S.R.C/ Swedish.Rehab.Center

23/09/2025

𝙏𝙤𝙧𝙩𝙞𝙘𝙤𝙡𝙡𝙞𝙨 (Wry Neck)

Torticollis, also known as wry neck, is a condition characterized by an abnormal, asymmetrical head or neck position due to sustained contraction or shortening of the sternocleidomastoid (SCM) muscle, or due to other neuromuscular, skeletal, or ocular causes. The term literally means “twisted neck.”

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𝙏𝙮𝙥𝙚𝙨 𝙤𝙛 𝙏𝙤𝙧𝙩𝙞𝙘𝙤𝙡𝙡𝙞𝙨

Torticollis can be classified broadly into:

1. Congenital Muscular Torticollis (CMT)

-Most common form in infants.

-Due to unilateral fibrosis/shortening of the SCM.

-Often associated with birth trauma, intrauterine malposition, or ischemic injury.

2. Acquired Torticollis

-May occur at any age, secondary to:

-Muscular causes – spasm or contracture of SCM, trapezius, or other cervical muscles.

-Skeletal causes – cervical spine anomalies, fractures, atlantoaxial rotatory subluxation.

-Neurological causes – dystonia, CNS lesions, syringomyelia.

-Ocular causes – ocular muscle imbalance (compensatory head tilt).

-Inflammatory/Infectious causes – retropharyngeal abscess, adenitis, tonsillitis.

-Drug-induced – acute dystonic reactions (e.g., to antipsychotics, metoclopramide).

3. Spasmodic Torticollis (Cervical Dystonia)

-A chronic neurological movement disorder.

-Involuntary intermittent or sustained contraction of neck muscles leading to abnormal postures and tremors.

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𝙋𝙖𝙩𝙝𝙤𝙥𝙝𝙮𝙨𝙞𝙤𝙡𝙤𝙜𝙮

1) Congenital muscular type: Fibrosis within SCM due to ischemic injury during labor → shortening → head tilt towards affected side and chin rotated to opposite side.

2) Acquired types: Imbalance in tone or control of cervical musculature caused by pain, trauma, infection, or CNS pathology.

3) Spasmodic type: Dysfunction in basal ganglia pathways leading to dystonia.

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𝘾𝙡𝙞𝙣𝙞𝙘𝙖𝙡 𝙁𝙚𝙖𝙩𝙪𝙧𝙚𝙨

1) Congenital Muscular Torticollis (CMT)

-Detected in infants (within 2–4 weeks of birth).

-Head tilt towards the affected SCM with chin rotated to the opposite side.

-Possible palpable SCM mass (“sternomastoid tumor”).

-Facial asymmetry (plagiocephaly) in untreated cases.

-Limited cervical range of motion.

2) Acquired Torticollis

-Sudden onset neck pain and stiffness.

-Restricted ROM due to spasm or guarding.

-Abnormal head position.

-Associated features depending on cause (fever, trauma, neurological symptoms, ocular issues).

3) Spasmodic Torticollis

-Gradual onset in adults (20–60 years).

-Involuntary spasms, jerks, or sustained abnormal head posture.

-May be painful.

-Psychological and social impact due to visible deformity.

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𝘿𝙞𝙛𝙛𝙚𝙧𝙚𝙣𝙩𝙞𝙖𝙡 𝘿𝙞𝙖𝙜𝙣𝙤𝙨𝙞𝙨

-Cervical spine fracture/dislocation.

-Atlantoaxial subluxation (Grisel’s syndrome).

-Posterior fossa tumors.

-Ocular palsy.

-Retropharyngeal abscess or cervical lymphadenitis.

-Dystonic reactions to drugs.

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𝙄𝙣𝙫𝙚𝙨𝙩𝙞𝙜𝙖𝙩𝙞𝙤𝙣𝙨

-Clinical examination (key for diagnosis).

-Ultrasound of SCM – in infants with suspected congenital muscular torticollis.

-X-ray cervical spine – to rule out bony abnormalities or subluxation.

-MRI brain/cervical spine – if neurological cause suspected.

-Blood tests – if infection/inflammation is suspected.

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𝙈𝙖𝙣𝙖𝙜𝙚𝙢𝙚𝙣𝙩

1. Congenital Muscular Torticollis

-Physiotherapy is the gold standard:

-Gentle passive stretching of SCM.

-Active range-of-motion exercises.

