Physical therapy for torticollis

Physical therapy helps children with torticollis develop properly.

Rehabilitative Services is staffed with physical therapists highly experienced in the treatment of torticollis and plagiocephally.

Also known as “wryneck,” torticollis is a condition in which a child's head is tilted. It is typically caused by either a tightening of the muscles of the neck, flattening of the back of the head or a combination of the two. The condition often refers to tightness of a specific muscle which pulls the head sideways toward the shoulder, turns the face toward the opposite shoulder and brings the head forward on the chest. Habitually spending time in this position frequently causes other neck muscles to tighten.

Torticollis limits a child's ability to turn the head to see, hear and interact freely with his/her environment. Because of this, torticollis may lead to delayed cognitive development, delayed whole body awareness, weakness and difficulties with balance. Since the neurological component that directs development and balance is not impaired, children with torticollis may compensate for their head positioning and progress through their developmental stages asymmetrically. This asymmetry may cause spinal misalignment and uneven distribution of weight over the legs, leading to the development of orthopaedic problems.

Torticollis is also associated with a flattening of the back of the head, known as plagiocephally. As the infant keeps the head turned to the same side, the constant pressure on the back of the head leads to flattening accompanied by a bulging on that side of the forehead. If unchecked, torticollis and plagiocephally may contribute to perceptual problems and learning disabilities when children reach school-age.

Torticollis and plagiocephally should be evaluated by a physician to determine the cause and whether treatment is required.If treatment is necessary, a referral will be made to physical therapy. A physical therapist should individually assess the needs of each child and provide treatment, home exercise and positioning suggestions.The incidence of torticollis and plagiocephally can be minimized by providing supervised, awake prone time (tummy time), encouraging babies to look equally in both directions and by minimizing the use of baby equipment (car seats, bouncy seats, swings, etc.).

Activities for children with torticollis

For children with torticollis, it is very important that they play in all the following positions: prone (on tummy), lying on their side, sitting and supported standing. These are appropriate and necessary at any age. Encourage them to look at and interact with toys that promote rotation of the head and body to the child's non-preferred side. Set up the child's environment (i.e. orientation of toys, crib and play mat) to promote exploration toward the baby's non-preferred side.

Prone:

• During stroller rides place grasp toys in front of or to the non-preferred side of the baby.
• Put your baby on your stomach over your lap. Hold toys above and to the non-preferred side.
• Carry your baby horizontally by scooping your hand under the baby's chest so its legs straddle your forearm. Play airplane or “so big” in this position in front of a mirror.
• Get down on the floor facing your baby with or without toys placed between you. Approach the baby from the non-preferred side. Hold toys above and to the non-preferred side.

Lying on their side:

• Encourage bilateral hand play (this promotes midline alignment).
• Place toys in a way that encourages downward gazing.
• This is an easy posture to start rolling to the stomach.

Sitting and standing (supported or independent):

• Encourage head turning to the non-preferred side with toys or visual engagement.
• Encourage looking and reaching with the baby's non-preferred hand.
• Encourage bilateral hand play in midline.

Carry your baby:

• Against your chest with baby facing out.
• Over or up against your shoulder.
• From under their tummy like a football.

Tummy time

It is important that all infants spend time awake on their stomachs (tummy time). Tummy time allows babies to strengthen and stretch muscles that are important for developing basic valuable motor skills such as crawling, standing, sitting and walking. Tummy time also facilitates visual development as your baby learns to move his/her head to look at objects and track movement. Tummy time should always occur while the baby is awake and be supervised by an adult. To reduce the risk of Sudden Infant Death Syndrome (SIDS) all healthy infants should sleep on their backs until they are able to roll from their tummies to their backs easily.

Babies who do not spend enough time on their tummy and spend too much time on their back generally:

• Walk later than babies who have spent time on their tummy.
• Have tight muscles in their necks.
• Have flat spots on the back of their heads.
• Have weaker back and stomach muscles which may lead to difficulty sitting, standing straight or balancing in upright positions.

Aim for your baby to spend half their waking time throughout the day on their tummy. Start tummy time the day of your baby's birth. The sooner a baby spends time on his/her tummy the more comfortable this position will be as he/she continues to develop. If a baby is not used to spending time on his/her tummy, they may not enjoy it at first. Try introducing small amounts of tummy time and build up to the half day slowly. Try the following positions to give your baby some quality tummy time:

• Place a thin blanket and toys on a firm surface (such as the floor) and lay your baby on his/her tummy to play. This is a great position for babies to look at toys and practice lifting their head.
• Place your baby on his/her tummy on your stomach while you are lying on your back. This way your baby can easily make eye contact with you.
• Put your baby on his/her tummy over your lap.
• Carry your baby horizontally by scooping your hand under the baby's chest so its legs straddle your forearm. Play airplane or “so big” in this position in front of a mirror.

For more information about these conditions related to physical therapy, call 773.327.2880. For an appointment or referral call 1.800.KIDS DOC.

See also: Neck masses, Congenital muscular torticollis