Children's Physiotherapy - Patient Information

This information has been provided by Move2Learn - providers of paediatric physiotherapy at Vale Healthcare. Find out more about this service…

Should you have any further questions about these conditions, or the paediatric physiotherapy services that they relate to, please contact contact Liz Atter on 07722 147 502.

What is Torticollis?

Torticollis or ‘Wry neck’ is the medical term used to describe when the neck becomes twisted and causes the head to tilt to one side whilst the face turns to the other.This can be due to tightness in the muscle that connects the breastbone (Sternum) and the collarbone (Clavicle) to the skull behind the ear. The muscle is called the sternocleidomastoid muscle.

When a baby is born with this condition it is known as ‘Congenital Muscular Torticollis’. The tightness or shortening of the muscle might have developed because of the way your baby was positioned in the uterus (with the head tilted to one side) or because the muscles were damaged during delivery. These are the most common causes.

You may also feel a lump on the muscle at the side of the neck. This lump is caused by the damaged muscle fibres bunching into a knot and is often called a ‘sternocleidomastoid tumour’.The Physiotherapist will show you exercises to help reduce this.

Torticollis is very often associated with Positional Plagiocephaly in that head flattening may cause your baby to lie with the head resting on the flattened side making it difficult for them to turn the head away to the opposite side. This causes subsequent tightness in the neck muscles. Alternatively, if the Torticollis comes first, lying with the head in one position can cause flattening to the skull bones.

What is Positional Plagiocephaly?

The baby’s head may be flattened as a result of remaining in one position - this may be called ‘Plagiocephaly’. If the baby’s head is flattened symmetrically along the back, this is known as Brachycephaly and Scaphocephaly when the head is long and narrow.

Positional Plagiocephaly is produced by pressure from the outside on part of the soft developing skull. It can occur while the baby is still in the womb for example, during breech presentation. In more recent years, flattening occurring after the baby is born is now more frequent following the introduction of the important ‘Back to Sleep Campaign’. Babies now spend more time on their backs or in baby carriers which can lead to the head remaining in one position causing flattening.

What treatments are available?

In mild cases, babies may not need any active treatment but you may feel more confident having your GP or Health visitor check it out. Moulding of the baby’s head and neck may also be associated with other conditions such as positional talipes (feet turning up and inwards) or hip dysplasia. A full physical examination by a children’s physiotherapist will be helpful in ruling these other features out whilst offering reassurance and guidance on ways to improve the neck and head shape.

Early recognition of the Torticollis and Positional Plagiocephaly: 

The younger the child is when the problem is recognised, the better the chances of stopping any progression and the greater chance of improving full ranges of head and neck movement and head shape.

‘Tummy time’:

The more time babies spend on their tummies, the better the chance of stopping the Plagiocephaly getting worse - and allowing natural correction to begin. This will also help strengthen muscles to overcome the Torticollis and enable your baby to turn their head from side to side to watch the world go by. Playing with your baby during supervised tummy time can take time to achieve as they may not like being on their front; however ‘little and often’ will allow them time to develop the strength and range of movements to tolerate this activity. Lying your baby over your lap or a rolled up towel or baby blanket to begin with can help them lift their head more easily and feel less trapped.

Sleeping position:

Adapt your baby’s sleeping position so that everything exciting is in the direction that encourages them to turn their head the ‘wrong way’ by altering the position of any toys or mobiles. Check how your baby is lying in the car seat or buggy too. If your baby is bottle fed, try to feed them from the ‘wrong side‘ to encourage relaxed head turning away from the tilted side.

Further investigations:

If the Torticollis is very tight and progress cannot be made with positioning and stretching, referral to an Orthopaedic Consultant might be recommended. With Positional Plagiocephaly, the problem might require x-rays or scans to determine the underlying causes and onward referral to a cranial-facial surgeon may be recommended.

For babies with positional Plagiocephaly, the use of Helmets and bands remains controversial and is still being researched. These often have to be worn for several months and daily for 23 hours out of 24 if they are to be effective. The Orthopaedic Consultant will make this recommendation but these are rarely supplied by the NHS and are expensive to buy.

References

• Physiotherapy department / Patient information programme 2010 www.royalfree.nhs.uk
• A Singh and I Wacogne ‘What is the role of helmet therapy in positional Plagiocephaly?’ 2008 Arch Dis Child 93: 807-809
• UCL Institute of Child Health in association with Great Ormond Street Hospital for Sick Children ‘Positional Plagiocephaly – information Sheet’ GOSH Trust September 2004. Reviewed March 2010 Compiled by the Physiotherapy and Craniofacial Departments in collaboration with the Child and Family Information Group. www.ich.ucl.ac.uk/gosh_families/information_sheets/plagiocephaly/plagiocephaly_families.html