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Torticollis: what is it and how to treat it

Torticollis is an involuntary contraction of the neck muscles that can be caused by poor posture when sleeping or when using the computer, causing pain in one side of the neck which may result in difficulty in moving your head.

It is common to wake up with torticollis and have difficulty moving the neck. In some cases, the muscles get so tight that the person cannot move the neck to either side and walks like a ‘robot’, for example.

In order to cure torticollis and eliminate neck pain it is necessary to fight the involuntary contraction of the muscles in the neck. Mild torticollis can be relieved only by using warm patches and gentle neck massage, but when the torticollis is more severe some specific techniques may be used.

To treat torticollis there are 5 simples steps that can be followed:

1. Tilt your body forward

Simply stand with your legs apart and lean your body forward, leaving your head hanging. The goal is to allow your head and arms to be loose, and you should stay in that position for about 2 minutes. This will cause the weight of your head to act as a pendulum, which may increase the space between the cervical vertebrae and decrease the spasm of the neck muscles.

You can also move your head with small movements to one side or to the other, just to make sure that the muscles of the shoulders and the neck are more relaxed.

2. Apply pressure to the neck muscles

This technique consists of using your thumb to apply pressure for 30 seconds to the middle of the muscle. Then, you have to press the part where the muscles begin, in the nape of the neck, for another 30 seconds. During this part of the treatment you can be standing or sitting and you head should be facing forward.

3. Physiotherapy

Physiotherapy is important because it can help you stretch your neck using a technique called muscular energy. This involves placing a hand (on the side of the torticollis) on the head and exerting force by pushing the head against the hand. Hold this position for 5 seconds and then relax, resting for another 5 seconds. Repeat this exercise 4 more times. Little by little your range of motion will improve.

If after you finish the exercise there is still movement limitation you can repeat the movement to the opposite side. This means that if the pain is on the right side you should put your left hand on your head and make force with your head and push on the hand. Hold this force without taking your head off for 5 seconds and then rest for another 5 seconds. This will stretch the muscles on the left side, which is that affected.

4. Massage and compresses

Massage from your shoulder to your ear

Apply a compress or warm pad to the spot

Massaging the neck using sweet almond oil or some other moisturizer is also a good way to decrease pain and discomfort. The massage should be performed on the shoulders, neck, back of the neck and head, but should only be performed in the final part of the treatment, after having performed the exercises and techniques previously indicated.

This type of massage should not be performed with a lot of force, but you can press your palm a little on the muscles of the neck, from the shoulders towards the ears. Small silicone cups that form a vacuum inside can also be used with little pressure to increase blood flow and help loosen the muscle fibers.

Finally, a warm compress can be placed on the neck, letting it act for about 20 minutes.

5. Remedies for torticollis

Medications for torticollis should only be used on the recommendation of a doctor and usually include anti-inflammatory ointments such as Cataflan, muscle relaxants, or anti-spasmodic medicines such as Ana-flex, Torsilax, Coltrax or Mioflax, for example. Applying a compress like Salonpas is also a good strategy to cure the torticollis more quickly.

These remedies are also recommended for individuals with spasmodic torticollis, which is a type of torticollis that recurrently occurs in several members of the same family.

When to go to the doctor

Usually the torticollis improves after the first 24 hours, and tends to last from 3 to 5 days. Therefore, if the torticollis takes more than 1 week to heal, or if symptoms such as tingling, loss of arm strength, difficulty in breathing or swallowing, fever or if you cannot control urine or your stools, you should seek medical help.

How long does torticollis last

Usually torticollis lasts a maximum of 3 days, but causes a lot of pain and discomfort, making day to day chores very difficult. Putting warm compresses on the neck and using the strategies indicated above is recommended for curing torticollis faster.

What causes torticollis

It is very common for a person to wake up with torticollis, but it can also happen due to:

  • Congenital problems, like when a baby is born with congenital torticollis, requiring treatment, sometimes surgical;
  • Injuries involving the head and neck;
  • Spinal changes, such as disc herniation, scoliosis, alteration of the C1 & C2 vertebrae in the neck;
  • Respiratory system infections, which cause torticollis and fever, or others such as meningitis;
  • Presence of a mouth, head or neck abscess;
  • In case of diseases like Parkinson’s, where the muscles are more prone to spasms;
  • Taking certain medications, such as traditional dopamine receptor blockers, metoclopramide, phenytoin or carbamazepine.

The most common type of torticollis usually lasts 48 hours and is easy to fix. But, when there are other symptoms like fever, you should go to a doctor for an evaluation. Some remedies that can be recommended by the doctor include Diprospan, Miosan and Torsilax, for example.

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Approach Considerations, Conservative Management, Surgical Intervention

Author

Michael C Kruer, MD Director, Neurogenetics and Pediatric Movement Disorders Programs, Barrow Neurological Institute, Phoenix Children’s Hospital; Associate Professor, Departments of Child Health and Neurology, Graduate Interdisciplinary Program in Genetics, University of Arizona College of Medicine in Phoenix

Michael C Kruer, MD is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine, American Academy of Neurology, American Academy of Pediatrics, American Neurological Association, American Physician Scientists Association, American Society for Cell Biology, American Society of Human Genetics, Child Neurology Society, International Child Neurology Association, Mitochondrial Medicine Society, Movement Disorder Society

Disclosure: Nothing to disclose.

Coauthor(s)

Norman C Reynolds, Jr, MD Neurologist, Veterans Affairs Medical Center of Milwaukee; Clinical Professor, Medical College of Wisconsin

Norman C Reynolds, Jr, MD is a member of the following medical societies: American Academy of Neurology, Association of Military Surgeons of the US, International Parkinson and Movement Disorder Society, Sigma Xi, The Scientific Research Honor Society, Society for Neuroscience

Disclosure: Nothing to disclose.

Jianxin Ma, MD Assistant Professor, Department of Neurology and Department of Physical Medicine and Rehabilitation, State University of New York Upstate Medical University

Disclosure: Nothing to disclose.

Chief Editor

Selim R Benbadis, MD Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida Morsani College of Medicine

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, American Medical Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Alliance, Bioserenity, Ceribell, Eisai, Greenwich, LivaNova, Neurelis, Neuropace, Nexus, RSC, SK life science, Sunovion<br/>Serve(d) as a speaker or a member of a speakers bureau for: Alliance, Aquestive, Bioserenity, Eisai, Greenwich, LivaNova, Neurelis, SK life science, Sunovion<br/>Received research grant from: Cerevel, LivaNova, Greenwich, SK biopharmaceuticals, Takeda.

Acknowledgements

Nestor Galvez-Jimenez, MD, MSc, MHA Chairman, Department of Neurology, Program Director, Movement Disorders, Department of Neurology, Division of Medicine, Cleveland Clinic Florida

Nestor Galvez-Jimenez, MD, MSc, MHA is a member of the following medical societies: American Academy of Neurology, American College of Physicians, and Movement Disorders Society

Disclosure: Nothing to disclose.

Stephen T Gancher, MD Adjunct Associate Professor, Department of Neurology, Oregon Health Sciences University

Stephen T Gancher, MD is a member of the following medical societies: American Academy of Neurology, American Neurological Association, and Movement Disorders Society

Harris Gellman, MD Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society

Disclosure: Nothing to disclose.

Carl R Menckhoff, MD, FACEP, FAAEM Associate Professor, Department of Emergency Medicine, Medical College of Georgia

Carl R Menckhoff, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians

Gurdeep S Othee, MD Staff Physician, Department of Emergency Medicine, Medical College of Georgia

Gurdeep S Othee, MD is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians

Disclosure: Nothing to disclose.

Lorenzo L Pacelli, MD Consulting Surgeon, Division of Orthopedic Surgery, Section of Upper Extremity Surgery, Scripps Clinic

Lorenzo L Pacelli, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Joseph E Sheppard, MD Professor of Clinical Orthopedic Surgery, Chief of Hand and Upper Extremity Service, Department of Orthopedic Surgery, University of Arizona Health Sciences Center, University Physicians Healthcare

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Michael Yaszemski, MD, PhD Associate Professor, Departments of Orthopedic Surgery and Bioengineering, Mayo Foundation, Mayo Medical School

Disclosure: Nothing to disclose.

Wryneck (torticollis): Causes, types, and treatments

Wryneck occurs when the neck muscles twist beyond their usual capacity, causing the head to tilt. The condition is also known as torticollis or loxia.

Wryneck may develop over time. It can also occur after an injury to the area, or because of a reaction to medication.

A person with wryneck may find it uncomfortable or painful to put their head up straight or bend their neck to the unaffected side.

Wryneck in infants is common, with some sources reporting that it affects 3 in every 100 babies. In most infants, the condition is easily treatable.

Benign paroxysmal torticollis of infancy (BPTI) is a much rarer medical disorder in infants where the baby experiences recurrent episodes of the head tilting to one side.

In this article, we take a look at the causes behind wryneck, along with the possible treatment options for this condition.

In adults, there are several reasons why wryneck may develop, though doctors are often unable to specify a reason.

