How to Know if Your Client is Affected by Cervical Dystonia: Vital Information for Therapists

Joaquin Farias PHD, MA, MS

This post aids therapists in identifying whether their clients may be affected by the neurological condition known as Cervical Dystonia. Explore the key signs and symptoms, enabling therapists to provide more precise and effective care for their clients.


If your client is experiencing tension in the neck, along with unexpected pulling, muscle spasms, discomfort, pain, or tremors, this article can help you determine the underlying cause of their symptoms and guide you in finding the most effective treatment options.

If your client’s neck tension persists beyond the expected duration of therapy, if their symptoms worsen with treatment, and if you find that conventional approaches for muscle tension, such as physical therapy, chiropractic care, or osteopathy, are ineffective, it’s crucial to consider the possibility of a neurological condition.

Cervical Dystonia is a neurological movement disorder characterized by neck tension, pulling sensations in the neck, shoulder pain, and involuntary neck movements. Unfortunately, most patients seek professional help when their symptoms first appear, but therapists often treat these symptoms as structural or muscular issues without recognizing the neurological root cause.

Misdiagnosis can lead to patients investing time and money in treatments that are not tailored to their needs, resulting in frustration and a sense of hopelessness. In 2023, the average delay for a patient with Cervical Dystonia to receive a proper diagnosis and initiate Neuro-Rehabilitation is a staggering 10 years.

Therapists have the opportunity to make a difference by learning to identify the initial symptoms of Cervical Dystonia and referring clients to neurologists for early diagnosis and specific Neuro-Rehabilitation protocols.

How to Determine if Your Client’s Neck Symptoms are Neurological or Muscular

Muscular Neck Tension:

  • Clients will experience relief after a massage session.
  • Physical therapy sessions will reduce symptoms, alleviating pain and enhancing mobility that persists beyond the session. These improvements will endure, with clients gradually feeling better over a few weeks.
  • Stretching will effectively reduce muscular tension.
  • Muscle tension will remain relatively stable throughout the day, with minimal fluctuations.
  • Clients will solely experience muscle tension without additional symptoms such as tremors, nausea, migraines, dizziness, or fatigue.
  • Clients may feel neck tension but will not exhibit involuntary pulling or movements.
  • Tension will not interfere with balance or walking.

Neurological Neck Tension Related to Cervical Dystonia:

  • Clients may experience temporary relief after a massage session, but it will be short-lived, sometimes lasting only minutes.
  • Conventional physical therapy may exacerbate symptoms, increasing pain without improving mobility. Weekly physical therapy sessions for six weeks may yield no improvement and may even worsen symptoms, signaling the need to consult a neurologist.
  • Stretching will not alleviate tension and may exacerbate pulling if not performed correctly.
  • Muscle tension will fluctuate throughout the day, with symptoms potentially worsening in public, during periods of stress, inadequate sleep, and improving when alone, dancing, relaxing, or after consuming alcohol.
  • Clients may exhibit additional neurological symptoms, including tremors, nausea, migraines, dizziness, fatigue, and vision issues.
  • Clients may experience pulling in the neck to the right or left, the neck fixed in a position, and an inability to voluntarily change it. Neck and shoulder pain, as well as tension, may also occur. Sudden tremors, jerks, and twitches of the neck may manifest during the day.
  • Symptoms may begin as mild neck tension and progressively worsen, leading to fixed postures, neck spasms, and involuntary neck or shoulder movements.
  • The onset of symptoms may coincide with periods of exhaustion, stress, emotional trauma, surgical procedures, mild concussions, post-COVID-19 recovery, infections, or the initiation of new medications (e.g., antidepressants, antipsychotics).

Seeking a Proper Diagnosis at a Neurologist’s Office

Proper diagnosis is crucial because various neurological conditions can cause neck muscle tension. If you suspect Cervical Dystonia based on these symptoms, prompt medical evaluation is essential. Neurologists and movement disorder specialists are typically involved in the diagnostic process, conducting a comprehensive examination, reviewing medical history, and performing neurological tests. An accurate diagnosis is the first step toward receiving appropriate treatment, as misdiagnosis can cause significant stress and delay effective care.

What Causes Involuntary Neck Twitching?

Cervical Dystonia, characterized by involuntary muscle contractions in the neck, leads to tightening and difficulty relaxing, resulting in abnormal movements resembling spasms or jerks. This condition significantly affects posture, leading to irregular movements of the head and neck.

Cervical Dystonia represents a localized manifestation of a broader neurological disorder known as dystonia. This condition primarily targets the muscles of the head and neck, causing involuntary contractures or muscle activations that result in various abnormal postures.

These postures can involve twisting or turning the neck, pulling the head back, rotating it to one side, tilting it to one side, or pulling it forward. The diversity of these manifestations underscores the complexity and variability of Cervical Dystonia, emphasizing the importance of recognizing symptoms and seeking timely medical attention and early diagnosis.

Cervical Dystonia Specific Symptoms:

Individuals may experience one or more of these symptoms to varying degrees. Additionally, each patient’s case may differ in the intensity of these symptoms.

  1. Involuntary Movements and Twitching: One of the primary symptoms of Cervical Dystonia is involuntary movements in the neck, ranging from subtle twitching to pronounced spasms or jerks. Observing these movements is often the first step in identifying the condition.
  2. Pain and Tension in the Neck and Shoulders: Patients commonly experience pain and tension in the affected areas, particularly the neck and shoulders, due to continuous muscle contractions, which can lead to discomfort and chronic pain.
  3. Restriction of Motion: A significant indicator of Cervical Dystonia is a limited range of motion in the neck, making it challenging for patients to move their neck freely and adopt certain postures.
  4. Neck Tremors: Tremors in the neck, characterized by rhythmic and involuntary shaking, are another distinctive symptom of Cervical Dystonia, contributing to the difficulty of maintaining a stable head position.
  5. Neck Pulling to the Right or Left: The asymmetry inherent in Cervical Dystonia often results in the head being pulled to one side, either to the right or left. This visible deviation from the normal head position serves as a key diagnostic sign.

Common Treatments for Cervical Dystonia

Treatment options for Cervical Dystonia vary and may include botulinum toxin injections, specialized physical therapy by therapists trained in movement disorders, Neuroplasticity-based Neuro-Rehabilitation, and, in some cases, surgical interventions. Early diagnosis and intervention play a crucial role in symptom management and improving the quality of life for individuals dealing with Cervical Dystonia.

Unlocking Hope: Neuro-Rehabilitation for Cervical Dystonia

As therapists, you can play a pivotal role in the journey of individuals with Cervical Dystonia by recognizing the potential for recovery and improvement through Neuro-Rehabilitation.

If you have a patient affected by Dystonia we are here to help