Journal of Neurology

, Volume 261, Issue 10, pp 1857–1865 | Cite as

The effectiveness of physiotherapy for cervical dystonia: a systematic literature review

  • Joke De Pauw
  • Kevin Van der Velden
  • Jill Meirte
  • Ulrike Van Daele
  • Steven Truijen
  • Patrick Cras
  • Rudy Mercelis
  • Willem De Hertogh


Cervical dystonia is a form of adult-onset, focal dystonia characterized by involuntary contractions of the neck muscles, leading to a disabling, abnormal head posture. CD has a great impact on the activities of daily living (ADL) and quality of life. Currently, the most widely used and recommended first line treatment is botulinum toxin type A (BoNT/A) injections. Physiotherapy is a potentially useful adjuvant, but little is known about its effectiveness. Consequently, our objective was to investigate the effectiveness of physiotherapy alone or as an adjuvant treatment to BoNT/A injections in cervical dystonia (CD) by means of a systematic literature review. Two online databases, PubMed and Web of Science, were searched for articles describing the effectiveness of physiotherapy treatment for CD. After screening, based on predefined in- and exclusion criteria, 16 studies were retained. Their methodological quality was assessed according to Cochrane guidelines. The methodological quality of most studies was low. Examples of shortcomings are small sample sizes, lack of randomization or blinding, and diversity in therapeutic techniques and outcome measures. Only seven studies were clinical trials; the remaining were either case reports or case series. The reported physiotherapy treatments included EMG biofeedback training, muscular elongation, postural exercises and electrotherapy. Improvements in head position, pain, cervical range of motion, quality of life and ADL have been reported, which is promising. Cautious interpretation on the effectiveness of physiotherapy as an adjuvant therapy is required. Before firm conclusions can be drawn, additional high quality trials are needed.


Cervical dystonia Physiotherapy Treatment Botulinum toxin Quality of life (4) 



We would like to thank Birgit Daalderop for helping with the data collection.


University of Antwerp (BDHG/3449/18.12.202).

Conflicts of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Joke De Pauw
    • 1
    • 3
  • Kevin Van der Velden
    • 1
  • Jill Meirte
    • 1
  • Ulrike Van Daele
    • 1
  • Steven Truijen
    • 1
  • Patrick Cras
    • 2
  • Rudy Mercelis
    • 2
  • Willem De Hertogh
    • 1
  1. 1.Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health SciencesUniversity of AntwerpAntwerpBelgium
  2. 2.Department of Neurology, University Hospital Antwerp, Faculty of Medicine and Health Sciences, Born Bunge InstituteUniversity of AntwerpAntwerpBelgium
  3. 3.Faculty of Medicine and Health SciencesCampus Drie EikenWilrijkBelgium

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