Simon Physical Therapy
                                                 

Common Concerns

Torticollis  

Does your baby prefer to look to one side or tilt his head to one side?  Does she have a flat spot on her head or have an unusual head shape?

Then, he may have torticollis.  This can either be present from birth condition or develop over time due to positioning.  Typically the sternocleidomastoid muscle becomes shorter on one side than the other, causing your baby to tilt his head to that side and turn his head to the opposite side, see Figure 1.  Other muscles may also become shortened causing the head tilt to linger even after she can turn her head fully to each side.   A small mass may be present in the SCM that is not tender to touch; resolution of torticollis typically takes longer for those children than for those without it.  An infant’s head is very pliable as the different bones of the skull not fused together and more cartilage less bone than adult.  Therefore, gravity causes the skull to deform (plagiocephaly) as shown in Figure 2.  This may result in facial asymmetry as well. 

There is an increased likelihood of hip dysplasia and metatarsus adductus in children with torticollis due to conditions during pregnancy.  This is most common with first time mothers due to smaller intrauterine space.  Hip dysplasia occurs when the ball and socket of the hip joint is not as congruent/well shaped as usual permitting the (femoral head ) ball of the hip to move around the socket (acetabulum), termed subluxation, or even to dislocate out of joint entirely.  Hip dysplasia is six times more prevalent in girls than boys due to the girls responding to hormones released by mom to increase ligamentous laxity and allow more room for delivery.  Best treatment practice for hip dysplasia is the Pavlik harness to hold the baby’s hips in a flexed and abducted position to allow the hip joint to become better shaped.  Figure 3.  For this reason, Shriners Hospital always x-rays hip of children referred to them for torticollis or plagiocephaly.  Metatarsus adductus is just the forefoot turned in.  If the forefoot is turned in with shortening of the Achilles tendon so the baby appeared to be on tiptoe is a different condition commonly called clubfoot.  Figure 4.  Bracing is the standard treatment for metatarsus adductus, while surgery is used for clubfoot.

Treatment of torticollis has three main components – 1) active and passive stretching of neck to the non-preferred side; 2) positioning to encourage head turning to the non-preferred side; 3) and strengthening of non-involved SCM and other muscles.  Note do not attempt to do stretching on your own until being instructed by a trained professional as mistakes can make the torticollis worse and harder to resolve.  Tummy time should be strongly encouraged to build neck strength and gain head control.  Interaction with the hand on the non-preferred side by placing toys in that hand, promoting reaching with that hand or self-soothing using that side’s thumb.  Not only does this encourage your baby to look to that side and promote development.  If your child has facial asymmetry or severe skull deformity, a helmet to re-shape his skull is strongly recommended.  This is especially true for involvement of the jaw and bones around the eyes.  Positioning can strongly improve head shape, achieve even full correction without use the helmet; this is especially true for younger infants.  Early detection and correction yield the best outcomes.  

Figures coming soon.

     

 

 

Simon Physical Therapy
438 West Pennsylvania Ave
Warren, PA 16365

(814) 688-0933
FAX (814) 728-6045

barry@simonphysicaltherapy.com

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