Some of the common causes include:

  • injury to the neck or spine, causing the muscles to spasm
  • infection of the head or neck, where inflammation causes the muscles to contract
  • abscesses in the throat or upper airway
  • infections of other parts of the body, such as ears, sinuses, jaw, teeth, or scalp

Less common causes of wryneck include:

  • scar tissue
  • arthritis of the cervical spine
  • vascular abnormalities
  • drug misuse that causes a lack of muscle control
  • use of certain medication
  • tumors

Wryneck in children

Children, infants, and newborns usually develop wryneck because of congenital muscular torticollis (CMT), meaning they are born with the condition.

CMT develops when a muscle on one side of the neck called the sternocleidomastoid muscle is too short.

Other causes of wryneck in children include:

  • trauma during birth
  • flat head syndrome, where an infant keeps their head in the same position whenever they sleep
  • inherited diseases that cause problems with the muscles and nervous system

There are several different types of wryneck. These include:

Temporary torticollis

Temporary torticollis will usually only affect a person for 1–2 days before disappearing. People with temporary torticollis may need to rest while keeping their neck as still as possible. They may not require any specific medical treatment, however.

Temporary torticollis can occur if the lymph nodes become inflamed after an infection or cold, or if a person has a neck injury that makes the joints between the neck bones swell.

Fixed torticollis

Fixed torticollis occurs because of an underlying problem with a person’s muscles or bone structure. It can also develop if a tumor is growing in the spinal cord, putting pressure on nerves in the area.

In children, fixed torticollis may cause their features to look unbalanced or their face to have a flattened appearance. Children may also experience a delay in their ability to use their facial muscles correctly.

Muscular torticollis

Muscular torticollis is the most common form of fixed torticollis. It happens when the muscles on one side of the neck are particularly tight, or when scar tissue affects mobility.

During pregnancy, muscular torticollis can develop in the fetus, if it moves into an unusual position in the womb, or the fetus does not have enough room.

Klippel-Feil syndrome

Klippel-Feil syndrome is a congenital condition. It develops when the bones in the neck do not grow correctly, and the neck becomes twisted.

People with Klippel-Feil syndrome may not be able to hear well if the bones in their ears are also affected.

Cervical dystonia

Cervical dystonia, also known as spasmodic torticollis, is a rarer form of the condition than other types. Cervical dystonia causes the neck muscles to spasm.

People with cervical dystonia experience painful episodes where the neck muscles contract and the head twists to one side, forward, or backward.

Symptoms of wryneck vary from person-to-person. The most apparent sign of the condition is the neck twisting or tilting to one side.

People with wryneck may also experience:

  • painful, tense neck muscles
  • neck cramps or burning sensations in the neck
  • an unwillingness to turn or bend their head and neck to the opposite side
  • their eyes looking up without control
  • their tongue sticking out without control
  • jerky muscle spasms and head and neck movements
  • back pain
  • headaches

In infants, the symptoms of wryneck include:

  • tilting of the head to one side
  • flattening on one side of the head behind the ear
  • limited movement in the head and neck
  • features of the face appearing asymmetrical
  • a small, soft lump in the neck
  • breastfed babies favoring one breast over the other
  • musculoskeletal problems, such as hip dysplasia

In cases of torticollis that develop after birth, a baby may appear tired, irritable, and may vomit during episodes of head tilting.

A doctor will diagnose wryneck with a physical examination and by asking questions about family history. They may also inquire about any current medications the person is taking.

The doctor may request X-rays of the neck to work out whether the problem is due to a bone fracture or dislocation.

A CT scan may be necessary to diagnose wryneck caused by more hard-to-spot abnormalities or conditions. These can include degenerative arthritis of the spine.

In some instances, what may appear as wryneck could be something more serious.

If a person experiences any of the following symptoms, they should seek immediate medical assistance:

  • muscle spasms in the neck after an injury
  • difficulty swallowing
  • difficulty breathing
  • problems walking
  • impaired speech
  • weakness or numbness in the arms and legs
  • difficulty passing urine
  • urinary or fecal incontinence
  • swelling of the mouth or tongue
  • fever
  • swollen glands
  • a headache

Treatment for wryneck depends on the type and cause.

Some instances of wryneck can disappear within a few days if the person rests and avoids moving their neck.

Treatments for wryneck include:

  • ice packs
  • medication
  • physical devices to keep the neck fixed in place
  • physical therapy
  • massage therapy
  • stretching exercises
  • surgery

A doctor may prescribe muscle relaxants and anti-inflammatory drugs for spasmodic torticollis caused by injury or as a side effect of medications.

In cases of chronic neck muscle spasms and cervical dystonia, botulinum A toxin, also known as Botox, may provide relief by preventing the muscles from contracting. Botox may also prevent the condition from progressing.

Surgery can help avoid further symptoms if other forms of treatment do not work. A surgeon may cut certain nerves and muscles to stop them contracting.

Around 10 percent of children who have wryneck from birth will require surgery to lengthen the sternocleidomastoid muscle in the neck. This surgery will likely take place once the child reaches preschool age.

Brain stimulation is a rare treatment option. A doctor can do this by inserting a wire into the part of the brain that controls movement and disrupts the brain signals. Brain stimulation may help with cervical dystonia.

People with wryneck can also try home remedies to help manage symptoms of pain and discomfort. These remedies include:

  • Sleeping and getting plenty of rest. Wryneck symptoms may disappear during sleep, so getting plenty of rest and lying down can help to ease symptoms and bring relief.
  • Using heat packs or ice packs. These devices can relieve pain and soothe tight muscles.
  • Touching the opposite side of the face, chin, or neck. Doing this can trick the body and could help to stop spasms temporarily.
  • Reducing stress. Stress can cause muscles to tighten and may worsen wryneck symptoms. Knowing what triggers stress and using stress-reduction techniques can help to manage symptoms.
  • Stretching exercises. These may include gradually trying to move the head in the opposite direction, further and further each time, and can help to improve motion and ease discomfort.

People may want to speak to a physical therapist before attempting any stretches for wryneck.

In infants with wryneck, stretching can also help. Encouraging the baby to turn their head in both directions can relieve tension and build strong neck muscles. Using stimuli, such as noise and lights, can also encourage babies to move their heads.

A physical therapist can perform more intensive treatment on infants with wryneck and can advise on stretches to try at home.

Wryneck is not always preventable, but prompt treatment can cure it or stop it from becoming worse.

There are many treatment options for managing symptoms and reducing how often they occur, and the outlook for people with this condition is usually good.

Nevertheless, people can become disabled from wryneck, particularly if they leave the condition untreated. They may find they have difficulty doing daily activities, such as driving, and they might experience persistent pain and discomfort.

Early intervention and physical therapy can help successfully treat infants and children with wryneck and prevent the condition from worsening.

In more severe cases, surgery on the nerves and muscles of the neck is an option, though the condition can still return.

In many cases, however, and with the right treatment, wryneck will go away within a few days or weeks.

Cervical dystonia – Symptoms and causes

Overview

Cervical dystonia, also called spasmodic torticollis, is a painful condition in which your neck muscles contract involuntarily, causing your head to twist or turn to one side. Cervical dystonia can also cause your head to uncontrollably tilt forward or backward.

A rare disorder that can occur at any age, cervical dystonia most often occurs in middle-aged people, women more than men. Symptoms generally begin gradually and then reach a point where they don’t get substantially worse.

There is no cure for cervical dystonia. The disorder sometimes resolves without treatment, but sustained remissions are uncommon. Injecting botulinum toxin into the affected muscles often reduces the signs and symptoms of cervical dystonia. Surgery may be appropriate in a few cases.

Symptoms

The muscle contractions involved in cervical dystonia can cause your head to twist in a variety of directions, including:

  • Chin toward shoulder
  • Ear toward shoulder
  • Chin straight up
  • Chin straight down

The most common type of twisting associated with cervical dystonia is when your chin is pulled toward your shoulder. Some people experience a combination of abnormal head postures. A jerking motion of the head also may occur.

Many people who have cervical dystonia also experience neck pain that can radiate into the shoulders. The disorder can also cause headaches. In some people, the pain from cervical dystonia can be exhausting and disabling.

Causes

In most people with cervical dystonia, the cause is unknown. Some people who have cervical dystonia have a family history of the disorder. Researchers have found gene mutations associated with cervical dystonia. Cervical dystonia is also sometimes linked to head, neck or shoulder injuries.

Risk factors

Risk factors for cervical dystonia include:

  • Age. While the disorder can occur in people of any age, it most commonly begins after age 30.
  • Your sex. Women are more likely to develop cervical dystonia than are men.
  • Family history. If a close family member has cervical dystonia or some other type of dystonia, you are at higher risk of developing the disorder.

Complications

In some cases, the involuntary muscle contractions associated with cervical dystonia can spread to nearby areas of your body. The most common locations include the face, jaw, arms and trunk.

People who have cervical dystonia may also develop bone spurs that may reduce the amount of space in the spinal canal. This can cause tingling, numbness and weakness in the arms, hands, legs or feet.


