Congenital Muscular Torticollis (CMT)
Having a baby can be a combination of pure joy, exhaustion, and feeling completely overwhelmed at the same time. As a father of 3, I’ve been there. If you’re a parent of a baby that’s been diagnosed with Congenital Muscular Torticollis (CMT), this can tip you over the edge, as it’s the parents who are often responsible for carrying out the treatment at home. Sound familiar?
Put your mind at ease by learning more about torticollis and how it can be treated. My goal with this article is to strike the balance between giving scientific information about torticollis while keeping it as simple as possible and offering practical, straightforward information for parents.
So, what is torticollis? There is a muscle at the front of the neck called the sternocleidomastoid (SCM). In some babies this muscle can be tight from birth, which typically causes the baby to tilt his or her head to one side, while rotating it to the other side. For instance, a tight left SCM will cause the baby to tilt left (left ear toward left shoulder) and rotate right (looking over right shoulder). While this is textbook presentation, I have learned over the years that torticollis can also present differently depending on the baby. For instance, babies may have a stronger rotation vs. tilt component.
The primary goal of treatment is to stretch the involved SCM, while strengthening the un-involved SCM. For the above mentioned tight left SCM, stretches would include tilting the baby’s head to the right, and rotating the head to the left. If the left SCM is short and tight, chances are the right SCM is lengthened and weak. Confused yet?! Tell me about it; it took me a while to figure this all out so don’t feel bad! Hopefully these pictures will help clarify things:
Causes and Signs of Torticollis
Causes of torticollis may included cramped position in the womb, breech position of the fetus (head up / feet and/or buttocks down), or birtch trauma (ie. Forceps or vacuum assist). While typically diagnosed by nurses, family doctors, and pediatricians, torticollis is often first notieced by parents. If your baby has a strong tendency to rotate to one side, this is one of the tell tale signs that he or she may have torticollis. You may notice a flat spot developing on the side of their head that they tend to rotate toward. A bald spot may also start to develop over time. If this is the case, consult with your doctor or physiotherapist at your earliest convenience to enquire about treatment options.
Treatment for torticollis is highly successful, and the earlier you start treatment, the greater the likelihood you’ll achieve success. Treatment options include education, positioning and play techniques, tummy time, and stretching and strengthening exercises as needed. The type and duration of treatment will vary, depending on the severity of the torticollis. Mild to moderate cases typically take 2-6 months to resolve, while more severe cases can take up to 12-18 months.
Torticollis Treatment Approach
An ideal approach to the management of torticollis includes a 1 hour initial assessment. Following this assessment a diagnosis will be communicated to the parent(s). Treatment recommendations will be made based on the severity of the torticollis. As much of the onus falls on the parents to carry out the treatment, a follow-up visit within 1-2 weeks of the initial assessment is highly recommended. There is often a lot of information to process, and a follow up visit is a great way to review treatment recommendations and answer any questions you may have. Being a parent is already hard enough, never mind doing baby physio every day! Not to worry, you can do it! As parents become more comfortable with what needs to be done at home, follow-up visits can be done on a monthly basis.
The key to success is consistency. If your baby requires a daily stretching or strengthening program, try to perform the exercises when your baby is calm, rested, and well fed. The other key is good team work. Baby physio can be stressful, so if you an perform the exercises with your partner, good friend, or family member the likelihood of success increases. Finally, don’t be too hard on yourself if you need the occasional break from your baby physio. Toritcollis is not a condition that is solved overnight, so take a deep breath, and do your best.
Baby Physio for Sensitive or Spirited Babies
If you happen to have a particularly sensitive or spirited baby, this can make treatment a little more challenging. There are ways to “trick” your little ones into stretches. For example, see below photo for a great side flexion stretch that fussy babies tend to tolerate better than the traditional stretches outlined above.
To delve a little deeper into this subject area, this is a great journal article by Anna Ohman which shows that physiotherapy intervention 3 times a week carried out by a licensed physiotherapist can cut treatment times in half (vs traditional methods outlined above).
If you have questions or concerns about whether or not your son or daughter may have torticollis, call us or email to chat. Futhermore, if you have any comments or feedback about this article we’d love to hear from you!
Author: Justin Chipperfield
Owner, Chipperfield Physiotherapy