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Congenital Muscular Torticollis (CMT) and Physical Therapy

What is torticollis?

Torticollis refers to asymmetric tilting of the head and neck to one side and may be caused by various factors. Congenital Muscular Torticollis (CMT) is the most common cause of torticollis in infants. It is a musculoskeletal condition typically observed at birth or in early infancy that results from unilateral fibrosis and shortening of the sternocleidomastoid muscle (SCM) (Karmel-Ross, 2006). It is the third most frequent musculoskeletal condition affecting infants with an incidence of 0.4% to 1.9% (Cooperman, 1997). CMT is commonly seen with associated musculoskeletal conditions such as metatarsus adductus, or in-toeing, and developmental hip dysplasia (Cooperman, 1997). Due to the positional preference, infants with torticollis may also have plagiocephaly, a flattening of the head. The incidence rates of plagiocephaly vary greatly between sources.

If left untreated, CMT can impact infant development. Achievement of many developmental milestones is dependent on the infant’s ability to explore their environment. However, CMT causes an unbalanced perception of the infant’s environment and self awareness that may cause asymmetries to develop.

What can a physical therapist do for torticollis?

The physical therapist will evaluate an infant with CMT to determine:

  • Active and passive range of motion of the neck and upper extremities
  • Head righting responses
  • Appropriate infant reflexes
  • Symmetrical use of body for developmental skills
  • Degree of plagiocephaly and appropriate referral if needed
  • Impact on developmental milestones

The plan of care varies for each patient based on the information obtained from the evaluation. The typical treatment plan involves just a few office visits and consists of several important elements including:

  • Home exercise program with weekly updates
  • Positioning and carrying techniques to facilitate lengthening of the shortened muscle
  • Manual stretching
  • Use of appropriate developmental skills and positions to encourage the strengthening and muscle activation of the weakened muscle
  • Ongoing assessment of developmental milestones with symmetrical activation on both sides of the body
  • Parent education on implementing all of the above techniques at home

Physical therapy goals:

  • Full active and passive range of motion
  • Symmetrical head righting response
  • Symmetry of skills in age appropriate developmental milestones
  • Decreased severity/resolution of plagiocephaly

Pediatric physical therapy is provided by Katie Kober, PT, DPT at the Urbana office, 3500 Campus Drive, Suite 101