Torticollis

Does your little one prefer to look to one side only? Does your baby prefer to breastfeed only on one side? Have you heard of the all-natural alternative, Osteopathic Manipulative Treatment (OMT)?

Studies have shown:

OMT should be included into the management plan of torticollis.
OMT of the cranium is beneficial to treat torticollis in infants developed as the result of birth trauma.
Torticollis improves with OMT.

Torticollis, also called wryneck or twisted neck, is a condition caused by tightened or shortened neck muscles. Children with this condition often have poor head control and tilt their head towards one side with the chin turned to the other side. This is usually observed in the first 6 to 8 weeks of life. In newborns, it can occur as a result of abnormal positioning of the head in the womb or birth trauma. In older children, it may result from injury to the neck muscles or from infections.

Causes
Torticollis may be an inherited defect, an acquired condition or congenital.

Inheritance: Gene mutations may result in different types of birth defects which may cause torticollis in the newborn.
Acquired causes of torticollis in children are:
- Injury to the neck muscles caused by sleeping in an abnormal position
- Dislocation/fracture of the vertebrae in the neck
- Infection or inflammation of lymph nodes in the neck may interfere with neck movement. Retropharyngeal abscess, an infection causing abscess deep in the throat, is common in children 2-4 years of age
- Injury or diseases of the nervous system
Congenital torticollis is present at birth and is usually caused by birth trauma or abnormal positioning of the growing fetus’s head in the womb.

Symptoms
Children with torticollis may exhibit various signs and symptoms such as:

Tilting of the head to one side with the chin pointing to the shoulder on the opposite side
Limited ability to move the neck or turn the head
One side of the face and head looks flattened (plagiocephaly) from the child laying their head on the same side while sleeping
Painless swelling or mass in the neck (can appear in infants during the first month)
Pain and stiffness in the neck; characteristic symptoms caused by injury or infection

Diagnosis
Your physician will diagnose torticollis based on the birth history, which reveals the possibility of any birth injury and a careful physical examination. X-rays and ultrasound examination of the neck may be done to rule out other abnormalities and confirm the diagnosis. A thorough neurologic exam helps to assess the cause of torticollis.

Treatment

Treatment of torticollis is especially successful when started at an early age. Treatment depends on the cause and is generally a conservative approach:

OMT has been shown to improve torticollis.

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Torticollis in the young often arises from the trauma of giving birth or malpositioning in the womb. The baby’s bones of the skull are designed to be as free as possible to allow for passage through the birth canal. Sometimes they can get stuck, which will affect the nerve (called the spinal accessory nerve) that plays a major role in neck muscle functioning. One focus in osteopathic treatments is correcting anatomical dysfunction to allow for better function. For example, one of the bones at the base of the skull is called the occiput. Another bone is called the temporal bone. There is a hole created between these two bones called the jugular foramen through which many nerves and veins pass through. Now, if you imagine a traumatic birth experience where the bones of the occiput and temporal bone squished these nerves, then one side of the neck muscles would pull harder than the other side resulting in torticollis. My job would be to help restore the bones to where they’re supposed to be so it takes pressure off this nerve and the baby can naturally correct its own posture.

Medical therapy: Medications prescribed for the treatment of acquired torticollis include analgesics such as NSAID’s (non-steroidal anti-inflammatory drugs) and anticholinergic drugs. Most cases of acquired torticollis are self-limiting, and OMT can be included in the management plan.
Physical therapy: This may be used in conjunction with OMT. The goal of physical therapy is to stretch the shortened neck muscles. Physical therapists will perform passive stretching exercises of the head and neck, massage, and apply heat to the area.
In rare cases, surgery may be considered.

For a list of articles supporting OMT, please click here.