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Torticollis (Wry neck)

Torticollis is a problem involving the muscles of the neck that causes the head to tilt down.  The top of the head generally tilts to one side while the chin tilts to the other side.

The word “torticollis” itself comes from two Latin root words, “tortus” and “collum,” that together mean “twisted neck.” This condition, sometimes called wryneck, is relatively common in children.

Classification:

  1. Congenital muscular torticollis: Your baby might have been cramped in the womb or may have been in an abnormal position, such as a breech position. That can put extra pressure on one side of your infant’s head, which can cause the Sternocleidomastoid muscle  to tighten and
  2. Acquired torticollis typically: It occurs in the first four to six months of childhood or later. It may come on quickly or slowly. Additional causes may include:
  • Sleeping in an awkward position
  • Neck muscle injury at birth
  • Burn injury
  • Any injury that causes heavy scarring and skin or muscle shrinkage
  • Neck muscle spasm

symptoms of torticollis:

Congenital muscular torticollis

  • The child has a limited range of motion in the head and neck.
  • The child’s head tilts to one side with their chin pointed to the opposite shoulder. In about 75% of babies with torticollis, the right side is affected.
  • A small, pea-sized lump (or “pseudo tumor”) is sometimes found on the sternocleidomastoid (SCM) muscle.
  • Asymmetries of the head and face, indicating plagiocephaly, may also be present.
  • Musculoskeletal problems, such as hip dysplasia, are sometimes present.

Acquired torticollis

  • There is limited range of motion in the head and neck.
  • Neck muscle pain or pain down the spine
  • Spasm or stiffness or  swollen of the neck muscles
  • Awkward position of the chin
  • Other symptoms may include shoulder pain, back pain, headache, neck cramps, muscle tightness, muscle pain, or burning sensations.
  • having one shoulder higher than the other.
  • With a condition called benign paroxysmal torticollis, there may be recurrent episodes, or “attacks,” of head tilting; often these attacks are accompanied by other symptoms, such as vomiting, irritability, and/or drowsiness.
  • Additional symptoms vary according to the cause of the torticollis.
  • With spasmodic torticollis (cervical dystonia), there may be neck muscle spasms that are sustained (tonic) or jerky (clonic)

Diagnose

The doctor will take a detailed medical history and then perform a physical examination.

When there is a history of trauma, the doctor may take X-rays of your neck to exclude a fracture or dislocation of the spinal bones in your neck.

  • Imaging tests such as X-rays and MRI scans can also be used to find structural problems that might be causing your symptoms.
  • An electromyogram (EMG) measures electrical activity in your muscles. It can determine which muscles are affected.
  • In a small number of cases, subtle abnormalities or preexisting conditions, for example, degenerative arthritis of the spine or of the neck, may require a CT scan.

Treatment:

Treatment for torticollis aims to relax the contracted neck muscles involved.  In most people, torticollis resolves in several days to a few weeks with a proper and active treatment plan. A few people will develop continuing neck problems for months to years. Persistent neck muscle spasms may require referral to a neurologist or surgeon.

Physical therapy :

Electrotherapy :

  • UST
  • TENS
  • HIL

Manual therapy : 

  • Myofascial release of the affected area
  • Taping to elongate the muscles to facilitate stretching
  • Gentle range of motion exercises for neck.
  • Stretching the muscle in a prone position both actively and passively.
  • Strengthening exercises
  • A home-exercise program to continue gentle rehabilitation at home

STRETCHING & POSITIONING FOR PLAY

Doing these stretching exercises, carrying your child properly, and correctly positioning the child for play can help to correct torticollis.

The best place for stretching exercises is a carpeted floor. Place your child on his back. If you’re sitting on the floor, you can place the child in your lap, with the child on his back and knees tucked.

SIDE BENDING [for RIGHT Torticollis]

Place your RIGHT hand on top of the RIGHT side of your child’s head. Hold your child’s RIGHT shoulder down with your LEFT hand. Slowly bend his LEFT ear towards his LEFT shoulder

Hold this position for 30 seconds, as tolerated by the baby. Repeat 2-4 times. Do this exercise 3-4 times a day.