-Positioning therapy: encourage infant to turn head towards affected side.

-Tummy time and play-based facilitation.

-Parental education.

-Helmet therapy if plagiocephaly develops.

-Surgical intervention (SCM release/lengthening) if:

-Severe contracture persists beyond 1 year.

-No improvement after 6–12 months of physiotherapy.

2. Acquired Torticollis

-Identify and treat underlying cause:

-Analgesics, muscle relaxants, or anti-inflammatory drugs.

-Immobilization (short-term) if traumatic.

-Antibiotics/drainage for infectious causes.

-Ocular correction (glasses, surgery).

-Stop offending drugs in drug-induced dystonia.

•Physiotherapy:

-Heat therapy and TENS for pain/spasm relief.

-Gentle stretching of tight muscles.

-Strengthening of contralateral and weak neck muscles.

-Postural correction training.

3. Spasmodic Torticollis

•Medical:

-Botulinum toxin injections (first-line, gold standard).

-Anticholinergics, muscle relaxants, benzodiazepines.

•Surgical:

-Selective denervation or deep brain stimulation (DBS) in severe refractory cases.

•Physiotherapy:

-Gentle stretching and relaxation.

-Sensory tricks (“geste antagoniste” – touching face to reduce spasm).

-Balance and posture training.

-Stress management techniques.

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𝙋𝙧𝙤𝙜𝙣𝙤𝙨𝙞𝙨

-Congenital muscular torticollis: 90% cases resolve with physiotherapy if started early (

19/09/2025

Golf Stretching Guidelines🏌
1. Chest Stretch= 2reps* 30 sec hold

》Standing up, clasp hands behind lower back with arms relaxed.
》Squeeze shoulder blades together and try to straighten and raise arms.
》Avoid tipping forward at the waist.
》Hold for 30 seconds.

2. Rear Shoulder Stretch= 2 (each side) 30 sec

🔸️Standing up, place one arm across chest, support elbow with opposite forearm.

🔸️Keeping arm straight, push elbow into chest with opposite forearm until a stretch is felt in the shoulder.

🔸️Hold for seconds and repeat for the other arm.

3. Side Bend Stretch= 2 (each side) 30 sec

▪️Standing up, place right arm by side and left up in the air as though asking a question.
▪️Slide your right arm down your right thigh allowing left arm to gently bend over head.
▪️Hold for 30 seconds and repeat for the opposite side.
▪️You can use a bar or chair to hold on to with your left if balance prevents a proper stretch.

4. Lower Back Twist Stretch= 2 (each side) 30 sec

●Lie flat on back, legs outstretched, arms out in a crucifix position.
●Keeping knees together, bring both knees into chest and twist knees to the left.
●Knees should remain bent at right angles and both shoulders should stay in contact with floor.
●Use left arm to gently push knees towards floor until a comfortable stretch is felt.
●Hold for 30 seconds and repeat to other side.

5. Quad Stretch= 2 (each side) 30 sec

☑️Lie on your side, grab right ankle and pull into buttocks.

☑️Push hips forward slightly until a stretch is felt in the right thigh.

☑️Hold for 30 seconds and repeat for the opposite side.

6. Standing Calf Stretch= 2 (each side) 30 sec

🔹️Stand a short distance from a wall, place your hands on it for support, and step one foot back, keeping its heel on the floor and toes pointed forward.

🔹️Bend your front knee and lean your hips towards the wall, keeping the back leg straight, until you feel a stretch in the back of the lower leg.

🔹️Hold the stretch for 30 seconds, then switch legs and repeat.

19/09/2025

🧠 Understanding Dystonia: A Guide

Dystonia is a complex group of movement disorders that can affect people in many different ways. If you or someone you know is living with dystonia, understanding the condition is the first step. Here’s a breakdown of what dystonia is, what causes it, and how it's treated, all based on the provided sources.

❓ What Is Dystonia?

Dystonia is defined by involuntary muscle contractions, which can be either sustained or intermittent. These contractions force the body into abnormal, often painful, movements or postures.

It can affect just one part of the body (focal dystonia), multiple adjacent parts (segmental dystonia), or the entire body (generalized dystonia).

Dystonia can be known by other names depending on the body part it affects, including:
▪️ 👁️ Blepharospasm (eyelids)
▪️ 🧍 Torticollis / Cervical Dystonia (neck)
▪️ 👄 Oromandibular Dystonia (mouth, tongue, or face)
▪️ ✍️ Writer’s Cramp (hand)
▪️ 🎤 Laryngeal Dysphonia (vocal cords)

⚠️ What Are the Symptoms of Dystonia?

