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Just wondering if anyone has any protocols in place regarding the need for a cervical spine xray prior to physio for babies with congnital musculartorticollis? Or does anyone know of any evidence supporting/refuting the need for an xray before any physio/stretches/manips Thank you!
hi all physiofriends
i m doing internship in india.i want a favour from u guys in preparing my dissertation on effects of stretching in
i also want to know the indication of using ultrasound therapy in torticollis children.
i want to know any website or book from which i get more details on this topic.
waiting for ur favourable response.
bye
How on earth you get such an idea to do ultrasound therapy on neonates? For ultrasound is contraindicate to be application in zone of the head (zone of highly differential cell) to adult people and yet you want to do it on new born baby (with little or no barrier to ultrasound)?
You have so much appropriate methods to threat torticolis, such as kinesytherapy and stretching as you sad, and if you want to treat hemathoma, there is electrotherapy (EF) and heat packs (before stretching, of course).
I believe this is not new for you because this is the protocol that exists for quite period of time but if you have some question about this if I can I’ll be answering to you, just PLEASE DON’T DO ULTRASOUND THERAPY ON BABY!
Hi 1234nale,
I don't think the OP was talking about a newborn with
People often use the term to describe postural abnormalities (where an uncorrected torticollis may have been present) or acute
Wouldn't it be nicer to check to see what he/she meant before flaming him???
So OP... what did you mean???
To make that a bit clearer for all, the term "
thanks for reply.
there was some misunderstanding and i m sorry for that.
i am not talking about newborn babies.
i have a boy of 3 and half year suffering from
as i m student i have not much clinical experience so i just want to know that should ultrasound be used as a second option to stretching and proper positioning?
i m stilllerning and want to learn a lot things. so please give me proper guiadance.
waiting for your favourable reply.
bye.
have a nice day.
I would suggest ultrasound is contraindicated in this case. You must consider the patients ability to understand a warning and be able to give feedback for any type of EPA at this age. Furthermore the skeleton is still forming at this time.
The is a basic list of contraindications at www.electrotherapy.org/contraindications.htm
Some of these include but are not limited to the following:
CONTRAIDICATION
• Undiagnosed pain
• Cancer
• Active tuberculosis
• Psoriasis
• Decreased circulation
• Infection
• Pregnancy
• Central nervous system tissue
• Joint cement (cannot use continuous mode, but may use pulsed mode 50% or less)
• Plastic components
• Pacemakers
• Thrombophlebitis
• Uncontrolled bleeding or blood-thinning medication (coumadin)
• Eyes
• Reproductive organs
• Heart
PRECAUTIONS
• Acute inflammation (use non-thermal settings only)
• Epiphyseal plates (use pulsed, low intensity <0.5w/cm2)
• Decreased sensation (esp. with thermal US)
• Over implanted materials: metal reflects 90% of incident US; plastic respond like periosteum and it absorbs a large % of US; generally safe if the sound head is kept moving.
After age of two years,
This discussion was designed to ask question about the things we don’t know, so go on, as long there are question there where be a different opinion…
Thanks, I would suggest a surgical intervention would be the very, very, very last possible direction in what is a fairly common problem. There is nothing to stop you doing gentle mobilitation to the neck in a NAG/Snag type of fashion. Also perhaps gain some input from someone who does craniosacral work on infants. There may be various reasons for the presentation? 8o
Hi.
1234nale, I agree with you that U/S to the head is not very appropriate. In fact, I only use my U/S to muscles for psychological reasons more that physical therapeutic reasons (my opinion only of course...).
In addition to NAGs, SNAGs and MWMs, I would also use muscle energy for the C/S, massage, games (since the child is 3 years old) amongst other things.
Most importantly, i would teach the parent what they can do to help since 30mins with you doesn't go far when the average 3 year old is awake for 12 or more hours!
I agree with you physiobase that this is the very common problem, and exactly because of that it is usually resolved until child’s age of two with no aggressive methods. You must have in mind that we are talking about child in very difficult age to cooperate, it to small to be told what need to do(if you want to stronger opposite SCM), and to big to be managed with stretching or other methods ( because it usually is afraid and push in wrong direction). Of course that we should try as much as possible to get trough game with child and surgery is always last possible option, but remember that child skeleton is still in growth so there is possible to develop some disorder like hemi vertebra etc or only the poor pattern of head movement (habitually). So that’s why is recommended surgery after the age of two if the state isn’t resolved with all possible kinesitherapy methods, so the child could grow properly.
