Wednesday, January 22, 2014


Torticollis literally means, “twisted neck” in Latin.  Also known as “wry neck” or “loxia,” Torticollis is a fixed or dynamic tilt, rotation, or flexion of the head and/or neck. This is usually manifested by a baby’s head being tilted to one side with their chin towards the opposite side.
The First Thing You Didn’t Know About Torticollis
There are actually three types of Torticollis.  The first type is called, Congenital Muscular Torticollis.  Although not completely clear, it’s most thought to be caused by trauma to the neck during birth or abnormal positioning of the baby while in the uterus (for example, a breech position).
This kind of Torticollis is usually discovered between six to eight weeks after birth when a baby begins to have more control over his head.  The sternocleidomastoid muscle (SCM), a muscle in the neck, becomes excessively shortened and causes the baby to be unable to turn and/or tilt his head.  If the shortened muscle is caused by trauma, the SCM will develop scar tissue as it heals, restricting the baby from turning his head.  The second type of Torticollis is Acquired Torticollis.  This type usually develops after the baby has reached its first birthday.  A child might develop it if he or she sleeps in the wrong position or injures his head.  The SCM and other muscles of the neck may spasm, causing the head to tilt to one side.  This type of Torticollis may also be caused by an upper respiratory infection when the lymph nodes in the neck swell. The third type of Torticollis is Spasmodic Torticollis (ak.a. Cervical Dystonia).  It is caused by a dysfunction of the brain which causes the muscles around the neck to contract intermittently or all the time.   This type of torticollis may be extremely painful and cause the shoulders to be uneven.  This type of Torticollis is mainly seen in adults.
The Second Thing You Didn’t Know About Torticollis
Did you know that Tortocollis is described depending on the position of the neck?  There are four positions:
  1. laterocollis : This is when the head is tipped to the side towards the shoulder. (think this: the ear is trying to touch the shoulder)
  2. rotational torticollis : This is when the head is actually rotated to one side.
  3. anterocollis : This is when the head and neck is tilted forward (think this: chin to chest).
  4. retrocollis : When the head is tilted backwards
The Third Thing You Didn’t Know About Torticollis

Physical Therapy provides treatment of Torticollis!  It is always a good idea to get an evaluation by a pediatric physical therapist if you suspect that your child has Torticollis. This type of therapist is specially trained to handle pediatric diagnoses.  He or she will assess and measure the range of motion of your child’s neck and evaluate any muscle tightness.  S/he will also evaluate your child’s muscle strength and gross motor skills.  Lastly, he or she will check for other conditions that can occur with torticollis such as plagiocephaly (abnormal head shape), hip dysplasia (misalignment of the hip joint), and spine problems. The therapist will then discuss these results with the family and make appropriate recommendations for physical therapy treatment. If it is indicated, the physical therapist will then perform a stretching program to the neck and instruct the family in a stretching and positioning program designed specifically to the child's needs. He or she will also educate the parent in how to perform a daily home exercise program.   

Why is Early Treatment Important?
Receiving early treatment for Torticollis is important.  It can prevent a permanent shortening of the involved muscle, avoid the need for surgery and prevent plagiocephaly (flattening of the head on one side), delayed developmental motor skills and facial asymmetries.
At Rapha Physical Therapy, our pediatric therapists use a hands-on method to treat Torticollis coupled with health education and internet resources.  We typically see significant results between 6 to 8 weeks and complete recovery within 12 visits.  When Torticollis treatment is implemented early, the majority of children recover completely in a short period of time.  Don’t go it alone.  If you see that your child’s head is tilted towards one side, talk to your doctor about treatment and ask for a referral to a pediatric physical therapist.

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