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Guest Blog: Torticollis - An Effective Tearless Approach To Treatment - featured May 25, 2011

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Torticollis: An Effective Tearless Approach To Treatment

By: Dr. Joni Redlich, DPT

Reprinted with the express permission of Joni Redlich, DPT, as originally appeared on her Kid PT Blog, May 5, 2011

“I watched a remarkable, quiet, tearless session in which Susan Blum treated a 2-months-old infant with torticollis that ended with his body and head in midline. No neck stretching!! No stretching of any kind! In fact, TMR uses the OPPOSITE of stretching to gain soft tissue extensibility and improved movement symmetry. It’s particularly appealing in that parents get to hug and hold their children and get changes in mobility without imposing any demands.”

Billi Cusick’s PT, MS, COF in the Progressive GaitWays Newsletter, February 2011

Torticollis is derived from the Latin word for “twisted neck.” The most common type of torticollis in children in Congenital Muscular Torticollis. The head is positioned in various degrees of tilt to one side and then rotation to the opposite side. Evidence-Based Care Guideline for Management of Congenital Muscular Torticollis in children age 0 to 36 months describes the traditional approach to torticollis treatment, which includes stretching, positioning, and active movement on the weaker side. The guideline does state to screen upper and lower extremity range of motion, but treatment of these limitations is not specifically recommended. Traditionally, the therapist will assess the full body, but then we treat the neck because this is the most visible and obvious problem area.

The TMR approach to torticollis is to treat asymmetries of the pelvis and trunk first and the neck will become symmetric as a result rather than treating the small muscles of the neck. Range of motion is assessed looking for significant differences between left and right sides of the body using with a series of at least 6 movement patterns. Common red flag areas are seen in this video. Some examples are that it may be harder to put one arm in the shirt when dressing, the baby may twist more to one side than the other so they always roll to one side, or when you bend both legs up and let one down there is a big difference between sides.

Treatment begins by addressing the area of greatest asymmetry between left and right sides of the body. Once the restriction is identified, the therapist will gently position the child deeper into the more flexible direction. For example, if the child in sitting can twist to the left, but is restricted when twisting to the right, then we will bring the child further to the left and hold there while singing or reaching for a toy for a few minutes. We shorten the tight soft tissue in order to create increased length and flexibility. If you picture having a knot in a necklace, then you can relate to needing to create some slack before you can undo the knot. If you stretch directly then you get the opposite result: you further tighten the knot in the necklace.

After we shorten the tight soft tissues then we reassess the child’s mobility. The child will typically have an immediate increase in range of motion for the treated movement, and often a cascading effect loosening other tight areas. Sensory experiences are then provided to the entire body, particularly any areas that have had limitations in movement. Movement experiences are also provided in the new symmetric alignment to enhance active and functional motor control in this new position.

Parents are taught how to do these exercises at home and are given control in the care of their child. They are also taught how to monitor their child’s movement patterns over time, so that if asymmetries increase while a child is learning a new skill, they can address it and contact the treating therapist for assistance if needed.

Featured Author: Dr. Joni Redlich, DPT

Dr. Redlich is a Mom, Wife and Pediatric Physical Therapist Specializing in Children with Developmental Disabilities. She received a B.A in Psychology from Emory University and her M.S in Physical Therapy and DPT from Arcadia University (formerly Beaver College). Please visit her website at Kid PT

Tags: Article Torticollis Newsletter 27 May 2011