Helping Children Improve Range of Motion in the Neck

Pediatric Physical TherapyTorticollis is a common diagnosis treated by therapists at Mercy and is a condition characterized by an asymmetrical positioning of the neck.

Typically with torticollis, the neck is tilted to the left or right and rotated to the opposite side. The child prefers looking only in one direction and has difficulty looking the opposite way. There is usually limited range of motion. Strength of the neck muscles is decreased, and the child generally has abnormal balance reactions. Tightness at the front and back of the neck, as well as, around the shoulder region and trunk is common. Facial and skull asymmetry can occur due to tightness of neck muscles and the resulting forces applied to the developing skull. Gross motor delay and asymmetry through the spine/pelvis are frequently observed.

Torticollis can be the result of positioning in utero, prematurity, or positioning of the child following birth. Over the past few years, therapists have seen an increased incidence of torticollis. This increase has been partially a result of the “Back to Sleep” program. While positioning babies on their backs is the ONLY recommended position for sleep, parents need to be educated on the importance of placing babies on their belly for supervised play. The neck becomes strong as a baby lifts his/her head against gravity while lying on his/her belly. Without supervised belly time, the baby does not have sufficient time to strengthen his neck and back extensor muscles, which are necessary for future motor development.

If a parent suspects torticollis, notification of the child’s pediatrician is recommended. The pediatrician can provide a prescription for physical therapy. Early diagnosis and treatment are highly recommended for best results.

Physical therapists at Mercy have received special training in the evaluation and treatment of children with torticollis from a nationally renowned therapist who provides continuing education courses throughout the United States.

During the evaluation, a physical therapist will assess the child’s neck range of motion, strength, postural control, balance reactions, skull-facial symmetry and gross motor skills. A treatment plan will be developed. Outpatient therapy services will be recommended on a case-by-case basis. Recommendations for home positioning will be provided. The therapist will instruct the family on feeding, diapering, and carrying techniques designed to promote increased neck range of motion and strengthening. The family will be taught a home exercise program for neck stretching, positioning and developmental activities.

Treatment goals for a child with torticollis include full neck range of motion, good strength of the neck muscles, normal balance reactions of the neck and trunk, symmetry of the neck with no tilt (eyes positioned on the horizontal), and age appropriate gross motor skills.

If you feel your child may have torticollis, please contact your physician to request a referral to physical therapy. EARLY TREATMENT IS THE KEY TO OPTIMAL RESULTS!