You may have noticed that your baby has a tendency to tilt their head to one side and a flat spot on your baby’s head. Having discovered that these symptoms are characteristic of torticollis and a head deformity known as plagiocephaly, you might be trying to decide on the best way forward.
Should you try a course of physiotherapy, osteopathy or chiropractic to treat the plagiocephaly and torticollis, or go straight to your doctor for advice?
The relationship between torticollis and plagiocephaly
Congenital muscular torticollis (‘wry neck’) is the medical term for an imbalance in the muscles on either side of the neck. These are called the sternocleidomastoid muscles and they turn the head left and right and tilt it sideways, or, working together, lift the head. They run diagonally from the mastoid process at the base of the skull, just behind the ear, and attach to the sternum (breastbone) and clavicle (collarbone) either side of the throat at the base of the neck. The imbalance can be caused by muscle damage during birth, a shortening from pre-birth positioning, or a lumpy knot of muscle fibres called a sternocleidomastoid tumour (a scary name but a benign condition). This imbalance is usually noticed within the first few weeks of life and it can restrict full range of movement in the neck, causing the head to flatten on one side as the baby is unable to turn the head freely.
Torticollis is often associated with positional plagiocephaly. Plagiocephaly starts by the baby being unable to turn the head and a habitual positioning occurs, causing the baby to rest the head on the flattened side, leading to further muscle restriction and difficulty in turning the head. Equally, the head tilt and restricted range of motion may contribute to the positional preference that causes a flat spot to emerge in the first place.
Physiotherapy for torticollis
If started early enough, physiotherapy can be very effective in stretching and releasing the sternocleidomastoid muscle, restoring full active range of motion in the neck. With early intervention and careful management, your baby should soon be able to hold their head straight and turn it equally in both directions.
Your Physiotherapist will show you how to gently stretch the muscle, which needs to be done several times a day. Although these exercises won’t harm your baby, you are stretching out a cramped muscle so they may be uncomfortable at first. Make sure your little one is well fed and as relaxed as possible before you begin each session.
NHS Wales’ physiotherapy information sheet provides a step-by-step guide to some basic stretches for torticollis. However, this is no substitute for the advice of a registered therapist who will be able to rule out other conditions such as positional talipes or hip dysplasia, which are often associated with torticollis.
If the muscle shortening is strong or if it hasn’t been noticed until later on, simple stretches can fail to yield adequate results and parents may be referred to an orthopedic consultant for further treatment. This can include using Botox injections to temporarily weaken the muscle, making stretching easier, or a small operation to lengthen the shortened muscle.
Physiotherapy for plagiocephaly
The first-line treatment for plagiocephaly is known as repositioning. This involves relieving pressure on the affected area by positioning the head away from the flattening. At this stage we also recommend seeing your doctor to rule out craniosynostosis, a premature closure of one or more of the fibrous connections between the bones of the infant skull.
We also recommend that parents start tummy time when your baby is awake and you are with them. This is a great exercise that not only reduces the onset and development of plagiocephaly, but also for strengthening the neck, shoulders and trunk, which in turn can help to prevent torticollis. It is also important to minimise the amount of time that your baby spends in carriers, car seats, and other such devices to relieve pressure on the back of the head.
Whilst your baby must always be placed on the back to sleep to minimise the risk of Sudden Infant Death Syndrome, there are various techniques you can try to subtly manipulate the position of the head when your baby is sleeping. Some of these can be found on our repositioning guide.
Provided it is started early on, repositioning can help to prevent a head shape deformity from starting and, if started early enough, can help to reverse the asymmetry. However, where the deformity is moderate or severe, and particularly where facial asymmetry and/or torticollis is also present, further intervention may be required.
What to do if your baby has plagiocephaly and/or torticollis
Whether you think your baby might have plagiocephaly, torticollis, or both, we can’t stress the importance of early intervention enough. It is far easier to perform the necessary stretches and repositioning techniques on a very young infant than it is in an older and active baby, and once a child reaches four to six months of age, there is a limit to what can be achieved through physiotherapy alone.
After four to six months of age, when your baby is becoming more mobile, if there is still a noticeable head flattening it is doubtful that it will self-correct without help. Technology in Motion can provide you with a custom-made helmet, also known as a cranial remoulding orthosis, to safely redirect growth into the flattened areas, resulting in a much more even, symmetrical head shape.
Call 0330 100 1800 or fill in our enquiry form to book a free, no obligation appointment at your nearest practice. Alternatively, browse our website and blog for more information on our clinics and the treatment that we provide.