congenital torticollis

[meganli]

It's hard to teach exercises for infants cos it's hard for them to do exactly what u need them to do. You can educate the patrents to hold the baby on the problematic side and let the righting reaction of the head stretching the SCM by side flexion.

I've done a post-op rehab to a 14-year-old. In the first few days his neck is immobilized in a soft collar. The following physiotherapy sessions are mainly passve stretching the SCM(exactly what to do to the infants, which is quite tiring to the therapists) Ultrasound and postural correction of the neck. The progression was good without any traction so I don't know if traction can be helpful.

The most important part is the postural correction. Because the child have already used to be in the habitual posture and it needs time to adapt and rehabilitate what is the true correct posture of the neck after the SCM is surgically released.

Hope these informations are useful

[neurospast]

Do not think as this child as an infant but more as an adult. What would you do with an adult in case you would chose for a "passive" treatment?
In general you should stretch actively by strengthening the "non torrticollis side" how about heading a ball side ways? pushing like a bull side ways? Make a play of it.

[physiobob]

Do not think as this child as an infant but more as an adult. What would you do with an adult in case you would chose for a "passive" treatment?
In general you should stretch actively by strengthening the "non torrticollis side" how about heading a ball side ways? pushing like a bull side ways? Make a play of it.

If you have ever had a torticollis or seen one you would not recommend this approach. There is cleary an underlying cause and there is nothing wrong with gentle mobilisation. Heading a ball ... r you crazy?

[meganli]

If you push the head sidewaysw with ball, you won't strengthen in isolation of SCM, but also upper trapezius, scalene, levator scapulae....... muscles of the neck.

If will cause muscle imbalance which will hinder postural re-education

[physiobob]

If you push the head sidewaysw with ball, you won't strengthen in isolation of SCM, but also upper trapezius, scalene, levator scapulae....... muscles of the neck. If will cause muscle imbalance which will hinder postural re-education

I totally agree with you on that one. Who would even suggest that sternocleidomastoid (SCM) is weak on one side? I have never seen an actually weak SCM, only ever overactive one's. The deep neck flexors might well be weak and also easily fatigued. Simple retractions exercises are often enough to tire them out so tread carefully. Don't focus on SCM at all as it's overactivity has been part of the problem (OK, passive stretching would be fine). Look at the thoracocervical junction and the mobility of the thoracic spine and even further down to the upper lumbar spine for a comprehensive approach to rehab in the older client where this is also known as a wry neck.

[meganli]

So, has I said that strengthening should be included in the treatment? I'd never.

[physiobob]

I agree with you and have edited my message to make it clearer on that issue. You do raise a good point about other elevators and accessories what we wish to keep quiet. We could also assess breathing patterns in the younger person to see if increased accessory mm use might be impacting on the problem. Respiratory problems can arise with positioning in the very young. That said positioning them to assist "stretch the SCM" can assist to add some passive treatment when they are resting.

p.s. There is also another discussion on torticollis in the forum. Click on the tags link and then on torticollis to find it

[neurospast]

If you have ever had a torticollis or seen one you would not recommend this approach. There is cleary an underlying cause and there is nothing wrong with gentle mobilisation. Heading a ball ... r you crazy?

You are right about the approach of heading a ball is inappropriate. You do have to realise though that active mobilisation is a far better approach than gentle passive mobilisation. Voita technique is in principle based on this and has after my observations very good results on infants. The idea is that you can inhibit one muscle by strengthening the other (in this case likely sterno cleido mastoideus).

[physiobob]

You are right about the approach of heading a ball is inappropriate. You do have to realise though that active mobilisation is a far better approach than gentle passive mobilisation. Voita technique is in principle based on this and has after my observations very good results on infants. The idea is that you can inhibit one muscle by strengthening the other (in this case likely sterno cleido mastoideus).

If in deed that muscle is not scm on the opposite side? Voita therapy is another interesting topic that we have discussed in the past on this forum with both positive and negative views. If anyone is interested the link is /forum/showthread.php?t=457&highlight=Voita

[MrPhysio+]

Hi
I have had some success with babies presenting with torticollis. One lass was seen at about 5 months of age, and is now 11, and only just reporting some mild neck stiffness on the original torticollis side. The condition occcurs due to the babies position in utero. I treated her as a baby, by firm massage, and sustained stretching, plus taught the parents to do the same. No traction. I have not had to treat her as an 11 year old, but may catch up with her soon.
The treatment is simple but effective. Obviously other risk factors must be excluded prior to treatment initiation, but that is what assessment is all about!
MrPhysio+