Sept. 12, 2019

Physical Therapy Guide to Torticollis

ChoosePT Guide

Torticollis is a condition that occurs when the muscle that runs from the breastbone and collarbone up and toward the back of the neck becomes tight, weakened, or thickened, causing the chin to point toward one shoulder, while the head tilts toward the opposite shoulder. The most common form of the condition is congenital muscular torticollis (CMT), which affects infants and is generally observed within the first 2 months of life.

In 1992, the American Academy of Pediatrics began its “Back to Sleep” campaign to reduce Sudden Infant Death Syndrome (SIDS). The campaign successfully decreased SIDS by 40% in the United States, but it had an unintended result of contributing to the development of CMT in approximately 1 in every 250 infants. (Talk to your family physician and/or pediatrician if you have questions about the “Back to Sleep” campaign.)

Torticollis also can occur in adults. Head tilt in children or adults also can accompany other symptoms of more serious conditions.

If symptoms such as trouble breathing or swallowing, weakness in the arms or legs, impaired speech, difficulty walking, a pins-and-needles feeling or numbness in the arms or legs, or urinary or fecal incontinence accompany the head tilt, seek immediate medical attention.


 



What is Torticollis?

Torticollis is the tilt and/or rotation of the head because of tight and weak neck muscles. It occurs when the muscle that runs up and toward the back of the neck (the sternocleidomastoid muscle) becomes tight, weakened, or thickened. There are 5 forms of the condition:

  • Congenital muscular torticollis (CMT) is the most common form of the condition. It affects infants and is generally diagnosed within the first 2 months of life. CMT is often caused by birth trauma, or by sleeping or remaining in 1 position for a prolonged period of time.
  • Postural torticollis is diagnosed when the infant’s head tilt comes and goes. It is diagnosed within the first 5 months of life and often is the result of a lack of a variety of positions, such as when the child is consistently placed in a car seat or other baby “container” for extended periods of time.
  • Ocular torticollis is caused by a vision problem in one eye, causing the individual to tilt his or her head to see better.
  • Spasmodic torticollis (wryneck) occurs in older children and adults. It can be caused by infection, inflammation, trauma, or the side effects of certain medications and/or drugs, such as amphetamines.
  • Acute torticollis occurs when a child or adult bends or twists the neck too far, or experiences some type of trauma. There may be pain when the head is moved from side to side or up and down; the neck muscle may be tender to touch.

Abnormalities associated with torticollis include:

  • Osseous abnormalities, caused by improper alignment of the cervical spine (at the spinal points C1-C2) when ligaments are damaged due to an infection. The types of infection that can cause this condition include severe upper respiratory, ear, or sinus infections; cervical adenitis; or cervical abscess. Any inflammatory process that irritates the muscles, nerves, or vertebrae—including surgery or trauma—can produce a reflex spasm resulting in this form of torticollis.
  • Neurogenic abnormalities, such as a spinal cord tumor or progressive spinal cord diseases, which can cause an acute episode of torticollis, usually in older children. Children may experience headaches, vomiting, and positive neurological signs, like limb weakness (either one side or both sides) and speech difficulties. Seek immediate medical attention if any of these symptoms occur.

Torticollis may lead to additional problems, such as:

  • Flattening of the skull (plagiocephaly or brachycephaly) in infants.
  • Movement that favors one side of the body, affecting the arms, trunk, and hips. This can lead to strength imbalances, such as an elevated shoulder and side-bending of the trunk. This movement pattern can lead to delayed gross motor development.
  • Developmental hip dysplasia.
  • Scoliosis.
  • Limited ability to turn the head to see, hear, and interact with surroundings, which can lead to delayed cognitive development.
  • Delayed body awareness or lack of self-awareness and interaction.
  • Difficulty with balance.
  • Asymmetrical vision changes.

 


Signs and Symptoms

An infant, child, or adult with torticollis may keep the head tilted and toward one side of the body and rotated to the other side of the body, as attempting to straighten the neck is difficult or painful. For example, if the muscle on the left side of the neck is shortened, weak, or in spasm, the head may tilt toward the left shoulder and rotate toward the right.

There may be tightness in the neck or a noticeable lump in the neck muscle called a pseudotumor. Pain may or may not be present, depending on the type of torticollis involved.

 


How Is It Diagnosed?

Torticollis in adults is generally diagnosed by a physician. Experienced pediatric physical therapists may diagnose the need for treatment of congenital muscular torticollis and positional torticollis in infants and children; however, most states in the United States require a prescription from a physician in order for the physical therapist to provide treatment.

Once the type of torticollis is determined, your physical therapist can provide treatment. In most cases, torticollis is a muscular problem, and physical therapists are musculoskeletal experts.

 


How Can a Physical Therapist Help?

Regardless of the patient’s age, physical therapy is the primary treatment for all forms of torticollis. Physical therapists provide treatment to address the impairments caused by torticollis. Early treatment produces the best outcomes. If not treated, torticollis can become a permanent condition.

The physical therapist will work with a child’s caregiver or an adult patient to develop and reach mutual goals. The physical therapist will design an individualized treatment plan to:

  • Strengthen neck muscles
  • Correct muscle imbalance
  • Gain pain-free movement (range of motion)
  • Improve postural control and symmetry
  • Improve the body’s alignment by easing muscle tension

These goals may be achieved through:

  • Gentle stretching of the neck and back muscles
  • Strengthening of the neck and back muscles
  • Massage of the affected area
  • Guidance for correct positioning of infants
  • Taping to elongate the muscles to facilitate stretching
  • A home-exercise program to continue gentle rehabilitation at home

 


Real Life Experiences

Ben is a 4-month-old infant who was born at full-term. Ben’s mom has noticed that since his birth, Ben seems to only like to look to the left with his head tilted to the right. She notices his position never changes in family photos. She decides to ask Ben’s pediatrician about it at his next well-child checkup.

At the checkup, Ben’s pediatrician identifies Ben as having congenital muscular torticollis caused by a traumatic childbirth, and refers him and his mom to a local pediatric physical therapist for an evaluation and treatment.

Ben’s physical therapist asks his mom questions about her pregnancy, his birth, how he sleeps and eats, and his favorite positions at home. Ben’s mom reports that he is her first child, and the pregnancy and birth were uneventful. She says he sleeps well, but prefers to only chew food on one side of his mouth. Ben does not like tummy time and prefers to look only to the left.

Ben’s physical therapist conducts a thorough evaluation, looking at his neck rotation, his trunk, and his positioning on his back, his tummy, on his side, and sitting up. He also examines Ben’s head shape. The physical therapist agrees with the physician that Ben has right torticollis, indicated by the right tilt of his neck and his preference to look left. 

The physical therapist begins treatment with gentle stretching of Ben’s neck; he teaches his mom how to position and hold him to help stretch his neck. He also begins to help Ben start to look to the right, using lights and sounds to his right that make him want to look in that direction. The physical therapist teaches Ben’s mom to complete some positioning and stretching exercises at home, multiple times per day, to help stretch his neck. He also encourages her to position Ben so he has to turn to the right in order to see what his family is doing, or to look at toys.

Ben’s physical therapy treatments consist of weekly visits to the physical therapist, who helps him stretch out his neck and look to the right. He also encourages his movement with fun tummy time, rolling, and sitting up. His focus is on stretching and strengthening the neck muscles.

After a few weeks of treatment, Ben’s mom reports that he can look to the right more and he is holding his head up straighter to look forward. His physical therapist treats Ben weekly for another 2 months to help him and his mom continue to improve his head position and gross motor skills, and advance his home-exercise program.

After 2 more months of treatment, Ben only has to see his physical therapist once a month to ensure that his neck continues to remain stretched and that he holds his head straight, as he progresses through crawling and creeping.

When Ben is 8-months old, he is discharged from physical therapy, thanks to his mom’s faithful completion of his stretching and positioning program at home. She is proud to report that Ben is a happy, healthy baby who now gets compliments about his alert behavior and straight posture!

This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.

 


What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat a variety of conditions, including torticollis. However, you may want to consider:

  • A physical therapist who is experienced in treating individuals with torticollis.
  • A pediatric physical therapist for a child who is affected by the condition.
  • A physical therapist who is a board-certified clinical specialist or who has completed training in pediatric or neurologic physical therapy. This type of physical therapist has advanced knowledge, experience, and skills that may apply to your condition.

You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you are looking for a physical therapist (or any other health care provider):

  • Get recommendations from family and friends or from other health care providers.
  • When you contact a physical therapy clinic for an appointment, ask about the physical therapist’s experience in helping people who have torticollis.
  • During your first visit with the physical therapist, be prepared to describe your or your child’s symptoms in as much detail as possible, including what makes the symptoms worse.

 


Further Reading

The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and prepare them for a visit with their health care provider.

The following articles provide some of the best scientific evidence related to physical therapy treatment of torticollis. The articles report recent research and give an overview of the standards of practice both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.

