weight as shown on the packet, or ask your pharmacist.
- Don’t force it. Avoid pushing or stretching the neck into painful positions.
- Keep up normal activities as comfort allows, including school.
How physiotherapy can help
Many children improve well with home care alone. If your child is very uncomfortable, or the stiffness is slow to ease, physiotherapy can help settle things sooner.
Treatment is always patient-specific but typically focuses on easing muscle spasm, gently restoring comfortable movement and settling sensitive joints. We’ll also show you what to do at home between visits.
When to seek help
Most wry necks are not serious, but a stiff, painful neck can occasionally be a sign of something else.
After an injury
If neck pain follows a fall, a car accident, a sporting collision or a blow to the head or neck, don’t ask your child to move or test their neck. Keep them still and comfortable and get them medically assessed. If the injury is significant, or they have any weakness, numbness or tingling in the arms/hands, call 000.
See your GP, go to the emergency department or call 000 if your child has a stiff or sore neck with:
- Fever, or they seem generally unwell, drowsy or irritable
- Drooling, trouble swallowing, or difficulty breathing
- A severe or unusual headache
- Neurological symptoms such as weakness, numbness, tingling in the arms or legs, poor balance
- Visual disturbances like blurred or double vision or dizziness
- Pain is waking them at night
- You are concerned for any other reason
Sore neck yourself?
Neck pain in adults is common, and it rarely has a single cause. Strength and endurance, previous injuries, activity levels, sleep and stress can all play a part.
- Posture isn’t the whole story. No one position damages the neck, but staying in one position for a long time can tire the muscles. Regular movement breaks help.
- Exercise helps. Research supports exercise for neck pain, and no single exercise is best for everyone. A patient-specific approach is best.
- Sleep and stress matter. Poor sleep and stress can make the nervous system more sensitive to pain. Research also suggests that stress, worry and low mood are among the most consistent predictors of neck pain lingering or coming back.
- Recovery varies. Many adults improve a lot in the first few weeks, but some take longer. Neck pain also often returns: research shows almost 50% of people have another episode within a year. Staying active and keeping up exercise between episodes helps, and it is worth getting help if pain lingers or keeps coming back.
Neck pain associated with pins and needles, numbness, weakness or pain running down the arm should always be assessed.
Some common approaches include control and endurance exercises for the muscles at the front and/or back of the neck.
Research shows these muscles are often weaker in neck pain populations. The activation and strength of the deep neck flexor muscles can be assessed using a pressure biofeedback device.
The bottom line
A wry neck after sleeping awkwardly usually settles quickly with gentle movement, warmth and simple pain relief. Get help straight away if it follows an injury or comes with fever, swallowing or breathing problems, or changes in strength, sensation or balance. Book in with your GP or physiotherapist if it isn’t improving as expected.
This article is general information only and is not a substitute for individual advice.
References
- Royal Children’s Hospital Melbourne. Clinical Practice Guideline: Acquired Torticollis.
- NHS Greater Glasgow and Clyde. Torticollis (congenital and acquired) in children: Emergency Department guideline. https://clinicalguidelines.scot.nhs.uk/nhsggc-paediatric-clinical-guidelines/nhsggc-guidelines/emergency-medicine/torticollis-congenital-and-acquired-in-children
- Perth Children’s Hospital. Emergency Department Guidelines: Torticollis. https://pch.health.wa.gov.au/For-health-professionals/Emergency-Department-Guidelines/Torticollis
- Hush JM, Lin CC, Michaleff ZA, Verhagen A, Refshauge KM. Prognosis of acute idiopathic neck pain is poor: a systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation. 2011;92:824–829.
- Romeo A, et al. Effectiveness of specific neck exercise for nonspecific neck pain: a systematic review with meta-analysis. Physical Therapy. 2022.
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- Verwoerd M, Wittink H, Maissan F, de Raaij E, Smeets RJEM. Prognostic factors for persistent pain after a first episode of nonspecific idiopathic, non-traumatic neck pain: a systematic review. Musculoskeletal Science and Practice. 2019;42:13–37. https://doi.org/10.1016/j.msksp.2019.03.009
- Vos CJ, Verhagen AP, Passchier J, Koes BW. Clinical course and prognostic factors in acute neck pain: an inception cohort study in general practice. Pain Medicine. 2008;9(5):572–580. https://doi.org/10.1111/j.1526-4637.2008.00456.x
- Yu CWG, Wongwitwichote K, Mansfield M, Deane JA, Devecchi V, Falla D. Physical and psychological predictors for persistent and recurrent non-specific neck pain: a systematic review. European Journal of Pain. 2025;29:e70168. https://doi.org/10.1002/ejp.70168
