When diluted and given intramuscularly in extremely small quantities, it can give rise to selective paralysis of the injected muscle and is safe. In spasmodic torticollis, the abnormally overactive neck muscles can be identified by clinical examination and palpation. These muscles can be injected with the toxin. The improvement following treatment lasts for about three months when patients need to be re-injected. The injections cause very little discomfort, are well tolerated, and produce no significant side effects.
Difficulty swallowing occasionally occurs.
This, however, has been mild, transient, and infrequent. The significance of this remains to be studied. Stress makes all movement disorders, including torticollis, worse. Some patients may benefit from a trained professional in learning stress management. A trained physiotherapist can suggest exercise and fitness programs suitable for the disability and can advise on the maintenance of good posture and strength in the back and shoulder muscles which are often secondarily affected by torticollis.