Torticollis is a condition in which there is limitation in neck movement. This is due to tightness of the sternocleidomastoid muscle on one side. If the right side is involved, the child’s head will be tilted to the right with the chin pointing towards the left. Depending on the age of the child, it might result in increased pressure on one side of the skull due to limited ability to move the neck to the other side, leading to flattening of that side of the skull which is called plagiocephaly If not treated, the tightness in the sternocleidomastoid muscle can increase, leading to neck pain, problems with chewing, altered vision, and asymmetrical facial appearance, affecting your child’s ability to function in the environment.
Malposition of the baby in the womb can cause pressure on the neck during birth. In turn, this can lead to obstruction of blood flow, which can result in the muscle becoming tight. Torticollis might also be secondary to central nervous system pathology, abnormalities in the spine, visual problems, hearing impairment, or part of another syndrome.
In a child with tightness of the muscle on the right side, which is right torticollis, you can:
A complete assessment will be undertaken to rule out problems in other parts of the body, such as the spine, rib cage, hips, or feet. Appropriate referrals will be made if torticollis is suspected to be secondary to problems relating to the central nervous system, vision, hearing, or other anomalies. Active as well as assisted stretching exercises for the tight muscles will be shown, which need to be incorporated into your child’s daily routine.
Advice will be given on positioning and handling, and age-appropriate activities will be provided to actively encourage movement in the desired direction and help decrease the tightness in the muscle. This will lead to muscle balance on both sides of the neck, resulting in your child being able to look freely in both directions. It is advisable that your baby is monitored at least until they start sitting independently, as the torticollis may become more evident with maturation.
If treatment is started early, and the advice provided is consistently adhered to, most children with uncomplicated torticollis recover completely. If physiotherapy has not been able to reduce the tightness or increase the movement in the neck, then surgical intervention might be needed depending on the cause. However, this is very rare. Intensive physiotherapy is required post-operatively to maintain the length of the muscle.