Torticollis

What is it?

Torticollis is characterized by tight neck muscles on one side of the neck and asymmetrical positioning of the head.

Congenital muscular torticollis (CMT) is present at birth and most likely due to positioning in utero. Torticollis can also be acquired after birth and is most likely related to how an infant is positioned.

Since pediatricians began to recommend putting babies to sleep on their backs we have seen an increase in the incidence of acquired torticollis and an exacerbation of congenital torticollis. This is due to the fact that the infant does not spend much time on his or her tummy and thus does not get an opportunity to turn their head to stretch out their neck muscles on their own.

In addition, the use of car seats and other equipment that put infants in an upright position before they have gained good head control also feeds into the tendency for the neck muscles to get tight on one side. This does not mean one should not position a baby on his back for sleep or in car seats for safety, it just means that these practices have made the incidence of torticollis more frequent (call it an unintended consequence).

This tightness in the neck muscles can affect acquisition of symmetrical movement in babies including head control, trunk control, reaching with the hand on the involved side as well as affect the child’s ability to weight shift using postural reactions.

In addition, without intervention the baby may develop other deformities such as plagiocephaly, scoliosis and thoracic asymmetry.

What are the symptoms?

A child may exhibit one or all of the following symptoms:

Tilting of the head to one side, the chin pointing to the opposite side.
Limited range of motion in the neck muscles.
A lump or swelling in the sternocleidomastoid (SCM) muscle.
Flattening on one side of the head in severe, untreated cases.
Asymmetry of the face.
Malalignment of the ears.

How is it treated?

The physical therapist has a vital role in treating of congenital and acquired torticollis. Initially, your child will receive an examination by the therapist to determine the severity and the treatment.

Treatment usually includes recommendations for positioning and stretching the tight muscles. In addition, strengthening exercises and facilitation of typical developmental sequencing is important to help the child develop good symmetry in movement.

Sessions with the physical therapist will most likely include all or some of the following:
Developmental activities Therapeutic exercises (such as strengthening and flexibility) Balance and coordination activities Mobility training Positioning and handling techniques for postural correction and lateral head righting Kinesiotaping Tot Collar

A pediatric therapist helps a young child at pediatric therapy center