Dystonia is an involuntary muscle contraction that causes awkward, often painful postures. Examples include the neck turning to one side, the toes curling under or a foot turning inward. Dystonia can be a idiopathic (without a known cause) without any other symptoms, hereditary or it can be a symptom of Parkinson’s or other acquired conditions like acquired brain injury or cerebral palsy, It is the third most common movement disorder.
Neck dystonia (the medical name is cervical dystonia, or sometimes spasmodic torticollis) is uncontrollable and often painful muscle contractions in the neck which cause awkward postures and discomfort. The head generally pulls to one side, backwards or forwards. Neck dystonia is believed to be caused by incorrect messages from the brain to the muscles and is often idiopathic (without a known cause). It is a neurological movement disorder and should be treated by a physiotherapist specialising in movement disorders.
Symptoms of neck dystonia usually appear between the ages of 30 and 50 but sometimes affect younger or older people. Neck dystonia is the most common dystonia and affects an estimated 18,000 adults in the UK.
How can physiotherapy treatment help with focal dystonias including cervical dystonia ?
Initial Session & Consultation
At Leeds Bradford Neuro Physiotherapy your treatment is tailored specifically to your needs, as each presentation of dystonia is unique to each person.
The first session will include a review of your medical history and a physical examination to evaluate the problem. Sometimes, with the patients permission, photographs are taken. These are often helpful to give a baseline picture so that progress can be tracked. Your physiotherapist will try and find out how your dystonia affects your everyday life, and agree some treatment goals.
At the end of your first session we always aim to have given you something to do at home. With your permission we will write to your GP and neurologist to advise them of our involvement in your treatment.
Strategies and Home Sessions
Dystonia is a long term condition and physiotherapy will be an ongoing process involving sessions with the therapist and exercises at home. The outcomes can be significant but it is not a quick or easy fix. It needs to be approached with commitment and integrated into everyday day life and activities of daily living.
Treatment within your physiotherapy sessions will generally but not always include hands on therapy, and advice on the correction of inappropriate compensatory strategies. A compensatory strategy is a posture or movement that your body automatically takes in response to a problem elsewhere. For instance a limp can be a response to a painful toe – however the limb can cause pain in hip due to the way the person is walking. The painful hip is caused by a compensatory strategy.
Follow up sessions
Your treatment plan will involve exercises that are expected to be done at home. Exercises are practiced during sessions and written instructions are given. Patients often find that their home exercise program can be incorporated into their daily regime easily. Little but often is often a good mantra to follow as treatment success is ultimately in the hands of the patient and is dependent upon them following the advice given.
Initially a few physiotherapy sessions are required to set up a treatment plan but then sessions can often be more infrequent. Progress is reviewed at follow-up sessions. Further hands on treatment may be appropriate and your exercise regime will be adjusted as appropriate. It is important to touch base regularly with your physiotherapist to ensure that things aren’t slipping and compensations developing. We can often offer follow up sessions via video conferencing to check on exercise plans if travelling to the practice is difficult.
Patients with focal dystonia often benefit from botulinum toxin therapy (BTT) which can be obtained through the NHS. BTT works best when combined with physiotherapy. Here at Leeds Bradford Neurophysiotherapy we work with patients and their neurologists to achieve the best outcomes.
It is important that physio is provided by physiotherapists who know about dystonia – for instance neuro-physiotherapists who specialise in working with people affected by neurological conditions.
At Nicole Lavin Neurological Rehabilitation Karen Hull has a special interest in the treatment of dystonia, and is a member of the International Parkinson and Movement Disorder Society. She has attended courses in London and an international conference.