Effectiveness of Acupuncture in Treating Acute Non-specific Torticollis (ANST)

Kurrajong Natural Medicine Centre offers Acupuncture, Chinese Medicine, Western herbal medicine and Remedial therapies to the communities of Kurrajong, Richmond, North Richmond, Glossodia, Kurmond, and the greater Hawkesbury area.
 

A Case Study Demonstrating the Effectiveness of Acupuncture in Treating Acute Non-specific Torticollis (ANST)

by Danny T Siegenthaler
MSc. (TCM), BSc (hons), DTCM., DAc. (Aust/China)

Introduction

Acute Non-Specific Torticollis (ANST) is a common musculoskeletal condition seen in many Acupuncture clinics (Irnich, et al., 2002; Samuels, 2003; Vas, et al., 2006). It is estimated that every year over 30% of people suffer from an acute onset of Torticollis (Borghouts, Koes, & Bouter, 1998; White & Ernst, 1999). Yet, despite the high incidence of ANST in the community, there is very little scientific information available and no Randomized Controlled Trials (RCTs) have investigated the effectiveness of Acupuncture or Chinese herbal medicine in the treatment thereof (Borghouts, et al., 1998; Samuels, 2003). For this reason alone, presenting this case study may be of interest to the reader and may generate some scientific investigation into the effect of acupuncture on this condition.

Literature review

Acute Non-Specific Torticollis (ANST) is characterized by a sudden onset of pain in the neck that restricts movement of the head to one or both sides (Borghouts, et al., 1998). It is also referred to as Wryneck, Spasmodic Torticollis, or acute non-specific neck pain (Annon., 2010). Congenital Torticollis is widely discusses and has been researched, however, this is not the topic of this case study and this literature review is restricted to non-congenital, non-pathogenic causes of acute torticollis.

Unlike lower back pain, there is a paucity of information on ANST in the scientific literature and no RCTs have investigated the effects of acupuncture on ANST (Borghouts, et al., 1998; Yip & Tse, 2006).

In the literature of traditional Chinese medicine (TCM), however, torticollis is widely discussed and addressed (Bensky, 1990, pp. 51-52; Maciocia, 1994, pp. 589-590; Peilin, 2002, pp. 198-200) and focuses around invasion of Wind-Cold and muscular sprain as the primary aetiologies of ANST (Maciocia, 1994, p. 589).

TCM Perspective
Acute non-specific torticollis has an aetiology of (a) Wind-Cold invasion or (b) sprain of the muscles in the neck (Maciocia, 1994, p. 589).
According to Maciocia (1994, p. 589), if torticollis is caused by muscular strain, then there is usually an underlying Liver pathology (Liver Xue Deficiency, Liver-Yang rising or Liver-Qi stagnation) present. However, if it is due to an invasion of Wind-Cold there may also be accompanying signs and symptoms such as an aversion to Cold, a runny nose with clear discharge, and/or headache, etc. (Peilin, 2002, pp. 198-199).

Biomedical Diagnosis
From a biomedical perspective this condition may be called: Acute Non-Specific Torticollis (neck pain), Acute Idiopathic Torticollis (Borghouts, et al., 1998) or Spasmodic Torticollis (Pullman-Mooar, 2008).

In the biomedical system, the symptomatology of ANST, is described as follows: neck muscle pain or pain down the spine, inability to turn the head, usually holding it twisted to one side, spasm of the neck muscles and awkward position of the chin (Annon., 2010).

However, irrespective of whether this condition is viewed from a TCM or biomedical view point, if there is acute pain in the neck with additional symptoms of headache, fever, nausea, etc., then this may be indicative of a more serious disease such as meningitis, encephalomyelitis, etc. (Kaufman, 2009) and will need to be investigated further.

Presentation of Case (Biomedical & TCM)

Presenting Symptomatology:
Patient was unable to move her neck from side to side, and pain radiated into the L/S trapezius muscle and to the top of the L/S shoulder blade.

On palpation, there was considerable muscle spasm in the trapezius muscle extending from the occipital region to the spine of the scapula and to the L/S Clavicle. In order for the patient to turn her head from side-to-side, she moved her upper body while keeping the neck rigid. Her face showed that she was in considerable pain and her voice was low and weak.

Patient History:
The patient reported that she has had a severe whiplash injury to her neck 20 years ago and “it had left my neck weak”. The patient also reported that this was not the first time she had experienced waking up in the morning with a painful, stiff neck.

