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Torticollis

Over 45,000 infants are born with congenital torticollis in the US each year. This twisted or tilted neck, the so-called "fixed wry neck" is often ascribed to problems during birth. The condition causes painful, involuntary spasms; impedes normal growth and development and disturbs vision. The medical approach to this condition is often surgery on neck muscles, nerves and tendons, and intensive physical therapy and drug therapy.

Treatment of an infant with wry neck associated with birth trauma
Pederick FO, Chiropr J Aust Dec 2004;34(4):123-8.

• Abstract: This paper describes the successful treatment of an infant with wry neck associated with birth trauma using low force, relatively long-duration cranial adjusting, and soft-tissue techniques to the whole body with special attention to the cervical region, and parental management of home care procedures. Wry neck, or congenital muscular torticollis (CMT), has been a well - recognized condition for centuries. CMT is often associated with plagiocephaly, which has long-term adverse effects on physical and mental functions. A review of some of the literature relating to this condition is provided. http://www.sotousa.org/frames.html
  
  Chiropractic correction of congenital muscular torticollis.   Toto BJ.   J Manipulative Physiol Ther. 1993 (Oct);16 (8):556-559

• OBJECTIVE:   To present a case of congenital muscular torticollis and discuss the clinical manifestations and chiropractic treatment.
• CLINICAL FEATURES:   A 7-month-old male infant with significant head tilt since birth was brought to a chiropractic physician for evaluation. The infant's history included ear infections, facial asymmetry and regurgitation. Significant spasm of the left sternocleidomastoid and trapezius muscles, a left lateral atlas and suboccipital joint dysfunctions were present upon examination. A diagnosis of congenital muscular torticollis was made
• INTERVENTION AND OUTCOME:   Treatments included chiropractic manipulation, trigger point therapy, specific stretches, pillow positioning and exercises. Excellent results were obtained.
• CONCLUSION:   Suggests that chiropractic intervention is a viable treatment option for congenital muscular torticollis. Further studies should be performed to compare the effectiveness of other treatment options.
  
  Manual Therapy in Children: Proposals for an Etiologic Model, Heiner Biedermann, M.D. J Manipulative Physiol Ther 2005 (Mar);   28 (3):   e1–e15 ~ FULL TEXT
  
  Torticollis Neonatorum: Asymmetry in newborn infants is a well-known problem, one which is often considered benign and disappears spontaneously if left alone long enough. It may be true that we have to be patient in the first days and weeks. After having passed through the birth channel, a realignment of the asymmetrical cranial bones and a resorption of soft-tissue edemas and hematomas take time. An initially asymmetrical posture should be noted and observed.If asymmetry persists after 3 to 4 weeks or additional symptoms appear, it is advisable to check if the range of movement of the head is impaired. This restricted movement may be a sign of a protective immobilization of the upper cervical spine. For a long time this was linked to a malfunction of the sternocleidomastoid muscle, leading to the common diagnosis of muscular torticollis. The most visible symptom was thought to be the cause. At least in the early phases the shortened and thick sternocleidomastoid muscle is so prominent that it was a natural culprit. Late cases of infantile torticollis often show a fibrosis of the sternocleidomastoid.These 2 facts were then combined: early hematoma results in later fibrosis. Article excerpted
  
  Congenital muscular torticollis: a review, case study, and proposed protocol for chiropractic management.   Colin N.   Topics in Clinical Chiropractic , September 1998:volume 5, number 3, pp27-33.

• A 7-month-old child subject became more confident and responsive, had better motor control,  and his head centered rather than being twisted and tilted after chiropractic care.
  
  Chiropractic care of the newborn with congenital torticollis.   Fallon JM and Fysh PN.   Journal of Clinical Chiropractic Pediatrics Vol 2, No.1 1997. P. 113-115.

• Congenital torticollis has been estimated to affect approximately two percent of newborn infants. The frank breech birthing position has been reportedly associated with the highest incidence of torticollis, with up to 34 percent of infants born in this position being affected.the most common type of congenital torticollis is that associated with subluxation of the upper cervical spine.
  
  Chiropractic management of congenital torticollis is primarily directed at reducing cervical spine subluxations, which have been identified as commonly present with this condition.. Chiropractic management of congenital torticollis, using a combination of spinal adjustments, cranial re-alignment and soft tissue therapies can produce rapid resolution in many cases of congenital torticollis and plagiocephaly (an asymmetrical and twisted condition of the head and face due to irregular closure of the cranial sutures, frequently occurs in con-junction with congenital torticollis) in the newborn infant.
  
  Spinal adjustments have been demonstrated to be efficacious to the resolution of the congenital torticollis. The medical approach to a protracted torticollis is surgical intervention. While surgical intervention is typically a solution of last resort, it is frequently the only solution considered by the medical community.
  
  Chiropractic care is considered essential to the health and maintenance of the child's spine and nervous system. It is therefore important that the doctor of chiropractic become part of the multi-disciplinary team and that medical doctors become aware of chiropractic management as a solution to the most common causes of congenital torticollis.
  
  Congenital muscular torticollis: a review, case study, and proposed protocol for chiropractic management.   Colin N.   Top Clin Chiro (1998); 5(3):27-33.
  

• From the abstract:   A case study of a 7-month-old infant who had been medically diagnosed with the disorder as birth-trauma related. Summary: Six sessions of chiropractic management involving low force adjusting and gentle myofascial release work were administered based on clinical mechanical findings derived from an apparent right hand and right leg dominance of the child. The child had not previously responded to several weeks of physical therapy. Following chiropractic care, the case completely resolved. The response was sustained at 1year follow-up.
  
