Torticollis and Physical Therapy

Torticollis is a condition that occurs when the muscle that runs up and toward the back of the neck becomes tight, weakened, or thickened, causing the head to tilt; the chin points toward one shoulder while the head tilts toward the opposite shoulder. The most common form of this condition is congenital muscular torticollis (CMT), which affects infants and is generally diagnosed within the first 2 months of life; however, torticollis also can occur in adults.

In 1992, the American Academy of Pediatrics began their “Back to Sleep” campaign to reduce Sudden Infant Death Syndrome (SIDS). The campaign successfully decreased SIDS by 40% in the United States, but it had an unintended result of contributing to the development of CMT in about 1 in every 250 infants. (Talk to your family physician and/or pediatrician if you have any questions about the “Back to Sleep” campaign.

If symptoms such as trouble breathing or swallowing, weakness in the arms or legs, impaired speech, difficulty walking, a pins-and-needles feeling or numbness in the arms or legs, or urinary or fecal incontinence accompany the head tilt—seek immediate medical attention.

What is Torticollis?

Torticollis is the tilt and/or rotation of the head because of tight and weak neck muscles. It occurs when the muscle that runs up and toward the back of the neck (the sternocleidomastoid muscle) becomes tight, weakened, or thickened.

  • Congenital muscular torticollis (CMT) is the most common form of the condition. It affects infants and is generally diagnosed within the first 2 months of life. CMT is often caused by birth trauma, or by sleeping or remaining in 1 position for a prolonged period of time.
  • Postural torticollis is diagnosed when the infant’s head tilt comes and goes. It is diagnosed within the first 5 months of life and often is the result of a lack of a variety of positions.

Torticollis may lead to additional problems, such as:

  • Flattening of the skull (phylagocephaly) in infants
  • Movement that favors 1 side of the body, affecting the arms, trunk, and hips. This can lead to strength imbalances, such as an elevated shoulder and side-bending of the trunk.
  • Developmental hip dysplasia
  • Scoliosis
  • Limited ability to turn the head to see, hear, and interact with surroundings, which can lead to delayed cognitive development
  • Delayed body awareness or lack of self-awareness and interaction
  • Difficulty with balance

Signs and Symptoms

An adult, child, or infant may keep the head tilted and/or rotated toward 1 side of the body as attempting to straighten the neck is difficult or painful. For example, if the muscle on the left side of the neck is shortened, weak, or in spasm—the head may tilt toward the left shoulder and rotate toward the right.

There may be tightness in the neck or a noticeable lump in the neck muscle. Pain may or may not be present, depending on the type of torticollis.

How Is It Diagnosed?

Torticollis is generally diagnosed by physicians. Experienced pediatric physical therapists may diagnosis the need for treatment of congenital muscular torticollis and positional torticollis.

Once the type of torticollis is determined, your physical therapist may provide treatment. In most cases, torticollis is a muscular problem, and physical therapists are musculoskeletal experts.

How Can a Physical Therapist Help?

Regardless of the patient’s age, physical therapy is the primary treatment for all forms of torticollis. Physical therapists provide treatment to address the impairments that are caused by torticollis. Early treatment results in the best outcomes.

The physical therapist will work with a child’s caregiver or with an adult patient to develop and reach mutual goals. This may include an individualized treatment plan to:

  • Strengthen neck muscles
  • Correct muscle imbalance
  • Gain pain-free movement (range of motion)
  • Improve postural control and symmetry
  • Improve the body’s alignment by easing muscle tension

These goals may be achieved through stretching, strengthening, massage, positioning, taping, and a home exercise program. If not treated, torticollis can become a permanent condition.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat a variety of conditions, including torticollis. However, you may want to consider:

  • A physical therapist who is experienced in treating individuals with torticollis
  • A pediatric physical therapist if it involves a child

Rehab Connection offers Pediatric Physical and Occupational Therapy Services and has clinicians with experience in working with patients with Torticollis. Please feel free to contact us at our main office (856) 547-4422 if you have further questions or would like to schedule an appointment.