The main symptom is abnormal muscle contractions, which are often triggered or made worse by voluntary actions. This can lead to a variety of presentations:

▪️ 🧍 Neck (Cervical Dystonia/Torticollis): Most commonly affected area, often causing the head to turn to one side. Can also involve jerky or tremulous head movements that might look like an essential tremor.
▪️ 👁️ Eyelids (Blepharospasm): Involuntary, forceful closure of the eyelids, leading to excessive blinking or persistent eye closure causing functional blindness. Stress and bright light can be triggers.
▪️ 👄 Mouth, Tongue, or Face (Oromandibular Dystonia): Causes difficulty with speaking or swallowing.
▪️ ✍️ Hand (Writer's Cramp): Frequently triggered by writing, typing, playing an instrument, or golfing.
▪️ 🧍‍♂️ Generalized Dystonia: Affects the trunk and at least two other body regions. Childhood onset often points to a genetic cause, while adult onset may suggest a structural issue in the brain.

✨ A unique and important diagnostic clue for dystonia is the presence of "sensory tricks" (gestes antagonistes). These are specific touches or movements that can temporarily relieve the symptoms. For example, a person with torticollis might find that lightly touching their face can reduce the head-turning. The presence of a sensory trick is almost exclusively seen in dystonia, making it a key feature for diagnosis.

👥 Who Gets Dystonia?

▪️ 📊 Prevalence: Estimated prevalence for all primary dystonias is 16.4 per 100,000 people.
▪️ 🚺 S*x: More common in females, with an estimated 1.5:1 female-to-male ratio.
▪️ 📅 Age of Onset: Varies significantly. Primary focal dystonias most often begin in a person's fifth decade (40s). Hereditary forms can start in either childhood or adulthood and tend to be more severe.

🔎 What Causes Dystonia?

Dystonia can be categorized by its cause:

▪️ 🧬 Primary Dystonia: Exact cause unknown or uncertain. Many forms are genetic, with autosomal-dominant, autosomal-recessive, X-linked, and mitochondrial inheritance patterns identified.
▪️ 💊 Secondary (Acquired) Dystonia: Result of another condition, injury, or exposure. It is crucial to always consider medications as a potential cause.

Causes of secondary dystonia include:
▪️ 💊 Drug Exposure: Certain medications, especially dopamine receptor blockers like antipsychotics and metoclopramide. Anticonvulsants and some calcium channel blockers can also cause dystonia.
▪️ 🧠 Brain Lesions: Stroke, infection, tumors, hypoxia, demyelination (like in multiple sclerosis), or physical injury.
▪️ ⚖️ Metabolic Disorders: Wilson disease, hypocalcemia, amino acid and lipid disorders.
▪️ 🦠 Infections: Viral encephalitis, HIV, syphilis, and others.
▪️ ☠️ Toxins: Carbon monoxide, cyanide, and methanol exposure.

🩺 How Is Dystonia Diagnosed?

Diagnosis is primarily clinical, based on medical history and physical examination. Doctors consider age of onset, affected body parts, progression, and associated features.

▪️ 🧲 Neuroimaging: MRI is preferred to look for structural causes, especially for patients under 40 or with generalized/hemidystonia symptoms. CT scans may be better for detecting brain calcifications. Primary dystonias are typically not associated with structural abnormalities.
▪️ 🧪 Laboratory and Genetic Testing: Blood tests are not usually helpful unless a specific secondary cause is suspected. Genetic testing may be recommended if there is family history or high suspicion of a genetic form.

💊 How Is Dystonia Treated?

Treatment is aimed at managing the symptoms and can involve multiple approaches.

🧘 Non-Pharmacologic Therapy:
▪️ Physical therapy, massage, heat, stretching, and biofeedback can help relieve pain and disability.
▪️ Sensory tricks provide temporary relief but are too brief to serve as therapy.

💉 Medication and Procedures:
▪️ Botulinum Neurotoxin (Botox): First-line treatment for focal dystonias like cervical dystonia and blepharospasm. Injected into affected muscles to weaken them.
▪️ Oral Medications:
▪️ For generalized dystonia in children, trial of carbidopa/levodopa to diagnose/treat dopa-responsive dystonia.
▪️ Other medications: trihexyphenidyl, benzodiazepines, baclofen, gabapentin, VMAT-2 inhibitors.
▪️ Intrathecal baclofen (via pump) may help trunk dystonia.
▪️ Surgery (Deep Brain Stimulation – DBS): For severe, disabling dystonia unresponsive to other treatments. Electrodes implanted in the internal globus pallidus.