American Physical Therapy Association. Guide to Physical Therapist Practice 3.0.  Accessed October 2, 2018.

Stringer H. PTs offer hope for treating flat head syndrome in babies. Today in PT. June 7, 2010:30–31. (Article summary is not available.)

Gray GM, Tasso KH. Differential diagnosis of torticollis: a case report. Pediatr Phys Ther. 2009;21:369–374. Article Summary in PubMed.

Ohman AM, Beckung ER. Reference values for range of motion and muscle function of the neck in infants. Pediatr Phys Ther. 2008;20:53-58. Article Summary in PubMed.

Freed SS, Coulter-O’Berry C. Identification and treatment of congenital muscular torticollis in infants. J Prosthet Orthot. 2004;16:S18–S23. (Article summary is not available.)

Mezue WC, Taha ZM, Bashir EM. Fever and acquired torticollis in hospitalized children. J Laryngol Otol. 2002;116:280-284. Article Summary in PubMed.

Long T, Tascano K. Handbook of Pediatric Physical Therapy. 2nd ed. Baltimore, MD: Lippincott Williams and Wilkins; 2002.

*PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.

Revised by Heidi Nelson, PT, DPT, and board-certified pediatric clinical specialist. Authored by Judy Lindsay, PT. Reviewed by the editorial board.

 

Spasmodic Torticollis (Twisted Neck) | Symptoms, Causes and Treatment

What is torticollis?

Torticollis – another name for having a ‘twisted neck’ or a ‘wry neck’ – often happens suddenly. You go to bed without any symptoms one night and then you simply wake up the following morning with a wry neck. This is known as acute torticollis.

It is a very common cause of neck pain and stiffness. However, although it can be very painful when you are affected by it, most people with the condition do not actually need to see their doctor, as simple treatment such as painkillers can be really effective.

Torticollis symptoms

Developing a wry neck (acute torticollis) occurs when the muscles supporting your neck on one side become painful. These symptoms usually come on very quickly, often overnight, so that you wake up with pain and stiffness down one side of your neck.

  • The pain is usually just on one side of your neck and stiffness of the muscles in that area twists the neck to one side.
  • You may find it very difficult when you try to straighten your neck, due to pain.
  • Occasionally, the pain is in the middle of your neck.
  • The pain may spread to the back of your head or to your shoulder.
  • The muscles of your affected side may be tender.
  • Pressure on certain areas may trigger a ‘spasm’ of these muscles.
  • Movement of your neck is restricted, particularly on one side.

Do I need any tests for torticollis?

The good news is that usually you will not need to have any tests to find out what is causing the problem. The diagnosis of sudden-onset wry neck (acute torticollis) is made from the typical symptoms. Many people with milder symptoms diagnose this on their own. Your doctor or a healthcare professional can usually make the diagnosis by performing an examination of your neck.

The examination can usually confirm the diagnosis and will also usually exclude the rarer causes of torticollis. Tests such as an X-rays are not generally needed. Your doctor would only refer you for further tests if a condition other than acute torticollis is suspected.

What causes acute torticollis?

The cause of sudden-onset wry neck (acute torticollis) is often not known. It can happen in people with no previous neck symptoms. It is a common cause of neck pain in young people. There is usually no obvious injury.

However, it may be due to a minor sprain or irritation of a muscle or ligament in the neck. Some reasons for this include:

  • Sitting or sleeping in an unusual position without adequate neck support.
  • Poor posture when looking at a computer screen.
  • Carrying heavy unbalanced loads (for example, a briefcase or shopping bag).
  • Allowing certain muscles of the neck to be exposed to cold (sleeping in a draught).

What are the other causes of torticollis?

Cervical dystonia

Cervical dystonia (also known as spasmodic torticollis) is a problem where abnormal movements develop in the muscles of the neck. It most often occurs in people over the age of 40 years.

You cannot control the contraction of the neck muscles which produce abnormal movements and postures of the neck and head. These can be either twisting (torticollis), being pulled forwards (antecollis), backwards (retrocollis), or sideways (laterocollis).

Cervical dystonia can range from being mild to severe. There is no cure. However, regular injections of botulinum toxin, which paralyse the affected muscles, are the most effective treatment.

Other less common causes

More rarely, torticollis in the neck occurs as a result of other conditions. These include:

  • Infections of your throat or upper airways. These can cause swelling in the lymph glands in your neck or infections in your skin and underlying tissues. The inflammation can trigger a spasm in your neck muscles.
  • Any abnormality or injury of your neck (cervical spine). For example, cervical spine tumours or blood vessel abnormalities.
  • As a side-effect of certain medicines – for example, phenothiazines.

Acute torticollis treatment

The aims of treatment for sudden-onset wry neck (acute torticollis) are to relieve the pain and try to reduce the stiffness in your muscles. The following may be advised:

Exercise your neck and keep active

Aim to keep your neck moving as normally as possible. At first the pain may be quite bad and you may need to rest for a day or so. However, gently exercise the neck as soon as you are able to. You should not let it stiffen up.

Gradually try to increase the range of the neck movements. Every few hours gently move your neck in each direction. Do this several times a day. As far as possible, continue with normal activities. You will not cause damage to your neck by moving it.

You should avoid driving until you can move your neck freely and without any pain.

What about medicines?

Painkillers are often helpful.

  • Paracetamol at full strength is often sufficient. For an adult this is two 500 mg tablets, four times a day.
  • Anti-inflammatory painkillers. Some people find that these work better than paracetamol. They can be used alone or combined with paracetamol. They include ibuprofen which you can buy at pharmacies or obtain on prescription. Other types such as diclofenac or naproxen need a prescription. Some people with stomach ulcers, asthma, high blood pressure, kidney failure, or heart failure may not be able to take anti-inflammatory painkillers.
  • A stronger painkiller such as codeine is an option if anti-inflammatories do not suit or do not work well. Codeine is often taken in addition to paracetamol. Constipation is a common side-effect from codeine. To prevent constipation, have lots to drink and eat foods with plenty of fibre.
  • A muscle relaxant such as diazepam is occasionally prescribed for a few days if the stiffness in your neck muscles is severe.

What about other treatments?

Some other treatments which may be advised include:

  • A good posture. Keeping a regular check on your posture may help. Make sure that your sitting position at work or at the computer is not poor. It is important to ensure that your head is not flexed forward and also that your back is not stooped when you are sitting and working. You should make sure you sit upright. Yoga, Pilates and the Alexander Technique can all improve neck posture but their actual value in treating neck pain is uncertain.
  • A firm supporting pillow. This seems to help some people when sleeping. Try not to use more than one pillow.
  • Heat packs. These can help relax the stiffness in the affected muscles and are useful for some people.

Remember: soft neck collars are not recommended anymore as they can actually worsen and prolong the stiffness.

How quickly does it get better?

The outlook (prognosis) is good. A wry neck (acute torticollis) often improves within 24-48 hours. However, it may take up to a week for the symptoms to go completely. Occasionally, the symptoms last longer or come back at a later time for no apparent reason. Most people who have had torticollis do not have is again in the future.

Torticollis – treatments, symptoms, causes and prevention

On this page

What is torticollis?

Torticollis is when the muscles of the neck spasm and cause the neck to twist to one side.

Torticollis is a common cause of neck pain in young people and it’s not generally associated with a previous neck injury or neck pain.

What are the symptoms of torticollis?

Torticollis usually causes pain on one side of your neck. You may feel pain in the middle of the neck and in the shoulders and head. Your neck may be very tender and if you try to massage the area, to provide some relief, it’s possible your neck muscles will spasm. You may also find it difficult to straighten your neck or turn your head a particular way.

Symptoms of a twisted neck will usually disappear completely within a week, and they usually ease considerably within 1 or 2 days. Sometimes symptoms last longer, but this is not common.

CHECK YOUR SYMPTOMS — Use our neck pain and stiffness Symptom Checker and find out if you need to seek medical help.

What causes torticollis?

Sometimes babies are born with torticollis, for example if there was birth trauma or they have an abnormality in their spine. Children can develop torticollis after a minor injury or inflammation.

In adults, a sudden muscle spasm in the neck may be caused by:

  • sitting or sleeping awkwardly, without sufficient support for your head
  • poor posture, such as at a workstation that is not ergonomically suited to you
  • carrying bags with unequal amounts of weight that cause your neck to strain, for example, a handbag on one side and heavy shopping bags on the other
  • inflammation or infection in the neck
  • a neck injury

Sometimes torticollis can happen due to a neurological problem called dystonia.

When should I see my doctor?

You should see a doctor if:

  • the pain is getting worse
  • the pain doesn’t ease up in a week or so
  • you have numbness, tingling or pins and needles in your arms or legs
  • you start having difficulties with your bladder or bowel, you have a fever as well as neck pain

FIND A HEALTH SERVICE — Our Service Finder can help you find doctors, pharmacies, hospitals and other health services.

How is torticollis diagnosed?

Your doctor will examine you and possibly order an x-ray or CT scan.

How is torticollis treated?

