Congenital muscular torticollis has a reported incidence of 0.3-2% of the population. A tightening and a shortening of the muscles in your neck, namely the sternocleidomastoid muscle. It presents itself with the head of the infant tilted toward the tight muscle with the chin rotated in the opposite direction.1 It is typically diagnosed in the first six to eight weeks of life. Congenital muscular torticollis may be associated with abnormal position in utero; however, the specific cause is unknown.2 Muscular tightness limits neck range of motion and contributes to difficulty in the child’s ability to turn his or her head. Physical therapy can be helpful in addressing muscular torticollis through stretches, strengthening and promote reaching the child’s motor milestones, especially when diagnosed early.3 However, children older than 1 year continuing demonstrating symptoms of torticollis that have not responded to conservative management (ex. physical therapy) may need to under corrective surgery.2 Plagiocephaly, characterized by a flattening on the back and/or side of the head has been reported in up to 90% of children diagnosed with congenital muscular torticollis and likely due to the child always resting his or her head in the same position.3 Mild plagiocephaly may be corrected with positioning; however, moderate to severe asymmetry may require helmet therapy.4 An orthotist will work with your child to fit a helmet to assist with correction of head and ear asymmetry.
Consult your pediatrician if you notice your child holds their head in a tilted position. After performing an examination, the pediatrician may refer your child for physical therapy. Physical therapists at Two Trees Kids will work with your child to improve neck range of motion and strength.
Cyndy Rivera PT, DPT
Doctor of Physical Therapy at Two Trees Physical Therapy in Oxnard (2100 Solar Drive Ste. 204, zip 93036).
I enjoy working with a wide variety of populations from pediatric to geriatric. A physical therapy internship with Easter Seals in Sacramento piqued my interest in working with children. My internship at Easter Seals included clinic-based therapy, home-based therapy and pool therapy. I have worked with children with typical and atypical development including Down syndrome, cerebral palsy and autism.
1Tomczak KK. Rosman NP. Torticollis. J. Child Neurol. 2013; 28:365-378.
2American Academy of Orthopaedic Surgeons. Congenital muscular torticollis (Twisted neck). http://orthoinfo.aaos.org/topic.cfm?topic=a00054. March 2013. Accessed January 17, 2017.
3Nilesh S, Mukherji S. Congenital muscular torticollis. Ann Maxillofac Surg. 2013; 3:198-200.
4Kim SY, Park MS, Yang JI, Yim SY. Comparison of helmet therapy and counter positioning for deformational plagiocephaly. Ann Maxillofac Surg.2013;37:785-795.