Torticollis Treatment Protocol Should Include:
- Massage
- Passive and Active Range of Motion
- Strengthening Exercises
- Positioning and Handling Guidelines
- Visual Exercises
- Righting Reactions/Postural Education
- Environmental Adaptations
One of the key components to successful treatment of Torticollis is early identification and initiation of Physical Therapy at an early age! Read more about the signs and symptoms of Torticollis here! If you have concerns seek medical advice, as parents and caregivers you are the best advocates for your children!
Pediatric Physical Therapy Torticollis Treatment
Massage
- Begin with gentle massage.
- Run fingers along muscle belly and press thumbs gently into tight spots along sternocleidomastoid muscle (highlighted above in red).
- Goals: Reduce tightness of muscle, increase flexibility and range of motion.
Passive Range of Motion
- Address Head Rotation and Lateral Flexion
- Target the range of motion of child’s head and neck.
- Can begin range of motion exercises with a little gentle cervical traction (as pictured above).
- Goals: To open up the joint space, allow child to more freely move head, reduce range of motion limitations.
Rotation (chin to shoulder)
- Place your one hand on child’s shoulder, cup child’s head with other hand.
- Slowly turn child’s head bringing chin to shoulder.
- Hold this stretch for 10-15 seconds.
- Gradually increase duration of stretch to child’s comfort level and tolerance.
Side-Bending (ear to shoulder)
- With child positioned comfortably on his or her back, either on softly padded floor or therapist/caregiver’s lap, begin tilting the head to opposite side.
- If you are trying to stretch the muscles on the left side, place your right hand on the child’s left shoulder.
- Press down as you use your left hand to tilt the child’s right ear to his or her right shoulder.
- Hold this stretch for 10-15 seconds.
- Gradually increase duration of stretch to child’s comfort level and tolerance.
Shoulder Depression
- Provide downward pressure at shoulders.
- Goals: To open up joint space, decrease elevation of shoulders, reduce muscle tightness.
Lower Trunk Rotation (guided rolling)
- Using pelvis to guide from supine into sidelying to prone on both sides.
- Begin by building momentum with gentle rocking side to side.
- As child gains mastery your handling will decrease, as child is able to roll independently.
- Goals: Promote transitional movements, encourage symmetry in rolling, and activation of both sides of body.
Strengthening Exercises
- Targeting muscles of head/neck, trunk, back and upper extremities.
- Be mindful of strength imbalance and compensations as you perform these activities.
Exercises on Therapy Ball
- Practice tummy time on therapy ball.
- While supporting child at trunk, gently rock side to side and front to back.
- You can place mirror in front of child to promote alignment as well.
- Practice therapy ball work with child seated to promote trunk strength and stability.
- Allowing child to lean back and promote rotation to return to upward seated posture.
- Lower support as child becomes stronger.
Exercises on Tummy Time Pillow or Incline Ramp
- Encourage head/neck extension and rotation.
- Also facilitates upper body weight bearing.
Positioning for Torticollis Treatment
Prone (or Tummy Down position)
- Encourage “tummy time” by placing child on stomach.
- Slowly increase duration as child builds strength and tolerance for longer intervals.
- Using tummy time mirror, fun toy, or even your child’s favorite pet.
- Encourage child to look away from restricted side.
- Goals: Encourage head, neck and upper body strength, facilitate pushing off surface, vertical visual gaze, promote fluid head rotation and range of motion!
- Can place child on soft incline wedge or with small towel or swaddle blanket rolled up under child’s chest.
- Position arms over the bolster with hands or forearms contacting surface.
- Encourage weight bearing through arms, by gently supporting under arms to facilitate lifting upper body off surface.
- Another great way to practice tummy time, especially in children who are more reluctant, is to place child tummy to tummy on you.
For more Tummy Time Toy ideas visit our post here!
Sidelying (or Child Positioned on Side)
- Encourage sidelying so that head and neck are turned away from restricted side, can utilize Boppy or wedge pillow to position.
- Keep child engaged in this position and allow them to utilize both right and left arms in play.
In Carseat/Stroller
- Encourage midline using supportive headrest or infant support as pictured.
In Carrier
- Encourage in-facing position until baby has head control and ability to right themselves and orient to both sides.
- Can promote looking away from area of restriction during time in carrier.
- One of our favorite carriers is the Beco Gemini Carrier, as pictured above!
Handling for Torticollis Treatment
Sidelying Carry
- Carry child with one arm positioned under area of restriction to facilitate stretch and encourage child to look away from limited side.
Superman Hold
- Supporting child in order to encourage extended position (can be done in arms or on lap).
Visual Exercises for Torticollis Treatment
Visual Tracking
- Promote tracking with fluid eye movements to both right and left sides.
- Stimulating visual or auditory objects may help motivate.
- Encourage visual tracking in all developmental positions: supine, sidelying, prone, quadruped, supported sitting.
Righting Reactions/Postural Education
Weight Shifting on Therapy Ball
- Weight shifting via ball in supine/prone/supported sitting.
Postural Education on Dynamic Surface
- Using dyna-disc or incline wedge to challenge trunk strength/stability in sitting and shoulder strength/stability in prone propping.
Environmental Adaptations for Torticollis Treatment
- Position child in the crib or on changing table to encourage looking away from restriction, place visually stimulating objects on opposite side of room.
- Position toys away from restriction to encourage child to look and reach with upper extremity away from affected side.
- While bottle or breast feeding, position child to stretch restricted side, alternate regularly.
- Use mirror during sidelying play to encourage gaze.
- When picking child up from floor, crib or changing table, facilitate roll to one side and then lift up, alternate regularly.
Stretching Images Credit:
https://www.nationwidechildrens.org/family-resources-education/health-wellness-and-safety-resources/helping-hands/exercises-left-torticollis-positioning-for-play
Read More About Equipment Ideas for Torticollis Treatment here!
Learn more about Dinosaur Physical Therapy!
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these photos are an absolutely fascinating way of showing how the body of the baby stretches here and there to help them keep limber. The top photo that shows the neck muscle is a new way to envision helping my baby keep loose and not get tightened muscles. I’m hopeful that this new way of seeing things will help me know how to keep my baby healthy and above all, comfortable. Do you have any other muscle examining photos?
Thank you for your message. The best anatomical renderings are done by Frank Netter in the “Atlas of Human Anatomy”. I highly recommend it as the most detailed comprehensive collection with a focus on functional anatomy.
Thankyou so much for this.
Thanks so much for this excellent information.
Thank you for taking the time to read this post and for your comment! Feel free to reach out directly with further questions at info@dinopt.com!