Torticollis, also known as wry neck, is defined as an abnormal and asymmetrical position of the head or neck. The Latin definition of torticollis is “twisted neck” – “tort” meaning twisted and “coll” meaning neck. Torticollis refers to symptoms that arise when neck muscles twist, flex or extend beyond their normal position. In children with this condition, the neck tends to twist to one side, causing a characteristic head tilt to one side, a result of spasm or tightening of one sternocleidomastoid (SCM), a muscle that runs on both sides of the neck from behind the ears to the collarbone, or clavicle. Torticollis is measurable; clinicians define it as a difference in range of motion between right and left of 15 degrees or more.
Related Reading: Physical Therapy for Torticollis
4-16% of babies have a diagnosis of torticollis, in which the SCM muscle is shortened. It is extremely important to have torticollis treated to prevent permanent shortening of the sternocleidomastoid muscle. This requires quality and timely intervention to lengthen the muscle, restore ideal alignment, and address any strength deficits. Appropriate intervention can help avoid surgery and decrease head and neck pain. When diagnosed and treated early with simple position changes and stretching exercises, 80% of children recover completely with no long-term detrimental effects.
Torticollis can occur right at birth. In fact, the majority of diagnoses are the result of a baby being born with torticollis. This is referred to as congenital muscular torticollis. Congenital torticollis is most commonly attributed to how the baby was positioned in utero. Other causes of infant torticollis may be prematurity, birth trauma, abnormalities of the spine and neck, and in rare cases more serious genetic diagnoses. In very rare cases, a child may acquire torticollis as the result of an infection or trauma.
In the final months of gestation, space in the uterus becomes limited, so babies find a nice position for their head and tend to stay there. If the neck muscles are not stretched naturally in both directions after birth, it can lead to torticollis, which requires PT intervention and could eventually cause abnormal head shape, requiring a corrective helmet. Similarly, a pregnancy of multiples (competition for space), being in the breech position where baby’s bum faces the birth canal (also tight quarters), or simply having low amniotic fluid or an otherwise traumatic birth process can make a baby more likely to develop congenital torticollis.
Torticollis can also appear at 2-4 months of age; this is known as acquired or positional torticollis. As a result of the Back to Sleep campaign of pediatricians recommending babies sleep on backs instead of tummies to reduce SIDS, many parents place their babies on their backs as recommended but then leave them there for far too long. Young children often develop torticollis as a result of the amount of time spent lying on their back during the day in car seats, swings, bouncers, strollers, and on play mats. Babies’ skulls are soft and flexible when they’re born (to allow them to fit through the birth canal). Being placed on their backs during waking hours, before the child’s neck muscles are strong enough to control head rotation, can lead to flattening. The flat spot can cause the child to keep the head in one position, making it harder to move out of that position, leading to neck muscles further tightening in that position.
In rare cases, torticollis can occur because of vision problems (ocular torticollis), neurological imbalances (benign paroxysmal torticollis), or bony deformities in the spine. Additionally, it is the third most common musculoskeletal diagnosis behind hip dysplasia and clubfoot.
Studies reveal that as many as 3 in every 100 infants are impacted by torticollis. Parents may start to worry when a baby’s head starts tilting to one side or if they prefer to look only in one direction. Your doctor may have noticed a head tilt at your baby’s last check-up. Infant torticollis (tor-ti-col-lis) is easily diagnosable by tightened muscles on one side of the neck, which leaves your baby’s head at a tilt and/or rotation.
Torticollis Symptoms in babies and children include:
If you have concerns that your child may have torticollis, contact your pediatrician immediately. Your pediatrician will likely recommend pediatric physical therapy which will consist of stretches and developmental positions to help strengthen your child’s neck.
You can also be proactive at home! Here are 3 ways you can help improve your child’s torticollis.
Our therapists love the following products in conjunction with therapy for the treatment of torticollis.
For specific torticollis physical therapy exercises and neck stretches, we encourage you to consult with a specially trained physical therapist. At NAPA Center, we offer both intensive and weekly torticollis physical therapy for neck strengthening, aligning, and lengthening – customized to your child’s needs. If you’d like to schedule a consultation to learn more, get in touch with us today.