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Treating Torticollis in Infants

topic posted Sat, August 4, 2007 - 1:08 PM by  Unsubscribed
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Does anyone have any experience working with toticollis "wry neck". I am treating an infant who had birth trauma causing damage to the sternocleidomastoid muscle in the neck.

In torticollis the SCM heals at a shorter length and causes the characteristic head position.
A mass in the affected muscle is noted, which is a contracted region of muscle and includes fibrosis (scar tissue).

With infants the slow approach is always best. It is so easy to move their whole body, especially for a dural tube glide. Infants especially respond very well to CST, but in shorter doses.

The CST is in conjunction with physical therapy. I am wondering at what age it would be appropriate to actually massage the muscles in the area of the neck, seems tender now.

Any help or input is appreciated.
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  • Re: Treating Torticollis in Infants

    Sat, August 4, 2007 - 8:10 PM
    Traditional approaches to treating congenital (infantile) torticollis focus on stretching of the muscles involved. I find it helpful to gently "unwind" the neck muscules prior to any stretching, by first taking the head into several positions of "ease" resting there and then following the movements inot the next direction of ease. The stretching is very similar except that the infants head is gently brought in the direction in whichthe ROm is restricted. Sometimes, the smae typs of positions of ease that initiate unwinding can be found by carefully taking the infants head into the restriction a little at a time, after each movement, the new position is held in an attempt to facilitate further unwinding. I think it is not only appropriate, but actually neccessary to directly massage the involved musculature of the infant immediately, regardless of age. The smaller the child and more tender the area the gentler the touch and more precise the practitioner needs to be, but directly addressing (or at least assessing) the involved body parts is required. While it is true that sometimes the muscle is actually shortened more often it is not truly shortened but rather contracted due to adhesions within the muscle itself or subluxations causing aberant proprioception which result in unilateral muscle contractions.

    Good luck and hope this helps!!!
  • Dom
    Dom
    offline 7

    Re: Treating Torticollis in Infants

    Mon, August 13, 2007 - 4:57 PM
    Hey, Everyone,

    When working with any torticollis, particularly secondary to birth trauma, I always make sure that there is no compromise of the spinal accessory nerve (XI). This cranial nerve ennervates the SCM, and, when irritated, can send signals to the SCM to keep it constantly "on".

    Of special concern is the spinal accessory nerve's path through the jugular foramen. Pressure on the infant's skull can easily compress the temporal bone on the occiput, directly effecting the jugular foramen and everything passing through it.

    Dom
  • Unsu...
     

    Re: Treating Torticollis in Infants

    Sun, August 26, 2007 - 4:34 PM
    Treatment Update.

    Thanks to everyone for the great advice.

    There is a strong link between toricollis and difficulty in breastfeeding. The infant I am treating wheezes when feeding. This is a direct symptom of the toricollis. The cause of this high pitched noise is in fact well explained when considering Dom's reference to Cranial Nerve XI which innervates the jugular foramen region aka the "windpipe".

    Weaving in the post by Doc Michael, the unilateral muscle contractions are present whereby the infant can suck the right thumb at ease, but not so with the left side (the affected side). The diminished development of proprioception and correlated weakness in muscle strength and control is evident.

    Another aspect of this case is the frequency of bowel movements. While an infant should soil 4-8 diapers per day; my patient only pooped once every 2 days for the first 2 months of his life. After his second CST session at 8 weeks of age, he is now pooping 2-3 times a day. Perhaps this is vagus nerve related.

    Many cases of torticollis are not discovered until the infant is 4 to 6 month's of age. In the case of my patient, the mother noticed a lump-fibrous tissue on the left SCM at the mastoid process when the baby was 3 weeks of age.

    The baby was seen by 4 pediatricians (3 at hospital, one at one week outpatient well baby exam) they all missed it. To be fair, considerable edema exists for the first few weeks and newborns can look quite contorted.

    After the next pediatrician visit, it was revealed that the left clavicle was broken during the birth (suction was used). Big props to Dr. Gerwin at Bayside Pediatrics in Berkeley who prescribed CST in addition to PT. Gotta love a MD who refers to craniosacral therapists.

    The combo of craniosacral, phyical therapy, and parental massage should result in a favorable prognosis.

    Final Notes
    *Performing CranioSacral on infants is a joy because you can move them in three dimensions with ease.
    *Check for toricollis in cases of difficulty in breastfeeding or wheezing when feeding.
    *Untreated toricollis will delay physical development milestones such as neck control, walking and crawling.
    *There is a pediatric CST class offered by Milne Institute (no affiliation) in Berkeley on Sept. 8-11.
    • Unsu...
       

      Re: Treating Torticollis in Infants

      Mon, September 3, 2007 - 3:12 PM
      I will be joyfully taking this Milne class. Benjamin Shield is an excellent teacher. He had loads to say about polyvagal syndrome, compression along the pyramidal tract, CP and autism in his 2-14 year old class.
    • Re: Treating Torticollis in Infants

      Fri, September 7, 2007 - 11:47 AM
      Excellent post Andrew!!!

