Congenital muscular torticollis develops when a child is positioned improperly in the uterus, which leads the muscles to become shortened and causes the neck to bend to the side. But infants who develop torticollis may also have inherited it from a family member. Torticollis can also be acquired meaning symptoms come about due to someone’s lifestyle. Some other causes of torticollis include:

• • • Cervical misalignment due to a herniated disc in the spine
    • A systemic infection (either bacterial or viral)
    • Injury or spasms to neck muscle(s) at birth
    • Misplaced facets (small outward-facing knobs on the vertebrae)
    • Regularly assuming uncomfortable, awkward sleeping positions
    • Burns and other trauma that lead to severe scarring or shrinkage of the skin and muscles

Torticollis is diagnosed after your doctor completes a medical history. This includes asking you about prior treatments, medications, surgical procedures that you’ve had, and any injuries or medical conditions that may have contributed to your symptoms. Your doctor will then perform a physical exam, which involves looking at and feeling the neck and surrounding structures. Your doctor will also ask you to assume certain positions to see what causes pain and what motions may be difficult for you.

If someone develops torticollis over time (called acquired torticollis), doctors usually begin with an imaging test called a computed tomography (CT) scan. A CT scan gives them a view of the neck and the cervical spine (located in the upper back) to determine if and where there are any abnormalities. If they cannot determine the cause from this exam, your doctor may ask you to undergo another imaging test called magnetic resonance imaging (MRI). An MRI will give doctors a closer look at the brain and the spinal cord to see where the issues lie.

Torticollis can cause someone to experience a variety of symptoms depending on the severity and whether or not it was inherited or acquired. Some symptoms of torticollis include:

• • • Pain in the neck, which may even extend to the upper spine
    • Spasms in the neck muscles, particularly the sternocleidomastoid muscle that extends to the jaw (when this is the predominant symptom, the condition is called spasmodic torticollis)
    • A twisted head that tilts to one side, as if the ear is trying to touch the shoulder
    • Decreased neck range of motion, seen by someone having difficulty turning or moving the head
    • Lack of symmetry in the face, especially at the chin

It may be more difficult to identify torticollis in infants, but they often struggle with breastfeeding on one side. Infants with torticollis will also usually look at you over the affected shoulder rather than turning their head and following you with their gaze. Babies who have torticollis may also develop other health issues. One such condition is flat head (plagiocephaly), which occurs on one side of their body and results from them laying on the same side without being able to switch.

Treatment for infants who have torticollis involves a concept called tummy time, where infants should spend a certain amount of time each day on their stomachs. This encourages them to lift and turn their head to explore their surroundings, which simultaneously strengthens the muscles in the head and neck. In addition to other positioning techniques, parents will also be educated on the importance of exercise and certain stretches to loosen the muscles in the neck and allow a more normal posture. While these treatments are often very effective, it takes time to see results. Children who are diagnosed with torticollis at birth may not see their symptoms go away for nearly 6 months.

For adults with torticollis, conservative treatments can be provided by a physical therapist or chiropractor. These clinicians can offer strengthening and stretching exercises that ease tension in the neck muscles, restore proper joint motion, and encourage symmetry in both posture and positioning. Treatments can include manipulative therapy and flexion distraction to mobilize the joints and allow them to move properly. Your provider may also use kinesiotape and myofasical release techniques to improve blood flow and circulation to the area. These therapies are also often supplemented by hot packs to ease pain and tension, which further enhances mobility. Some clinicians may also recommend that patients wear a torticollis neck collar that keeps the head straight and allows the muscles to heal during the recovery period.

Surgery is not often recommended for torticollis, since this condition responds very well to conservative treatments. However, about 10% of cases in infants and adults are so severe that surgery is the only option. Surgery usually involves sectioning off parts of the sternocleidomastoid muscle, which runs from the upper shoulder to the jaw and controls much of the body’s head and neck movement. By separating this large and powerful muscle into smaller parts, surgeons can relieve tension and prevent the excessive muscle contraction that often causes this condition.

If you begin to experience any symptoms of torticollis, you should seek medical advice from your doctor or other healthcare provider. The earlier you begin treatment for torticollis, the sooner you can relieve pain and experience restored motion.