Everything you wanted to know about Torticollis
Today I wanted to focus on one particular condition I see quite frequently in clinic; something that does sound a little bit like a Harry Potter spell, does seem more intimidating than it should be and more common than one would think. Torticollis. It is not a diagnosis rather it’s a description of a posture in the neck. One that presents with the neck tilting (or side flexing) to one shoulder and the chin rotating to the opposite shoulder, usually involving a weak and/or tight sternocleidomastoid muscle (or SCM).
We are still learning why some infants experience torticollis while others don’t, but we are seeing connections to some of the following:
- History of trauma at birth (perhaps prolonged position in the vaginal canal or use of forceps/vacuum)
- Intrauterine crowding (twins, triplets, etc.)
- Preferred position in utero or while sleeping during the first few months of life
Congenital, meaning from birth, muscular torticollis (CMT) is what I see most commonly in clinic. It’s important to note there are other, although considerably rare, causes of this posture; and Pediatric Physical Therapists are trained to assist you in referring and ruling out neurological, vestibular, rheumatological, skeletal or neoplastic conditions.
You might notice the torticollis posture in your littles neck, but you may also observe them having trouble turning their head to one side or looking up and down, a small bump on the SCM muscle (this is a benign tumor that often resolves itself) and they may even have difficulty with feeding.
Untreated CMT may lead to consequences in infancy and adulthood; most commonly resulting in prolonged external pressures when laying down on one side of the head causing flattening of the skull and facial bone asymmetry (this is also known as plagiocephaly).
Less commonly asymmetrical or delayed gross motor development, strength imbalances, scoliosis, vision and vestibular changes, and mobility restrictions; take heed, and fret not – these are very rare. Treatment for CMT is very manageable, easy to do at home and most effective when started at a younger age (less than 2-3 months old is ideal).
What needs to be determined is if there is true shortening or tightness in the SCM muscle, weakness in the neck and supporting musculature (often core and postural responses), age-appropriate motor skill development or positional preference. Once this problem list is accrued treatment can be personalized for your little!
This may involve manual stretching and strengthening exercises along with positioning and handling skills that will become part of your daily routine at home. Severity of neck rotation stiffness is usually the best determinant of prognosis along with consistency of the at-home exercises.
If you have questions or concerns about your little’s neck, don’t hesitate to reach out with any questions to see if physical therapy is right for you!
Jessie Brown
Hi, I’m Jessie! Edmonton born and raised, I am a graduate from the University of Alberta with a Bachelors in Kinesiology and a Masters in Physical Therapy; along with holding post-graduate training in Biomedical Dry Needling. While attending the UofA I played and captained for the Pandas varsity soccer team; and twice represented Canada at the Universiade games. Read More →