Torticollis has been defined as a deviation of the head and neck to one side that may be present at birth or develop afterwards.1-4 There are numerous potential underlying causes of torticollis including muscular, skeletal, inflammatory and neurological origins.1,2,5,6 Researchers tend to link the increased prevalence of torticollis to the change in the guidelines for infant sleeping positions to prevent Sudden Infant Death (SID).1,2 According to an article published by the Cincinnati Children’s Hospital, the rate of infants seen for physical therapy for torticollis increased in 1992 following the recommendation by the American Academy of Pediatrics for infants to be positioned on their backs when sleeping.
The majority of infants who have signs and symptoms of torticollis have been found to have congenital muscular torticollis (CMT).2 CMT can be present at birth or develop later. It is characterized as a muscular condition caused by the shortening of sternocleidomastoid muscle (SCM).1,2 CMT is sometimes referred to as wry neck, twisted neck, and fibromatosis colli.6
Typically these infants and/or toddlers have head tilt towards the involved side and neck rotation in the opposite direction. The restrictions may be active and/or passive in nature. Over 80% of infants with torticollis presents with CMT and it is the third most prevalent musculoskeletal disorder present in infants.2,3
Craniofacial deformation or DP can be present at birth or perpetuated by sleeping on their back.1,2 According to Vlimmeren et al., neonatal occipital lobe flattening is the precursor for deformational plagiocephaly. DP is defined as deformation of the face and/or head that is not associated with premature closure of the cranial sutures or stenosis.2 These asymmetries present with DP are also seen clustered with other defects including scoliosis, rib cage and pelvic obliquities as well as hip dysplasia and foot asymmetries.1,2 These abnormalities and deformities can lead to developmental delays and a host of functional deficits that can potentially affect one indefinitely.
A variety of intervention recommendations currently exist including stretching, strengthening, righting, positioning, weight-bearing and education.1,2,5 The earlier the problem is diagnosed and proper treatment is initiated the better the outcomes. There is also a general consensus that stretching and strengthening exercises up to 6 months in duration are effective in treating infants with CMT from 0 to 36 months.1,2,5
- L. A. Van Vlimmeren PJMH, L.A Van Adrichem, R.H.H. Engelbert. Torticollis and plagiocephaly in infancy: Therapeutic strategies. Pediatric Rehabilitation. 2006;9(1):40-46.
- Burch C HP, et al. Therapy Management of Congenital Muscular Torticolis in children age 0 to 36 months.Cincinnati Children’s Hospital Medical Center; March 17 2009.
- Christensen E CK, Hussey E. Clinical Feasibility of 2-Dimensional Video Analysis of Active Cervical Motion in Congenital Muscular Torticillis. Pediatric Physical Therapy. 2015;27(3):276-283.
- Freed SS C-OBC. Identification and Treatment of Congenital Muscular Torticollis in Infants. Journal of Prosthetics and Orthotics. 2004;16(4):S18-S23.
- J.C.Y Cheng, M.W.N Wong, S.P. Tang, T.M.K. Chen, S.L.F. Shum, E.M.C. Wong. Clinical Determinants of the Outcome of Manual Stretching in the Treatment of Congenital Muscular Torticolis in Infants. The Journal of Bone & Joint Surgery. May 2001;83-A(5):679-687.
- Kaplan SL, Coulter C, L F. Physical Therapy Management of Congenital Muscular Torticolis: An Evidence-Based Clinical Practice Guideline. Pediatric Physical Therapy. 2013;25(4):348-394.
- C E. The Determinants of Treatment Duration for Congenital Muscular Torticollis. Physical Therapy. October 1994;74(10):921-929.
- Hardgrib N RO, Moller-Madsen B, Maimburg RD. Do Obstetric Risk Factors Truly Influence the Eitopathogenesis of Congenital Muscular Torticollis. J Orthop Traumatol. June 29 2017.
- Han JD KS, Lee SJ, Park MC, Y SY. The Thickness of the Sternocleidomastoid Muscle as a Prognostic Factor for Congenital Muscular Torticollis. Ann of Rehabil Med. 2011;35:361-368.