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Torticollis: What Is It and How Do You Treat It?

By Allison Elbeblawy PTA

What is torticollis?

Torticollis, also known as wry neck, means “twisted neck.” It is most often caused by the tightening of the muscle that connects the breastbone and the collarbone to the skull. This muscle is called the sternocleidomastoid or SCM, which is the common abbreviation. The SCM assists in rotation and side bending of the neck. Who does it affect and why?

Torticollis most commonly affects infants. When a baby is born with the condition, it is called congenital muscular torticollis. It can also occur after birth and sometimes later on in life, which is called acquired muscular torticollis. Congenital torticollis most likely happens in utero and can be caused by the way your baby is positioned in the womb, with his/ her head tilted to one side. It can also be due to injury of the muscle during delivery. Although it can look painful, it usually is not. Acquired muscular torticollis in an infant can be caused by positioning. If the baby tends to sleep with his/her head towards one side or is positioned to one side during feeding, the SCM can tighten. It can also be caused by an injury to the head or neck, which can cause the muscle to spasm.

In much less common cases, the condition can be caused by abnormalities of the cervical vertebrae (bones in the neck). The bones in the neck can either be abnormally formed, fused together, or both. This condition is called Klippel-Feil syndrome. This condition can also affect a child’s hearing and kidney function. The recommended stretching exercises performed to treat congenital and acquired muscular torticollis are ineffective and can be dangerous for a child with Klippel-Feil syndrome. It is important to have a thorough examination by your baby’s pediatrician to determine the cause of your child’s symptoms.

What does it look like?

Torticollis is usually spotted in the first couple months of the child’s life. It can be very prominent and can look like your child’s head is tilted to one side and has limited neck movement. Another common sign can be a small bump on the side of the neck. In more severe cases, it can be accompanied by positional plagiocephaly (flat head), which happens when the child consistently sleeps and rests his/her head to one side, flattening that side of the skull. The condition’s severity can also be very mild and may be difficult to detect when looking at your baby. There is no need to worry if you don’t notice because your pediatrician most definitely will. Your pediatrician will provide a physical examination and possibly order X-rays to determine which type of torticollis your child may have. Depending on the type and severity, your doctor may order other diagnostic testing.

Treating torticollis with physical therapy

Physical therapy is often prescribed by the doctor and is a successful intervention of the condition. A physical therapist will perform an initial evaluation of the child, which can include measurements and palpation. Then the therapist will develop a specific treatment plan for your child. After the plan of care is developed, it is recommended that your child be seen by the physical therapist or physical therapist assistant as prescribed by the doctor. Treatment can include stretching exercises, various positioning to promote head control, and soft tissue massage to the affected muscle. Treatment should always incorporate various forms of play, whether it be visually using toys or through playful sounds or song that will stimulate the baby and encourage him/her to turn toward the desired side. This can also assist in keeping your baby calm and relaxed to achieve a successful treatment.

A home program including the stretching and positioning will be given by the therapist for the parent to continue with at home. Positioning throughout the day during play time, feeding time, and while sleeping and resting are also very important for the child’s recovery. “Tummy time” is also very important as it allows for the strengthening and stability of the neck muscles. If muscular torticollis is detected early within the first couple of months of life, and consistent treatment through physical therapy and the instructed home stretching program is followed, then results and improvements will begin to be seen. At All-Care Physical Therapy Center, we can provide one-onone treatment that will assist in the recovery of this condition.

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Allison Elbeblawy PTA Physical Therapy Assistant

Allison Elbeblawy is a Physical Therapist Assistant (PTA) in All Care Physical Therapy. She holds an Associate’s Degree in Applied Science from the Physical Therapist Assistant Program at Union County College.

Allison works closely with supervising Physical Therapists to implement treatment programs in order to decrease pain, increase strength, and improve ADL function to improve the patient’s quality of life. She has a focus in outpatient orthopedic care where she utilizes various manual therapy techniques and therapeutic exercise interventions. Allison has worked with patient’s of all ages ranging from 6 weeks to 96 years, but has found a passion for working with babies and children with Special Needs.

Allison strives to give each patient she works with the best quality of care while upholding a positive attitude and compassion.