By: Laura Kendall, DPT

Exploration of the world starts in infancy. Some infants, however, have limited motion, specifically with their neck. This is often due to a tight neck muscle, typically the sternocleidomastoid, and is called torticollis. Torticollis is a condition that occurs in infants and can be diagnosed shortly after birth. Torticollis can also be identified in the first few months of life. Torticollis is observed when an infant rotates his or her head one direction and tilts the head, bringing one ear towards the shoulder; this is an abnormal pattern that results in the head being “stuck” or not being able to move in the opposite direction.
There can be different reasons for the development of this abnormal pattern. One reason can be a large birth weigh. Decreased space in the womb can limit movement for the infant. Another cause of torticollis may be positioning and posture due to how parents hold/carry the child.

Torticollis is often associated with plagiocephaly or brachycephaly. Plagiocephaly refers to the asymmetrical change in head shape. Often one side of the child’s head is flatter. This can also have an effect on how the ears are shaped. Brachycephaly is a condition in which the back of the head is flat. Flattening on the sides or back of the head is caused by increased pressure to the head. This happens when infants spend a lot of time laying on their backs, sitting in car seats, or other carrying devices where their head is in contact with a firm surface for long periods of time.

Torticollis, plagiocephaly, and brachycephaly are all issues that Physical Therapy addresses. Muscle lengthening and movement are key factors in promoting age appropriate development. Physical therapy works on providing stretching and strengthening exercises to promote head and neck movement in both directions. Massage can often assist with gaining full neck movement. Positioning advice and techniques are provided to promote sustained stretching within a pain free range. All of this leads to cranial reshaping which subsequently leads to a symmetrical head shape!

Physical therapy for torticollis and head shape abnormalities are best combated with early intervention and home programming. Though torticollis is an issue affecting the neck musculature and range of motion, it can lead to limitations with motor milestones by creating compensatory movements. Physical therapy works to alleviate the torticollis and ensure appropriate movement patterns for overall gross motor development. The sooner an infant is able to start physical therapy for torticollis, the quicker their range of motion and developmental motor milestones will progress.