I Went to Bed; Now I Can’t Turn my Head!

I hear this a lot in clinical practice: “I went to bed and now I can’t turn my head, how did I do this?” It is very common for this to happen, and when it does, it is completely understandable for people to think they have “trapped a nerve” because it is incredibly painful. What has actually happened is something that many people (including clinicians) are unaware of even being a thing. The good news is, when this occurs as a one off, the treatment for it is very simple and usually only needs a handful of treatment sessions to resolve. However, if this is something that you or someone you know experiences several times a year, there might be another underlying issue occurring in your neck that might need further investigations. We will get into all of this in detail in this blog post to provide detail, but reassurance that this issue is treatable using conservative approaches to healthcare, such as chiropractic.

Neck Anatomy

So, what happens with I go to bed; now I can’t turn my head? A lot of us have or will experience this scenario in our lives, usually due to sleeping with an unsupported or abnormal neck posture that causes a small part of the joint ligament to move into the joint space. These small ligaments are called intra-articular synovial folds¹. These synovial folds are normal structures found in all spinal joints that are part of the ligaments that support the joints of the spine. These folds are found just on the outer margins of the joints at the front and back of the joint extending into the joint only a few millimetres¹ (Figure 1).

Figure 1. Taken from Webb et al (2011).

When we sleep in an unsupported position, maybe after a couple of drinks on a Friday night, or we accidentally fell asleep on the sofa etc, the joints of the neck are put under abnormal stress, which causes them to open in an abnormal way. The longer the joints are in this position, the synovial folds extend into the joint further than they normally would. This in itself isn’t a problem, however, when we wake up, we suddenly put pressure through the joints with muscle contraction, causing the joint to close onto the synovial folds. There are two proposed mechanisms that result from this: entrapment and ex-trapment¹.

Entrapment is where the synovial folds have crept further into the joint space than normal, when we wake up, the muscles contract, bringing the joint surfaced back to their normal position which traps the synovial fold between the joint surfaces, pinching them in the joint (Figure 2).

Figure 2. Taken from Webb et al (2011).

Ex-trapment is where the synovial fold is pushed out or away from their normal position to the outside of the joint. This results in the synovial fold being pushed out the joint surfaces and gets compressed between the bone and the rest of the ligament complex (Figure 3).

Figure 3. Taken from Webb et al (2011).

Both of these scenarios cause the same result: severe pain, and muscle spasm resulting in you being unable to turn your head. In their research paper Webb and colleagues (2011) demonstrate synovial fold injuries in cadavers that show bruising of the fold itself and swelling around the associated nerve root¹.

Treatment

So, we know the what and the why, but how do we treat it? How can we treat the problem when it occurs? Well, the first this is to apply ice and or heat to the neck to help reduce the pain and ease the discomfort. Applying ice to the area can help reduce the pain severity and reduce the swelling so an injured joint. However, we must keep in mind how deep these soft tissues are in the neck. We have already shown that these synovial folds are deep within the joint itself, which means that applying ice to reduce inflammation to these tiny tissues directly might not be very effective. That being said, ice can still be effective for reducing the pain severity, so I recommend applying it anyway. Remember to wrap the ice pack in a thin tea towel (do not apply directly to your skin) and keep it on the area for 20 minutes, three times per day.

Between applying ice, you can also apply heat in the form of a hot water bottle or a heat pack. This can be very helpful to improve muscle pain and increase mobility. It is worth noting that the additional mobility you will experience will be temporary, like the pain relief from ice, but the combination of both can help you manage your symptoms in the early stages.

How does Chiropractic fit into this equation? Well, it turns out that spinal manipulative therapy can be used very effectively in the management of synovial fold impingement syndrome. For those of you reading this blog post who have experienced the “I went to bed, now I can’t turn my head” syndrome, you will be well aware of the fact that sudden movements of your neck, such as coughing and sneeze are not comfortable during the early stage. Therefore, timing it crucial; too soon and the muscles will be so tight with spasm that trying to release the fold won’t be possible, so we have to apply the manipulation once the severe spasm has resolved and the joint is more mobile. That being said, the point is that spinal manipulation of the neck should be on your radar to help manage this painful condition when it strikes.

Prevention

So how do we prevent getting these synovial folds from being pinched again? Well, one way to potentially reduce the risk of future episodes might be to use a supportive pillow. Here at Spriggs Chiropractic, we work with Groove Pillows to help support your neck in a neutral position when sleeping. If you feel your pillow is not supporting your neck when you sleep of you feel your episodes of neck pain are worse in the mornings, then maybe your pillow needs a change. Give the Groove Pillow a go, it is no risk with a money back guarantee, it might be worth a try.

Key Takeaway Point

If this is something your have experienced in the past, or you are currently experiencing this condition, which is what lead you to this blog, the most important thing to remember is getting the right treatment at the right time. Synovial fold impingement syndrome is very treatable with ice packs, heat packs and spinal manipulation. As we have said in previous blog posts, it is crucial to get a full assessment of your spine by a professional before receiving any treatment. Here at Spriggs Chiropractic, we are trained to assess your spine, find the diagnosis and perform the right treatment for you!

If you have experienced this issue repeatedly, then a more detailed assessment of your neck might be required. There might be an underlying cause such as a previous injury or changes to how your neck functions might be affected, causing you to repeatedly pinch these synovial folds. Here at Spriggs Chiropractic, we will therefore perform x-rays of your neck to assess why you keep suffering this painful condition. X-rays might also alter your treatment options^2–5, therefore, a more complete assessment of your spine might be required before treatment can commence. To find out more about how Chiropractic can help manage this condition, call us on 01635 43238 or email hello@spriggschiropractic.co.uk.

As always, I hope you enjoyed reading this blog post as much as I enjoyed writing it. I will keep them coming as long as you keep reading them.

By Mark Spriggs DC, MChiro, MSc, PGCert, FRCC

References:

1. Webb AL, Collins P, Rassoulian H, Mitchell BS. Synovial folds – A pain in the neck? Man Ther. 2011;16(2):118-124. doi:10.1016/j.math.2010.11.004
2. Spriggs M, Foulkes D. How Frequently Do Lateral Cervical Spine Radiographs Alter Treatment Options In Chiropractic Practice? J Contemp Chiropr. 2022;5(28):57-75.
3. Beck RW, Holt KR, Fox MA, Hurtgen-Grace KL. Radiographic anomalies that may alter chiropractic intervention strategies found in a New Zealand population. J Manipulative Physiol Ther. 2004;27(9):554-559. doi:10.1016/j.jmpt.2004.10.008
4. Pryor M, McCoy M. Radiographic findings that may alter treatment identified on radiographs of patient receiving chiropractic care in a teaching clinic. J Chiropr Educ. 2006;27(9):554-559.
5. Jenkins H, Zheng X, Bull P. Prevelence of congenital anomalies contraindicating spinal manipulative therapy within a chiropractic patient population. Chiropr J Aust. 2010;(40):69-76.