Torticollis: Implications for Physical Therapy

Torticollis is a condition in which a baby’s neck muscles are tight, weak, or a

combination of both.  Babies with torticollis often have poor head control and delayed

gross motor skills. The primary treatment for babies with torticollis is a comprehensive

program designed by a skilled pediatric physical therapist. Physical therapy treatment is

essential in order to avoid surgical intervention, and/or several long-term effects that

torticollis will have if untreated (see below). The word torticollis means “wryneck” in

Latin. An infant or baby with torticollis will typically tilt their head/neck one way, and

look the opposite direction.

There are two very different types of torticollis: congenital muscular torticollis

(CMT) and acquired torticollis. CMT is caused directly by a tightness and weakness of

the neck muscles. The tightness is likely a result of damage to the muscles in utero, or at

some point during the delivery process. The sternocleidomastoid muscle is typically the

primary muscle injured. When the muscle(s) heals, it also shortens – just like a scar that

heals and tightens the skin in and around the scar. CMT is typically noticed when the

infant is 2-3 weeks old - when the healing process of the damaged muscle(s) is complete.

A small percentage of babies (8-10%) with CMT also have developmental dysplasia of

the hip.

Acquired torticollis is characterized by the same neck posture, however, the neck

tightness and weakness are secondary to something else. Potential causes of acquired

torticollis include: an ocular muscle impairment, a bony abnormality of the neck or spine,

poor head control or muscle imbalance from a neurological impairment, or neck

posturing to decrease esophageal pain and inflammation caused by gastroesophageal

reflux disorder. The onset of neck position varies depending on the primary cause.

A Total Approach offers a unique physical therapy evaluation and individualized

treatment program for an infant or baby with torticollis. The evaluation includes the

assessment of neck flexibility and strength; comprehensive assessment of arm, leg and

trunk flexibility and strength; and the assessment of gross motor skill development.

Without proper evaluation and early intervention, an infant or baby with torticollis is at

risk for developing permanent long-term effects.

Babies with torticollis have limited neck range of motion that, unless treated

appropriately will result in a permanent loss of flexibility.  Additionally, where there is

tightness in muscles, there is always weakness. The weak neck muscles result in poor

head control, and difficulty assuming upright and/or prone (belly) positions that are

integral in the development of gross and fine motor skills. Babies may also develop a

significant muscle strength imbalance that can cause an arm preference, or a preference

for attending to one side of the body more than the other. A muscle strength imbalance

will have immediate implications for a baby’s development of proper reaching, rolling,

sitting, crawling and walking skills.  A muscle strength imbalance can have later

implications that impact higher-level balance and bilateral coordination skills. Babies

with torticollis could also develop a permanent flattening of the head on one side and/or

asymmetrical facial features.

A skilled pediatric physical therapist will assist the family in carrying out appropriate

flexibility and strengthening exercises. Treatment often includes myofacial release

techniques in the neck and shoulder area, and/or transverse friction massage to the injured

muscle itself in conjunction with proper stretches. Strengthening exercises for infants and

babies include the facilitation of appropriate head control, arm strength, and gross motor

skill facilitation. Physical therapy will also focus on positioning the baby for play,

including techniques for increasing tummy time, and positions to prevent flattening of the

head.

At times a baby’s primary physician will recommend a consultation with additional

medical specialists, including pediatric orthopedists, orthopedic surgeons,

opthamologists, neurologists, gastrointestinal physicians, and/or orthotists. Please consult

your doctor or physical therapist with any further questions.