      A few other things that you have already probably deduced. The commonality in all these things wryneck, difficulty breastfeeding, upper respiratory problems, vagal nerve involvement and spinal accesory nerve involvement is...the upper cervical region. Treatment should focus on releasing/unwinding the atlas and the associated tissue. There is also quite often a rotary type subluxation (misalignment) at C1/C2. Also, the fibrous lump that the mother found at 3 weeks of age usually takes at least that long to develop and quite often does not appear until later 4-6 months not being uncommon. Shoulder/clavicle involvement is not uncommon as you related with the broken clavicle. Sometimes there is also an association with klippel-feil syndrome, which involves a accessory rib and a scapula that fails to descend.

      Thanks for sharing,
  • Unsu...
     

    Re: Treating Torticollis in Infants

    Thu, October 18, 2007 - 9:33 PM
    4 Month Update

    The case keeps getting more interesting. At about 4 months of age the infant received a double CST session (2 practitioners). The baby went through a complete re-birthing, being born the way he would have preferred...slow and gentle. Weaved into the session are the very physical side of CST: stretching the SCM, unwinding the clavicle and a/c joint.

    After the session the baby produced a very green bowel movement: meconium. Neither parent has seen this color since the 3rd or 4th day of the infant's life. The bm before and after were both characteristic mustard color. The only explanation is that the CST released the meconium that was stuck in his intestines. Wow-to think you could retain fecal matter in your intestines your entire life, including your in utero time!

    At this time the parents were recomended not to lift the baby from under the armpits. Does that seem like good advice?

    Also, they were told to not assist the infant to stand although the baby is attempting to stand. What is the consensus here: place pressure on the hips or not when the sacrum is balanced?

    Om Shanti!
    • Dom
      Dom
      offline 7

      Re: Treating Torticollis in Infants

      Fri, October 19, 2007 - 8:58 AM
      Hey, Andrew,

      This is an unusual case, but you're not giving us enough info. First of all, I thought you were giving the treatment, but, if that were the case, who is recommending the baby not be picked up under the armpits? The only way to judge this advice is to ask about the reasoning behind it. We cannot really say much about this without more infomation. Ditto for the standing advice.

      As a practitioner, and having worked in ER's sewing up kids and resetting bones, I have seen how fragile, yet how resilient humans (particularly young humans) are. We have to trust the life force that is within all of us. It is this force that we reach out and communicate with when we do cranial work, and it is this force, not us, that does the healing. If a treatment has been done correctly, and this force has taken hold and effected healing, then something as minor as helping a baby stand should not get in its way. In fact, unless you're throwing your baby across tha room, I would encourage all the touch you can manage with your child.

      Again, I say this not knowing the reasoning behind this advice. As far as the meconium goes, that happens, and I've heard of it happening up to one year of age. Gastric emptying happens many times with adults, as well, but, for some reason, after age 16, clients usually vomit and have healing occur only after this event (if this is what the body needs).

      I'm glad this child's dysfucntion has resolved, and, please, give us more up dates as you can.

      Namaste
      Dom
    • Unsu...
       

      Re: Treating Torticollis in Infants

      Thu, June 11, 2009 - 5:45 PM
      I feel you have to understand that cervical dystonia in not "wry neck", though the movements may be similiar. I am not a Doctor nor do I play one on television but I am a 49 year old man who has suffered from ideopathic Cervical Dystonia for nearly 28 years.

      From what I understand "wry neck" is a curable condition which is reversable and usually effects Infants, and again, is not a lifelong curse.

      Cervical Dystonia or Spasmodic Torticollis usually strikes older individuals. There is also adolecent onset but most times it will develop later in life. It is important to understand that Cervical Dystonia is a Neurological condition and Wry Neck is not.

      In my "amateur" opinion, Torticollis is not a disorder that effects infants. Then again ideopathic Cervical Dystonia is misunderstood by many, including some Doctors. It has been mistakenly diagnosed as Parkinsons or MS for years. The turning and twisting of the head are firstly treated with medication such as Baclofen, Klonopin, Artane or Sinemet. If the person is not dopa responsive, and most of us are not, Sinemet is pretty much useless. As adults are treated with meds as the first level of defense. Regular Botox injections in the neck became popular in the 1990's and has brought relief to many of us. The problems w/Botox is that the long term effects are not known (it is food poisoning after all) and resistance may be as such as if you get too much accumulated (which depends on the individual) it stops working. Botox (B) can be substituted but does not work as well as Botox (A).

      The last alternative is surgery. In the early 90's cutting muscles around the neck, which was unfortunate, as it did not work. DBS (Deep Brain Stimulation) which involves a kind of "pacemaker for the brain" has become popular though it is brain surgery. Holes are drillied into the patients head, electrodes are placed into the brain stem, then internal wires are connected into a pacemaker of sorts that controls the Dopamine levels giving most patients long term relief (though the batteries have to be replaced every 4 years or so).
  • Unsu...
     

    Re: Treating Torticollis in Infants

    Fri, December 14, 2007 - 11:03 PM
    6 Month Update

    The fibrotic lesion on the SCM is almost imperceptible. Full neck ROM has been restored.

