Why Neck Stretching Alone Isn't the Answer for Torticollis Treatment
As a pediatric physical therapist, I treat infants with torticollis daily in my practice, a common condition where a baby's neck muscles are tight, causing their head to tilt to one side and leading to issues with head shape. While stretching the neck might seem like the solution here, there's more to effective methods to treat torticollis than just stretching. It’s important for parents and providers alike to understand why treating the whole body for torticollis is essential for resolving this condition fostering infant development.
Torticollis is when the muscles of the neck cause the head to tilt to one side. As you can see in the image above, this newborn is leaning more over his right shoulder. This means his tightness is on the right side. Torticollis can develop due to multiple factors, including positioning in the womb or preferences in head positioning post-birth. While it might be instinctive to think that simply stretching this tight muscle in the neck is the solution, torticollis is often a symptom of broader neuromuscular or skeletal issues that require a multifaceted treatment approach.
There are many reasons why neck stretches are actually more limiting than helpful. First of all, there is often an overemphasis on passive stretching. Relying solely on passive stretching can lead to an overemphasis on lengthening the muscle without actually strengthening it. This can be counterproductive and completely ignores symmetry of strength. Stretching alone only addresses the more visible symptom and does not allow us to address the underlying cause. Issues such as core weakness, limited range of motion throughout the body, or even visual tracking problems can contribute to torticollis. The body needs to be addressed as a whole. Especially in infants, whose structures are delicate and still developing, there is a risk of overstressing or damaging the tissues with aggressive stretching. The solution to this is assessing and treating the pelvis, ribcage, shoulder, and trunk mobility first, then moving onto the neck. Aggressively stretching the neck without considering the pelvic mobility will give suboptimal results.
When treating torticollis, it is important to take a comprehensive approach and treat the whole body. This includes first improving whole-body range of motion and strength, modifying a baby’s environment, and positioning strategies to mitigate head shape issues. Along with gentle myofascial release techniques, strengthening the neck muscles and sensory strategies to improve positional sense of the baby’s posture. This ensures balanced muscle function of the pelvis and trunk first, which will get to the root cause faster in infants with torticollis. Often, simple changes in the baby’s day can help resolve the torticollis. This includes adjusting how a baby is held, fed, or positioned during sleep and play to encourage more symmetrical neck movement and muscle development. Using toys, sounds, and positioning activities to encourage the baby to “find” a true centered posture. **BONUS - this approach also promotes overall motor skills and brain development.
Educating parents on the signs of torticollis and proper treatment is key. As they say, knowledge is power and can make a significant difference if your baby has torticollis. Furthermore, treatment plans need to adapt to baby’s growth. If you have concerns about torticollis with your munchkin, visits with a pediatric physical therapist will help make sure treatment remains effective as your little one grows. Well intentioned pediatricians often recommend stretching a baby’s neck, but what they do not understand is the root cause of torticollis. Taking the recommended “wait and see” approach can cause a baby to need more intensive physical therapy later on. Even waiting 2 months can make a significant negative impact in the amount of treatment sessions and strength and milestones to “fix.”
While stretching can help in treating torticollis, it should not be the sole solution. A whole body approach that combines myofascial release, strengthening, and active engagement will lead to more effective outcomes. If your child is diagnosed with torticollis, working with a pediatric physical therapist can provide you with a comprehensive plan tailored to support your child’s unique needs and promote healthy development. If you are already seeing a provider who is treating your child’s torticollis, be sure they are assessing and treating the whole body and not just the neck!
