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Have you noticed that your infant tilts their head to one side or has a preference to look only one direction when lying on their stomach or back? Torticollis, sometimes referred to as congenital muscular torticollis (CMT), is a condition affecting infants that can impact the range of motion of their neck, ability to interact with their environment, and, ultimately, their head shape. In this blog post, we will discuss the causes and potential complications associated with torticollis, as well as physical therapy for torticollis and how a physical therapist can help treat it. 

Understanding Torticollis in Infants 

Torticollis is a condition, most commonly seen in infants, characterized by the shortening or tightening of the child’s neck muscles on one side leading to a tilting of the head to one side and limitations in head rotation. There can be several different causes of infant torticollis, including the way the child was positioned in the womb prior to birth, abnormal development of the sternocleidomastoid (SCM) muscle, trauma or damage to the SCM during or after birth, or the way the child is held and positioned following birth. 

Torticollis used to be considered a rare condition in infants, but as diagnosis tools and early recognition of the condition have improved, it has become more common. Some studies report up to 3% of infants will develop torticollis early in their lives. Fortunately, with the aid of targeted physical therapy for torticollis and specific exercises designed for torticollis, it has become a more manageable and treatable condition.

Why Does My Baby Lean Their Head to One Side? Identifying the Signs and Symptoms of Torticollis to Promote Early Intervention  

The most obvious sign of torticollis in infants is an unusual tilting and rotating of the head that the child displays most or all of the time. Other signs include neck muscles that are very rigid or hard to the touch, reduced range of motion (the inability of the child to look both directions), and distress or pain with palpation of the neck muscles or with head movements. 

If any of these signs or symptoms of torticollis are observed, it is crucial to contact your pediatrician to determine next steps. Early detection and intervention are key pieces to helping a child with torticollis regain full range of motion and avoid further complications and potential long-term effects of torticollis. Torticollis is generally diagnosed by observation (seeing the tilt and rotation), palpation of the neck muscles, and by measuring the child’s range of motion with head movements. The child’s pediatrician will often classify the diagnosis based on which side is affected (either right-sided torticollis or left-sided torticollis). Following diagnosis, the child will likely be referred to a physical therapist for evaluation and subsequent treatment. 

Physical Therapy for Torticollis

The first thing a physical therapist will do is complete a comprehensive evaluation to assess the child’s torticollis. During this evaluation, you will likely see the physical therapist take measurements of the child’s neck range of motion, assess for any head shape abnormalities (which can be associated with torticollis), touch the child’s neck muscles to see if they feel hard or painful, assess the child’s strength, and observe the child’s tolerance for a variety of positions, including lying on the stomach and back. 

During this evaluation, the physical therapist will discuss areas that require treatment and goals that will be addressed, as well as a plan going forward (including how many times they would like to see your child, etc). They will also likely provide you with some strategies and exercises to use at home so that progress can be made between physical therapy visits. 

During each physical therapy visit, you can expect the physical therapist to perform a variety of stretches and strengthening activities, as well as to provide you with education on how you can continue these activities at home. Because these stretches and exercises can be uncomfortable for the child, you will likely see the child become upset and tearful at times. This is completely normal for an infant, and the pediatric physical therapist is trained to assess pain throughout each activity and modify them as appropriate. 

The good news is that the potential tears and discomfort will be worth it for infants with torticollis in physical therapy! With early intervention, consistent stretching and strengthening, and environmental changes at home, torticollis often resolves quite quickly and no additional conditions (such as changes to the child’s head shape) develop. 

Exercises for Torticollis

When treating torticollis, the interventions that a physical therapist will prescribe can be arranged into three categories: stretching, strengthening exercises, and environmental and positional changes.

First, stretching is an essential part of any torticollis treatment plan. Infant torticollis stretches  include tilting and rotating your child’s head the opposite direction of their consistent tilt and rotation while holding down the affected SCM musculature. Your physical therapist will demonstrate how to safely perform and progress each stretch to improve the range of motion of your child’s neck.

While improving the flexibility of the neck muscles is incredibly important, strengthening the muscles of the neck is also a key part of any treatment for torticollis. The best way to strengthen these muscles is to make them work against gravity. For example, putting your child in tummy time (lying on their belly) will require them to work against gravity to keep their head up, thus strengthening that part of the neck.  

Finally, your physical therapist will make a series of individualized recommendations for how to make changes to your child’s environment in order to promote head rotation and tilting to the opposite direction of the torticollis. Some examples of these recommendations include placing your infant in a different direction in their bassinet or crib to encourage rotation to the non-preferred direction, breastfeeding or bottle feeding adjustments, and promoting playing with your infant while they are lying on their side or in tummy time.  

Choosing the Right Torticollis Physical Therapy Program

When looking for a location for your child, whether for infant physical therapy or general physical therapy for babies, there are a number of factors to consider and questions to ask to ensure you feel comfortable with the care your child will receive. These factors include ensuring that you are seeing a physical therapist with training in pediatrics, making sure that the physical therapist has availability to see your child quickly and as frequently as needed, and the therapy approach and style of the provider and clinic as a whole. Because early intervention is so important, it is recommended that you seek out a physical therapy evaluation as soon as possible. 

When thinking about questions to ask your physical therapist, you may consider the amount of experience the therapist has in the field, how many children they have treated who had torticollis, and how much availability their schedule has.  

How Can CI Pediatric Therapy Centers Help My Child? 

In summary, torticollis is a common condition affecting infants in which they tilt and rotate their head in an abnormal manner due to their position in the womb, trauma before, during, or after birth, or positional factors. This condition is very treatable with physical therapy, so early detection of the signs and symptoms, as well as early diagnosis, are essential pieces to resolving torticollis. While in physical therapy, your infant’s neck muscles will be stretched and strengthened, and you will receive strategies to use at home to continue this progress outside of the clinic.

The infant physical therapy team at CI Pediatric Therapy Centers has many years of experience working with infants with torticollis and have availability to evaluate your child and initiate treatment. If you are interested in getting your child scheduled with one of our experts in physical therapy for babies, please visit our website for more information or call us at (608) 819-6394 today! 

Frequently Asked Questions

What causes torticollis?

There can be several different causes of infant torticollis, including the way the child was positioned in the womb prior to birth, abnormal development of the sternocleidomastoid (SCM) muscle, trauma or damage to the SCM during or after birth, or the way the child is held and positioned following birth. 

Does torticollis go away?

In most cases, a stretching and strengthening program, along with environmental changes, are needed to help resolve torticollis in babies. A physical therapist can evaluate your infant and provide you with the appropriate stretches, exercises, and other recommendations to help your baby. If you see signs and symptoms of torticollis in your baby, it is highly recommended you not “wait and see,” but rather seek out your pediatrician for a referral to physical therapy. 

How do you treat torticollis in babies?

Treatment for torticollis generally is a combination of stretching, strengthening exercises, and making changes to your baby’s environment to promote positioning that reduces torticollis. In physical therapy, all of these forms of treatment will be provided to help assist your baby in achieving full range of motion and avoiding any of the other detrimental effects of torticollis.