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What is Torticollis and How Can it be Treated?

Sep 28th, 2019 | by Lisa Murphy OTD, OTR/L, SWC
Lisa Murphy OTD, OTR/L, SWC

Lisa Murphy OTD, OTR/L, SWC

September 28th, 2019

What Is Torticollis?

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. 

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. 

 What Causes Torticollis?

1. Congenital Torticollis in Babies (Present at Birth)

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. 

2. Acquired or Positional Torticollis (After Birth)

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

Signs and Symptoms 

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:

  • Baby tilting head to one side – Head tilt in the direction of the short or tight SCM muscle, with child’s chin tending to turn opposite direction 
  • Limited range of motion resulting in difficulty turning head with eye – may be observed by no response to sights or sounds presented to the short side 
  • Tense and tender neck and shoulder muscles on the affected side, or a lump in the SCM muscle on the short side
  • Unwillingness to turn his/her head to one side, or Visible frustration or wincing with attempts to turn head to the opposite side 
  • Sustained or recurring muscle spasms in the neck area
  • Shoulder pain, neck cramps, muscle tightness or headaches
  • Eyes that look upward involuntarily
  • Tongue protrusion
  • General irritability, drowsiness or vomiting
  • If breastfeeding, having trouble on one side or infant has a preference to one breast only
  • Favoring one side during active play or rolling only one direction 
  • Plagiocephaly (“flat head syndrome”) – child’s head develops a flat spot from repeated pressure on that area 
  • Torticollis and Plagiocephaly often go hand in hand, and any container – carriers, swings, anything that puts pressure on one spot on a child’s head – could be detrimental for plagiocephaly and torticollis.  

Baby Torticollis Treatment

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. 

  1. Be conscious of how you position your child in his/her crib, highchair, swing. Try turning your child so that he/she has to rotate their head in the non-preferred direction to interact with the environment. 
  2. Limit the amount of time your baby spends in ‘baby containers’ – this includes infant car seats and swings. We recommend spending as much time on the floor as possible.  
  3. Tummy time is a great way to strengthen neck muscles! We know that tummy time can be tough for some babies. Try tummy time in more manageable spurts of 1 minute, three times in a tummy time session to build up baby’s tolerance. Some babies tolerate tummy time better when placed over a boppy pillow. 

 

Torticollis Products

Our therapists love the following products in conjunction with therapy for the treatment of torticollis. 

  • The Ubimed Lifenest: Thanks to its netted area, Lifenest redistributes pressure away from soft spots! This is crucial for all babies, especially those with torticollis!
  • Ellie Ears: Provides positioning support. Works better than rolled blankets or towels because it stays in place and doesn’t unravel.
  • Activity gyms: The wide array of activity gyms available encourage tummy time.

The key to treating torticollis is to be proactive in seeking the appropriate treatment. At NAPA Center, we offer custom-designed treatment programs that will take your child’s unique needs into consideration. If you’d like to schedule a consultation to learn more, get in touch with us today.

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