Torticollis is the shortening of a neck muscle called the sternocleidomastoid.
The side that is affected causes a child to have their neck tilted to the side of the shorted muscle and their chin rotated to the opposite side. The child has difficulties tilting their head the opposite direction of the tight muscle and turning their head to the involved side.
Sometimes a firm, non-tender mass can be felt in the muscle. If left untreated, a child will develop a misshapen head, experience difficulties acquiring gross motor skills, and suffer potential facial asymmetry.
Most cases resolve with conservative physical therapy treatment. The earlier a child starts therapy, the better the outcome. In the event conservative treatment is not successful, surgery to lengthen the muscle may have to be performed (if a significant deformity still exists after one year of age).
Before physical therapy begins, cervical abnormalities should be ruled out as a possible cause, as well as any visual problems.
Treatment of torticollis consists of stretching the sternocleidomastoid muscle.
This means tilting the head away from the involved side and holding the shoulder on the same side, as well as turning the head to the involved side. A physical therapist can demonstrate how to do these stretches correctly.
Positioning is also key to successful treatment. Rolled-up towels in car seats to prevent a head tilt, placing the child in his or her bed so they have to turn their head to the involved side to look at you, feeding the child to encourage the neck to turn the correct way and tilting the head, having the child in his or her bouncy seat so they have to turn to their involved side to watch you in the kitchen, are all ideas to help encourage your child to actively stretch their neck out as well.
When the child is a little older, after about three months of age, therapy also addresses head control with equilibrium reactions (the natural response to trying to maintain your balance) and head righting reactions (the natural response to keep your eyes level when you are in different positions).
When Should We Seek Outside Therapy?
Typically, children under three respond to therapy very well in their most natural environment, whether that is their home or daycare. Sometimes, however, children may respond better to treatment in a new environment. This may be because new toys motivate the child, or behavior needs to be modified and can best be done outside of the home environment.
There are other therapies that can be provided outside of the home that may be very beneficial as well, such as aquatherapy, or by using clinical equipment that is impossible to bring to home therapies. Whatever the case may be, your therapist can work with you and your child to help best meet your child’s needs.