What is Torticollis?

Torticollis is the tightening of muscles on one side of the neck. The primary muscle that is affected is called the sternocleidomastoid or SCM. Tightening of the SCM can be caused by a variety of reasons which are broken down into two categories, congenital or acquired.

 Congenital torticollis is tightness a child is born with and is commonly caused from the baby’s position in the womb. Congenital torticollis may also occur if there is trauma or damage to the SCM during the birthing process. Less common reasons include malformation of the bones of the neck, and certain syndromes that affect muscle and bone development.

Acquired torticollis occurs after birth and is related to an irritation to the SCM muscle. This type of torticollis may be caused by gastroesophageal reflux (GERD), problems with vision, soft tissue infections of the neck, or muscle spasms. In addition to physical therapy, children with acquired torticollis often require additional support from a specialist to address the underlying cause.

 Infants with torticollis generally have a head that tilts towards the side of the affected muscle and a chin that points away from the affected muscle, as seen in the image below.

Treatment for torticollis often includes soft tissue work to break up adhesions, strengthening of the muscles on the other side of the neck to help hold the head in a midline position, and encouraging play to the middle and affected side.

What is Plagiocephaly?

Plagiocephaly is the flattening of the skull that is due to repeated pressure over one area. This flattening is very common and very treatable, and is not painful for your child. Plagiocephaly ranges from mild to severe and can be categorized based on where the flattening is occurring, as seen in the image below. 

Premature infants are more likely to develop plagiocephaly due to the increased pliability of the bones of their skull. Full term babies may also have plagiocephaly that could be caused by sleeping in the same position, tightening of neck musculature on one side (torticollis) leading to a preference to look to one side more than the other, or from their positioning in the womb.   

Treatment for plagiocephaly is determined by severity, ranging from repositioning during daily activities to use of corrective headbands. More severe plagiocephaly can result in facial asymmetry and problems with vision if left untreated. Below is an image of the head band commonly used to treat plagiocephaly. This band is worn 23 hours a day, helping to relieve pressure over the flattened area. 

Patients with plagiocephaly are often referred to a neurosurgeon or plastic surgeon before beginning treatment with a headband for a second opinion. This is also to ensure the child does not have craniosynostosis, which is an early fusion of the skull soon after birth. Craniosynostosis often presents the same as plagiocephaly but is much more uncommon and requires surgery to correct