Associated Underlying Condition – Symptoms and Signs
In addition to the acute ANST the patient also had the following signs and symptoms: dizziness, blurred vision, muscular cramps, anxiety, palpitations, insomnia, irritability, repressed anger, red face/facial flushing and headaches; Tongue: purple body with little coating and a slightly rapid and wiry (probably due to pain) pulse.

TCM Diagnosis
Muscle sprain due to sleeping awkwardly, with an underlying Liver Blood Deficiency failing to nourish the Liver Yin causing Liver Yang rising.

Discussion of Diagnosis and Pathogenesis (TCM and Biomedical)

TCM
This case is ANST due to muscle sprain resulting from sleeping awkwardly and is accompanied by an underlying Liver Blood Deficiency. There is also an element of Liver Yang rising. When Liver Blood is deficient it cannot adequately nourish the Yin, which in turn becomes deficient and thus is unable to control the Liver Yang (Maciocia, 1994, p. 223; McDonald, 1985, p. 39). Therefore, Liver Yang rising symptoms are also part of the presenting signs and symptoms together with symptoms of Liver Xue Xu.

Biomedical
An acute onset of stiffness in the neck may be due to meningitis, encephalomyelitis, or of idiopathic aetiology. However, this patient did not present with any other symptoms other than waking up in the morning with acute neck pain and not being able to rotate her neck. She had no fever or any other symptoms that would cause alarm or concern to suspect anything other than acute non-specific neck pain.

Torticollis is described as being “…characterized by involuntary tonic contractions or intermittent spasms of neck muscles. The cause is unknown. Diagnosis is clinical (Pullman-Mooar, 2008)”. Mengel and Schwiebert (2009, p. 328) describe ANST as being recent, sudden onset of unilateral muscular pain. It may be caused by irritation to the cervical nerves from trauma or vigorous movement, or from sleeping in an awkward position; anxiety; neck muscle injury at birth (congenital), or neck muscle spasm (Annon., 2010; Timothy, et al., 2008).

Treatment Management and Strategies (Biomedical and TCM)

Biomedical Management of Acute Torticollis
Biomedical treatment may include:
Selective denervation of neck muscles with surgery; locally injected botulinum toxin; cervical collar; heat therapy; ultrasound therapy; physical therapy; drug therapy such as botulinum-A toxin and others, or surgery (Annon., 2010; Pullman-Mooar, 2008; Tsui, Jon Stoessl, Eisen, Calne, & Calne, 1986; White & Ernst, 1999).

TCM Treatment Strategy and Treatment
Treatment Strategy
Treatment Principles for Acute Non-Specific Torticollis due to Neck-muscle Sprain:

Treat every 2nd day for the first week, then reassess frequency.

Initial Treatment (31/10/2009)

Follow up treatments
3/11/2009
Neck and shoulders are pain free.
Some tightness in trapezius muscle, otherwise no more restrictions to moving the neck.
No pain since Sunday (day after 1st treatment)

At this point, the patient was reassessed and treatment focus was shifted to the underlying condition of Liver Xue & Yin Deficiency with Liver Yang rising using primarily Chinese herbal therapy (this part of the treatment is not discussed as it is beyond the scope of this case report).

Collaborative intervention may combine acupuncture with remedial massage, chiropractic manipulations, physiotherapy, etc., (Kaufman, 2009), however this was not a consideration, as the patient was virtually symptom free after the first treatment. However, if this was a chronic case of non-specific torticollis, remedial massage and exercise therapy would have been implemented in addition to Acupuncture and Chinese herbal medicine.

Conclusion

Acute Non-Specific Torticollis is a very common condition for which little scientific investigation has been undertaken (Borghouts, et al., 1998; Samuels, 2003). TCM literature covers ANST in some detail and provides both underlying pathologies, as well as effective treatment solutions for this condition (Maciocia, 1994, pp. 589-590; Peilin, 2002, pp. 198-199). TCM provides two distinct causes for ANST, (1) invasion of pathogenic factors (Wind-Cold) and (2) Muscle sprain associated with an underlying Liver pathology (Liv. Xue Xu, Liv. Yin Xu with/without Yang rising).
The biomedical system offers primarily drug therapy, physical therapies such as Physiotherapy, etc., or surgery as treatment solutions. However, this condition is poorly understood and little research in to ANST has been published (Borghouts, et al., 1998; Samuels, 2003).


