5 Minutes of Torticollis Interventions!

An assortment of easy-to-perform treatment strategies for torticollis with minimal to no equipment necessary.
For more torticollis PT information you can see my earlier video: • Torticollis (Overview ...
Visual impairments and red flag conditions that feed into torticollis won't be discussed here since treatment for those conditions can be highly specific and require much more elaboration.
Note: this is a mash up of clips from a more in-depth presentation I gave recently and not all activities and educational components were included due to transitioned propriety rights by the virtual venue.
As such, I wanted to elaborate on a few key points not included:
1) If you choose to provide soft tissue mobilization consider avoiding massage on the SCM with infants. Given the size of your fingers in relation to their necks. I wouldn't want you to accidentally elicit a carotid sinal reflexive syncope. So, clinical judgment will dictate the use and type of soft tissue work you perform (sustained pressure, do some skin rolling, run pressure longitudinally, etc.).
2) When I refer to modified prone, I mean cocked on a pillow (given their ROM limitation) to ensure continued patent airway. You can also use a towel wedge under anterior 1/3 of face to increase rotation stretch yet not block the view of the stimuli/distractor (TV, caregiver, toy) rest your hand on the shoulder/upper lateral back ipsilateral to the stretch to increase stretch and limit upper trunk rotation (note: don't push down too firmly to prevent chest expansion for breathing)
3) Plagiocephaly and brachycephaly might not only be secondarily manifested due to torticollis, but it can also further the severity of torticollis so positioning and environmental modifications become incredibly important to address.
POSITIONING
Evaluate seating (high-chair, car seat, stroller, carrier), bedding, etc.
Encourage tummy time and teach them how to roll or provide pressure relief if unable to already.
Tummy time with infant-level children to reduce the time they're feeding into their torticollis positioning and to also promote optional head shaping. For kids that don't like the floor, place them on your tummy while you lay in recliner or supine or use pillows/boppy.
Consider swapping breast feeding positions.
ENVIRONMENTAL MODIFICATIONS
Consider the crib/bed placement in room, TV positioning, etc. and place on their non-preferred side to incentivize them to look in that direction more frequently throughout the day.
Lastly, promote more symmetrical joint motion and movement patterns for any asymmetries you find below the neck that could perpetuate torticollis. Consider other activities like downward depression of shoulder(s) if too elevated, trunk rotation via rolling activities, etc.
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This video was made for the purposes of providing guidance to newer pediatric physical therapists and is meant to be coupled with their own clinical decision making and judgment. Given the implications of different medical conditions, the education and techniques used in this video may not be entirely applicable for every patient and should not be used if contraindications are present.
Copyright, Liability Waiver and Disclaimers. All rights reserved.
This publication may not be reproduced in any part, transmitted in any form, or stored in a retrieval system except under the express written permission of Warren McAdams, PT, DPT as permitted under the United States Copyright Act.
Information provided is for the guidance of licensed physical therapists only and is not meant to supplement a formal physical therapy evaluation or physician visit. Seek consult from your appropriate health care provider for questions pertaining to your medical concerns. Warren McAdams will not be liable for any injuries or damages resulting from advice and/or treatment strategies presented in this video thus will not be liable for any consequential, direct or indirect, incidental, or punitive damages or harm arising out of access to or the use of any content.
#physicaltherapy #education #training #rehab #torticollis

[@missmaliciousss]

I love your content! Speaking about torticollis I would like to hear abit theory about asymmetry and children 3 and up, asessmeny and how it can influence their development, it feels like its covered quite deeply when it comes to babies, but not older children

[@WarrenMcAdamsPT]

Gabriela, I appreciate your enjoyment of my content! I agree that torticollis in children older than 3 isn't explored very thoroughly in the literature. Although, similar concerns for altered or asymmetrical motor milestone acquisition rates would persist. However, from my experience, hemineglect is less apparent (vastly due to the child's overall matured cognitive status and elevated sensory integration compared to their infant counterparts). I speculate that a significant factor why older children are less explored in the literature may be the reduced prevalence (as treating infants seems to hold relatively high levels of effectiveness). Those that slip through the cracks or have persisting torticollis may have other underlying conditions that lead to more significant variability in standardizing research outcomes and measurements or establishing appropriate control groups. I have other thoughts on this topic, and I would be happy to continue the discussion via LinkedIn if you'd like. Just search for my name and send a message. Happily, Warren

[@asfdfsd1990]

This exercise are aply one month baby