Torticollis Treatment for Children

torticollis treatment

Torticollis Treatment Protocol Should Include:

  1. Massage
  2. Passive and Active Range of Motion
  3. Strengthening Exercises
  4. Positioning and Handling Guidelines
  5. Visual Exercises
  6. Righting Reactions/Postural Education
  7. 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 

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.
torticollis treatment

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.

torticollis treatmentRotation (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.

torticollis treatmentSide-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.

torticollis treatment

Shoulder Depression

  • Provide downward pressure at shoulders.
  • Goals: To open up joint space, decrease elevation of shoulders, reduce muscle tightness.

torticollis treatmenttorticollis treatmenttorticollis treatment

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

Torticollis Treatment 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.
Torticollis Treatment Therapy Ball
  • 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

Torticollis Treatment Incline Wedge

  • Encourage head/neck extension and rotation.
  • Also facilitates upper body weight bearing.

Positioning for Torticollis Treatment

Torticollis Treatment Tummy Time1. 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.Torticollis Treatment Tummy Time
  • Using tummy time mirror, fun toy, or even your child’s favorite pet (pictured above Abe and Daze gaze longingly into each other’s eyes!).
  • 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!

For more Tummy Time Toy ideas visit our post here!

torticollis treatment tummy time mat

  • Can place child on padded mat or with small towel or swaddle blanket rolled up under child’s chest.
  • Position arms over the bolster with hands or forearms contacting surface.

Torticollis Treatment Tummy Time

  • Encourage weight bearing through arms, by gently supporting under arms to facilitate lifting upper body off surface.Torticollis Treatment Tummy Time
  • 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 Tips and Tricks read our post here!

Torticollis Treatment

Sidelying (or Child Positioned on Side)

  • Encourage sidelying so that head and neck are turned away from restricted side, can utilize rolled up towels or pillows to position.
  • Keep child engaged in this position and allow them to utilize both right and left arms in play.Torticollis Treatment Baby Moon

Supine (or Child Positioned on Back)

In Carseat/Stroller

Torticollis Treatment Baby CarrierIn 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

Torticollis TreatmentSidelying Carry

  • Carry child with one arm positioned under area of restriction to facilitate stretch and encourage child to look away from limited side.

torticollis treatment

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.

Here is a short video of Abe as we use letter links to promote active visual tracking and upper body activation as he reaches and grabs ahold of the links!

Righting Reactions/Postural Education

Torticollis Treatment Therapy Ball

Weight Shifting on Therapy Ball

  • Weight shifting via ball in supine/prone/supported sitting.

torticollis treatment                      torticollis treatment

Postural Education on Dynamic Surface (Dyna-disc or Incline wedge)

  • 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

  1. Position child in the crib or on changing table to encourage looking away from restriction, place visually stimulating objects on opposite side of room.
  2. Position toys away from restriction to encourage child to look and reach with upper extremity away from affected side.
  3. While bottle or breast feeding, position child to stretch restricted side, alternate regularly.
  4. Use mirror during sidelying play to encourage gaze.
  5. When picking child up from floor, crib or changing table, facilitate roll to one side and then lift up, alternate regularly.

Read More About Equipment Ideas for Torticollis Treatment here!torticollis treatment equipment

Learn more about Dinosaur Physical Therapy!

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