Treating tricky torticollis
Ok, so your pediatrician has diagnosed your baby with torticollis. Or maybe after reading my last blog post you looked through your baby photos (adorable, by the way!) and identified some concerns yourself, so you reached out for a PT referral (nice work!). The good news is, early identification and treatment is KEY, so congrats on catching the condition early!
If you’re like me, you probably want all the information and tips on how to help your baby ASAP. While it’s crucial to get a full PT evaluation, today' I’m going to talk about some basics to get you started (as always, this blog is for informational purposes only and should not take the place of seeking medical treatment and advice).
Remind me: what is torticollis, again??
Remember, torticollis translates to “twisted neck” in Latin, and occurs when one SCM (that’s sternocleidomastoid for my fellow anatomy nerds!) muscle in the neck gets tight. This results in baby tilting their head to the same side as the tight muscle, and turning their head the opposite direction. Check out the mini anatomy lab we did in the Teasing out Torticollis post to get it down!
Today we are going to assume our baby has a LEFT-sided torticollis, which means the LEFT SCM is tight. This will cause your baby to tilt to the LEFT but prefer to look and turn their head to the RIGHT. It can be tricky to get the directions down, so be sure to consult with your pediatrician and PT to make sure you’re addressing the correct side.
Left side tight, right side weak, all sides CUTE!!!
Key concepts of treating torticollis—the three S’s!
When we break down the treatment of torticollis, there are many components that need to be addressed, and a plethora of strategies to do so. A full PT assessment will take an in-depth look at your baby’s individual presentation and give you exercises tailored to their needs. Today, I’m going to break down the key concepts that should go into every plan of care when treating torticollis.
In the PT world, we love a good acronym. APTA, ROM, ADL, and GMFM are just a few (this list could go on and on, and trust me, you don’t want me to describe each one here!), so to help break down the general concepts needed to effectively treat torticollis and ensure symmetrical development, I’ve created our own acronom: SSS!
Stretch the tight muscles, strengthen the weaker ones, and survey baby’s environment to set them up for symmetrical success! (Sufferin’ succotash, so many S’s!)
The first S: STRETCH!
We know that torticollis happens when the SCM gets tight, so it’s really important that we help loosen it by stretching! There are lots of ways to do this, but I’m going to show you my favorite, and the way I find to be best tolerated by babies and parents alike. It’s called the FOOTBALL HOLD, and it is great because it gently stretches while SNUGGLING! What’s not to love?!
In our example today our baby has a LEFT torticollis, so we will be targeting the LEFT SCM to stretch. To use the football hold, hold your baby facing away from you, with the LEFT side of their neck in the crook of your left elbow. With your right hand, gently hold on to baby’s arm at their side to stabilize the stretch. To get a good stretch, we lift up our left elbow, and we can back off by lowering it if baby is squirming. Now go find a mirror to stand in front of, rock your baby, and sing and be silly for 3-5 minutes to allow the muscle to relax.
Using the football hold to stretch the LEFT SCM—see how much fun we’re having?!
The second S: STRENGTHEN:
Usually when one side of the neck (in our case the LEFT) gets tight, the opposite side (the RIGHT) gets weaker. Our goal is to encourage symmetry and neutral midline posture, so we need to get that RIGHT side stronger!
The key to strengthening a muscle is repetition. Think about your last trip to the gym (maybe it’s been a while…thanks a lot COVID!). If you just did one bicep curl and called it a day, your muscle would never get any stronger. It takes many reps over many days to build strength and get that bicep poppin’! With baby’s neck muscles, our goal is not to tone and get that beach body, but the concept is the same. We want to use reps to encourage them to use their weaker neck muscles over and over again, building strength over time. Eventually the right and left muscles will be equally as strong, and this will help baby hold their head in midline. There are lots of ways to work on this, but here’s the basic idea:
Hold your baby facing away from you. Since our baby’s RIGHT side is weak, we are going to tilt baby to the LEFT, encouraging them to squeeze their RIGHT neck muscles to lift their head. That’s one rep. Now do it again. And again. And, yep, you guessed it: AGAIN! You can also carry baby around slightly tilted to the left for a sustained hold to work on strength and endurance.
Here we are strengthening the RIGHT neck muscles!
The last S: SURVEY
The final key to our torticollis treatment break down is to SURVEY your baby’s environment to set them up for symmetrical success! On Instagram I suggested switching up which direction your baby lies in the crib each night (see below). This way, baby will have to look both right and left to greet you as you approach the crib. Is baby’s swing positioned so that they are consistently looking to the right to sneak peeks at the off-limits but oh-so-enticing TV? Mix it up! Does your babysitter always bottle feed baby in the same arm, so baby’s neck is always in the same position? I know it’s awkward, but switch arms when you hold baby for feeds (as well as snuggles!).
Follow @bebe__pt on Instagram!
Borrow my PT brain for a day and closely analyze baby’s posture (focusing on the head and neck) as they move throughout the day. Which way are they looking? Is their head typically tilted to one side? Surveying their environment can provide opportunities to support midline, neutral postures and symmetrical neck rotation all the live long day!
TL;DR
Torticollis occurs when the SCM gets tight, causing baby to tilt their head to the same side and rotate/turn their head to the opposite side.
The three S’s of treating torticollis: STRETCH the tight muscle; STRENGTHEN the weak side; SURVEY baby’s environment to identify postures and positions that contribute to asymmetry.
Follow @bebe__pt on Instagram and check out the #tiptuesday about crib position to encourage symmetry!
As always, talk to your doctor or PT if you have concerns and before starting any exercises.