Sustained muscle contractions that can cause involuntary twisting and repetitive movements resulting in abnormal postures that sometimes can be painful. The dystonia can be focal (involve only one area of the body) or may include many body parts. Treatments include oral medications, botulinum toxin injections and DBS.

It is also described as a state of abnormal muscle tone resulting in muscular spasm and abnormal posture, typically due to neurological disease or a side effect of drug therapy.

The movements may resemble a tremor.

Dystonia is often initiated or worsened by voluntary movements, and symptoms may “overflow” into adjacent muscles.

Dystonia is often described as a brain circuit disorder and typically Basal Ganglia in ORIGIN

As there are any parts of the BG and therefore many ways to arrive at dystonia

Dystonia is Complex there are No blood test or lab test as chemical/functional and more often not visible on CT/MRI  making is a diagnosis of Exclusion

Cervical Dystonia

Patterned, repetitive, and spasmodic or sustained muscle contractions resulting in abnormal movements and postures of the head and neck may affect any combination of neck muscles result in jerky head movements or periodic or sustained unnatural positioning of the head (dystonic posturing).

Jean Pierre Bleton

Physiotherapist of the Parkinson’s Unit in the Neurology Department at the Rothschild Foundation in France – the Guru!!!

Intervention Goals are based around maintaining the flexibility of the spinal column and the cervical muscles, diminishing the intensity of the spasms, achieving  voluntary control, then automatic control of the correct head position and, if you have pain, to alleviate  pain

General Dos…

  • 30 min +/day
  • Relax –reduce any stress, depression or anxiety
  • Perform active corrective exercises
  • Keep your head in the correct alignment TV/radio -giving your body lots of support in sitting
  • Arrange your work area so correcting position
  • Hold the telephone on the corrective side
  • Position so talking to people to the corrective side
  • Perform retraining  exercises in the swimming pool
  • Think length not stretch

Try to avoid…

  • adopting the posture of torticollis
  • holding your head with your hand
  • shoulder strap bag
  • isolation
  • ineffective or even harmful.
  • massage of spasmodic muscles
  • mechanical traction or manipulation
  • wearing a cervical collar
  • analgesic therapies such as infra-red or lasers

The link

But dystonia effects not just the neck…although it is the same principles for treatment management


Blepharospasm, Oromandibular dystonia, Meige syndrome, Spasmodic dysphoria, Writers cramp

Occupational dystonia and Generalised dystonia

One of the most common treatment choices include Botox In conjunction with experienced neurological physiotherapy input.

What about Exercise?

If you are considering embarking on an exercise programme be aware and being slowly - let pain be your indicator to modify an exercise.

Even with dystonia it is important to reach optimal health, becoming proactive about general health.

Dystonia is sensitive to any kind of stress including fatigue - to managing your time to managing your dystonia – fight fatigue

Julie Rope

Online resources


Bleton J-P, Spasmodic Torticololis. A physiotherapy handbook. 2014, Frison-Roche

Cassidy A pathophysiology of idiopathic focal dystonia ACNR 2010 10 14 – 18

Chan, J. Brin, MF, Fahn, S: Idiopathic cervical dystonia: clinical characteristics. Movement disorders 1991;6(2):119-26

Chronicles of a dystonia muse

Dashtipour K, Lew M. Handbook of Dystonia. 2007: 37-154.

Dystonia foundation organisation – living with dystonia physical therapy resource

Joost van den Dool, et al; Effectiveness of a standardised physical therapy program: study design and protocol of a single blind randomised controlled trial. BMC Neurology December 2013, 13:85

Mueller J, Wissel J Visual biofeedback treatment improves cervical dystonia Department of Neurology, Vivantes Hospital Berlin Spandau, Academic teaching Hospital of the Charité, Berlin

Ostrem Jill L. , MD Diagnostic criteria for cervical dystonia: Can botulinum neurotoxin manage, as well as, cure the problem? Professor of Neurology UCSF Department of Neurology Movement Disorder and Neuromodulation Center Bachmann Strauss Dystonia and Parkinson’s Disease Center of Excellence Dec 2015

Thong, D, Mayank P and Frei K. Living Well with Dystonia. A patient guide. 2010.

National Institute of Neurological Disorders and Stroke

Wolfgang H.Jost et al: Rating scales for cervical dystonia: a critical evaluation of tools for outcome assessment of botulinum toxin therapy, J Neural Transm. 2013 Mar; 120(3): 487–496.

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