References

  1. Annon. (2010). Torticollis (Wryneck).   Retrieved 09/04/2010, from http://www.uchospitals.edu/online-library/content=P01389
  2. Bensky, D., Barolet, R. (1990). Chinese Herbal Medicine: Formulas & Strategies. Seattle, Wasington: Eastland Press, Inc.
  3. Borghouts, J. A., Koes, B. W., & Bouter, L. M. (1998). The clinical course and prognostic factors of non-specific neck pain: a systematic review. Pain, 77(1), 1-13.
  4. Irnich, D., Behrens, N., Gleditsch, J. M., Stör, W., Schreiber, M. A., Schöps, P., et al. (2002). Immediate effects of dry needling and acupuncture at distant points in chronic neck pain: results of a randomized, double-blind, sham-controlled crossover trial. [doi: DOI: 10.1016/S0304-3959(02)00062-3]. Pain, 99(1-2), 83-89.
  5. Kaufman, R. (2009). Comanagement and Collaborative Care of a 20-Year-Old Female With Acute Viral Torticollis. [doi: DOI: 10.1016/j.jmpt.2008.12.008]. Journal of Manipulative and Physiological Therapeutics, 32(2), 160-165.
  6. Maciocia, G. (1994). The Practice of Chinese Medicine: The Treatment of Diseases with Acupuncture and Chinese Herbs. New York: Churchill Livingstone.
  7. McDonald, J. (1985). Zang Fu Syndromes: Differential Diagnosis and Treatment with Acupuncture and Chinese Herbal Medicine (1st Edition ed.). Sydney: New South Wales College of Natural Therapies.
  8. Mengel, M. B., & Schwiebert, L. P. (2009). Family Medicine: Ambulatory Care and Prevention (5th ed.). New York: McGraw Hill Medical.
  9. Peilin, S. (2002). The Treatment of Pain with Chinese Herbs and Acupuncture. Edinburgh: Churchill Livingstone.
  10. Pullman-Mooar, S. (2008). Spasmodic Torticollis.   Retrieved 9/04/2010, from http://www.merck.com/mmpe/sec04/ch041/ch041b.html?qt=acute%20stiff%20neck&alt=sh
  11. Samuels, N. (2003). Acupuncture for acute torticollis: a pilot study. American Journal of Chinese Medicine, 31(5), 803-807.
  12. Timothy, J., Foley, E., Comer, C., Barron, D., Sloan, J., & Shilliday, H. (2008). Soft tissue injuries: 3. Paraspinal. Emergency Medicine Journal, 25(8), 514-521.
  13. Tsui, J. C., Jon Stoessl, A., Eisen, A., Calne, S., & Calne, D. B. (1986). Double-Blind Study of Botulinum Toxin in Spasmodic Torticollis. [doi: DOI: 10.1016/S0140-6736(86)92070-2]. The Lancet, 328(8501), 245-247.
  14. Vas, J., Perea-Milla, E., Mendez, C., Navarro, C. S., Leon Rubio, J. M., Brioso, M., et al. (2006). Efficacy and safety of acupuncture for chronic uncomplicated neck pain: A randomised controlled study. [doi: DOI: 10.1016/j.pain.2006.07.002]. Pain, 126(1-3), 245-255.
  15. White, A. R., & Ernst, E. (1999). A systematic review of randomized controlled trials of acupuncture for neck pain. Rheumatology (Oxford), 38(2), 143-147.
  16. Yip, Y. B., & Tse, S. H.-M. (2006). An experimental study on the effectiveness of acupressure with aromatic lavender essential oil for sub-acute, non-specific neck pain in Hong Kong. [doi: DOI: 10.1016/j.ctcp.2005.09.005]. Complementary Therapies in Clinical Practice, 12(1), 18-26.


About the Author:
Danny Siegenthaler (MSc. (TCM), BSc. (Hons), DTCM., DAc. (Aust/China)) is a doctor of Traditional Chinese Medicine (TCM) with over 25 years of experience. He specialises in Women's health using Acupuncture and Chinese herbal medicine and has given many lectures and public talks on the subject.
He has written many articles on Chinese medicine and is the author of 'Lecture Notes on Acupuncture'.
Danny practices at Kurrajong Natural Medicine in the lower Blue Mountains, West of Sydney

About Us | Site Map | Privacy Policy | Contact Us

Kurrajong Natural Medicine Centre & Wildcrafted Cottage
7/1147 Grose Vale Rd.
Kurrajong Village, NSW, 2758
(02) 4573 0784

© Wildcrafted Cottage Pty Ltd. & Wildcrafted Herbal Products Pty Ltd. 2007 - 2016