Treating Torticollis
Congenital Muscular Torticollis (CMT) “also known as twisted neck or wry neck is a postural, musculoskeletal deformity evident at, or shortly after, birth. It results from unilateral shortening and increased tone of the sternocleidomastoid (SCM) muscle and presents as lateral flexion of the head to the ipsilateral side with rotation to the contralateral side.”1
Due to CMT, the sternocleidomastoid muscle can experience shortening and increased tone and causing one side of the neck to be stronger than the other. There are 3 types of CMT, including postural, muscular, and sternocleidomastoid mass. Postural CMT is the least problematic and occurs when the baby favors one side, but there is not much tightness. Muscular CMT involves tightness in the SCM. Sternocleidomastoid mass is the most serious of the three types and occurs when the CMT causes thickening of the muscle.
The cause of CMT is still relatively unknown but could be due to trauma during birth, positioning throughout the day or at night, positioning in the womb, or a problem with blood supply to the womb. CMT is treated mainly through stretching and repositioning. In the most serious cases, it can require botulinum or surgery. However, most cases of CMT, when addressed before the age of six months to a year, are treatable with little to no long-term effects.
Most Effective Treatments
If CMT is not addressed, it can cause limited movements, craniofacial asymmetry, plagiocephaly, scoliosis, and effects on motor development.2 It is also thought that CMT co-exists with developmental dysplasia of the hip, so it Is recommended to assess for this when treating CMT.3
Passive stretch exercises can be effective, but infants around 3-4 months of age can become fussy, making the stretches difficult to perform during treatment. The main course of treatment can be dependent on the age of the infant.
The most effective treatments are cervical active range of motion exercises, positional sustained passive stretches, and parent education on handling.4 Other than the exercises and stretches done during therapy, one of the most critical aspects of improving CMT is to provide the parents with proper education on how to handle, position, and stretch the child, and to provide information on what occurs in the case that intervention is interrupted or ceased.
Clinical Practice Guidelines
Clinical practice guidelines, or CPGs, are used both to educate practitioners on evidence-based best practices and to create a uniform, consistent standard of practice.
The APTA provides current CPGs and resources to offer parents, as well as guidance for therapists.
The APTA guidelines are linked here.
The link above provides:
-the CMT CPG
-resources and tips for parents and caregivers, like tips on positioning and play
-discharge guide for clinicians
-Self-assessment for clinicians
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1. “Congenital torticollis,” Physiopedia, 29 November 2021, https://www.physio-pedia.com/Congenital_torticollis.
2. Luxford, Bernadette K, Leigh Hale, and Jan Piggot. “The Physiotherapy Management of Infants with Congenital Muscular Torticollis: A Survey of Current Practice in New Zealand,” New Zealand Journal of Physiotherapy. 37, no. 3 (2009): 127. https://login.ezproxy.uakron.edu:2443/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=105266405&site=eds-live
3. Luxford, Bernadette K, Leigh Hale, and Jan Piggot. “The Physiotherapy Management,” 132.
4. Ibid, 132.
Sources:
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"Congenital torticollis," Physiopedia, 29 November 2021, https://www.physio-pedia.com/index.php?title=Congenital_torticollis&oldid=287944.
Luxford, Bernadette K, Leigh Hale, and Jan Piggot. “The Physiotherapy Management of Infants with Congenital Muscular Torticollis: A Survey of Current Practice in New Zealand,” New Zealand Journal of Physiotherapy. 37, no. 3 (2009): 127–35. https://login.ezproxy.uakron.edu:2443/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=105266405&site=eds-live.
Nixon-Cave, Kim, Sandra Kaplan, Robin Dole, and Joseph Schreiber. “Pediatric Physical Therapists' Use of the Congenital Muscular Torticollis Clinical Practice Guidelines: A Qualitative Implementation Study,” Pediatric Physical Therapy. 31, no. 4(2019), 331-336. DOI: 10.1097/PEP.0000000000000639.