Torticollis comes from the Latin for “twisted neck”. A child with torticollis will present with their head tilted towards one side with chin turned to the other. In more technical terms, torticollis causes a lateral flexion contracture of the cervical spine musculature. The muscles affected are principally those supplied by the spinal accessory nerve.
Congenital Muscular Torticollis is the diagnosis applied to the majority of pediatric patients that we as Pediatric Physical Therapists will see, and it is due to a shortened sternocleidomastoid muscle. The tightness may be due to the child’s positioning in utero or some muscular damage done during delivery. Congenital Torticollis affects 1 in 250 infants.
Plagiocephaly (or the flattening of one side of the head) is a common occurrence in children with torticollis. Because the child spends the majority of their time on their back, with their head titled to one side, the head becomes flatter on the side which bears the weight. Facial asymetry may also occur. Treatment to address the torticollis will also address the plagiocephaly. With active exercise in prone and proper positioning of the child, the child’s head shape will become more symmetrical and the plagiocephaly will resolve
“With timely medical care most cases of Congenital Muscular Torticollis (CMT) can be resolved or dramatically improved. The best treatment involves a multidisciplinary team that involves swift referral, accurate assessment and differential diagnosis, specialized Physical Therapy treatment, and in some cases surgical intervention.” Diane Damiano, PhD, PT
The diagnosis of CMT is usually made upon physical examination within the first few month. Visit your pediatrician if you suspect your child may have torticollis. We want to rule out non-muscular origins of the presentation, such as Klippel-Feil Syndrome(fusion of cervical vertebrae), scoliosis, brachial plexus injury, ocular damage, or other congenital neurologic conditions.
Treatment Ideas to Come…