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  • Writer's pictureRobin R Varghese, PT.

"Torticollis." Are you feeling like a folly with no life's jolly? You are not to loose hope.

Updated: Apr 28, 2023

Torticollis

  • Torticollis refers to a condition in which the sternocleidomastoid muscle is shorter (and sometimes tighter) on one side of the neck, causing the head to tilt toward the shortened muscle, while at the same time the chin rotates in the opposite direction.

  • This condition (also known as wry neck or loxia) can be observed at all ages, from newborn children to adults, and it can be acquired congenitally or postnatally.

  • Derived from Latin words Tortus (twisted)+ Collis (neck or collar)

Types:




The two types are Congenital and Acquired Torticollis.

Congenital torticollis.

  • Some children are born with torticollis

  • There are three types of congenital muscular torticollis:

  1. Postural - occurs in 20% of cases - the infant will have a postural preference, but they do not have any muscle restrictions or reductions in passive range of motion

  2. Muscular - occurs in 30% of cases - the infant will have SCM tightness and a reduction in passive range of motion

  3. Sternocleidomastoid mass - occurs in 50% of cases - the infant will have thickening of SCM and restricted passive range of motion

Acquired torticollis.

  • Acquired torticollis may be caused by irritation to the cervical ligaments from a viral infection, injury, muscular spasm or vigorous movement.

  • Adult torticollis, also referred to as cervical dystonia or spasmodic torticollis, is a condition in which the muscles that control the neck are locked into a sustained involuntary contraction.

  • The study by Qiyu Chen et al. suggests that the presence of Head Tremors (HT) and its type depend on a patient’s predominant posture. (patients with retrocollis were more prone to have HT than patients with anterocollis), age (earlier age of onset compared to patients without HT), and duration (longer disease duration compared to patients without HT)


Cervical dystonia can subdivide into two groups:


  • Primary (or idiopathic) cervical dystonia

Primary dystonia, also called idiopathic dystonia, is characterized by the absence of lesions of the basal ganglia

  • Secondary cervical dystonia (or symptomatic).

Secondary cervical dystonia may follow trauma, drug use, or be the result of a pathological trigger. Its origin is, therefore, linked to a known external factor.




Causes


Experimental models of torticollis show that torticollis can result from both local factors and central nervous system disorders

  • It is muscular in more than 80% of the cases. Types of muscular torticollis:

– Fibromatosis colli: torticollis with palpable mass in the SCM;

– Tightness of the SCM without an apparent mass;

  • Postural torticollis with neither mass or tightness.

  • Birth trauma: facet dislocation, tears in the sternocleidomastoid muscle

  • Congenital anomalies of the craniovertebral junction.

  • Sternocleidomastoid tumor.

  • Ocular abnormalities.

  • Intrauterine mechanical factors

SYMPTOMS seen in Torticollis

  • The twisting of your neck (torticollis) occurs when your muscles supporting the neck on one side are painful.

  • The pain is usually on one side of your neck and stiffness of the muscles in that area twists the neck to one side.

  • Difficult to straighten neck, due to pain. Occasionally, the pain is in the middle of neck.

  • The pain may spread to the back of head or to shoulder. The muscles of the affected side may be tender. Pressure on certain areas may trigger a ‘spasm’ of these muscles. Movement of neck gets restricted, particularly on one side.

Treatment

Oral Medications

In the early stages of cervical dystonia, medications used in low doses (ex. benzodiazepines, baclofen, or anticholinergic agents) may be useful. Anticholinergic agents were reported to have better outcomes than in those receiving benzodiazepines or baclofen. Side effects may include dry mouth, cognitive disturbances, diplopia, drowsiness, glaucoma, or urinary retention. So we strongly recommend you to consult with you practitioner before starting with your medication.


Surgical

Selective Peripheral Denervation

This surgical approach denervates muscles responsible for abnormal movements and reserves innervation to muscles that are noncontributory

Deep Brain Stimulation

The use of DBS of the globus pallidus internus (GPi) or the subthalamic nucleus (STN) was implemented in patients with intractable cervical dystonia. This surgery involves the placement of microelectrodes into the GPi, typically bilaterally, with identification of the GPi and guidance of the microelectrode placement by micro stimulation.


Physical Therapy Management

  • Rest.

  • A good posture.

  • A firm supporting pillow.

  • Heat pack

  • Positioning.

  • Gentle range of motion exercises for neck.

  • Stretching of sternocleidomastoid muscle.

  • Strengthening exercises

  • Developmental facilitation

  • Aggressive repositioning

  • Helmet therapy for infants with moderate to severe and persisting asymmetry.

  • Education, guidance and support can reassure and help parents on positioning and handling skills to encourage active neck rotation towards the affected side and to discourage side flexion to the affected side

Little research has been done on physical therapy management of adult torticollis.

  • Vibratory stimulation

Karnath et al. documented the effects of vibratory stimulation on a single patient. Vibration directly to the contracted muscle, with a duration of either 5 seconds or 15 minutes, demonstrated the ability of the muscle to relax, and normal head posture to be assumed. Relaxation times were not documented, but it was reported that the patient was able to maintain a relaxed position for a longer time following the 15 minutes treatment


  • Muscle relaxation, isometric muscle contractions, exercises and stretching

Zetterberg et al conducted an ABA-style case series studying the effects of progressive muscle relaxation, isometric muscle contractions, exercises for improving coordination, balance, and perception, and stretching. Outcome measures were patient quality of life and pain, using the TWSTRS. Patients demonstrated short term benefits from the interventions provided and regressed when the protocol was halted.

  • Strengthening contralateral sternocleidomastoid, scalene and primary neck extensors

Since torticollis usually involves contractions of the sternocleidomastoid and scalene muscles that perform cervical flexion, lateral flexion, and rotation, antagonist strengthening may improve posture. Strengthening the contralateral sternocleidomastoid and scalene muscles along with the primary neck extensors may aid the patient in achieving a proper head position.

  • Stretching and relaxation

stretching accompanied by relaxation techniques may help restore natural muscle length. If this causes an increase in pain or does not yield positive results, refrain from this intervention.

  • Soft tissue mobilization

Palliative interventions may also include soft tissue mobilization at the therapist’s discretion.



There is no universally accepted intervention for the condition. An impairment-based approach focusing on the individual patient’s restrictions and limitations will produce the best outcomes. Primary components of treatment should include pain control, range of motion, and postural cueing.


At Valley Healing Hands, Brownsville, Texas, we provide the best Physical Therapy treatment for Congenital Torticollis and Acquired Torticollis/ Adult dystonia/ Cervical dystonia or Spasmodic torticollis. Our highly skilled therapists will plan the exercise programme as per the requirement and walk you through them. We are highly sensitive about your needs. Our patients are totally satisfied about our services. You may learn about what they have to say about us here and get connected to us here. Our patients love us and you too will.



Source:


https://mobilephysiotherapyclinic.in/torticollis-physiotherapy-management-exercise/




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