Infant Torticollis and Chiropractic

Crosby Chiropractic St. Peters

Infant Torticollis and Chiropractic

Torticollis is also known as wry neck and is defined by an abnormal,
asymmetrical head or neck position, which may be due to a several causes.
Torticollis can results from a variety of causes from scarring of muscles, or
damage or disease of cervical vertebrae to infection of the adenoids, tonsils,
enlarged cervical glands or throat abscesses, to tumors of the head or neck.

Congenital muscular torticollis
Occurring in infancy, the cause of congenital muscular torticollis is unclear. The
birth process is thought to damage the sternocleidomastoid muscle in the neck of
these infants shortening the muscle. The shortened muscle develops scar tissue
and stays shortened, causing the baby’s head to be tilted toward the affected side
while rotating the head toward the opposite side.
About 1 in 250 infants are born with torticollis. (Ten to 20 percent of babies with
torticollis also have hip dysplasia, in which the hip joint is malformed and they
should also be checked for club foot malformations.)

Acquired torticollis
The most common form of torticollis occurs with one or more painful neck
muscles and will pass spontaneously in 1–4 weeks. In many of these cases no
clear cause is found in medicine although in chiropractic we often find
biomechanical issues.
Infants may develop torticollis after birth as a result of too much time spent lying
on their back during the day while in car seats, swings, bouncers, strollers or on
play mats. Infants with torticollis have a higher risk of developing flat head
syndrome. Most pediatricians recommend repositioning the baby for healthy
head and neck movement. Torticollis is almost always preventable in infants.
Correct positioning is important, and most pediatricians recommend parents
reposition baby's head every 2–3 hours during waking hours. When torticollis is
not corrected before 18 months of age, facial asymmetry can develop.

The most effective treatment for infants/children with torticollis involves
adjusting the neck, soft tissue stretching, trigger points, and exercise for neck
stability. A study from 1993 also recommend pillow instruction for home use to
position the neck correctly with the infant lying down.


A chiropractic evaluation of a child with torticollis begins with history taking to
determine circumstances surrounding birth and any possibility of trauma or
associated symptoms. X-rays or other imaging (MRI/CT) may be taken to ensure
that there is no underlying pathology causing the torticollis. Physical examination
will include both an orthopedic and neurological evaluation. Torticollis with no
neurological involvement will reveal decreased rotation and bending to the side
opposite from the affected muscle.
When infant torticollis is due to muscle damage, the cervical spine can be gently
adjusted and the damaged musculature needs to be stretched to encourage
normal movement of both spine and soft tissue.
The involved muscle is gently, passively stretched by turning the baby's head so
that the chin is moved towards the affected side. 'Passive' means that the
stretching is done by the doctor who can also show the parent/caregiver home
stretching. For home care the infant can also be encouraged to stretch the
muscle (active stretching) by putting things that they will be interested in looking
at on her unaffected side encouraging active movement of the involved muscle in
stretch, or by moving objects from the affected side to the unaffected side
encouraging the baby to follow the movement.
Usually there will be improvement within 2 to 3 months and the baby will be able
to move her neck fully in less than 12 months. Rarely surgery is needed to
lengthen the muscle.

The Journal of the Canadian Chiropractic Association. 1990 March; 34(1)13

 Chiropractic correction of congenital muscular torticollis.
J Manipulative Physiol Ther. 1993 Oct ;16(8):556-9.

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