Infant Torticollis: An Overview

Squatting | Studio shot of a woman working out against a dark backgroundTorticollis is an abnormal tightening of one side of the neck muscles, generally occurring in an infant, which results in a tilting and a turning of the head. Torticollis can occur in older children and adults, but that is usually in response to some sort of trauma. The focus of this blog article, however, will be on torticollis that occurs in infants, which generally occurs either due to positioning or visual issues. Congenital and positional torticollis occurs when an infant either sleeps in the same position all of the time (for example, on his/her stomach with the head turned to one side) or when an infant is placed in a certain position, such as in a car seat, too often, thus resulting in head drop to one side or the other. Torticollis can also occur due to an infant’s visual deficits (called ocular torticollis), which causes the child to turn and/or tilt his/her head in order to view surroundings properly. Whatever the cause, torticollis results in shortening of muscles (particularly the sternocleidomastoid muscle) on one side of the neck, thus resulting in an abnormal tilting and turning of the head.


Torticollis is often easily recognizable by the telltale tilting and turning of the head, which is a position that will be held nearly constantly, but other symptoms that may surface include flattening or abnormal head shape (known as plagiocephaly or bradycephaly), restrictions with head turning to one side, and the favoring of movement to one side, such as rolling to only one side. Parents often notice these signs first, but clinical diagnosis is generally made by a physician, such as a pediatrician. Treatments that are ordered for infants with torticollis and associated skull deformity can include helmets for proper shaping of the skull and specialized pediatric cervical bracing for neck positioning, but the most common treatment that is prescribed is physical therapy.


Once an infant is referred to physical therapy for treatment of torticollis, the physical therapist will perform a comprehensive examination, including neck range of motion, neck strength, movement patterns (e.g. rolling), visual field testing, muscle tension assessment, and any other tests or measures that may be appropriate. Because infants cannot comprehend a traditional physical therapy program, meaning that they cannot be expected to follow a normal exercise program, physical therapy treatments for infants are very hands on. Physical therapists will use handling techniques and positioning as well as introduction of stimuli such as toys and mirrors in order to promote head movement toward the desired side (that is, in order to stretch the tight neck muscles on the opposite side). Physical therapists will also implement manual therapy techniques, including soft tissue mobilization and manual stretching, to address tight musculature. A major part of infant physical therapy, however, is parent/caregiver education. Physical therapists will work directly with the parents or caregivers of an infant patient so that exercises and manual techniques can be performed on the infant at home, thus speeding the infant’s recovery.


I have personally worked with a handful of infants with torticollis through my years with Advanced PMR, and I have found that infants are some of my favorite patients. If you or anyone you know has an infant diagnosed with torticollis, feel free to contact Advanced PMR for physical therapy treatment!


Rob Kohutanycz, PT, DPT

Posted in: Neck

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