The Academy of Pediatric Physical Therapy defines congenital muscular torticollis (CMT) as a postural difference of the neck muscles resulting in an imbalance of range of motion (flexibility) and/or strength.¹ It is often characterized by tilting of the head to one side, turning to the opposite side and possibly feeling a benign mass in the muscle itself. Torticollis has been observed in infants due to poor uterine positioning such as breech, with multiple births, low tone (hypotonia), and/or other conditions.

Torticollis is an increasingly common pediatric diagnosis. It is so common that the Academy of Pediatric Physical Therapy has created clinical practice guidelines (CPG’s) for the management of congenital muscular torticollis highlighting key points for practitioners and caregivers.

At Westchester Physical Therapy – Sensory Jim Pediatric Therapy, we are expert clinicians that successfully manage and treat infants diagnosed with torticollis. Our Westchester Torticollis Management Program (WTMP) follows the CPG’s of our profession to ameliorate the musculoskeletal manifestations often associated with Congenital Muscular Torticollis. Additionally, as certified sensory specialists, we also incorporate a holistic approach to mitigate potential sensory implications of torticollis as commonly seen with visual and vestibular systems.

If torticollis is left unresolved it CAN result in:

• Flat head syndrome (plagiocephaly)
• Decreased muscle range of motion and strength
• Accomplishment of motor milestones with compensation
• Development of idiopathic scoliosis
• Impaired visual development with a tendency to neglect the side that the infant has difficulty turning towards
• Altered ability for infants to gain midline control of their bodies
• Retaining of primitive reflexes that should disappear around 12 months old
• Impacted vestibular (balance) system development and associated visual reflexes, typically on the same side of the torticollis
• Altered eye hand coordination, body awareness and laterality
• Delayed fine, speech and gross motor milestones

A diagnosis or concern of torticollis warrants an assessment as early as possible for the most optimal outcomes. The PT will assign a severity from Grade 1 (mildest) – Grade 8 (most severe) based on theses factors:

• Baby’s age at the time of the initial evaluation (the earlier the better)
• The presence of a benign muscular mass or nodule in the neck muscle
• The difference between passive range of motion of neck turning to the left and right sides

Our approach utilizing the Westchester Torticollis Management Program will encompass an Individualized Home Program with caregiver training to:

• Improve range of motion
• Improve muscular strength
• Achieve alignment, symmetry, and posture
• Attain motor milestones without complications
• Incorporate baseline visual exercises
• Provide strategies for tolerance of all positions, including tummy time (See video for Suggestions to improve tolerance for tummy time) and lying on one’s back
• Enhance vestibular (balance) integration (See Astronaut Program 2 )
• Equipment, Car Seat and Positional education
• Consultation with your child’s pediatrician/physician
• Consult with Cranial Technologies (We are conveniently located next door to the Cranial Scarsdale Office) We are delighted to offer appointments either before or after scheduled Cranial appointments

Call for free PT 15 minute consultation by appointment only at 914.574.6493.

1. Kaplan SL, Coulter C, Fetters L. Physical Therapy Management of Congenital Muscular Torticollis: An Evidence-Based Clinical Practice Guideline. Ped Phys Ther. 2013; 25: 348-94.
2. Kawar M, Frick S, Frick R. Astronaut Training: A sound activated vestibular-visual protocol. Madison, WI, Vital Links, 2005.6.