Congenital Muscular Torticollis (CMT) is a musculoskeletal condition affecting infants and babies that inhibits full head movement due to a shortened neck muscle. The head of a baby with torticollis tilts to the affected side with the chin rotated toward the opposite shoulder.
Although the exact cause of CMT is undetermined, theories suggest possible causes may include intrauterine positioning and/or decreased blood supply, as well as trauma during pregnancy or birth to the sternocleidomastoidmuscle, which flexes and rotates the neck.
Parents concerned that their baby may have torticollis should schedule an evaluation by the child’s physician as quickly as possible. The sooner a baby who is diagnosed with torticollis receives physical therapy treatment, the faster he or she will get better.
Bacharach’s Pediatric Coordinator Mora Pluchino, DPT (pictured here) shared the initial physical therapy evaluation process for toricollis patients, saying, “The first step is to evaluate the range of motion and strength in the neck and arms. Many times children with torticollis have a decreased range of motion in their arms because when their neck is tilted toward one side they can’t lift their arm as high. We also assess the child’s gross and fine motor skills – babies with torticollis often have developmental delays as it is harder for them to roll, sit and crawl.”
After an initial evaluation, parents receive a 10 to 15-page packet of exercises and play ideas to do at home with their baby. The three most important exercises are stretching the areas that are tight, rotation, and those that help the baby to play in midline. Children with torticollis have a skewed sense of where the middle is due to the tilting of their heads. Midline exercises help them to refocus their alignment. Parents are also educated on the correct way to carry and position their child and are given playtime tips they can implement on an ongoing basis. For example, it is recommended that babies with torticollis lay on their stomach to play frequently to alleviate pressure on the back of their head so they don’t develop plagiocephaly, or flat head syndrome, which is very common among torticollis patients.
With proper evaluation and physical therapy treatment, many torticollis patients are 85 to 100 percent better within three to seven months. In addition to achieving range of motion and strength improvement, physical therapists assess the baby’s progress with developmental milestones before releasing them from treatment.
Mora shared, “We typically see families for a treatment session once a week. We hold them in a football hold and walk them around, which helps them stretch their neck, sit them in a supportive infant seat moving toys from side to side to encourage neck movement, play on a therapy ball, sing songs with arm and leg movements and even feed the babies while holding them in therapeutic positions. If you didn’t know we were doing physical therapy, it might seem like we were just playing with the babies.”