Physical Therapy and Torticollis

What is torticollis?

Torticollis or “wry neck”  in a baby describes one of the head positions seen below.  The baby will prefer to keep one ear closer to their shoulder and will prefer to look in one direction.  The child with torticollis may not look at you when you move to their non-preferred side or they may have one shoulder always shrugged up.

A child’s head orientation will affect the development of motor skills as well as their sensory experiences as they are learning about the world around them.   Some children also have flattening of part of the head, called plagiocephaly, along with the head preference.

Physical Therapy and Torticollis

During a Physical Therapy Evaluation the therapist will look at the baby’s head and body positions and flexibility.  The therapist will also assess the child’s gross motor skills and visual tracking skills.

During traditional physical therapy for torticollis, parents are taught neck stretches and strengthening the opposite side of the body.  

The SMILE Approach For Children with Torticollis

Consider an infant’s experience. The child in utero is curled up tight to fit in a small space.  If a baby’s neck is tilted, it is visually obvious to the parent and pediatrician.  If they have imbalances elsewhere, the observations may be more subtle.  It may be harder to put one arm in the onesie, the child may prefer to play with toys on one side, the child may prefer to roll in one direction or the child may crawl with one leg dragging behind.  

Torticollis is often looked at as an isolated neck problem.  Kid PT approaches torticollis as a whole body imbalance, rather than a neck problem.  We like to describe the problem as “tortisoma” as we address the full body, rather than merely the infant’s tiny neck muscles that they are just learning to activate.   We suggest trying the below tests and observations to see if more of your child’s body is involved. Share what you find with your doctor or physical therapist.

DAILY ACTIVITIES

  1. It is harder to put one arm in the onesie compared to the other arm.
  2. Baby likes to breastfeed on one side only or be held only on one side for bottle feeding.

FLEXIBILITY

  1. Lie baby on his back. Bend both legs. One leg will go straight down and the other pops up.
  2. With baby on your lap, bring baby’s elbow to the opposite knee.  Repeat with the other side.  They should go the same amount on each side.

MOVEMENT SKILLS

  1. Baby rolls in one direction only or most of the time.
  2. Baby reaches for toys on one side most or all of the time.
  3. Baby sits leaning on one butt cheek more than the other.
  4. Baby crawls with one leg dragging or scoots on their bottom instead of crawling.
  5. Baby pulls to stand, but always leads with the same leg.
  6. Baby cruises only in one direction along the couch.

Learn More About the SMILE Levels of Intervention

SMILE Level 1: ALIGN

  • Rather than treat the obvious asymmetry, it is effective to identify and treat larger asymmetries in the body, providing the neck the opportunity to naturally come into alignment.  Common asymmetries seen are the upper body preferring to twist to the left, the baby in sitting shifted onto the right butt cheek, and the baby preferring to use one arm over the other.
  • Your physical therapist at Kid PT will assist you in identifying where in the body your child is tight and teach you how to do the same. Learning your child’s movement preferences puts you in the drivers seat. You will have a tool to check your own child’s body when therapy is over or in between sessions. You will know how to treat any tightness that develops as the child reaches a growth spurt or a new milestone without necessarily calling in the therapist.  Once areas of tightness are identified your therapist will teach you how to relax those areas while holding, carrying and playing with your baby without any discomfort and without stretching your child’s neck.
  • Addresses the ability to move in all directions from the inner core out.  An infant needs to be able to twist to the left and right, shift to each sit, and curl and stretch in order to rolls, sit and crawl.
  • The SMILE Approach assesses a child’s restrictions that are affecting their head position. This approach gives parents the tools to create and maintain alignment in their child.  Simply by cuddling with your child in certain positions or guiding them to perform certain preferred movement patterns during play, you will be helping your child’s head position.
  • For most children with torticollis SMILE level 1 will be all they need.  For children who are older and have altered sensory motor experiences had  children, they will need to move on to Level 2 and 3 of the SMILE approach.

SMILE Level 2 & 3: ACTIVATE

  • Some older children with torticollis will also benefit from exercises that stimulate their inner ear balance systems in addition to the alignment work.  This will help these children develop awareness of their middle and how to look, feel, listen, and move in all directions.  They will also benefit from some help to turn on their core muscles in a more balanced manner.

To learn more about this approach to the assessment and treatment of torticollis call Kid PT at (908) 543-4390. If your child is currently attending physical therapy and you are concerned about your child’s progress, please share this information.  Reach out to Kid PT and we will be happy to consult with your current therapist.

If you have concerns both in your child’s movement patterns as well as their engagement with you, contact Kid PT here or Call us at 908-543-4390 to arrange a screening.