What is Torticollis?

sternocleidomastoid diagram

Torticollis is a condition that occurs when the sternocleidomastoid muscle (abbreviated as SCM, this paired muscle is located at both sides of the neck that works to flex the neck sideways in one direction and rotate the head towards the opposite side) becomes tight, weakened, or thickened.  This results in a head tilt towards one direction with rotation towards the opposite side.  The most common form of this condition is Congenital Muscular Torticollis (CMT), which affects infants. Typically, it is diagnosed within the first 2 months of life. In most cases, torticollis is a muscular problem.

 

If left untreated, Torticollis can have the following sequelae such as:

› Flattening of the skull (plagiocephaly) 

› Limited ability to turn the head to see, hear, and interact with surroundings that can lead to delayed cognitive development

› Delayed body awareness or lack of self-awareness and interaction

› Movement that favors 1 side of the body, affecting the arms, trunk, and hips. This can lead to strength imbalances, such as an elevated shoulder and side-bending of the trunk

› Developmental hip dysplasia

› Scoliosis

› Difficulty with balance  


Signs and Symptoms

The infant may keep the head tilted and/or rotated toward 1 side of the body and attempting to straighten the neck is difficult. For example, if the muscle on the left side of the neck is shortened, weak, or in spasm—the head may tilt toward the left shoulder and rotate toward the right (this is referred to as a left torticollis).  There may be tightness in the neck or a noticeable lump in the neck muscle.


How is it diagnosed?

Torticollis is generally diagnosed by pediatricians.


How can a physical therapist help? 

Physical Therapy is the primary treatment for all forms of torticollis.  Our therapists provide treatment to address the impairments that are caused by torticollis. Early treatment and intervention yields the best outcomes.  We will work with parents and caregivers to develop and reach mutual goals.

 

This will include an individualized treatment plan to: 

› Strengthen neck muscles

› Correct muscle imbalance

› Gain pain-free movement (range of motion)
› Improve postural control and symmetry
› Improve the body’s alignment by easing muscle tension

 

These goals will be addressed through stretching, strengthening, myofascial work, positioning, possible kinesiotaping, and a home exercise program. If not treated, torticollis can become a permanent condition. 


What kind of physical therapist do I need?  

A pediatric physical therapist is best suited to address Congenital Muscular Torticollis and Positional Torticollis in young infants.  Our therapists have extensive training in infant development and a thorough understanding on facilitating acquisition of motor milestones while focusing on maintenance of midline head orientation and appropriate muscular balance.