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What is Torticollis?
Most of us realise how critical the neck is in allowing us a free range of movement only when its muscles are injured and we are partially constrained. For instance, a ‘crick’ in the neck could make even sitting up in bed a challenge!

Now imagine a baby whose neck muscles are ‘stretched tight’ and less elastic than normal. Torticollis or ‘wry neck’ is a condition where the neck muscles are damaged, causing the baby’s head to tilt to one side and the chin to point downwards and towards the opposite shoulder. This happens when the sternocleidomastoid (SCM) muscle in the neck is tight.

Torticollis is caused by several factors, mainly due to the neonate’s position in the uterus and injury to the SCM muscle during delivery. Torticollis is usually diagnosed two to three weeks after birth.

When a baby’s neck is impaired, it invariably restricts movement and leads to delays in achieving developmental milestones, such as rolling, flipping and sitting up independently. This leads to a cascading effect on growth and development but it can be corrected with effective physical therapy.

Treatment is most effective when Torticollis is treated early.

  • Plagiocephaly: Flattening of the back of the head on one side
  • Facial asymmetry
  • Abnormality of the vertebrae or the neck
This takes place because the weight of the head falls on the same portion of the skull at all times. Advanced cases may exhibit flattening of the forehead on the same side with prominence of the forehead on the opposite side.

With physical therapy that leads to postural correction and as the baby increases his / her range of motion, plagiocephaly usually resolves itself. This is because the skull of a newborn is soft and still growing.

Hip Dysplasia
A large percentage of Torticollis cases exhibit hip dysplasia, where one thigh looks longer then the other or where one hip moves differently than the other.

Physical Therapy
Since the baby’s head cannot move freely, the other senses do not develop normally. Hearing and vision are limited as interaction with the environment is restricted. This leads to developmental delays, which means delayed body awareness, weakness & difficulty with balance, and asymmetrical use of the arms and legs. This inevitably leads to the child favouring one side of the body over the other, exacerbating weight imbalance.

Babies with Torticollis are very responsive to physical rehabilitation and the earlier the diagnosis and intervention, the greater the recovery. As the child grows, the SCM muscle tightens further and more resistant to stretching.

It is also important for parents to be actively involved with the child’s rehabilitation programme as Torticollis therapy requires the baby to undergo a range of motion exercises, massage, positioning exercises and strengthening exercises. In fact, a blend of physical therapy and thorough home exercise programme is key to recovery.