In wry neck the head is flexed to one side by contraction of muscles ; the face is rotated to the opposite side, and the chin is tilted. The sterno-mastoid is, as a rule, the muscle primarily affected ; other muscles which move the head become more or less contracted. In slight cases caused by cold, sitting in a draught, or rheumatism, the muscles are tender, but not hardened ; movement of the head by the patient is prevented by pain. These cases yield readily to hot fomentations, massage, and exercises. Chronic wry neck is more serious, and requires longer treatment. The contracted muscles harden ; the head is not only drawn towards the shoulder : the shoulder and clavicle are pulled up towards the head. The sternum is sometimes drawn to the contracted side, and there is cervical and even upper dorsal curvature, with the convexity to the opposite side. In such cases the muscles of the chest and upper part of the back are involved, and are included in the treatment. The muscles of the opposite side of the neck are necessarily much stretched ; the sterno-mastoid may become so thin that it is impossible to isolate it.

The patient is seated, and is uncovered to below the scapula ; the operator sits behind on a seat higher than that of the patient (or stands). The head is steadied with one hand, while the work is done with the other. The back is fixed against the back of the chair.

1.   Every part of the neck is stroked downwards.

2.  The sterno-mastoid and all the muscles on the contracted side are kneaded with thumb and fingers and heel of hand, a stretching movement being given at the same time.

3.  The opposite side is manipulated in much the same way, but stretching is omitted. Where the sterno-mastoid cannot be isolated, finger-kneading is appropriate.

4.   Hacking on stretched muscles.

Exercises—Passive.—The shoulders are held by an assistant ; the head is taken between the hands and drawn as far as possible to the stretched side ; at the same time a twisting movement is made to turn the face towards the contracted side. The head is flexed and extended.

Active.—The operator holds the shoulders while the patient tries to do the above movements.

Resistive movements cannot be done for some time.