What is Torticollis?
When we think about physical therapy, we often think of our young athletes returning to sport, adults status-post joint repairs and the elderly working on improving balance. What is not often considered is an infant’s need for physical therapy intervention. Infants and children may need physical therapy intervention for a variety of reasons from delayed rolling, sitting, and crawling, to impaired walking, jumping and running. A newborn baby may also need PT to address impairments from a torticollis diagnosis.
Torticollis is a non-life threatening, musculoskeletal diagnosis, developed in utero due to sustained positioning. This sustained positioning leads to cervical muscular contractures, which is known as torticollis. Muscular shortening in the neck can lead to postural abnormalities and a misshapen cranium, known as plagiocephaly. Torticollis and plagiocephaly can be corrected conservatively with early intervention.
The sternocleidomastoid (SCM) muscle in the neck is most often impacted by torticollis. The job of this muscle is to side-bend the head to the same side (ipsilateral) and rotate the head to the opposite side (contralateral). For example, if the right SCM is shortened, you will see side-bending of the head to the right (right ear toward right shoulder) and rotation of the head to the left (looking over the left shoulder). Parents, caregivers, or pediatricians may notice that their baby favors looking to one side or that their baby tends to rest with their head out of midline, despite a stimulus elsewhere. This is because it is challenging for the baby to move their head against the muscular resistance. When a baby’s neck muscles are shortened, they are unable to move through a full range of motion and as a result their head will stay in the same positions for prolonged periods of time. As a newborn’s head is malleable, these sustained positions can lead to plagiocephaly. Plagiocephaly may appear as a flat spot on the back side of the cranium, a forward ear or a change in cheek bone or jaw height.
Treating torticollis and plagiocephaly requires a combination of early interventions: physical therapy, positional changes, compliance with a home exercise program and occasionally a cranial helmet. The physical therapy initial evaluation will assess range of motion, milestones met, emerging and delayed, the patient’s home environment and the mother’s pregnancy and delivery history. Once the assessment is performed, the therapist will cultivate a home exercise program of stretches, exercises, position management and create a plan of care for the therapy sessions. The physical therapist will also provide referrals to orthotists for a helmet assessment, should they see it necessary. Physical therapy intervention will work toward stretching out the muscles in the neck, strengthening the core, trunk and cervical stabilizers, facilitating the patient in meeting age appropriate milestones and helping parents and caregivers better understand the impairments found with torticollis and plagiocephaly.
If a helmet is deemed necessary by an orthotist, the wearing period will be determined based on the needs of each individual child. Parents may be apprehensive at first to have their child fitted for a helmet and may wonder why a helmet is even necessary. The use of a helmet is not simply cosmetic. It will help a patient achieve full range of motion in the neck, which will ease a baby’s ability to roll, crawl and walk. A typical shaped cranium will also allow a child to fit into an off the shelf helmet or hat. Parents or caregivers to a patient needing a helmet may be apprehensive. These individuals can seek comfort in knowing that a helmet is temporary, that wearing a helmet does not mean anything is medically wrong with their child and that these babies do not notice the helmet is on after the first couple days.
At OMPT Specialists, we have a handful of physical therapists at our various locations who are trained in treating torticollis and plagiocephaly. If you have any questions or concerns about your newborn, speak with your pediatrician and set up an initial evaluation appointment at OMPT Specialists.
By Paula Terenzi, PT, DPT, KEOMPT