Understanding Torticollis & Plagiocephaly

What is Torticollis?
Torticollis is a condition where an infant experiences limited neck movement, causing their head to tilt to one side and their chin to rotate toward the opposite side. The muscles involved are the sternocleidomastoid, trapezius, and scalenes, which are responsible for the head and neck’s movement and stability. In some cases, a small mass called a fibrous tumor can form in the affected muscle, though this is not always present.

When these muscles are tight, they can affect a baby’s ability to control their head properly. This may reduce strength and movement on the affected side, delay motor skills such as rolling or sitting, and make it difficult for the baby to fully turn their head or track objects on the opposite side. In severe cases, poor head control can prevent the baby from repositioning themselves in their crib, which can contribute to plagiocephaly. Plagiocephaly is a condition where one side of the infant’s head becomes flattened from prolonged pressure on that area of the skull, often a result of limited movement or staying in the same position for long periods.

Who Does Torticollis Affect?
Torticollis is fairly common, occurring in about 1 in 6 births. It affects both males and females equally. There are two types:
● Congenital Torticollis: This type is present at birth or develops shortly after. It may not be noticeable immediately but typically becomes apparent as the infant gains more control over head movements, usually within the first few weeks of life.
● Acquired Torticollis: This type often develops after birth, usually after 4 to 6 months of age, and can be caused by various factors that occur post-birth.  

What Causes Torticollis?
Acquired Torticollis
Acquired torticollis can develop for several reasons:
● Positional Factors: If a baby spends a lot of time lying on one side or consistently turns their head toward one direction, it can lead to muscle tightness and imbalance.
● Birthing Process: Difficult deliveries, particularly those involving the use of forceps or vacuum extraction, can result in injury to the neck muscles or nerves. This may lead to torticollis, as the baby might be unable to turn their head comfortably.
● Infections or Tumors: In some rare cases, infections or the presence of tumors near the cervical spine can cause pain. As a result, the baby may naturally favor one side to avoid discomfort, causing neck tightness and spasms.
● Stress and Fatigue: Prolonged crying, stress, or fatigue can strain the neck muscles, making the condition worse or triggering it in the first place.
Congenital Torticollis
Congenital torticollis typically develops before birth, often due to one of the following:
● Intrauterine Compartment Syndrome: This happens when there is limited space in the womb, which is more likely in cases involving multiple pregnancies (e.g., twins). This restricted space increases the likelihood of abnormal positioning and muscle tightness in the neck.
● Breech Position: If the baby is in the breech position (buttocks facing the birth canal), it can put pressure on the sternocleidomastoid muscle, which leads to tightening and the development of torticollis.
● Cervical Spine Deformities: Abnormalities in the cervical spine (the neck area) can affect the normal alignment and movement of the neck, making it more difficult for the baby to turn their head freely.

How is Torticollis Treated?
Early treatment through physical therapy is critical for treating torticollis, as prolonged muscle tightness can lead to muscle shortening, which is harder to treat later on.
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Here are the common treatment approaches:
1. Gentle Soft Tissue Mobilization
This involves techniques designed to relax and lengthen the affected muscles, reducing tightness and improving flexibility.
2. Range of Motion Exercises
Exercises that help improve neck mobility and overall movement are essential for restoring the baby's ability to turn their head freely in all directions.
3. Manual Stretching
Techniques like the football stretch, which involves gently stretching the affected muscles, help alleviate tightness and improve flexibility.
4. Parent Education
Educating parents on proper positioning and handling techniques is crucial. Parents are taught to encourage their babies to turn their head in both directions and avoid positions that could reinforce muscle tightness. For instance, ensuring that babies spend time on their tummy while awake can help strengthen their neck muscles.
5. Functional Activities
Incorporating age-appropriate functional activities—such as reaching for toys, rolling, or sitting up—can help with overall motor development and promote better head control. Engaging in these activities encourages the baby to move their head and neck in different directions, which helps improve their flexibility.
6. Helmet for Plagiocephaly
If torticollis leads to plagiocephaly, where the baby's head becomes flattened, a helmet might be recommended. This helmet is designed to apply gentle pressure on specific areas of the skull, helping to reshape the baby's head over time.

Why Early Treatment Matters
Addressing torticollis early—ideally within the first few months—helps prevent long-term issues such as muscle shortening, developmental delays, and potential changes to head shape. Early physical therapy ensures that the baby reaches their motor milestones on time and avoids complications that can result from untreated torticollis, such as issues with vision and motor skills development.
​By intervening early and providing appropriate PT treatments, many babies can recover fully from torticollis and avoid the need for more invasive treatments later on.

If you have any concerns about your child's development, please call either
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