Torticollis, a real pain in the neck

Torticollis – What is it?

Torticollis refers to an unnatural change in the position of the head and neck which causes them to twist. This is due to the shortening of the sternocleidomastoid muscle in the neck, which results in the head being tilted towards the shortened muscle and the chin being rotated to the side opposite from the shortened muscle. Instead of being a distinct diagnosis, torticollis is regarded as a sign. There are also many different types of torticollis which include congenital (from birth) muscular torticollis, osseous (bone-based) torticollis, nervous system torticollis, ocular (visual based) torticollis and spasmodic torticollis (neck spasm). Torticollis is a common condition and is present in all age groups, from newly born babies to adults. It can also be congenital or acquired postnatally (after birth). The condition has an estimated prevalence of 1.3% in children.The causes of torticollis in children range from being generally harmless to severe conditions.

The symptoms that frequently associate with congenital torticollis are the presence of asymmetries in the brain and face. However, these symptoms are very uncommon in acquired postnatal torticollis. At any age, acquired torticollis usually occur due to other disorders. They include muscular, osseous, ocular, ligamentous, psychiatric, and neurologic disorders. The most common symptom of torticollis, regardless of the type, is the shortening of the sternocleidomastoid muscle (SCM), which causes the head to be tilted to the affected side and rotated to the opposite side. In addition, the SCM may also be tight and there may be a firm mass located at the bottom one-third of the SCM muscle depending on the type of torticollis present. Other symptoms of torticollis that may also be present depending on the type of torticollis include headaches, neck pain, eye deviations, muscle spams and positional plagiocephaly (flat head syndrome) in children. There is also a reported association of torticollis with hip dysplasia, which range from 2% to 20%.3

There are different treatment methods depending the type of torticollis present. For congenital muscular torticollis, early treatment is crucial. Treatment of the condition may include positioning the child such that the head is tilted to the side of the unaffected SCM and rotated towards the side of the affected SCM, rotating the child’s chin toward the shoulder of the affected SCM during feeding and passively stretching the shortened SCM so as to increase its length. If certain signs are still present after 6 months of stretching, surgery might be recommended to restore neck movement with minimal risks.

Treatment options

Treatment methods for osseous torticollis due to atlantoaxial subluxation is dependent on how serious the condition is and the duration. For less serious cases and those present for less than a week, rest, analgesics, and the use of a soft cervical collar is recommended. For more serious cases, it is recommended to utilise cervical traction and immobilization. Surgery may be required if the condition does not improve with traction. In addition, nonsteroidal anti-inflammatory drugs may also help to relieve pain. For ocular and nervous system torticollis, there has been some evidence to indicate that the use of botulinum toxin (botox) injections can help to improve those conditions. The use of botox injections on the SCM can help to relax muscle tone and hence reduce the contraction strength of the muscle, as well as relieve pain.

For spasmodic torticollis (cervical dystonia), botulinum toxin is also recommended and has been found to be effective in treating the condition in adults. Other treatments that may be effective in treating certain types of torticollis include antibiotics such as cephalosporins, antihistamines and anticholinergics. However, certain drugs may also cause a type of torticollis called drug-induced torticollis. In such cases, the use of the drug causing the condition should be discontinued.

Chiropractic and torticollis

Chiropractic care can also help to treat certain types of torticollis. The techniques most commonly used by chiropractors to treat torticollis are soft tissue therapy, diversified manipulative therapy, instrument adjusting and exercise prescription. There are many case reports of rehabilitation medicine and congenital torticollis on infants, which described successful treatment of congenital muscular torticollis and cervical dystonia using chiropractic care. In one case report, chiropractic treatment applied on a patient with cervical dystonia saw improvements in the patient’s posture and a reduction in spinal distortion. Positive results were also obtained in the chiropractic treatment of a patient with congenital torticollis. For congenital torticollis, chiropractic treatment aims to reduce the effects of the condition through removing any restrictions influencing the movement of the cranial bones and rest of the body. Therefore, chiropractic care is suitable for treating torticollis in both adults and infants.

Dr. Debbie Tan (2017)

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