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Torticollis & Positional Plagiocephaly - San Diego

Torticollis & Positional Plagiocephaly

What is Torticollis?

  • A condition of limited neck motion where the baby holds his head tilted to one side and rotated to the opposite side.
  • Results from shortening of the neck muscles while in utero or with poor positioning. 
  • TORTLEOrder Now

    Tortle is a repositioning system to be worn only during your infant’s awake time to improve neck and head symmetry. Please consult a therapist if you have questions about sizing and wear schedule for your infant’s unique situation.

    May lead to plagiocephaly
  • May be reduced with stretching, positioning, and exercise, all of which physical therapy can provide.
  • May be related to visual deficits (pseudo-torticollis)
  • Most infants will demonstrate good results within 6 months, however treatment varies

Signs & Symptoms May Include:

  • Head tilted to the left and rotated to the right (Left side torticollis)
  • Head tilted to the right and rotated to the left (Right side torticollis)
  • Sometimes presents with head tilted and rotated to the same sides
  • Weakness of the neck muscles on the opposite side of the tightness
  • Sometimes a firm, non-tender mass may be felt in the mid portion of the tight neck muscle in young infants
  • Flattening of one part of the head (plagiocephaly)
  • Facial asymmetries
  • Delayed motor skills due to weakness

Physical Therapy Can Help With:

  • Family education
  • Positioning/Carrying strategies
  • Tummy Time (click here for more info)
  • Stretching Exercises
  • Strengthening Exercises
  • Prevention of skull asymmetry
  • Providing equipment that may help (collars, positioning equipment, may need referral for re-shaping helmet depending on presence of plagiocephaly)
  • Developmental Assessment
  • Home exercise program

Brachycephaly vs. Plagiocephaly

(prepared by Allison Darsey)

Brachycephaly

  • Head is wider than normal
  • Head has shorter length than width
  • Back of head is flat
  • Head is taller than normal
  • Extreme forehead incline
  • Bumps/bulging above ears
  • Face appears small in proportion to head

Plagiocephaly

  • 2:1 ratio of right- versus left-sided plagiocephaly
  • Parallelogram shape from bird's-eye view
  • Eyes & ears misaligned
  • One cheek appears “fuller”
  • Angled forehead
  • Top of head slopes in one direction

Brachycephaly: a disproportionally short and broad head

Treatment Recommendation:

Normal

  • Length of head is 1/3 longer than width
  • Curve at base of skull
  • No bumps or bulging above ears

  • Treatment not necessary
  • Assess neck and development
  • Continue repositioning, developmental activities and an average of 60 minutes per day of tummy time

Mild

  • Minimal decreased length
  • Flattening is difficult to see
  • Face appears proportionate to width
  • No noticeable bumps or bulging above ears

  • Treatment not necessary
  • Continue repositioning, developmental activities and an average of 60 minutes per day of tummy time
  • Consider PT referral for neck ROM, weakness or developmental delay

Moderate

  • Flattening and increased width are easy to see
  • Head is taller at the back and slopes to forehead
  • Little to no curve at base of skull
  • Bumps and bulging above ears

  • Treatment recommended
  • Education about neck and trunk strengthening activities, neck ROM, and positioning
  • Consider PT referral for neck ROM, weakness or developmental delay

Severe

  • Flattening and increased width are obvious
  • Head is taller at the back and slopes to forehead
  • No cure at base of skull, may be indented
  • Face is lost in the width

  • Treatment recommended
  • Education about neck and trunk strengthening activities, neck ROM, and positioning
  • Consider PT referral for neck ROM, weakness or developmental delay

 

Plagiocephaly: Positional plagiocephaly is a disorder in which one side of an infant's head is flattened, often with little hair growing in that area.

Treatment Recommendation:

Normal

  • All symmetry within normal limits
  • Unable to see asymmetry in any areas

  • Treatment not necessary
  • Assess neck and development
  • Continue repositioning, developmental activities and an average of 60 minutes per day of tummy time

Mild

  • Minimal asymmetry
  • Flattening is difficult to see
  • No noticeable ear shift or facial asymmetry

 

  • Treatment not necessary
  • Continue repositioning, developmental activities and an average of 60 minutes per day of tummy time
  • Consider PT referral for neck ROM, weakness or developmental delay

Moderate

  • Flattening and asymmetry are easy to see
  • Visible ear shift with one cheek appearing fuller
  • One side of the head may be higher than the other

  • Treatment recommended
  • Education about neck and trunk strengthening activities, neck ROM, and positioning
  • Consider PT referral for neck ROM, weakness or developmental delay

Severe

  • Flattening and asymmetry are obvious
  • Angle of flattening is sharp
  • Significant ear shift and facial asymmetry
  • One side of the head is higher than the other side

  • Treatment recommended
  • Education about neck and trunk strengthening activities, neck ROM, and positioning
  • Consider PT referral for neck ROM, weakness or developmental delay

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