Also alophysio is right, education of parents is essential in all cases.
See the following topic Torticollis
Also see Torticollis Kids
For more exercise resources see Exercise HQ
I would not recommend the use of ultrasound for
For more exercise resources see Therapeutic Exercise Foundation and Techniques Third edition By Carolyn Kisner & Lynn Allen Colby and many more good textbook in this regard.
For detail of Surgcal information see good textbooks on orthopaedic and/or paediatric Surgery.
These are
Campbell's Operative Orthopaedics. 9th ed. St Louis, Mo: Mosby-Year Book.
Turek's Orthopaedics: Principles and Their Application. 5th ed. Philadelphia, Pa: Lippincott-Raven.
Apley's A System of Orthopaedics and fractures 8th edition by Louise Solomon, David J. Warwick and Selvadurai Nayagam.
Data Trace Publishing Orthopaedics
Adult-onset idiopathic torticollis
Posttraumatic painful torticollis
Idiopathic muscular torticollis in infants
I want to know the exercises for congenital
Many thanks
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
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 aQuote:
Originally Posted by neurospast
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 aQuote:
Originally Posted by meganli
So, has I said that strengthening should be included in the treatment? I'd never.
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
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).Quote:
Originally Posted by physiobob
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=VoitaQuote:
Originally Posted by neurospast
Hi
I have had some success with babies presenting with
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+
i wanna make project on cmt .... cud u guys plz help me in any way..
i need articles..or any pics of patients..case history..assessment criteria/scales..treatement comparison.PLZ reply ASAP at [email protected].
THANKING U ALL IN ANTICIPATION..
Hi,
I was wondering whether there is any difference in the duration and repetitions of stretches in paediatric patients as opposed to adult patients.
If yes, can anyone tell me the difference please?
Thanks :)
dear Marticlar,
Are you a colleague, another health professional, parent or patient?
Could you be a bit more specific about why you want to stretch and about what you would like to stretch, in which circumstances you would like to stretch.
For example: children with ROM loss after a fracture heal by themselves in time and nearly never need help stretching. So please be a bit more specific.
kind regards
Esther de Ru
I am a physiotherapy student.
I was wondering about stretching in general in children, and also for infants with
Can any one post a reply please? shouldn't be too diffidult to answer!!
dear marticlar....
I am afraid you will have to do a lot of reading....
for example read everything that RHH Engelbert has to say about generalized hypermobility and hypomobility. In Pubmed and via Google you can find a lot of articles about his work;
the work of KR FLowers about the effects of total and end range time on improving passive ROM;
LJ van der Giessen et al Validation of Beighton score and prevalance of connective tissue signs in 773 Dutch children.
Personally, I never actively stretch babies and young children´s muscles..... I try to enhance the child to look the other way ( example in
Look up the guidelines for treating Cerebral Palsy.....
Your question is a very good one, with many answers possible....
We know that contractile tissue changes with age....... so at what age do we stretch for how long??
I would advise you always do a good assessment first, then make some goals and try to work as functionally as possible. We ( in Holland) have been trained to make our own physiotherapeutic diagnosis first... that makes making goals a lot easier.
A medical diagnosis does not very often give us much to go on.
In the countries with free accees, assessing and chosing the right therapy is one of the most challenging parts of our work.
Good luck
Esther de Ru
www.estherderu.com
Yes your question is interesting!
Generally, I know to hold stretching technique for 10 seconds in adults,6 seconds in elderly people
If you would do releaseing during stretching thats not a streching ,you should sustain your streching technique for a while.
hi every body
I wanna share all u in my case......:O
i have pt 2 y\o with torticolls. bending & turning of the to one side but with mild tightness iin rotation only. i found that coze of weakness of the neck muscle
I did sretching and strengthening exer with the swiss ball. ( 3 times \wk)
what i can do else 4 him?