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STIFF NECK, WRY NECK
 
This painful and common complaint is the result usually of exposure to cold, camp or a draught, or of a slight strain in persons predisposed to "rheumatic" trouble; or those prone to anxious states. The muscles most commonly involved are the sterno-mastoid and the trapezius, which are superficial but deeper muscle; may at times share in the disability.
A "stiff neck" is due to local changes in the nutrition and circulation of the muscle resulting from exposure to cold with, generally, the additional factor of some mild focal infection elsewhere in the body. The affected muscles are painful at rest, tender to the touch and very painful on movement. They may feel slightly swollen and there may be redness of the skin over them. Their condition is one of fibrositis (q.v.), with swelling and hardening of their fibres, some engorgement of their vessels, and sta.gnation of the lymph flow through their channels.
WRY NECK.
This condition, also known as torticollis occurs in two main forms, fixed wry neck and the spasmodic variety.
The former is usually of congenital origin, or at any rate arises very early in life, though it often escapes notice at first owing to the shortness and lack of development of the neck.babics. The trouble lies chiefly in the sternomastoid muscle, which runs obliquely up the side of the neck in babies from the breast bone or sternum to the mastoid process.
 
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The action of this muscle is to bend the head sideways and turn the chin to the opposite side, well exemplified in wry neck, for this is the attitnde the head assumes. When this posture is maintained for some time other muscles associated with the sternomastoid become shortened as well as the connective tissue. The shortening of the stemomastoid, however, is the salient faature of the deformity, and it may be seen to stand out as a tense cord.
The precise cause of the disease is puzzling. Some observers have referred it to an injury to the stcrno-mastoid sustained at birth, followed by shrinking of the damaged muscle. Others have considered the condition to be due to an early infantile paralysis affecting in this instance the muscles of the neck. In support of the last suggestion is the fact that the face on the affected side is under-developed.
The head can be straightened by dividing the shortened structures. The facial asymmetry, however, remains rather apparent unless the straightening is undertaken in early life. The after-treatment consists in fixing the head in the over-corrected position until the opposite muscles can maintain the head level.

In spasmodic wry neck the deformity is due to overacting muscles on one side, the spasm being either continuous or manifested by sudden jerky movements.
Methods of Treatment.
Treatment aims at the restoration of a free flow of lymph through the affected area and the removal of stagnant waste products, acceleration of blood flow through the part and a suppling of the hardened fibres. Local applications of heat are of great value; flannels wrung out of hot water, hot sponging muslin or flannel hags filled with salt heated in the oven and linseed poultices are all useful in promoting an incrrased flow of blood to the area and in softening the stiffened fibres and the hard fascia which constricts them.

Rubbing or skilled massage helps in clearing away waste material and opening up the lymph channels; it must be very gentle at first but at a later stage it is advisable to employ more force and to attempt to reach the deeper layers of muscle. Liniments containing turpentine or eucalyptol facilitate rubbing and nt the same time apply a counter-irritant to the surface and promote free circulation.

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