Neck Involuntary Movements: If your neck is pulling how to help yourself

Joaquin Farias PHD, MA, MS

If you have suddenly started to feel tension in your neck, accompanied by unexpected pulling, muscle spasms, discomfort, pain or tremors. This post can help you determine the cause of your symptoms and find the best treatment for you.


If you are experiencing neck tension that is lasting way longer than your physical therapist was expecting, if you are feeling frustrated that your symptoms are not getting better, but are getting worse with therapy, if you feel that your Physical Therapist, Chiropractor or Osteopath do not know how to help you because your symptoms are different than those produced by poor posture, poor sleep position, teeth grinding or using the computer for long hours, if your symptoms first appeared suddenly without a clear mechanical cause, this post may enable you to find the help that you need.

The first piece of advice I would give to you: If conventional treatment for muscle tension is not helping, you feel that you are getting worse, and the neck spasms and neck tension is affecting your quality of life, please consider the possibility that you could be dealing with a condition that is neurological in nature.

As of this writing in 2023, most Physical Therapists, Chiropractors and Osteopaths have not received enough training on how to treat and spot neurological conditions that affect movement and muscle control (movement disorders). It is estimated that there are 300,000 people affected by Cervical Dystonia worldwide. Cervical Dystonia is a neurological movement disorder that produces tension in the neck, neck pulling, pain in the shoulder and involuntary movements of the neck. When their symptoms first begin the vast majority of patients seek professional help, but their therapists treat the symptoms without success because they consider them to be structural or muscular in nature and are unaware of the neurological cause. I understand that neurological conditions are deceiving, because a brain imbalance can produce neck tension and it seems like resolving the neck tension is the right thing to do, when in fact restoring balance in the brain is the only option that will work.

The main problem of a misdiagnosis of these symptoms is the patient loses precious time that should be invested in their rehabilitation. They can spend large sums of money in treatments that are not adapted to their needs, making them feel frustrated that they have tried everything and nothing works.

In 2023, the average time a patient affected by Cervical Dystonia (also called Spasmodic Torticollis) will wait to receive a proper diagnosis and start receiving much needed Neuro-Rehabilitation is 10 years!

We can do better, therapists can learn to spot the initial symptoms, patients can be sent to a neurologist to receive an early diagnosis and start a specific Neuro-Rehabilitation protocol as soon as possible.

How to determine if your neck symptoms are neurological or muscular

If your neck tension is muscular in nature:

  • You will feel much better after a massage session
  •  Physical therapist sessions will decrease your symptoms, reducing your pain and increasing your mobility after the session. Improvements will last and you will gradually feel better in a few weeks. A physical therapy session once a week will resolve your tension in a period of time between one week and 6 weeks.
  • Stretching will reduce your tension
  • Your muscle tension will be quite stable during the day and will fluctuate little, no matter where you are.
  • You will just feel muscle tension but no additional symptoms such as tremors, nausea, migraines, dizziness, tiredness
  • You will feel tension in the neck but no involuntary pulling or movements.
  • Your tension will not interfere with your balance or your ability to walk

If your neck tension is neurological in nature:

  • You will feel slightly better after a massage session but the relief will last less than an hour, sometimes minutes
  •  Conventional Physical therapy may increase your symptoms, increasing your pain and not improving your mobility after the session.  A physical therapy session once a week for 6 weeks will not make a difference and you may feel you are getting worse. This is the moment to visit a neurologist.
  • Stretching will not reduce your tension and will increase your pulling if not done properly
  • Your muscle tension will fluctuate during the day, symptoms can suddenly increase if you are in public, stressed, or you did not sleep well. Symptoms may suddenly reduce when you are alone, dancing, relaxing or you had a cup of wine.
  • You may notice additional neurological symptoms such as tremors, nausea, migraines, dizziness, tiredness, vision issues.
  • You may experience neck pulling to the right, neck pulling to the left, neck fixed in a position and you cannot voluntarily change it. Neck and shoulder pain and tension may also be felt. Sudden tremors, jerks and twitches of the neck may be felt during the day.
  • Your symptoms may start as mild neck tension and get worse over time leading you to experience fixed postures, neck spasms, and involuntary motions in the neck or shoulder.
  • Your tension may interfere with your balance and your ability to walk

If your condition is neurological in nature, it would be normal that your symptoms suddenly appeared just after a period of exhaustion, stress, emotional trauma, a surgical operation, mild concussion, after Covid 19, after infection or after receiving a vaccine or starting a new drug (antidepressants, antipsychotics).

Seek a proper diagnosis at your neurologist’s office

This is very important, there are many different neurological conditions that can produce muscle tension in your neck and determining which one is affecting you is paramount. If you suspect cervical dystonia based on these symptoms, seeking a medical evaluation is crucial. Neurologists and movement disorder specialists are typically involved in the diagnosis process. They may conduct a thorough examination, including assessing your medical history and performing neurological tests. A good differential diagnosis is the best way to start receiving the treatment you need. Do not underestimate the importance of a proper diagnosis. A study conducted over 1,071 patients in 38 countries, showed that 66% of patients affected by Cervical Dystonia were misdiagnosed at first,  producing enormous stress for the patient and also delaying the opportunity to receive proper specific treatment for their condition.