Usually there is no treatment for torticollis other than a heat pack, pain relief and massaging the neck. If a baby has torticollis, you may be advised how to position them during feeding and sleeping and shown how to gently move their head to encourage the neck to stretch.

You should keep active and move your neck as normally as possible. Don’t make sudden movements for a day or so, but then try to carry on with your normal routines and move your head and neck to prevent it stiffening up.

Try gently moving your neck in circles and moving it backwards, forwards and to either side to loosen the muscles and keep your neck supple.

If the torticollis doesn’t improve or you’re worried, you may need to see a physiotherapist or doctor or have further investigations.

Can torticollis be prevented?

To reduce your chances of future episodes of neck pain, you can:

  • improve your posture with gentle stretching exercises, such as those popular in activities such as yoga or Pilates
  • arrange your workspace so that your desk and chair are suitable for your needs. Ask for a footrest if you find that your knees and hips are not level and your feet do not sit flat on the ground. You may also need to move items that you use regularly closer to you, so that you don’t twist or reach too far to find items you need
  • support your neck while sleeping with a support pillow, and sleep with just one pillow
  • make sure your neck is supported in the car by adjusting the headrest so that it is at least at eye level and as close to the back of your head as possible. Don’t drive if you can’t turn your head properly

Complications of torticollis

Very rarely, torticollis may be the sign of something more serious like an infection, an abscess in the head or neck or a neck injury.

Resources and support

These websites provide more detailed information about the causes and management of neck pain.

90,000 Spastic torticollis – treatment, symptoms, causes, diagnosis

Cervical dystonia, also called spastic torticollis, is a pathological painful condition in which the muscles of the neck involuntarily contract, causing the head to rotate or turn to the side. Cervical dystonia can also cause the head to tilt forward or backward uncontrollably.

Cervical dystonia is a fairly rare disease that can develop at any age, even in infancy, but most often occurs in middle-aged people, more in women than in men.Symptoms tend to develop gradually and then peak when they are most pronounced.

Unfortunately, there are no methods of treatment to completely get rid of this disease. The disease sometimes goes away without treatment, but stable remissions are rare. Botulinum toxin injections into affected muscles often reduce symptoms of spastic torticollis. In some cases, surgical treatment can be effective.

Symptoms

Muscle contractions, with cervical dystonia, can lead to head rotation in various directions, including:

  • Chin tilted to shoulder
  • Ear to shoulder
  • Chin lifts up
  • The chin goes straight down

The most common type of curl in cervical dystonia occurs when the chin is pulled to the shoulder.Some people have a combination of incorrect head postures. There may also be head jerking movements.

Most patients with cervical dystonia may also experience neck pain, which may radiate to the shoulder. The disease can also cause headaches. In some patients with spastic torticollis, the pain can be intense and debilitating.

Reasons

In most cases, doctors cannot figure out why some people develop cervical dystonia, while others do not.In some cases, however, the development of spastic torticollis is associated with head, neck or shoulder injuries. Certain medications, such as certain psychotropic or antiemetic drugs, can cause cervical dystonia in some people.

Risk factors

Risk factors for cervical dystonia include:

  • Age. While the disease can develop in people of any age, even in children, it most often begins between the ages of 40 and 70.
  • Paul. Women are more likely to develop spastic torticollis than men.
  • Family history. If a close family member has cervical dystonia or some other type of dystonia, then the patient has a higher risk of developing the disease.
  • Complications: Some people who first develop cervical dystonia later develop similar symptoms in neighboring regions such as the shoulder or face. In addition, disability and pain that can be caused by cervical dystonia can lead to depression.

Diagnostics

The diagnosis of cervical dystonia (spastic torticollis) is made on the basis of the characteristic symptoms of the examination data and the results of instrumental studies.

Physicians may be interested in answers to the following questions:

  • When did the symptoms start?
  • Have symptoms worsened over time?
  • What relieves symptoms?
  • What medications does the patient take?
  • Have you had a stroke or head injury in the past?

Physical examination and medical history help to provide a preliminary diagnosis of cervical dystonia.But for an accurate diagnosis, it is necessary to exclude other conditions in which there may be similar symptoms and to use additional research methods. Tests may include:

  • Blood or urine tests. They can reveal the presence of intoxication.
  • Magnetic resonance imaging (MRI). This type of medical imaging can be used to identify and visualize tumors or diagnose a stroke.
  • Electromyography (EMG). This diagnostic method allows the conduction of electrical impulses in the muscles.EMG helps to assess and diagnose conduction abnormalities in nerves and muscles and helps to confirm the presence of cervical dystonia or other disease.

Treatment

Spastic torticollis cannot be cured. In some patients, symptoms may go away without treatment, but symptoms often recur. Treatment focuses on reducing symptoms.

Drug treatment

Patients with spastic torticollis often need a combination of drugs to reduce the intensity of symptoms.

  • Botulinum toxin. This drug, which is often used to smooth out wrinkles on the face, can be injected directly into the muscles in the neck, which are involved in cervical dystonia. Botulinum toxin is found in medicines such as Botox, Dysport, Xeomin and Myoblock. In most patients with cervical dystonia, after using the toxin, there is a significant improvement, but the effect does not last long and the toxin injections have to be repeated every 3-4 months.
  • Drugs for the treatment of Parkinson’s disease. Medicines used to combat tremors associated with Parkinson’s disease can be used in combination with botulinum toxin injections. Common side effects of these drugs include dry mouth, constipation, memory problems, urinary problems, or visual impairment.
  • Muscle relaxants. These drugs are often not very effective and have side effects, most notably sedation, impaired motor coordination, and mild cognitive impairment.These are drugs such as diazepam (Valium, Diastat), lorazepam (Ativan), clonazepam (Klonopin) and baclofen (Lioresal, Gablofen).
  • Painkillers. Pain in cervical dystonia can be intense and may require the use of over-the-counter and prescription analgesics.
  • exercise therapy. A carefully selected exercise program can improve neck flexibility and reduce muscle spasms.

In cases where conservative methods (including the use of botulinum toxin) do not give an effect, then surgical methods of treatment can be applied.

  • Muscle or nerve dissection may be performed. Selective denervation is not very common.
  • Deep brain stimulation (DBS). In this surgical procedure, a thin electrode is inserted into the brain. The tip of the electrode is placed in the part of the brain that controls movement. Electrical impulses are sent down the wire to interrupt signals from nerve cells that cause the head to turn. HCM is used only in the most difficult cervical dystonia.

Lifestyle

Cervical dystonia is an incurable disease, but following certain recommendations you can minimize the consequences of this disease:

  • Reduce stress. Situations that lead to the development of stress or anxiety should be avoided.
  • Adequate sleep and rest. Symptoms often resolve during sleep, so getting enough rest is important. Even short breaks during the working day, during which you need to lie on your back and relax, can significantly improve your well-being.
  • Use of heat. Heat packs can help loosen tight neck muscles and relieve pain.

Torticollis: what is it, causes, symptoms and methods of treatment

What can darken the joy of a family, into which a newborn man has just entered? Only concern for his health. Examination in the first days does not reveal pathologies in the baby, but some of them may appear a little later, for example, torticollis.

What is torticollis?

Under the influence of a number of factors, the muscular and bone apparatus of the neck is deformed, after which the head turns to one side when it is tilted to the opposite shoulder.Caring relatives sometimes mistakenly assume torticollis in newborns, it is just that the child does not yet know how to twist his head and change position. Doctors must be told about your suspicions.

Torticollis is perhaps the most common orthopedic problem in infants.

Osteopathy considers a defect not as a separate disease, but as a complex of disorders that have a congenital or acquired character during life.

By showing the child to the osteopath soon after birth, it is possible to establish torticollis and other malfunctions quickly and without developing complications, even before the defect manifests itself visually, which usually happens on the 2-3rd week, when it comes to torticollis inherent from birth …

Main types and causes of pathologies

Congenital torticollis is based on damage to the cervical spine or a defect in the formation of the sternocleidomastoid muscle. The muscle is a steam room, consists of two parts, which, uniting from above, are attached to the temporal process and the occipital bone, and from below – the front part to the sternum, the back to the clavicle. The muscles are responsible for turning and tilting the head back, forward, to the side, and also participate in lifting the chest during inhalation, in the movement of the jaws, in swallowing, etc.

Unilateral atrophy with simultaneous hypertrophy of the opposite muscle gives rise to an unnatural turn of the head to the right or left side and up. Compression and compaction of both muscles causes the head to tilt back – this is bilateral torticollis, which is much less common. Attempts to turn the head into the correct position cause the baby to cry, indicating excruciating pain.

Congenital torticollis develops more often and may be caused by unfavorable factors during pregnancy:
  • Infections, intoxication, medications taken, chronic diseases, toxicosis, oligohydramnios;
  • Uncomfortable position of the fetus in the womb, squeezing the head, pressing it tightly against the uterine wall or shoulder, transverse presentation;
  • Muscle shortening due to intrauterine inflammation or other abnormalities of ontogenesis;
  • Umbilical cord entanglement;
  • Fetal hypoxia, insufficient blood supply to tissues.

