Effective Treatment Options for Pediatric Torticollis: Seeking Guidance

Q: Effective Treatment Options for Pediatric Torticollis: Seeking Guidance

Hello Mr. <br>Ma： Generally, patients with torticollis are affected by the sternocleidomastoid muscle. <br>When this muscle is engaged, the face turns toward the opposite side while the head tilts toward the same side. <br>For instance, if the left sternocleidomastoid muscle is a

Treatment issues for pediatric torticollis?

Dear Director Hsu,
My child is 5 years and 9 months old and was diagnosed with torticollis (tilting to the left) at 5 months of age.
We have consulted with rehabilitation specialists who performed a muscle ultrasound and found no fibrosis.
Pediatric surgery and orthopedic evaluations with X-rays showed that the spine is symmetrical and there is no scoliosis.
An ophthalmologist examined him and found no strabismus.
Following the rehabilitation specialist's advice, we have been using a cervical collar that has adjustable height on both upper and lower sections for over six months now.
The collar is only removed during bathing, and he wears it even while sleeping.
However, there has been no significant improvement in the torticollis or facial asymmetry.

I would greatly appreciate your guidance on any other methods that could assist in treating my child.
Thank you very much for your help.

Fanrao de Ma Baba, 30~39 year old female. Ask Date: 2004/08/31

Dr. Xu Zhenrong reply Rehabilitation

Hello Mr.
Ma: Generally, patients with torticollis are affected by the sternocleidomastoid muscle.
When this muscle is engaged, the face turns toward the opposite side while the head tilts toward the same side.
For instance, if the left sternocleidomastoid muscle is affected, the face will turn to the right while the head tilts to the left.
In rehabilitation, the treatment approach typically begins with ultrasound therapy to soften the muscle tissue, followed by massage and stretching exercises to relax and increase the elasticity of the muscles, thereby improving the range of motion in the neck.

Importantly, it is essential to consider the child's age when incorporating neck muscle training activities.
If the left sternocleidomastoid muscle is tighter, the right sternocleidomastoid muscle may become weaker due to prolonged stretching.
Therefore, it is crucial not only to stretch the left muscle but also to strengthen the right muscle to achieve balance in muscle strength and prevent head tilt.
A neck brace is merely an assistive device that helps maintain the head in a more "neutral" position; however, over-reliance on it can lead to further weakness in the neck muscles.
Thus, it is recommended to remove the brace during exercise, as well as during bathing and sleeping.
Your child is already five years and nine months old and should be able to follow instructions.
I suggest the following exercises to enhance the strength of the right neck muscles: 1.
Sit-ups: You can hold your child's right hand to help them move from lying down to sitting up, ensuring that you wait for their head to tilt to the right before continuing to pull them up.
Their left hand should be placed on their chest without pushing against the bed.
2.
While playing on their stomach, place toys on the upper right side so that when they reach for the toys, their head will turn to the right and tilt to the left, thereby engaging the right sternocleidomastoid muscle.
3.
While sitting or standing, they can engage in activities similar to a seesaw, tilting their body side to side.
This will help maintain the head in a vertical position relative to the ground, thereby training the neck muscles.
I hope this information is helpful to you.
However, I still recommend consulting a professional physical therapist in rehabilitation to design a comprehensive training plan for your child.
Thank you for your inquiry.

Rehabilitation Department, Xu Zhenrong

Reply Date: 2004/08/31

More Info

Torticollis, commonly known as "wry neck," is a condition characterized by an abnormal, asymmetrical head or neck position. In pediatric cases, it can be congenital or acquired, with congenital muscular torticollis being the most common form. This condition often arises due to tightness or shortening of the sternocleidomastoid muscle, which can lead to a tilted head posture. Given your child's diagnosis and the treatments attempted thus far, it’s understandable to seek further guidance on effective treatment options.

Current Treatment Approaches
1. Physical Therapy: This is often the first line of treatment for torticollis in children. A physical therapist can provide specific exercises to stretch the tight muscles and strengthen the weaker ones. These exercises are crucial for improving range of motion and correcting head posture. It is essential to ensure that the exercises are performed consistently and correctly.

2. Use of a Neck Brace: As you mentioned, your child has been using an adjustable neck brace. While this can help in some cases, it is not always effective for all children, especially if used for an extended period without significant improvement. The brace should ideally be used in conjunction with physical therapy to maximize its effectiveness.

3. Positioning Techniques: Encouraging your child to turn their head towards the affected side during playtime can help promote muscle use and improve symmetry. This can be done through engaging toys or activities that require them to look in the direction of the tight muscle.

4. Surgery: In cases where conservative treatments fail to yield results, surgical intervention may be considered. This typically involves lengthening or releasing the tight sternocleidomastoid muscle. However, surgery is generally reserved for more severe cases or when significant functional impairment is present.

Alternative Therapies
1. Chiropractic Care: Some parents explore chiropractic adjustments for their children with torticollis. While there is anecdotal evidence of benefits, it is crucial to consult with a healthcare provider to ensure that this approach is safe and appropriate for your child.

2. Massage Therapy: Gentle massage of the neck and shoulder muscles may help relieve tension and improve flexibility. This should be performed by a qualified therapist experienced in treating pediatric patients.

3. Botulinum Toxin Injections: In some cases, botulinum toxin (Botox) injections may be used to temporarily weaken the tight muscle, allowing for better positioning and facilitating physical therapy. This is typically considered when other treatments have not been effective.

Monitoring and Follow-Up
It is essential to maintain regular follow-up appointments with your healthcare providers to monitor your child's progress. If there has been no significant improvement after six months of treatment, it may be worthwhile to seek a second opinion or consult a pediatric orthopedic specialist who specializes in torticollis.

Conclusion
In summary, while your child has been undergoing treatment for torticollis, it may be beneficial to reassess the current approach and consider additional therapies or interventions. Consistent physical therapy, proper use of the neck brace, and engaging in positioning techniques are critical components of treatment. If conservative measures continue to show limited improvement, discussing surgical options or alternative therapies with your healthcare provider may be warranted. Always ensure that any new treatment is discussed with a qualified healthcare professional to ensure it is safe and appropriate for your child's specific condition.

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