Congenital muscular torticollis, or CMT, is a birth defect of the neck muscles in which the muscles are shortened or contain scar tissue. Infants born with CMT display a characteristic tilting of the head away from the defect. Physical therapy is typically recommended as a first-line treatment for CMT and fortunately corrects most cases of CMT without the need for surgery.
Goals for Physical Therapy
Conservative therapies are the mainstay treatment for CMT. Goals for physical therapy include increased range of motion of the neck, prevention and alleviation of tight muscles, improvement of head tilt to a more upright position, and restored functionality of the neck.
Passive Stretching Exercises
Passive stretching of the neck is the most frequently prescribed treatment for CMT, according to a 2004 article published in the "Journal of Prosthetics and Orthotics," and primarily functions to increase the range of motion of your baby's neck. The specific exercises recommended by your doctor or physical therapist may vary according to the type and severity of the condition, but they focus on stretching of the sternocleidomastoid muscle in the neck. Neck rotations and side bends are two commonly used stretches for this muscle. It is recommended that these stretches be done every time you change your baby's diaper or a minimum of five times per day. The stretches should be held to a point of resistance but never to the point of pain.
Head Positioning Techniques
Head positioning techniques are included as a part of therapy for CMT to encourage head movement in the direction of the defect. For example, toys should be placed on the same side as the defect so that your baby must turn his neck in that direction. Similarly, during feedings, the bottle should be turned slightly in the direction of the affected side. Proper technique should be utilized when carrying your baby as well. To carry your baby, position him sideways so that his head is facing forward and the neck defect is closest to the ground. Carefully support his head with your arm.
Additional Therapies
Additional therapies may also be prescribed for your baby such as massage, taping of the neck or myofascial release. A neck orthotic or brace may be recommended if your child does not respond to physical therapy exercises.
Success and Outlook
The outlook for congenital muscular torticollis is quite good. According to the American Academy of Orthopaedic Surgeons, 90 percent of cases resolve with a proper stretching program alone. In most cases, the mass resolves by age 4 to 6 months. The prognosis is best for children who begin conservative measures early, as a complete recovery is typically attained without the requisite for surgery. Conversely, children who delay treatment are more likely to require surgery. Surgery is necessary for children who do not improve after one year of conservative measures, and it involves release of the sternocleidomastoid muscle.
References
- "Journal of Prosthetics and Orthotics"; Identification and Treatment of Congenital Muscular Torticollis in Infants; Susan Scott Freed and Colleen Coulter-O'Berry; 2004
- Neurosurgeons for Kids: Neck Stretching Exercises for Torticollis
- Orthoseek: Instructions for Stretching and Positioning Right Sternomastoid Torticollis
- American Academy of Orthopaedic Surgeons; Congenital Muscular Torticollis (Wryneck); August 2007
