top of page

Torticollis and Plagiocephaly

What is Torticollis?


Torticollis, also called “wry neck” is a condition when tightness in the sternocleidomastoid muscle (SCM) causes the neck to tilt in one direction and rotate to the opposite direction. When a baby is born with this condition it is called congenital torticollis. If the condition develops during the first few months of life it is called acquired torticollis.


Congenital torticollis is often caused by awkward positioning of the baby in the uterus or by trauma to the baby’s neck muscles during the birthing process. In these situations, natural healing of the muscle causes bands of fibrotic scar tissue (or a ball of scar tissue called a psuedotumor) to form in the sternocleidomastoid muscle of the neck which leads to the abnormal “twisted” neck posture.  In rare situations congenital torticollis is caused by a boney abnormality of the cervical vertebrae known as Kilppel-Feil syndrome.  The bones may be abnormally formed, fused, or both.


Acquired torticollis, or torticollis that develops over the course of the baby’s first few months has seen a drastic rise over the past few years. With the initiation of the “Back to Sleep” program babies are sleeping on their backs and are developing decreased tolerance to “tummy time” positions. In addition, babies are spending an abundance of time in semi-reclined positioners such as car seats, bouncer seats and swings. These static positions cause gravity to pull their heads down into asymmetrical positions, ultimately resulting in tightness of the neck muscles.


Other less common causes of torticollis include: reflux, ocular issues, viruses and in rare cases tumors.


What is Plagiocephaly?


Pagiocephaly is when the side or back of the skull becomes flattened often due to lying in the same position for extended periods of time. An infant’s skull is very soft and malleable during the first year of life. If a baby constantly rests on their back with their head facing the same direction, a flat spot with likely form. For this reason there is a very strong correlation between torticollis and plagiocephaly.


Brachycephaly is a similar condition however the flatness occurs down across the back of the skull and not on one particular side.


Does my baby have torticollis and/or Plagiocephaly?


Signs and symptoms include:



  • The baby’s head is always tilting in one direction (ear close to shoulder)

  • The baby has a preference to only turn to one direction

  • The baby demonstrates limited range of motion of the head and neck

  • A small, pea-sized lump is felt in the SCM muscle of the neck

  • A flat spot forming on the back or side of the baby’s head

  • The baby demonstrates facial asymmetries such as uneven eyes and ears or bulging of the forehead or cheek on one side

  • Poor tolerance to tummy time

  • The baby demonstrates a hand preference (Babies should be using both hands equally and a dominance should not be observed until a minimum of age two)

  • Difficulty breastfeeding on one side



My baby might have torticollis and/or plagiocephaly. What do I do next?


If you suspect that your baby has either of these conditions it is extremely important to initiate physical therapy as soon as possible. The younger a baby begins treatment for torticollis, the quicker and easier the rehabilitation process will be. Initially, torticollis begins as an orthopedic issue that can be treated with stretching, positioning and soft tissue work (instructed to you by your physical therapist). Left untreated, torticollis will often work its way down the developmental chain causing asymmetries with gross motor skills or in many cases developmental delays. If babies do not rotate their head toward one direction, it is likely for them to avoid use of that side completely. The earlier Torticollis is treated the less developmental implications arise.


In terms of plagiocephaly, it is important to learn positioning techniques as early as possible to prevent the flat spot from worsening. The most growth and re-modeling of the infant skull takes place between the ages of 4 to 6 months. It is important to take advantage of this window of time to prevent further flattening and promote rounding out of the skull.


How are these conditions treated at PTatric Therapy?


At PTatric Therapy we believe that parent education and a thorough home exercise program is vital to the success of torticollis/plagiocephaly treatment. While we are here to guide you through every step of the process, our main goal is to foster parent independence in managing the symptoms of torticollis at home during daily routines.

Upon initial evaluation, extensive range of motion measurements will be taken of the baby’s neck. In addition, cranial measurements will be taken of the head shape in order to establish base line information regarding developing flat spots. Parents will be given detailed pictures of stretching and positioning exercises tailored specifically to the needs of their child. The most crucial part of the evaluation is extensive hands on practice for parents to learn and become comfortable with stretching and positioning techniques. The therapist will be there to guide the parent in hand placement, correct form and tips to improve the baby’s tolerance to these exercises.


Follow-up sessions are usually scheduled to ensure that the parents are performing the exercises correctly at home and to assess the baby’s progress all while giving parents ample opportunity to practice exercises and ask questions.


If in fact helmet therapy is deemed necessary to correct plagiocephaly, the therapists at PTatric Therapy are thoroughly trained in taking all needed cranial measurements and will assist parents in choosing the helmet vendor that best suits their needs.

Resources and Articles:

bottom of page