    The remaining issue is weakness in the left arm and shoulder. Since the baby is likely right handed, this could be more pronounced as he favors his right hand.

    What is interesting to me is the union of physical therapy and CST, both are necessary to correct torticollis. PT sessions are usually instruction session for the parents and caregivers on exercises for the child. Parent education and follow-through are an important factor here and definitely something to consider when taking on such a case.
  • Unsu...
     

    Re: Treating Torticollis in Infants

    Thu, January 24, 2008 - 6:30 PM
    Its back.

    Evidently, growth spurts and developmental milestones cause the torticollis to flare up again, much to the chagrin of the parents.

    Just when you think your on top of it, the baby grows an inch or two and the lesion pattern returns.

    Now the PT's at Children's hospital want to do a neck brace of sorts to keep the head neutral. My first thought is that keeping a 7 month old in a neck brace for 12 hours a day will atrophy the muscles. But I am out of my league on that, having no experience with braces.

    The mom expressed concern about the brace and the PT agreed to a 2 week wait and see period because sometimes the head tilt returns only for a few days after a major growth spurt.

    Any thoughts or advice?





    • Re: Treating Torticollis in Infants

      Sat, February 2, 2008 - 5:51 PM
      Bracing a 7 month old neck against torticollis is tantamount to torture. Not only could it cause muscles to atrophy, it can also create tensile and compensatory forces which can create misalignment in the infants cranial and cervical spine. The SCM attaches to the mastoid which is part of the temporal bone. Increasing stress at this attachment point can increase the tension upon the fragile infantile cranium. Phagiocephaly due to prolonged muscular pull is already associated with congenital torticollis. Bracing the infant's head in Neutral, can actually increase the tension at the attachments of the hypertonic muscles, if this bracing is done while the torticollis is active. I was actually in shock that this was even being considered, so I doubled checked 3 different treatment and diagnosis manuals for congenital torticollis. All of them suggest stretching, massage, gentle mobilization and manipulation, and moist heat as treatment. None mention bracing as an alternative.


      I did find the site of the company that produces braces that has links to a few articles and guidelines for their use.

      symmetric-designs.com/tot-collar-.html

      I would suggest an intensive series of CST (or SOT) sessions prior to proceeding with the brace as well as regular CST sessions if they decide to go ahead and use one.
      • Unsu...
         

        Re: Treating Torticollis in Infants

        Mon, February 4, 2008 - 9:59 PM
        Thanks Dr. Michael.

        I agree with everything yo have written. I am also a little confused and wondering if you or anyone else can comment..

        1- the brace can cause neck muscle atrophy.

        The right SCM is overdeveloped since it has been working overtime and left SCM is underdeveloped. How can you encourage muscle development in the left SCM only? How can you discourage the right SCM from building up more, shouldn't it be allowed to atrophy a little?

        2- The brace can create tensile forces that can misalign the cranial and cervical spine.

        Currently the infants head is already tilted and he is growing without his eyes on a horizontal plane, so I am assuming there is some misalignment of the cranial and cervical spine. Would the brace make this worse?
  • Re: Treating Torticollis in Infants

    Sun, September 4, 2011 - 7:49 AM
    Hello Unsubscribed.

    I realize that you made this post years ago but I was wondering if there was anyway you could help me? It seems my 5.5 month old has all the same issues and she is also getting craniosacral therapy. She has a bowel movement 1-2 times a week and she had a huge meconium bowel movement in utero. She's constantly pushing and straining in pain. I was wondering if the baby you worked on had any other symptoms than what you decribed? Can you possibly describe how you performed the double CST session to release the meconium?? Perhaps I could mention it to my chiriopractor! Please help!!!!

    yndi
    • Re: Treating Torticollis in Infants

      Tue, September 13, 2011 - 9:13 AM
      Cyndi,
      I can't give you advice but if the baby belonged to me and was making bowel movements infrequently with the history of making a stress shit in labor.
      I would seek to find an osteopathic M.D. and discontinue other options and just use the M.D. or perhaps Indian medicine in addition .
      I am not sure whether internal medicine doctor would help but I might would consider as well and if you have an ultra sound when pregnant get an order for the physican to look at those too.
      The reasons would be sometimes treatments and adjustments can be overly stimulating for some infants causes sensory overloads the baby's neuorology is still wiring and developing .
      I am *not* sure whether constipation is to be expected as a prognosis for infant who have the descriptions given here has problems with constipation.
      Nor whether you are soley bottle feeding or breast feeding or if foods have been instroduced.
      Constipation sometimes is dehydration or undeveloped internal organs one might think such would show up before five months though.
      There several internal organ considerations as to why you may want to get to the M.D. Osteopathic or any M.D. first.
      I can't say either way if these are truths but I would do so and as a parent please consider all options available for the child's well being.
      I would also probably instroduce fish oil and blue berries slowly to the infant diet if I chose to feed her other than breast milk so young or I would ingest those items myself and the breast milk would have such.

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