What Causes Involuntary Neck Twitching?

Cervical dystonia manifests itself through involuntary muscle contractions in the neck. When these contractions occur, the muscles tighten and struggle to relax, leading to abnormal movements resembling spasms or jerks. This condition significantly affects posture, causing the head and neck to engage in irregular movements.

Cervical dystonia represents a localized, or focal manifestation of the broader neurological disorder known as dystonia. As a prevalent movement disorder, cervical dystonia primarily targets the muscles of the head and neck. The hallmark of this condition is the occurrence of involuntary contractures or muscle activations in the neck, resulting in various abnormal postures.

These postures can involve twisting or turning of the neck, pulling the head back, rotating it to one side, tilting it to one side, or even pulling it forward. The diversity of these manifestations underscores the complexity and variability of cervical dystonia, making it crucial for individuals to recognise the symptoms and seek timely medical attention and early diagnosis.

Cervical Dystonia Specific Symptoms:

You may feel just one, some or all of these symptoms to a greater or lesser degree. It’s also important to note that every single patient’s case will differ in the intensity of those symptoms.

1. Involuntary Movements and Twitching

One of the primary symptoms of cervical dystonia is the presence of involuntary movements in the neck. These can range from subtle twitching to more 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

Individuals with cervical dystonia commonly experience pain and tension in the affected areas, particularly the neck and shoulders. The continuous muscle contractions can lead to discomfort and, in some cases, chronic pain.

3. Restriction of Motion

A significant indicator of cervical dystonia is a decreased range of motion in the neck. Patients may find it challenging to move their neck freely, and certain postures may feel restrictive.

4. Neck Tremors

Tremors in the neck, characterized by rhythmic and involuntary shaking, are another distinctive symptom of cervical dystonia. These tremors can contribute to the overall difficulty in maintaining a stable head position.

5. Neck Pulling to the Right or Left

The asymmetrical nature of cervical dystonia often results in the head being pulled to one side, either to the right or left. This visible deviation from a normal head position is a key sign that clinicians use to diagnose the condition.

What are the most common treatments for Cervical Dystonia?

Treatment options for cervical dystonia vary and may include botulinum toxin injections, physical therapy (performed by a Physical Therapist with training in movement disorders), Neuroplasticity-based Neuro-rehabilitation and in some cases, surgical interventions. Early diagnosis and intervention can significantly improve the management of symptoms and enhance the quality of life for individuals living with cervical dystonia.

Unlocking Hope: Neurorehabilitation for Cervical Dystonia

As we navigate the intricate landscape of cervical dystonia, it’s imperative to shine a spotlight on the potential for recovery and improvement through Neuro-rehabilitation. Neuro-rehabilitation, a specialized form of therapy aimed at optimizing the nervous system’s function, holds promise for those grappling with the challenges of cervical dystonia.

The Importance of Early Intervention

Timing is Key: When it comes to Neuro-rehabilitation for cervical dystonia, the adage “the sooner, the better” resonates profoundly. Early intervention can play a pivotal role in shaping the trajectory of recovery. Initiating neuro-rehabilitation as soon as the diagnosis is confirmed is advised, as it provides the brain with an earlier opportunity to rewire and adapt.

Stimulating the Brain: Neuro-rehabilitation involves targeted exercises and therapies designed to stimulate the brain and promote neural plasticity. In the context of cervical dystonia, where abnormal muscle contractions disrupt normal movement patterns, neuro-rehabilitation becomes a beacon of hope.

Unleashing the Brain’s Potential

Recovery Options: The brain possesses an incredible capacity for adaptation and recovery. Engaging in neuro-rehabilitation early on maximizes the potential for the brain to reorganize itself, finding alternative pathways to control movement. This adaptability becomes a cornerstone for individuals with cervical dystonia, offering a spectrum of recovery options.

Holistic Approach: Neuro-rehabilitation for cervical dystonia is often a multidisciplinary endeavor. Physical therapists, occupational therapists, and sometimes speech therapists collaborate to tailor a comprehensive rehabilitation plan. This holistic approach addresses not only the physical aspects of the condition but also the broader impact on daily functioning and quality of life.

Partnering in the Recovery Journey

Patient-Centric Care: Neuro-rehabilitation is not a one-size-fits-all solution. Tailoring interventions to the specific needs and goals of each patient is essential. A patient-centric approach empowers individuals to actively participate in their recovery journey, fostering a sense of control and optimism.

Ongoing Support: Cervical dystonia is a condition that requires long-term management. Neuro-rehabilitation is not a quick fix but rather a process that unfolds over time. Ongoing support and regular adjustments to the rehabilitation plan ensure that the individual’s evolving needs are met.

Embracing Hope and Possibility

In conclusion, Neuro-rehabilitation emerges as a beacon of hope for individuals grappling with cervical dystonia. Starting this journey as soon as possible is not merely a suggestion but a strategic decision that opens doors to a spectrum of recovery options. By actively engaging the brain in the process of recovery, individuals can reclaim control over their movements and enhance their overall well-being.

Remember, the journey towards recovery is unique for each individual. With Neuro-rehabilitation as a guiding light, we pave the way for a future where the full potential of the brain is harnessed, offering renewed hope and possibilities for those affected by cervical dystonia.

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