ROTATION (HEAD TURNING) [for RIGHT Torticollis]

Place your LEFT hand on your child’s LEFT shoulder. Cup your child’s head with the RIGHT hand. Use your LEFT hand to hold your child’s chin. Slowly turn your child’s nose to his RIGHT shoulder.

Hold this position for 30 seconds. Repeat 2-4 times. Do this exercise 3-4 times a day.

POSITIONING FOR PLAY

Playing while lying on his side (side-lying): Position your child so he can play while lying on his side

This position allows gravity to do some of the work of stretching the neck and bringing the hands to the middle of the body. Bringing hands to the middle is an important step for feeding, hand-eye coordination, and other areas of your child’s development.

PLAYING ON HIS STOMACH

When your child is awake, it’s important he be placed on his tummy for play. This helps him learn to control his head movements.

When your child is on his tummy on the floor, place all toys so he has to turn his face to the RIGHT.

You can help him turn his face to the left while he plays on his tummy.

CARRYING YOUR CHILD

Hold the child facing away from you, in a side-lying position, with your child’s RIGHT ear resting against your RIGHT forearm.

Get your forearm between the child’s ear and shoulder to help stretch the tight muscles. You can use your forearm to lift your child’s head away from the shoulder to get a side-bending stretch. Place your LEFT arm between your child’s legs and support your child’s body and grasp her right shoulder with your left hand.

Carry your child in this position as much as possible. You can use this position to stretch the tight muscles if your child doesn’t tolerate the side-bending stretch well on her back.

Strengthening Exercises

  • Tummy time on therapy ball, rocking side to side and front to back. Toys, mirrors, pets, siblings, etc. can be used to encourage child to look away from restricted side.
  • Seated on therapy ball to work on trunk strength and stability, lean side to side/front to back and have child work on returning to sitting position.
  • Place child on soft incline wedge/ramp or pillow (Boppy works great) for tummy time to encourage head movement and arm weight-bearing. Increase challenge by decreasing size of support (pillow → rolled up swaddle blanket →  small towel roll)

  • Sitting activities: child will typically lean their trunk or fall away from the short side and toward the long side; place a toy on the shorter side to encourage weight-shifting to tight side and turning on muscles on weak side.

Positioning/Handling 

  • Vary sleep and play surfaces; limit time in swings, bouncers, and plush surfaces to 15-20 min, as these restrict head and body motion and promote poor posture overtime if overused.
  • Side-lying position is excellent to get child off their back and brings their hands to the middle of their body for midline play. Use a towel roll or pillow to help them keep this position.
  • Football hold (side-lying carry): hold child with one arm between their legs and under their belly, with your hand at the shoulder on the shortened side of the neck. In this position, they are working to keep their head up and strengthening the long and weak side while stretching the short side.
  • Hold your baby out in front of you and facing away – takes weight off the head and encourages neck strengthening.
  • In infant carriers, have child face in until they show good head control and are able to right themselves

Righting Posture 

  • Weight-shifting on ball: lying on back or belly, or sitting up on ball.
  • When picking baby up from floor, crib, or changing table, first roll child to one side, then lift up; switch sides regularly

Environment

  • When putting baby down to sleep, turn their head so that they are not always looking one way.
  • Another way to encourage this is putting baby down with the head at a different end of the crib every day.
  • Alternate sides whenever you feed baby a bottle (happens automatically with breastfeeding!) and change the hip that you hold your child on.
  • Avoid leaving child in a car seat, infant seat, swing, carrier, etc., where head is likely to rest on the same spot.
dr-debbekadhar
Dr. Debika Dhar

Physiotherapist , Mayfair Wellness Clinic

BPT (DU),
faculty of Medicine (NITOR),
Sports Injury Specialist,
Trained in Neuro Rehabilitation

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2022-05-12T09:46:39+00:00

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