Congenital muscular torticollis is a common condition seen by physical therapists in the pediatric setting.  Torticollis is the tightness of the sternocleidomastoid muscle on one side of the neck.  This tightness causes the infant to tilt their head toward the tight side and look to the opposite side.  For example, an infant with right torticollis would have a right head tilt and prefer to look to his/her left side.  Torticollis can be caused in many ways, including intrauterine mal-positioning, birth trauma, or positioning after birth.  An infant is more likely to present with torticollis if they are a larger size, were in the breech position, equipment used during delivery, complicated labors, or when also diagnosed with hip dysplasia.  Torticollis can also lead to tightness of other neck and shoulder muscles, decreased shoulder motion, asymmetrical facial features, skin redness or abrasions, functional asymmetries, and delayed motor milestones.  If left untreated, torticollis can lead to plagiocephaly (flatness of the skull), facial and cranial asymmetries, positional deformities of the eye and/or ear, scoliosis as well as ocular and visual impairments.  It is essential that torticollis is diagnosed early, treated with physical therapy and that parents are compliant with stretching, positioning, and exercises at home. 

The majority of cases resolve after 4-6 months of weekly physical therapy visits and parent compliance at home.  Physical therapy focuses on stretching the involved muscle and strengthening the one on the opposite side.  Your physical therapist will also give you tips on positioning at home, including, limiting time in equipment (bouncers, swings, etc.), increasing time in prone and side-lying, using towel rolls to adjust the infant’s position in the car seat as well as recommendations on sleep positions.  Another key part of physical therapy visits will involve working on symmetrical movement patterns.  This means, encouraging the infant to use both sides of his/her body equally during play and gross motor skills.  The infant should be encouraged to roll to both sides, reach for objects with both arms equally, bear weight through both sides equally during tummy time and sitting.

If you think your child would benefit from physical therapy for torticollis, please contact Sensory Solutions LLC to set up a time for an evaluation.

Lauren Kray PT, DPT

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