⚡ For acute dystonic reactions (often medication-induced), emergency treatment with intravenous diphenhydramine or benztropine is given, and the offending drug is stopped.

🌿 Living with Dystonia

While spontaneous remission can sometimes occur, dystonia is generally progressive, and medications are often only partially effective. Management usually involves a team of specialists:
▪️ 🧠 Movement disorders neurologists
▪️ 🏃 Physical therapists
▪️ 🧬 Geneticists (if hereditary cause suspected)
▪️ 🩻 Neurosurgeons (for DBS consideration)

17/09/2025

Rehabilitation Exercises ⚡️
1. Neck Range of Motion (ROM):
→ Slowly move head side-to-side, up and down
→ Hold each position for 5 seconds
→ Repeat 10 times daily

2. Upper Trapezius Stretch:
→ Sit tall, tilt head to one side
→ Use hand to gently deepen the stretch
→ Hold for 20–30 seconds, repeat both sides

3. Levator Scapulae Stretch:
→ Turn head 45° to one side, then tilt downward
→ Use hand to assist stretch
→ Hold 20–30 seconds, repeat both sides

4. Chin Tucks (Postural Training):
→ Sit or stand tall
→ Gently pull chin back (like double chin)
→ Hold 5 seconds, repeat 10–15 times

5. Shoulder Rolls:
→ Roll shoulders forward and backward
→ 10 times each direction

6. Isometric Neck Strengthening:
→ Press your palm against forehead, side of head, and back
→ Resist movement gently (without moving neck)
→ Hold 5 seconds, repeat each direction

⚠️ Avoid sudden or jerky movements.

▶️ Apply moist heat or cold packs before exercises if needed.

👉Talk to your doctor!

🔎 It is important to consult your doctor before starting any exercise. If any of the exercises below cause more or worse pain, please stop immediately.

14/09/2025

Sciatica is pain that radiates along the sciatic nerve, which runs from the lower back through the hips and buttocks down each leg. It typically affects one side of the body.

Causes of Sciatica:
• Herniated disc (most common)
• Spinal stenosis
• Degenerative disc disease
• Spondylolisthesis
• Piriformis syndrome
• Trauma or injury
• Pregnancy-related changes

Symptoms:
• Sharp or shooting pain in the lower back, buttock, and leg
• Tingling, numbness, or muscle weakness in the leg or foot
• Pain worsens with sitting, coughing, sneezing, or bending
• Burning or electric-shock-like pain

Physiotherapy Treatment for Sciatica:

1. Pain Relief Techniques:
• Hot or cold packs
• TENS therapy (Transcutaneous Electrical Nerve Stimulation)
• Ultrasound therapy

2. Stretching Exercises:
• Piriformis stretch
• Hamstring stretch
• Knee-to-chest stretch

3. Strengthening Exercises:
• Core strengthening
• Pelvic tilts
• Glute bridges

4. Postural Training:
• Correcting posture while sitting, standing, and lifting
• Ergonomic advice for work and daily activities

5. Manual Therapy:
• Soft tissue mobilization
• Joint mobilization for lumbar spine and sacroiliac joint

6. Neural Mobilization:
• Sciatic nerve glides to reduce neural tension

20/08/2024

17/08/2021

Limited Time 50% discount

04/09/2020

Benefits of Ultrasound therapy

* Relaxation of tissue
* Heating of tissue
* Reduces pain
* Increases blood flow in the area
* Breakdown of scar tissue

09/08/2020

Physiotherapists Job Opportunity

Sweden Center for physiotherapy & rehabilitation in Erbil is looking for expert therapist staff male & female are needed to work with a talented & expert staff.

With the growing of our center we need more staff to serve health care.

Candidates should have:
1. Bachelor degree - natural treatment (Phisiotherapy) department.
2. Years of experience: 2-3 years
3. Working hours: 8 hours a day
4. Kurdish & Arabic languages are must, English is a plus.

Only good candidates are required to send their CVs to our page, by email or visit us at P**y hospital, fourth floor - Sweden center for natural treatment.

[email protected]
0750-190 88 04