Often torticollis occurs during childbirth or caesarean section, when the child is pulled by the head, including using forceps or vacuum.

Acquired torticollis develops mainly up to a year, but it is not excluded in adults.

The causes of secondary deformity in babies include
  • Non-observance of the rules for caring for the baby: laying on one side – in the crib, when carrying and feeding;
  • Location of the source of light, sound, toys on one side of the crumbs;
  • Neck trauma, including thermal trauma, inflammation of the lymph node;
  • Strabismus, hearing loss.

Acquired torticollis is easier to prevent, or it is easier to get rid of it with the initial symptoms with therapy.

The occurrence of congenital torticollis is difficult to control and prevent, except for health care and careful preparation for childbirth. As only a symptom, torticollis in newborns is indicative of a general imbalance. In some cases, it is complemented by hip dysplasia and clubfoot due to skeletal deformity.

Concomitant diseases

Timely diagnosed torticollis with a correctly established form is more successful in treatment.Are allocated:
  • Myogenic torticollis, the most common, which is created by shortening and compression of the sternocleidomastoid muscle, subsequently leads to curvature of the spine and facial asymmetry.
  • Idiopathic form. Often of unknown origin, found after difficult delivery, manifested by uneven tension of muscle tissue. The risk of central nervous system disorders is high.
  • Osteogenic type. This is an anomaly in the development of the cervical vertebrae, in which they are shortened and often merge into one.The neck is practically invisible, the turn is limited, then cervical radiculitis (inflammation of the nerve fibers) is likely.
  • Neurogenic. Torticollis of this type is observed with spasmodic contractions of the muscles not only of the neck, but also of the entire body, arms and legs on one side. As a result, the body is strongly curved.

In addition to directly related pathologies and direct consequences of torticollis, there is a high risk of destruction in various systems of the body:

  • Children are lagging behind in development, motor and speech skills are difficult for them;
  • Poor appetite, sleep disturbances, tearfulness;
  • Deficiency of hearing and vision, often one-sided;
  • Head deformation.

Long-term complications are possible years later.

These are painful changes in various parts of the spinal column, distortion of the lungs and deformation of the trachea, asymmetry of the face and skull, malocclusion, compression of the carotid artery and, as a result, headaches, dizziness, cerebral dysfunction, excessive fatigue. In addition, the inner ear may suffer, an imbalance is noted, and the skeleton is skewed to the side.

If the matter is in the acquired manifestations of torticollis, it is necessary to determine the cause and eliminate it, thereby saving the baby from adverse factors and improving the quality of life in general.

There is a risk that, together with torticollis, these circumstances create other abnormalities in a healthy infant.

Diagnosis and treatment of torticollis.

Pathology is noted by a doctor during examination, on the basis of which one or more diagnostic methods are prescribed:
  • assessment of the general condition of the musculoskeletal system;
  • X-ray of the cervical vertebrae;
  • Ultrasound of muscles and blood vessels;
  • Doppler blood flow;
  • consultations of other specialists: neurologist, traumatologist.

Additional examinations may be required: MRI, CT, electroneurography (determination of the speed of passage of nerve impulses).

In order for the treatment to be beneficial and not harm, it is necessary to establish the complete clinical picture of torticollis, to reveal the true origin.

Depending on this, rehabilitation measures are prescribed: exercise therapy, massage, electrophoresis, recreational swimming, warming up, stretching the neck muscles. Corset, collar-splint, head-holder are individually selected, in which the baby will have to spend up to several months.

All this, taking into account healthy living conditions, leads to the external elimination of torticollis, the muscle reaches the required size. In severe cases, a muscle excision operation is performed.

Torticollis also occurs in adults. Residual phenomena from infancy often make themselves felt.

Or, in adulthood, the condition can be caused by the following root causes:
  • damage to the skin in the cervical region by burns, postoperative or post-traumatic scars;
  • destructive processes in the vertebrae of the neck, their subluxation and other deviations;
  • infectious, toxic effects;
  • Disorder of the transmission of nerve signals from the brain to the corresponding muscles, paralysis or spasticity.

The patient will be able to independently feel the lump in the sternocleidomastoid muscle, trying to return the neck to its natural position. From such attempts, palpable soreness arises, radiating to other parts of the body and the head.

Abnormalities in the functioning of various systems and organs can also lead to torticollis, for example, endocrine, when metabolic processes in muscle tissues are disturbed.

In addition to special exercises and procedures, it is customary for adults to prescribe medications and injections to relieve muscle strain.

Torticollis through the eyes of an osteopath

Osteopathic treatment is most effective in the early stages of the disease or, in cases with congenital pathologies, in early infancy, when the body has not yet begun to adapt to the disorders, creating new dysfunctions. Vice cannot exist in isolation.

Removing torticollis symptoms, the osteopath simultaneously evaluates all structures.

Already immediately after birth, when there is no diagnosis yet, the osteospecialist is able to determine the uneven development of muscles or the displacement of the cervical vertebrae.

The doctor collects anamnesis, asking about the course of pregnancy and childbirth, the factor of heredity is also taken into account.

Diagnostics in osteopathy is carried out by palpation and examination.

The study examines the size and shape of the head, the density and tension of muscle tissue, the symmetry of the body.

The osteopath uses all available examination results, and if they were not carried out, he can send them to clarify the type of disease.

At the first session, his task is to relieve increased tone, relieve pain, in order to further deal with the elimination of the cause.

Torticollis does not arise by itself. A newborn could experience oxygen starvation before or during childbirth, and this is fraught with multiple problems in the future, including after growing up. Deformation of the bones or muscles of the neck is an indispensable displacement of the plates of the skull, clamping of the arteries, and impaired venous outflow.

Interestingly, an osteopath is able to tell about the details of birth by symptoms, because a child receives certain injuries during childbirth.

Unfortunately, standard orthopedic treatments, removing a visible flaw, often make the situation worse.How is this possible? After all, the neck muscles return to normal.

The fact is that in case of birth injuries or incorrect position of the fetus, compensatory mechanisms are triggered. The body learns to function under the prevailing conditions, rebuilding the functionality of systems to preserve life. And forced stretching of the muscle can lead to undesirable results, the connection of which with corrective techniques is difficult to establish.

An osteopathic session for the smallest lasts an average of 20 minutes.The manipulations are absolutely painless, sometimes children fall asleep under the gentle movements of the doctor’s hands.

Crying, as a rule, indicates the presence of strong clamps and blocks, and the osteopath works with them as carefully as possible. If the patient is overly concerned, the session is suspended.

It takes time after each visit to adapt to the new condition.

The further course of osteotherapy depends on the type of torticollis, symptoms and stage.

The doctor releases the nerves that affect the tone of the muscle fibers of the neck, parallel to the right of the spinal column along its entire length.Craniosacral techniques are aimed at restoring the balance between the skull and the pelvic bones, between which the cerebrospinal fluid (CSF) rhythmically moves along the spinal canal. When the moving parts of the skull move, the natural rhythm is disturbed, provoking incurable pathologies and ailments that cannot be explained.

Structural osteopathy is aimed at the development of skeletal and muscular mechanisms. Here the osteopath pays attention directly to the fact of torticollis, while simultaneously eliminating the associated changes in the musculoskeletal structures of the body.

The child’s body is malleable, therefore, up to 3-6 months, there is a high probability of completely eliminating torticollis and associated pathologies in several sessions.

Sometimes, after one visit, there is an alignment of the shoulders, ease of turning the head in any direction, a decrease in anxiety and tearfulness.

Peculiarities of working with adults

Treatment of torticollis in older clients may take longer. Sessions last about an hour, and here the osteopath is already engaged in the restoration of all areas of the body.Such a disease does not develop against the background of complete health, even if the outpatient card is almost empty. The more advanced the stage of the disease, the longer the chain of related disorders.

The doctor assesses the quality of the muscular and skeletal systems in movement and at rest, asks to get up, sit down, bend over, bend and rotate the joints. Draws attention to the movement of the sternum when breathing, to the trajectory of the lower jaw when speaking.

What effect of treatment can the older generation expect?

At least to relieve pain and improve general well-being:
  • symptoms of constant fatigue go away, thinking ability is restored;
  • sleep is getting better, good rest is felt;
  • pressure stabilizes;
  • increases the mobility and elasticity of joints and muscles;
  • the functions of internal organs are restored.

After treatment with an osteopathic doctor, many patients say that they seem to have been born again, that they did not know how good they can feel, because an unhealthy state often seems familiar. Torticollis becomes less pronounced, and at the same time other, too “native” diseases go away.

Treatment of torticollis with osteopathic methods will be even more effective with an integrated approach.

Regular exercise, massage and self-massage of the cervical region are recommended.Make it a good habit and prevent the disease from returning.

Prevention of torticollis

Expectant mothers are recommended to undergo osteopathic treatment at least in the last months of pregnancy, as well as at the planning stage. The specialist will correct violations that can complicate gestation and childbirth, and will show you useful exercises.

