The Torticollis Clinic at Johns Hopkins All Children’s in St. Petersburg, Florida, addresses the medical and rehabilitative care of infants and young children with torticollis, a condition that causes a child’s neck muscles to tighten and the head to tilt to one side. If not treated, children with torticollis can end up with plagiocephaly, a fairly permanent head tilt, as well as flattening or asymmetry of the skull. For children with torticollis, prompt diagnosis is key since treatment is most effective in a young baby. The good news is torticollis can be resolved with timely physical therapy treatment.

Because parents and caregivers are now advised to lie infants on their backs to sleep, a torticollis diagnosis is becoming increasingly common. The condition can make it difficult for the child to turn his or her head for visual tracking, hold the head in an upright position and perform appropriate lower/upper extremity movements necessary for feeding and play. It can also cause flattening of the child’s face, ear and head, and make cleaning the neck and shoulder difficult.

About Clinic Appointments

Treatment at our Torticollis Clinic includes evaluations by a rehabilitation medicine specialist and a physical therapist. During the initial appointment, the patient is evaluated and given an individualized plan of care. Our physicians determine each patient’s candidacy for physical therapy based on American Physical Therapy Association guidelines. Therapy typically begins within two weeks of the initial appointment. During Tampa clinics, a representative from Westcoast Brace & Limb is available to evaluate children with plagiocephaly for a cranial orthotic device to reshape the skull.

The majority of physical therapy sessions for torticollis consist of stretching muscles and soft tissue to loosen tightness, as well as strengthening exercises to ensure the spine can hold the patient in a midline position. Weakness caused by torticollis can cause delays in gross motor skills, so we don’t want to discharge a child until we’re sure he or she has reached an appropriate level with those skills and can hold his or her head in a midline position.

Physical Therapy Program Overview

• Initial evaluation scheduled to determine full needs of each patient
• Measure active and passive range of motion
• Assess muscle tightness
• Test muscle strength
• Evaluate gross motor skills
• Check for associated conditions:
  • Plagiocephaly (abnormal head shape)
  • Hip dysplasia (misalignment of the hip)
  • Spine problems
• Discuss results with parent and make a joint plan for treatment
• Schedule treatment
• Family instruction for stretching and positioning during treatment sessions
• Individualized home exercise program

Goals of Physical Therapy

• Improve child’s ability to turn head between right and left sides
• Improve child’s ability to bring chin to chest
• Improve child’s ability to orient the head to midline against gravity
• Encourage child to lift head against gravity while lying on stomach
• Achieve normal weight bearing and shifting over upper extremities
• Encourage symmetrical use of upper/lower extremities
• Allow child to experience proper weight shifting during developmental activities including sitting, rolling, crawling and walking

Why Therapy is Important

• Prevent permanent shortening of the involved muscle
• Avoid surgery
• Decrease headache and neck pain
• Prevent asymmetries in vestibular and visual development
• Prevent head and face shape asymmetry
• Prevent scoliosis

How Long Will Treatment Take?

• 30- to 60-minute sessions
• One to three sessions per week
• Three to nine months