The Johns Hopkins All Children’s Torticollis Clinic addresses the medical and rehabilitative care of infants and young children with torticollis, a condition that causes a child’s neck muscles to tighten and the head to tilt to one side. If not treated, children with torticollis can end up with plagiocephaly, a fairly permanent head tilt, as well as flattening or asymmetry of the skull. For children with torticollis, prompt diagnosis is key since treatment is most effective in a young baby. The good news is torticollis can be resolved with timely physical therapy treatment.
Because parents and caregivers are now advised to lie infants on their backs to sleep, a torticollis diagnosis is becoming increasingly common. The condition can make it difficult for the child to turn his or her head for visual tracking, hold the head in an upright position and perform appropriate lower/upper extremity movements necessary for feeding and play. It can also cause flattening of the child’s face, ear and head, and make cleaning the neck and shoulder difficult.
Symptoms of Torticollis
- Titling of child’s head to one side
- Difficulty bringing chin to chest
- Firm small mass on the neck muscle
- Difficulty turning head to follow movement with eyes
- Frustration when trying to turn head completely
Causes of Torticollis
An infant’s skull is very soft in the first year of life. For this reason, parents and caregivers should change the baby’s position often when the baby is awake. It is also very important for the baby to have frequent supervised time on his or her tummy when awake to help take pressure off of the back of the head. Tummy time can strengthen the baby’s neck, arms, back and tummy muscles. Parents and caregivers should avoid:
- Leaving infants in one position for long periods with the infant’s head turned to only one side
- Letting the baby sleep or rest in a car seat, bouncy seat, swing or stroller for much of the day
Breech delivery at birth also may cause an infant’s neck muscles to be stretched or pulled.
About Clinic Appointments
Treatment at our Torticollis Clinic includes evaluations by a rehabilitation medicine specialist and a physical therapist. During the initial appointment, the patient is evaluated and given an individualized plan of care. Our physicians determine each patient’s candidacy for physical therapy based on American Physical Therapy Association guidelines. Therapy typically begins within two weeks of the initial appointment. During Tampa clinics, a representative from Westcoast Brace & Limb is available to evaluate children with plagiocephaly for a cranial orthotic device to reshape the skull.
The majority of physical therapy sessions for torticollis consist of stretching muscles and soft-tissue to loosen tightness, as well as strengthening exercises to ensure the spine can hold the patient in a midline position. Weakness caused by torticollis can cause delays in gross motor skills, so we don’t want to discharge a child until we’re sure he or she has reached an appropriate level with those skills and can hold his or her head in a midline position.
Physical Therapy Program Overview
- Initial evaluation scheduled to determine full needs of each patient
- Measure active and passive range of motion
- Assess muscle tightness
- Test muscle strength
- Evaluate gross motor skills
- Check for associated conditions:
- Plagiocephaly (abnormal head shape)
- Hip dysplasia (misalignment of the hip)
- Spine problems
- Discuss results with parent and make a joint plan for treatment
- Schedule treatment
- Family instruction for stretching and positioning during treatment sessions
- Individualized home exercise program
Goals of Physical Therapy
- Improve child’s ability to turn head between right and left sides
- Improve child’s ability to bring chin to chest
- Improve child’s ability to orient the head to midline against gravity
- Encourage child to lift head against gravity while lying on stomach
- Achieve normal weight bearing and shifting over upper extremities
- Encourage symmetrical use of upper/lower extremities
- Allow child to experience proper weight shifting during developmental activities including sitting, rolling, crawling and walking
Why Therapy is Important?
- Prevent permanent shortening of the involved muscle
- Avoid surgery
- Decrease headache and neck pain
- Prevent asymmetries in vestibular and visual development
- Prevent head and face shape asymmetry
- Prevent scoliosis
How Long Will Treatment Take?
- 30- to 60-minute sessions
- One to three sessions per week
- Three to nine months
To schedule an appointment for physical therapy evaluation, please call 727-767-7272. Patients must have a prescription from a pediatrician for “physical therapy evaluation and treatment” with torticollis diagnosis.
Johns Hopkins All Children’s,
Johns Hopkins All Children’s Outpatient Care, Tampa