It is important for both children and adults not to stay in an uncomfortable position, to control the positioning of the head, to master relaxation techniques.

Nutrition, a competent alternation of activity and rest is of great importance.

It is important to remember that the disappearance of symptoms does not equal cure.

90,000 signs, treatment at the clinic. Wayne

Spastic torticollis or cervical dystonia is a neurological disease, one of the forms of focal dystonia, which is characterized by an abnormal position of the head or / and neck due to spasm of the neck muscles, and may also be accompanied by a tremor of the head. Unfortunately, cervical dystonia in adults (spastic torticollis) significantly worsens the quality of life of people, leads to social maladjustment: disability, and the development of social phobias.Patients suffer from pain and depression.

Torticollis in adults: treatment, signs and development of the disease

Torticollis in adults (cervical dystonia) can begin at any age, but most often between 30 and 60 years. Statistically, women develop spastic torticollis a little more often than men. Torticollis usually develops gradually, and only rarely can the onset be acute. Most patients report a slow onset of symptoms and signs of torticollis – from minimal to pronounced – over 5 years.

Signs of torticollis begin with discomfort in the cervical spine, mild pain and stiffness. As a consequence of the contraction of the neck muscles, there may be a slight twitching of the head, similar to a tremor. All these signs and symptoms can be unstable, and manifest themselves with emotional excitement, walking, physical exertion.

Such signs of cervical dystonia (torticollis) can be regarded as a manifestation of myositis or osteochondrosis. Gradually, the symptoms intensify and force you to see a doctor.

In 1/3 of patients, cervical dystonia is transformed into segmental dystonia, when adjacent areas are involved in muscle spasm and additionally blepharospasis (closing the eye), oromandibular dystonia (movement in the lower half of the face in the form of involuntary opening or closing of the mouth), writing spasm is formed. About 5-20% of patients may have spontaneous improvement within 6 months after the first symptoms of torticollis.

Many people can control pathological postures and movements of the neck and head for some time using special techniques: antagonist gestures or corrective gestures, for example, touching the head or neck with a hand, etc.Such “tricks” are unique and specific only for dystonia and are a kind of “diagnostic clue” in almost 70% of patients. The most common corrective gestures are to touch the lower part of the face with a finger or hand to return the head to its normal mid-position. Other more subtle and invisible tricks: stretching the tip of the nose or ear, sucking beads on the neck or biting a pencil, holding the head by touching the occipital region, supporting the occipital region against the back of a chair or a wall.It is interesting to note that even a mental representation of this antagonistic gesture evens out the position of the head.

Signs (symptoms) of torticollis can worsen when walking, carrying heavy loads, emotional stress, excitement, general weakness. At the same time, some patients note that the condition worsens during rest, reading or watching TV.

Today there is an effective treatment for spastic torticollis in adults. Our clinic occupies a leading place in Moscow in the treatment of this disease.The use of botulinum therapy (BTA) for torticollis in adults is today the first line of treatment.

Depending on the posture, there are the following main types of cervical dystonia:

  • Torticollis – turning the head to the right, left
  • Laterokollis – tilting the head to the left or right shoulder
  • Retrocollis – tilting the head back
  • head forward
  • Sagittal shift – head displacement forward or backward
  • Lateral shift – head shift to the right or left

For the treatment of spastic torticollis in adults, contact one of our specialists:

  • Naprienko Margarita Valentinovna
    Chief Physician , Doctor of Medical Sciences, Professor, Neurologist of the Highest Category

  • Yekusheva Evgeniya Viktorovna
    Neurologist, Doctor of Medical Sciences, Professor

  • Latysheva Nina Vladimirovna
    Neurologist, Doctor of Medical Sciences

  • Sazonova Angelina Gennadievna
    Neurologist, functional diagnostician, candidate of medical sciences

  • Mikhailova Svetlana Anatolyevna
    Neurologist, candidate of medical sciences

  • Gubanova (Kadymova) Natalya Borisovna
    Neurologist, candidate of medical sciences functional diagnostician

  • 9004

    Nevrologist Candidate of Medical Sciences

  • Bayushkina Lyudmila Igorevna
    Neurologist

Help with crankshaft

Chronic pain

Torticollis is a disease caused by changes in the soft tissues, skeleton and nerves of the neck.It is manifested by an inclined position of the head with its turn in the opposite direction. The development of torticollis can be based on various reasons, one of the most common is the deformity of the cervical vertebrae caused by osteochondrosis of the spine.

How torticollis occurs

In middle-aged people with the tissues of the spine, age-related changes begin to occur. And first of all it concerns the intervertebral discs – they are deformed, stratified, thinned.This is how osteochondrosis manifests itself – a degenerative disease of the spine. A sedentary lifestyle, lack of regular physical activity, excess weight, sedentary work of a modern person are additional negative factors that aggravate the process.

Changes in tissues entail metabolic disturbances in the spine. In addition, due to deformation, the roots of the spinal nerves and blood vessels can be squeezed, which leads to pain and deterioration of blood supply.If osteochondrosis affects the cervical spine, the brain suffers from a lack of blood supply, and pain can spread to the occiput and forehead, shoulder, scapula and interscapular region 1 . Against the background of cervical osteochondrosis, a condition of acute torticollis may occur.

As a rule, it makes itself felt in the morning after sleep. A striking sign of torticollis is a slight tilt of the head. Additional symptoms are muscle tension and soreness when the neck is extended, which limits its mobility.This condition can last from a few days to a couple of weeks.

Treatment of torticollis

With pain in the neck, you should try to get a doctor’s advice in a timely manner, since changes in the cervical spine lead to further complications. The most dangerous among them are cerebrovascular accident and the development of scoliosis. In addition, the symptoms of many diseases are often similar; only a qualified specialist can correctly assess the clinical picture and establish an accurate diagnosis.

Treatment of torticollis is always selected in a comprehensive manner. It includes both drug therapy and physical therapy, orthopedic treatment, physiotherapy exercises aimed at relaxing and strengthening the muscles of the neck.

Non-steroidal anti-inflammatory drugs of local action – a variety of ointments, gels and creams – are an effective remedy for relieving local pain in torticollis. One of them is Aertal® cream. It is an aceclofenac-based drug with established clinical efficacy and good tolerance 2 .

Aertal® cream relieves pain, relieves swelling and inflammation. After application, the active substance of the drug is absorbed from the application area, quickly reaching saturation.

For the treatment of torticollis, the remedy is applied topically three times a day. A small strip of cream should be applied to the painful area with light massaging movements. The dose depends on the size of the affected area: 1.5–2 g of Aertal® cream approximately corresponds to a strip of cream 5–7 cm long.

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1 Levin O.S. Diagnostics and treatment of pain in the neck and upper extremities // Russian medical journal No. 9 dated 05/03/2006. P. 713.
2 AIRTAL® instructions for use.

About cream

Aertal ® cream has anti-inflammatory, analgesic and decongestant effects.

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Treatment of torticollis in a child in Krasnoyarsk

Treatment of torticollis in Krasnoyarsk

  • Initial appointment and accurate diagnosis;
  • Individual treatment program;
  • The appointment is conducted by an experienced orthopedic surgeon with over 15 years of experience.

Get advice

Torticollis is a pathology of the cervical spine with a forced tilt of the head to the side and limitation of neck mobility. Torticollis in infants can be congenital or setting (occurs when the baby is mistreated during childbirth, further care). This condition is easy to cure if you consult a specialist in a timely manner.

Reception is conducted by a doctor

Shalaev Sergey Alekseevich – doctor of medical and physical rehabilitation, traumatologist-orthopedist, manual therapist.She has extensive experience in working with children. Work experience 15 years.

Signs of torticollis in a child

While the baby cannot hold his head, it is quite difficult to notice signs of torticollis. However, upon closer inspection, you will notice the following:

  • The head is set low and constantly turned to the side.
  • The kid does not turn his head, but looks over his shoulder.
  • 3 weeks after birth, the muscle on the neck thickens, you can feel a thickening, which gives the baby discomfort.
  • The baby is actively nursing only one breast.
  • Constant lying on one side can cause asymmetry of the skull, face shape.

A more accurate diagnosis can only be made by a doctor. Krasnoyarsk Institute of Traumatology invites everyone to a consultation and examination. Our specialists will prescribe a therapy that will allow you to completely get rid of the pathology.

Treatment of the disease

To make a diagnosis, you will need to undergo an examination.You may be prescribed ultrasound, MRI, neurosonogram, Doppler of the neck vessels, consultation with an orthopedist, traumatologist. Treatment can begin at 2–3 weeks of age. Torticollis in newborns is treated conservatively. The following methods give a good effect:

  • massage – our specialist will conduct several sessions and teach you how to stretch your neck muscles;
  • Remedial gymnastics – effective exercises that you can repeat at home will be selected for you;
  • classes in water – they will be held in the pool, you can repeat the exercises at home in the bath;
  • use of orthopedic structures – if necessary, the orthopedist will prescribe the wearing of a cervical brace or Shants collar;
  • taping – the muscle will be fixed with special adhesive tape, which will make it work correctly;
  • electrophoresis – a weak painless current discharge will deliver the medicine prescribed by the doctor to the muscle;
  • manual therapy – a specialist will correct the condition of the cervical spine and give the neck a natural position.

