Torticollis in Infants & Adults - How is it Treated?
What is Torticollis?
Torticollis, also known as wry neck or loxia is defined by an abnormal, asymmetrical head or neck position, which may be due to a variety of causes. It is a fixed or dynamic tilt, rotation, or flexion of the head and/or neck. The type of torticollis can be described based on the positions of the head and neck though a combination of movements is often observed.
There are several classifications of Torticollis:
Spasmodic Torticollis
Extremely painful chronic neurological movement disorder (Also known as Cervical Dystonia) causing the neck to involuntarily turn. The primary type has a known genetic link while the secondary type is typically experienced midlife as a result of brain damage including perinatal, cerebral injury, cerebrovascular diseases, central nervous system tumor, drug induced, peripheral or central trauma etc. While many treatment option exist medically such as deep brain stimulation, research shows that Botulinum Toxin A injection in conjunction with Physiotherapy intervention shows greatest improvement in pain, severity, postural awareness and quality of life
Congenital Muscular Torticollis
As the name implies, this type of torticollis affects infants and is present at birth. It is characterized by a head position that is tilted to one side. The infant thus has difficulty turning his or her head equally to either side.
This type involves the sternocleidomastoid (SCM) muscle extends from immediately behind the ear to the sternum and clavicle (collar bone), obliquely crossing each side of the neck. When only one side is contracted, the muscle bends the neck towards the contracting side and rotates the head away from it. Then the two muscles work together, they flex the neck but extend the head. When this muscle is in a shortened position, it causes the typical head position associated with Torticollis.
The infant may also suffer from Plagiocephaly, which is a condition where one side of the head or face is relatively flattened. This is often developed as a result of the amount of time spent lying on their back during the day in a car seat, swings, bouncers, strollers and on play mats. This type of Torticollis, called Acquired Torticollis is almost always preventable in infants.
There are several reasons debated in research literature for Torticollis to develop in infants. Some include:
Breech position or ‘crowding’ in the uterus
Difficult delivery causing the SCM muscle to tear (bruising and scar tissue may even be noticed after birth as a small lump in the muscle)
Some studies even suggest that plagiocephaly may cause Torticollis rather than the other way around.
Treatment for Infants with Torticollis
The first line of conservative treatment should include physiotherapy and/or massage with appropriate application of Myofascial principles. During an assessment, the therapist assesses the infant’s gross motor development, neck and shoulder range of motion, strength of the neck, cranial mobility/motility (The movement of the skull bones relative to the flow of cerebrospinal fluid), and sacral mobility (To assess the strong correlative effect of imbalance through the cranial system that restriction here may produce). From here, Myofascial and craniosacral techniques can be used to reduce plagiocephaly by treating the bones of the skull and the dural tissue around the nervous system structures. Soft tissue techniques will also be used as appropriate to address the muscles of the neck and to balance the pelvis if needed.
The Home Program – to be carried out by the parents is a large part of your infant’s treatment. The therapist will guide parents through an age appropriate exercise program, enabling your infant to improve his/her neck range of motion. This typically involves gentle low load stretching in several positions that help to lengthen the affected structures. The therapist will also demonstrate functional strategies which encourage your child to turn their head equally to both sides, such as crib positions, carrying/holding positions during feeding, and engaging in supervised ‘tummy time’ promoting neck strengthening and stretching.
Acquired Torticollis (Non-congenital Muscular Torticollis)
Acquired Torticollis is a self-limiting spontaneously occurring ‘stiff neck’ usually involving the SCM or trapezius. It can be associated with colds or unusual postures but often has no clear cause and typically resolves spontaneously in 1-4 weeks. There are a number of other potential causes including disease of the cervical spine, adenitis, tonsillitis, rheumatism, enlarged cervical glands, retropharyngeal abscess or cerebellar tumors so it is wise to consult with your doctor if you are concerned that more may be involved in your symptom presentation.
Treatment for Acquired Torticollis
Your therapist will ask you about your symptoms, observe any postural imbalances, and identify areas of pain, tightness, or tension in your neck, chest and shoulder region. With postural evaluation and physical assessment, areas that are hot, hard or tender are identified and appropriate joint mobilization, soft tissue, and Myofascial Release techniques are applied. You will be instructed in effectively engaging and maintaining proper posture, and provided with self-care stretches and mindful movement practices to optimize your recovery.
