Although the cause of torticollis cannot be determined with complete certainty, it is believed to be influenced by the position the baby occupies in the mother's stomach in the last months of pregnancy, as well as the presence of postural deformities (feet, hips). It rarely happens that the cause of torticollis is irregularities in the development of the bony structures of the neck, but in this case it is usually a shortening of the muscle (sternocleidomastoideus). Physiotherapist Mladen Pelević talks about this problem, which is quite common in babies and requires immediate treatment.
What is torticollis?
Torticollis or crooked neck is the third most common deformity in newborn babies. It is recognized by the characteristic position that the baby takes in the first weeks of life: the head and neck are tilted to one side, while the face is turned to the opposite. The inclination is on the side of the shortened muscle. It is very rare that the muscles on both sides of the neck are affected, when the head is standing straight with limited mobility. As the muscle on the side of the neck (sternocleidomastoideus) has two functions - tilting and turning the head, in the presence of torticollis the face is turned towards the healthy side", explains the physiotherapist.
When is torticollis congenital and when is it acquired?
"That the baby has congenital torticollis is obvious right after birth. After the third month, asymmetry of the face, and sometimes of the body, is noticeable, due to hypotrophy (weaker development) on the affected side. Later, the asymmetry of the back of the head (plagiocephaly) is seen, because the baby generally occupies the same position due to the deformity.
Another form is traumatic or acquired torticollis, which occurs during childbirth itself, almost always when the baby is born breech, that is, when the legs go first. When pulling out the head, the muscle fibers on one side of the neck may tear, which cannot be immediately noticed. Trauma is manifested by an egg-shaped swelling on the neck in the second or third week of life, in the middle or lower third of the muscle. It is a hematoma, which recedes by the end of the sixth month", explains our interlocutor.
How is this problem treated?
"Treatment of muscular torticollis, whether congenital or acquired, is conservative, with exercises, positioning of the head in the first months - a folded diaper, which is placed under the baby's head when he sleeps, on the affected side, and under the pelvis - when he sleeps on the opposite side. While lying on her back when she is awake or in the stroller, a folded diaper is placed on the side of the shortened muscle, or symmetrically on both sides - to keep her head straight. It is important to start the treatment immediately, 24 hours after the established diagnosis, because the course of recovery cannot be predicted. Congenital torticollis is expected to heal in one to three months, but sometimes it takes longer. The results are fastest in the so-called torticollis posture - where, in fact, it is not a deformity, but an incorrect head posture.
Sometimes parents unknowingly lead to this phenomenon: by constantly placing the baby in a position in which it attracts - primarily sound and light, they come only from one, same side. Then the baby, by turning to one side for a long period of time, adopts an irregular head position. The goal of therapy in this case is to prevent the development of contractures (shortening) of the muscles," says Pelević.
Who conducts the therapy and what is achieved with the exercises?
"Passive stretching exercises for shortened and tense muscles are performed by a physiotherapist or a well-trained parent. They aim to achieve full range of motion of the neck and head. As the other side of the neck is weakened, it is necessary to strengthen those muscles, which should stabilize the head - the baby does this actively, in response to our stimulation. At the same time, while doing passive stretching and active muscle strengthening, we try to keep the baby's head in the central line as often as possible, and arms and legs on the sides - symmetrically in relation to the trunk, in order to form the most regular position and movement patterns.
That is why it is very important how we pick up, hold, carry and give toys to the baby, because through these activities we simultaneously stimulate it. We do this in a targeted manner, because due to less activity of the arm, and sometimes the leg - on the torticollis side, there is a possibility of developing asymmetry. To prevent this, the treatment sometimes includes an orthosis, wearing a Thomas collar (a soft collar that is made individually for each baby), which prevents the head from tilting to the side.
In case of traumatic torticollis, electrophoresis of potassium iodide is applied before exercises (introduction of medicine via electricity, to break up the hematoma). In addition to accelerating hematoma resorption, exercises and head positioning prevent the development of sternocleidomastoid contracture (shortening of the neck muscle). When the muscle shortening is large, the head does not cross the midline to the other side. Before stretching exercises, we use heated paraffin or some other form of warm compress as an introductory procedure. Stretching can also be done when the baby is sleeping, because then it is relaxed and does not resist while we perform the exercises", explains our interlocutor.
Can torticollis have any consequences?
"If torticollis is corrected by the third month, only facial asymmetry can remain as a consequence. If it is not treated, or not completely cured, the consequences, in addition to the aesthetic ones, will be in the development of vision - the child will probably have to do vision exercises for a while. Asymmetry of the neck will develop into cervical or thoracic scoliosis (twisting of the spinal column to the side). It will also affect the asymmetrical development of the jaw, so the child will have to wear a corrective prosthesis when the permanent teeth grow. That's why we have to make sure that the torticollis is corrected completely. For this reason, the baby is followed until it can walk, that is, up to 18 months.
If the full range of motion in the neck has been achieved, the head stands straight in the extension of the spinal column, and the child has been walking for several months - there will be no consequences of torticollis.
Untreated torticollis in the first year, as well as severe forms of deformity, sometimes require surgery. The surgical procedure relaxes the shortened muscle (tenotomy), and the best results are achieved between the first and fourth years of life," says the physiotherapist.
Watch your baby
"When a physiotherapist starts working with a baby, and it is a question of torticollis, he must pay special attention to the following things: spontaneous position of the head in relation to the spinal column, shoulders and arms, spontaneous movement of the head in all directions, control of the head in all positions depending on motor maturity and durability - where the left and right sides are compared. If torticollis is not noticed in the maternity ward, all this can be 'discovered' by the parent, by constantly observing their baby. That way, the baby will start treatment on time, and the consequences of torticollis will be minimal," advises physiotherapist Mladen Pelević.
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