If after 4-5 years the prescribed therapy has not worked, surgical intervention may be required.

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Krivosheya – ProMedicina Ufa

Torticollis – a disease in which there is a tilt of the head with its simultaneous rotation in the opposite direction.It occurs as a result of pathological changes in the bones, nerves and soft tissues of the neck. Can be congenital or acquired. Congenital torticollis is an intrauterine malformation, acquired can develop as a result of pathological childbirth, trauma, infectious diseases and diseases of the nervous system. Torticollis can result in deformities of the skull and spine, neurological disorders, impaired intellectual development, decreased memory and attention, and impairment of respiratory function.

Reasons

Congenital torticollis appears in the prenatal period as a result of an infectious disease of the mother or fetus, pathology of the mother’s pelvis, improper position of the fetus relative to the pelvis, genetic and chromosomal diseases.Acquired torticollis can appear as a result of pathological childbirth with injury to the muscles of the neck, dislocation, ischemia, entanglement with the umbilical cord, and can occur at a later age due to infection, trauma, diseases of the nervous system.

Symptoms

It is possible to detect pathology in a child if you closely monitor his condition and behavior. Obvious symptoms of torticollis:

– The child keeps the head tilted to the right or left.
– The kid constantly turns his head to one side.
– The baby is unable to keep his head upright in a straight position.
– The part of the neck on the side to which the baby turns his head becomes stiff to the touch.

If you find these signs, you should see a doctor as soon as possible. If measures are not taken in time, then the child may experience such consequences as disproportionate development of the skull, asymmetric position of the eyes, mouth and other parts of the face. The large side of the neck is shortened, the tissues on this side are denser.The entire structure of the body is gradually changing. First of all, the clavicle and shoulders are subjected to deformation. Over time, scoliosis develops due to the inability to keep the head upright.

Diagnostics

The basis of diagnostics is a thorough examination of the child by an orthopedic doctor and a visual assessment of the position of the head, palpation of the muscle and its comparison with the healthy side, setting the head in the required position.

For the purpose of additional diagnostics, an X-ray of the cervical spine is performed, sometimes an MRI of the cervical spine will also be used.

Treatment

Treatment of torticollis depends on its type. Both conservative and operational methods are used. The earlier treatment is started, the faster it is possible to correct the pathology. Therefore, it is important to seek medical attention immediately if any symptoms of the disease occur. Treatment is prescribed by an orthopedic traumatologist.
Congenital muscle torticollis sometimes requires surgical treatment, for example, if the muscle has a scar, it must be excised.The duration of treatment is established and depends on the severity of the disease, the timeliness of the diagnosis.

Installation torticollis with timely diagnosis is most easily treated. It is necessary to carry the baby correctly in your arms. Lay the child on the side that the specialist advises. Sometimes even these elementary measures are enough. But only if torticollis in newborns is detected in the early stages. Medical gymnastics, massage, physiotherapy methods are also prescribed.

Treatment of spastic torticollis should be carried out depending on the reasons that caused it. In infants, this is a pathological condition caused by an incorrect position of the head during pregnancy. It is treated with massage and wearing a Shants collar.

If spastic torticollis is caused by osteochondrosis, osteochondrosis should be treated. Special medications are also used to relax the muscles.

90,000 Torticollis: Causes, Symptoms, Treatment | doc.ua

Due to the development of neck deformity, as a result of the processes of development and growth of the child, there is a deformed posture and the skeleton as a whole, there is a disturbed symmetrical development of the head.

Torticollis in children is a fairly common pathology, which is more often observed in girls. In some cases, it is considered as one of the developmental defects.

Torticollis in newborns is the third pathology, taking its place after congenital clubfoot and hip dislocation.

In the vast majority of cases, people have muscle torticollis.

Classification

In medicine, the disease is divided into two main types of torticollis
  • congenital torticollis is a form of the disease that appears in a child at birth;
  • acquired torticollis is a form of the disease resulting from abnormalities in the development of the skeleton or disorders of muscle tone.

Anatomical landmarks of tissues affected by the disease allow us to identify several more varieties of torticollis.

Anatomical views of torticollis
  • cutaneous form – the skin and subcutaneous tissue are affected;
  • desmogenic torticollis is the result of inflammatory processes in the neck, for example, abscesses, phlegmon or lymphadenitis;
  • myogenic – a consequence of muscle tissue damage;
  • neurogenic form – a form of a disease in which the receptor musculo-nervous apparatus is affected, followed by a violation of muscle tone;
  • arthrogenic torticollis – develops as a result of damage to the joints of the cervical spine;
  • osteogenic – a form in which the osteochondral apparatus is affected, additional processes of the cervical vertebrae, false cervical ribs, etc. are formed.etc .;
  • installation torticollis – develops in children, as a result of the child’s stay in one position for a long time;
  • Spastic torticollis is a form of muscle torticollis, also considered a form of development of a disease called dystonia.

Reasons

The main reasons for the development of torticollis are known. Torticollis in adults or torticollis in children is formed by damaging the sternocleidomastoid muscle, which is directly involved in the process of nodding, bending and turning the head.

Congenital muscle torticollis is fraught with the fact that against its background, a shortening of the neck develops inside the womb due to underdevelopment.

Also, the development of the disease can take place against the background of prolonged incorrect positioning in the process of intrauterine development, the cause of which is insufficient load on the muscle.

Torticollis can also form during childbirth due to muscle damage resulting from a birth trauma and accompanied by muscle rupture, stretching, hemorrhage, or gross manipulations of doctors, for example, pulling on the head.In addition, the formation of torticollis during childbirth can be affected by the delivery in the breech position, in which there is an incorrect removal and tilting of the head of the newborn.

After birth, a child can get torticollis due to a long stay in one position, or as a result of constant lying in an uncomfortable bed.

Symptoms

The main symptoms of torticollis are very pronounced. Muscle torticollis tends to develop after 2–3 weeks of birth.It differs in the invisibility of the first manifestations, therefore, the signs can be determined by experienced parents or exclusively by an orthopedist.

When a newborn reaches three weeks of age, a thickening and a process of significant muscle compaction is observed in the neck region on one side, most often in the middle or lower third of the muscle.

Over time, an increased manifestation of torticollis symptoms will occur, when trying to feel the cervical region, the child’s capriciousness may appear, he may frown, when he tries to turn his head in the other direction, the child starts crying or the attempt has no result.

In case of severe manifestations of the disease, the process of deviation of the head towards the affected area is observed, the patient’s face turns towards the healthy muscle, the pathological state of the head goes through the stage of fixation.

In the absence of timely correct therapy, the affected muscle becomes shortened and hardened, and atrophies over time. The skull undergoes deformation processes, the cranial surface is smoothed on the affected side, the skull becomes asymmetric, and the head is fixed in a pathological position.In the case of severe lesions, the shoulder of the affected side may rise, the facial and cerebral parts of the skull are markedly deformed.

On the side of the back, the formation of cervical scoliosis occurs, the asymmetry of the skull in the ear and cervical regions, the muscles are subject to deformation.

Diagnostics

The diagnosis of this disease is based on the examination of the child by an orthopedist, during which a visual assessment of the correct positioning of the head is carried out, the palpation of the muscles and comparison with the side that is not subject to pathology, the head is set in the correct position.

Additional diagnostics is carried out using X-ray of the cervical spine, in some cases the use of MRI of the cervical spine is acceptable.

Treatment

Muscle torticollis of newborns can be cured with the use of conservative methods of treatment of this disease, since damaged muscles can be stretched and developed due to the flexibility of the muscles and tissues of the body.

Such treatments for torticollis include
  • special laying on the side in order to stretch the muscle through the position;
  • special massages aimed at increasing muscle tone, activating the blood circulation process and eliminating the inflammatory process;
  • use of special orthopedic constructions, for example, Shants collars;
  • the use of heating pads, sollux lamps, the use of electrophoresis;
  • the use of a special position of the child during sleep using rolled up towels and rollers, which are placed under the child’s back.

In the case of a severe lesion, in which the severity of defects is observed, the use of surgical methods for correcting the pathology is permissible.

The average time for elimination of torticollis is 5–6 months, during which the processes of gradual stretching of the damaged muscle and its gradual alignment with the healthy one take place. The average rehabilitation period after torticollis cure in case of an operation is from two or more months.

Operative methods of treatment are used for children over 2 years of age in case of severe dermogenic and muscle defects.Muscle lengthening is carried out artificially, after which special structures are applied, physiotherapy exercises, massages and gymnastic exercises are prescribed, which allow to raise muscle tone, stretch and develop the affected muscle.

On average, rehabilitation after surgery takes 2 or more months.

The prognosis with timely treatment of torticollis is favorable, it disappears without a trace.