Congenital Torticollis in Babies: Treatment & Exercises

What is Congenital Muscular Torticollis?

Congenital Muscular Torticollis (CMT), often referred to as "wryneck," is a relatively common postural deformity observed in infants. It occurs when the sternocleidomastoid (SCM) muscle—a major muscle that runs along the side of the neck and controls head rotation and tilt—is shortened and tight on one side.

As a result, the baby holds their head tilted toward the side of the tight muscle (ipsilateral tilt) while the chin is rotated toward the opposite shoulder (contralateral rotation). CMT is usually diagnosed within the first few weeks to months of life.

Causes & Risk Factors

The exact cause of CMT is not fully understood, but clinical evidence points to several predisposing factors:

• Intrauterine Crowding: Breech positioning or a large baby in a small uterus can compress the neck muscles during gestation.
• Birth Trauma: Injury to the SCM muscle during a difficult delivery (e.g., forceps or vacuum extraction) can lead to bleeding and subsequent scarring/tightness.
• Congenital Muscular Nodule: A localized fibrous lump ("torticollis tumor") may form in the SCM muscle, which is benign and resolves with stretching.

The Connection to Flat Head Syndrome (Plagiocephaly)

Because babies with CMT prefer to keep their head turned in one direction, they spend a significant amount of time lying on the same spot of their skull. This constant pressure on a soft, developing skull can cause Positional Plagiocephaly—a flattening of one side of the head. In severe cases, it can cause facial asymmetry, shifting the ears and forehead forward on the flattened side. Treating torticollis is the most effective way to prevent or correct plagiocephaly.

Pediatric Physiotherapy Stretching & Exercises

Physiotherapy is highly effective for CMT. A pediatric physical therapist will teach parents gentle, specific stretches and positioning strategies to perform during daily activities:

1. Passive SCM Stretching

• Rotation Stretch: With the baby lying on their back, place one hand on the shoulder of the tight side to hold it down. Gently turn the baby's chin toward that same shoulder until a light stretch is felt. Hold for 10-15 seconds. Repeat 3 times, several times a day.
• Lateral Flexion Stretch: Hold the shoulder on the opposite side of the tightness down. Gently tilt the baby's head, bringing the ear on the healthy side down toward the shoulder. Hold for 10-15 seconds. Repeat 3 times.

2. Environmental Repositioning

• Feeding Placement: Feed the baby from the side that forces them to turn their chin toward the tight SCM side to nurse or take the bottle.
• Crib Setup: Place the baby in the crib so that they must turn their head toward the non-preferred side to see the room or toys.

3. Tummy Time and Active Rotation

• Supervised Tummy Time: Place the baby on their stomach. Use brightly colored or musical toys to encourage them to lift their head and look in both directions. Tummy time unloads the back of the skull and strengthens the neck extensor muscles.

If you notice your baby keeping their head tilted or turned to one side, consult your pediatrician or a physical therapist. For more information, read our guide on developmental milestone delays or learn about pediatric rehabilitation services.

References

• Kaplan SL et al. Physical therapy management of congenital muscular torticollis: an evidence-based clinical practice guideline. Pediatric Physical Therapy. 2013.
• Stellwagen L et al. Look at the baby's head: asymmetry, torticollis, and plagiocephaly. Contemporary Pediatrics. 2008.
• Rogers GF et al. Congenital muscular torticollis and positional plagiocephaly. Journal of Craniofacial Surgery. 2009.