Torticollis

Types of Torticollis

Torticollis affects approximately 0.5% of all newborns and can have a wide variety of causes. (Source: Region Midtjylland).
In general, there are two main types of torticollis: congenital torticollis and functional torticollis, both of which are explained below.

Congenital muscular torticollis (CMT)

In congenital torticollis, the neck curvature occurs during or immediately after birth. It is often caused by either a prolonged labor or a birth where the baby has become stuck in the birth canal with either the head or shoulders, and often has not been able to be pushed out naturally. In these situations, the use of, for example, a suction cup may be needed to deliver the baby.
This process can cause excessive stretching, pulling and tearing of the muscle tissue in the child’s neck and nape. This can manifest as a congenital malposition of the head and at the same time there may be a small hemorrhage or swelling in the sternocleidomastoideus muscle. This will be seen and felt as a small pea/nodule in the muscle tissue. It will gradually decrease during healing, but can leave scar tissue in the muscle, which can become tight and stiff.

Another cause of congenital torticollis is the position of the baby inside the womb. For example, the baby may have been in the same position in the womb for a long time, with pressure on the head and neck. An increased incidence of torticollis is seen if the baby lies with the bottom down, the so-called breech position. (Source: Region Syddanmark).

Finally, the child may be genetically predisposed to developing torticollis if the parents had it as a child.

In congenital torticollis, a strong favored side will be seen, with the child’s head tilted towards one shoulder and rotated to the opposite side. There will be limited active and passive movement of the head, and the child will typically not be able to turn the head to the difficult side.

Functional torticollis (postural torticollis)

The causes of functional torticollis are the same as those of congenital torticollis.

Functional torticollis can occur immediately after birth and up to a few weeks after birth.

Clinically, it is similar to congenital torticollis, but is less pronounced. Here, there will not have been swelling/bleeding in the sternocleidomastoid muscle, but instead there will be increased tension in the muscle.

Functional torticollis causes the same neck and head curvature mentioned above, but the child will still be able to actively turn his head to the affected side, but to a limited extent. This can be described as a favorite or favorite side of the head towards one side.

If parents are not aware of an incipient favorite side, a flat/crooked back of the head can develop over a short period of time – also called plagiocephaly. This occurs when the baby is lying on his back and primarily lies with his head, for example, to the right, so the pressure on the back of the skull will be increased on the right side.

Other causes of acute torticollis that parents should be especially aware of

• Trauma, for example, from a loss or fall, a fracture of the collarbone which may have occurred at birth
• Impaired vision or hearing
• Infection, fever, and other illness
• Tumor/node in neck muscle
• Development of bone deformity

In cases where a misalignment of the neck and head occurs acutely in combination with the above, a doctor should be sought.

Symptoms of torticollis

• Head position with the ear tilted towards one shoulder and the head rotated to the opposite side. This includes challenges in turning the head freely to one side
• Swelling/nodule/scar tissue in the muscle, the size of a pea
• Reduced mobility of the head and neck
• Difficulty breastfeeding at the breast, possibly on one side
• Discomfort and increased crying
• Tenderness when touching the neck
• Asymmetrical shoulder height
• Flat and crooked back of the head, plagiocephaly
• Banana shape/C-shape in the body

The impact of torticollis on motor development

Torticollis has an impact on the sense of sight and balance. The eyes are a major factor in our sense of balance in combination with the vestibular sense (the sense of balance), which is located in the ear canals. It is important that the eyes are in a horizontal position so that the brain can create a symmetrical image from the sense of sight. If this is not the case, the visual image will be perceived crookedly and thus make it difficult to sense balance in, among other things, sitting and walking positions.

Furthermore, the balance organ has an impact on the postural reflex, which is the body posture.

If a child with torticollis and a favorite side of the neck is not loosened up and/or trained to the difficult side, the baby’s brain development will become asymmetrical.

This will be expressed in the child only perceiving half of the world, and for example, will become more motorically oriented towards using an arm, a hand and a leg, and crossing movements may also become difficult.

Osteopathic treatment of torticollis

Osteopathic treatment of children will be based on an examination of the entire body, to uncover any tension and discomfort that may arise elsewhere in the child’s body due to neck strain.

In addition, when treating babies and children, the goal is always to use gentle techniques with relaxation, stretching and light mobilization of tissue to ensure free movement of the neck and head.

Osteopathic treatment of torticollis will mainly focus on treating the skull, neck and collarbone to release tension. In particular, the sternocleidomastoid muscle is important from its attachment and origin on the skull behind the ear and to the collarbone.

Furthermore, the treatment involves releasing the 11th cranial nerve (n.accessorius), which is the nerve supply to the sternocleidomastoid muscle, whose function is to activate muscle tension. The nerve exits the skull from the same opening as, among others, the vagus nerve (10th cranial nerve).

In addition, the treatment will aim to normalize tension from the chest and spine, as seen, for example, in c-shape/banana shape, where there is asymmetry.

Home training

The treatment will also involve home training with a focus on stretching the short neck muscles through movement exercises and strength training of the weak muscles, with the goal of achieving symmetrical mobility. It is important that parents make an active effort at home to help and support the child to move symmetrically and relieve tension.

It should also be mentioned that you must be patient during the treatment process and home training, as torticollis can be a long-term condition.

What can you do yourself?

You can start by reviewing the layout of your home. For example, where the changing table is placed in relation to the light from the window and toys. Feel free to screen off the favorite side so that it becomes uninteresting. This can be done by moving the furniture around or placing a cardboard box against the light. At the same time, move all the exciting toys and colors to the difficult side – that way the child will be motivated to look at the “difficult” side.

In addition, you can benefit from:

• Talk to the child from the side and play to the difficult side as the child will actively turn his head towards you.
• Change position frequently from back to stomach and side.
• Stretch the neck by moving the baby’s head towards one shoulder (right). Gently grasp the opposite side of the head (left) and place one hand on the (left) shoulder. Hold the position for approx. 10 sec.

Contact us here to hear how we can help you get started with home training.