  Pediatric traumatic torticollis: a case report.   Moore TF, Pfiffner TJ,   Journal of Clinical Chiropractic Pediatrics Vol. 2, No. 2 1997.
  

• This is the case of a 4 year old male child who sustained a moderate trauma (falling off a bed landing head first) with left lateral head tilt and right lateral rotation the "cock robin" position that is typical or atlantoaxial rotary fixation.
• Results:   Two weeks following the spinal adjustment, the patient returned to the clinic reporting that complete resolution had occurred and no clinical signs or symptoms were present to substantiate further radiographic study.
• From the conclusion:   "Any child presenting with a recent upper respiratory infection, sore throat, otitis media or minor trauma with torticollis is a candidate for consideration of atlanto-axial rotary fixation."
  
  Chiropractic adjustments and congenital torticollis with facial asymmetry: a case study.   Hyman C.A.   ICA Review September/October 1996. Pages 41-45.
  

• A two-month-old black female presented with obstetrical brachial plexus injury (Erb's palsy) who had been under the care of several medical pediatricians without resolution. The condition showed complete resolution under chiropractic care without any complica-tions or residual impairments.
  
  Kinematic imbalances due to suboccipital strain in newborns.   Biedermann H. J.   Manual Medicine 1992, 6:151-156

• More than 600 babies (to date) have been treated for suboccipital strain. One hundred thirty-five infants who were available for follow-up were reviewed in this case series report. The suboccipital strain's main symptoms include torticollis, fever of unknown origin, loss of appetite and other symptoms of CNS disorders, swelling of one side of the facial soft tissues, asymmetric development of the skull, hips, crying when the mother tried to change the child's position, and extreme sensitivity of the neck to palpation. 78 to 79 infants with torticollis responded favorably to a short course of conservative chiropractic care. Most patients in the series required one to three adjustments before returning to normal. "Removal of suboccipital strain is the fastest and most effective way to treat the symptoms...one session is sufficient in most cases. Manipulation of the occipito-cervical region leads to the disappearance of problems...." 181
  
  Chiropractic Care of the Newborn with Congenital Torticollis,   Fallon, JM, Fysh, PN   Journal of Clinical Chiropractic Pediatrics.

• From the abstract:   Chiropractic management of congenital torticollis using a combination of spinal adjustments, cranial re-alignment and soft tissue therapies can produce rapid resolution in many cases of congenital torticollis and plagiocephaly in the newborn infant. Spinal adjustments have been demonstrated to be efficacious to the resolution of the congenital torticollis. Before commencing a course of conservative spinal care however, accurate identification of the cause of the torticollis must be made to rule out complicating conditions which may result in high morbidity or mortality. The typical course of spinal adjustments for torticollis is usually of short duration requiring just a few treatments. Early correction of congenital torticollis should be the goal since prolonged contraction of the SCM can be the cause of cranial and facial anomalies as well as scoliosis. The medical approach to a protracted torticollis is surgical intervention. While surgical intervention is typically a solution of last resort, it is frequently the only solution considered by the medical community. Chiropractic care is considered essential to the health and maintenance of the child's spine and nervous system. It is therefore important that the doctor of chiropractic become part of the multi-disciplinary team and that medical doctors become aware of chiropractic management as a solution to the most common causes of congenital torticollis.
  
  Blocked atlantal nerve syndrome in infants and small children.   Gutman G.   ICA Review, 1990; July:37-42. Originally published in German Manuelle Medizin (1987) 25:5-10.

• From the abstract:   Three case reports are reviewed to illustrate a syndrome that has so far received far too little attention, which is caused and perpetuated in babies and infants by blocked nerve impulses at the atlas. Included in the clinical picture are lowered resistance to infections, especially to ear-,nose-, and throat infections, two cases of insomnia, two cases of cranial bone asymmetry, and one case each of torticollis, retarded locomotor development, retarded linguistic development, conjunctivitis, tonsillitis, rhinitis, earache, extreme neck sensitivity, incipient scoliosis, delayed hip development, and seizures.
  
  Chiropractic Care of an Infant with Plagiocephaly, Quezada D, Journal of Clinical Chiropractic Pediatrics, 2004; 6(1): 342-8.
  

• Objective: The purpose of this case study is to discuss the chiropractic care of a child diagnosed with cranial plagiocephaly due to intrauterine constraint and development delay of unknown etiology. This article will also discuss the subsequent rapid progression of developmental skills as craniosacral therapies were administered.
• Patient: A Caucasian male, 8 months of age, presented with a large posterior bilateral prominence of the occipital bone. His developmental milestones were predominately equivalent to those of a 3 month old and cranial facial asymmetries were detectable. He fussed or screamed if his head was touched or if placed to sleep in the supine position due to pressure on the back of his head. His sleep and feeding habits were also abnormal.
• Results: With chiropractic care, this infant's developmental milestones progressed to match his age, and his cranial facial symmetries improved even though the shape of his occipital bone changed minimally. He was able to eat normally and sleep through the night in the supine or side laying positions. He also allowed his head to be touched and caressed without fussing.
• Conclusions: This is a case where attempts to remold the occipital bone were made using Upledger and Sacro-occipital Techniques. Although changes in the shape of the occipital bone were minimal the child benefited by experiencing a rapid progression of developmental skills, bringing him from grossly delayed to current. His facial features, sleeping and feeding patterns normalized, and he would allow his head to be touched.
  
  http://www.sotousa.org/frames.html
  
  Pediatric Torticollis with Allergies and Head Injury: A Case Study   By Nancy Molina,DC
  
  Acquired Torticollis   By Peter Fysh
  
  Congenital Muscular Torticollis   By Warren Hammer, MS, DC, DABCO