Torticollis Physical Therapy & Treatment

Also known as “wryneck,” torticollis is a condition in which a child's head is tilted. It is typically caused by either a tightening of the muscles of the neck, flattening of the back of the head or a combination of the two. The condition often refers to tightness of a specific muscle which pulls the head sideways toward the shoulder, turns the face toward the opposite shoulder and brings the head forward on the chest. Habitually spending time in this position frequently causes other neck muscles to tighten.

Torticollis limits a child's ability to turn the head to see, hear and interact freely with their environment. Because of this, torticollis may lead to delayed cognitive development, delayed whole body awareness, weakness and difficulties with balance. Since the neurological component that directs development and balance is not impaired, children with torticollis may compensate for their head positioning and progress through their developmental stages asymmetrically. This asymmetry may cause spinal misalignment and uneven distribution of weight over the legs, leading to the development of orthopaedic problems.

Torticollis is also associated with a flattening of the back of the head, known as plagiocephaly. As the infant keeps the head turned to the same side, the constant pressure on the back of the head leads to flattening accompanied by a bulging on that side of the forehead. If unchecked, torticollis and plagiocephaly may contribute to perceptual problems and learning disabilities when children reach school-age.

Torticollis and plagiocephaly should be evaluated by a physician to determine the cause and whether treatment is required. If treatment is necessary, a referral will be made to physical therapy. A physical therapist should individually assess the needs of each child and provide treatment, home exercise and positioning suggestions.

The incidence of torticollis and plagiocephaly can be minimized by providing supervised, awake prone time (tummy time), encouraging babies to look equally in both directions and by minimizing the use of baby equipment (car seats, bouncy seats, swings, etc.).

Activities for Children with Torticollis

For children with torticollis, it is very important that they play in all the following positions: prone (on tummy), lying on their side, sitting and supported standing. These are appropriate and necessary at any age. Encourage them to look at and interact with toys that promote rotation of the head and body to the child's non-preferred side. Set up the child's environment (orientation of toys, crib and play mat) to promote exploration toward the baby's non-preferred side.

Torticollis Prevention Tips

  • During stroller rides, place grasp toys in front of or to the non-preferred side of the baby.
  • Put your baby on their stomach over your lap. Hold toys above and to the non-preferred side.  
  • Get down on the floor facing your baby with or without toys placed between you. Approach the baby from the non-preferred side. Hold toys above and to the non-preferred side.
  • Place a thin blanket and toys on a firm surface (such as the floor) and lay your baby on his tummy to play. This is a great position for babies to look at toys and practice lifting their head.
  • Place your baby on his tummy on your stomach while you are lying on your back. Your baby can easily make eye contact with you. 

Lying on Their Side

  • Encourage bilateral hand play (this promotes midline alignment).
  • Place toys in a way that encourages downward gazing. This is an easy posture to start rolling to the stomach.

Sitting & Standing (Supported or Independent)

  • Encourage head turning to the non-preferred side with toys or visual engagement.
  • Encourage looking and reaching with the baby's non-preferred hand.
  • Encourage bilateral hand play in midline.

Carry Your Baby

  • Carry your baby horizontally by scooping your hand under the baby's chest so their legs straddle your forearm. Play airplane or “so big” in this position in front of a mirror.
  • Against your chest with baby facing out
  • Over or up against your shoulder

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