Torticollis: what is it, what types are there, why is it dangerous?
Torticollis is a disease in which deformity of the spine develops in the cervical region. It is accompanied by tilting the head and raising the scapula on the sore side and turning the face to the healthy side. Torticollis can be caused by problems with the development of muscles, fascia, nerves or vertebrae.
Due to deformation, doctors distinguish:
Congenital torticollis: – muscular – caused by dysfunction of the muscles that turn and tilt the head; – bone – caused by structural anomalies of the cervical or thoracic vertebrae.
Acquired torticollis (eg, Grisel's disease).
Depending on the side of the lesion:
– right-sided torticollis; - left-sided torticollis.
According to statistics, congenital, right-sided torticollis is more common and girls are affected less often than boys.
Deformity with torticollis can be:
– fixed – when the muscles have lost their extensibility and the child’s head does not change position, even if he turns over, if the parents put a special pillow under his head or try to straighten it with his hands; – not fixed – when the muscles still retain the ability to stretch, the listed manipulations help tilt the head to the healthy side.
If you suspect torticollis, do not try to correct the position of your head yourself. Only a specialist can make an accurate diagnosis, determine its type and prescribe therapy. Self-medication can only make the problem worse.
Why torticollis should not be ignored
The neck contains vital organs:
- spinal cord - controls movements, transmits information from all organs to the brain and back; - carotid arteries, jugular veins - provide blood supply to the head; - esophagus - ensures delivery of the bolus of food to the stomach; - trachea - participates in the act of breathing; - larynx - contains the voice-producing apparatus; - thyroid gland - participates in maintaining hormonal balance.
Pathological changes in torticollis can lead to disruption of the functions of these organs and the child may become disabled.
What complications are torticollis dangerous for:
– Change in the shape of the skull (plagiocephaly); – Asymmetry of facial bones; – Spinal deformities, for example, scoliosis; – Hydrocephalus - increased intracranial pressure as a result of disruption of the normal outflow and accumulation of cerebrospinal fluid; – Brain damage; – Neurological disorders (increased excitability, excessive regurgitation, muscle hypertonicity, etc.); – Difficulty breathing; – Strabismus; – Hearing impairment, underdevelopment of the auricle; – Delayed speech development; – Behavioral disorders (aggression, inappropriate actions, disobedience); – Poor sleep; – Incorrect development of the upper and lower jaws; – Late teething, improper growth; - Nosebleeds.
In newborn babies, the neck is involved in the act of sucking, so the deformation can interfere with normal feeding. Children with torticollis begin to crawl, sit and walk later than their healthy peers.
Torticollis is one of the three most common congenital diseases of the musculoskeletal system in children, second only to congenital dislocation of the hip joint and clubfoot. It can cause neurological disorders in the child, changes in the shape of the skull, spine and other complications.
Changes in the shape of the skull occur in every third baby with a diagnosed neck deformity. In addition to an aesthetic defect and, as a consequence, psycho-emotional disorders, it can lead to developmental delays.
Knowing the causes and signs of this disease will help young parents seek help from a doctor in time to prevent its development or for treatment.
Prevention of the formation of a sloping head in children.
While the child is small, 1-2 months old, it is advisable for him to do at least a little gymnastics, and regularly. Rolls from back to stomach, turns to the side, movements of the limbs, turns of the head to the right and left up to 90 degrees (so that the cheek lies parallel to the surface on which the child is lying). The baby needs to change his position in the crib, i.e. turn it with your head, one day it lies in one direction, the next day in the other. This is so that the baby, when he pays attention to sounds, people, lights, turns his head towards them, every day in a different direction. Also, lying on your side and stomach is very useful; with such poses, a sloping neck does not occur.
Causes of development of torticollis in newborns
Torticollis is caused by changes in muscles, fascia, vertebrae, or nerves. It can also be the result of muscle tension in response to pain, neurogenic diseases or abnormalities in the development of blood vessels, but these causes are rare.
The pathogenesis of deformity almost always involves the sternocleidomastoid (sternocleidomastoid) muscles. They stretch along the sides of the neck, from the jugular fossa to the behind-the-ear region and are responsible for the ability to turn and tilt the head and keep it vertical.
If torticollis is from birth , then its cause is in the pathology of the sternocleidomastoid muscle or vertebrae.
Risk factors:
– Poor posture and scoliosis in the mother. They cause displacement of the internal organs of a pregnant woman, incl. the uterus, so the fetus is located in it asymmetrically even at the implantation stage. If torticollis is not treated, it can lead to scoliosis in a child. – Difficult pregnancy. Severe toxicosis, the threat of its interruption, impaired mobility of the pelvic bones, tension in the woman’s muscles and ligaments can disrupt the blood circulation of the fetus and cause a disruption in the formation of its organs and tissues, followed by torticollis. - Breech presentation. The uncomfortable position of the child in the uterine cavity leads to a pathological change in the muscle when, along with muscle fibers, fibrous tissue appears in it. The muscle does not stretch well and this prevents it from growing normally. - Umbilical cord entanglement. A condition that may be accompanied by oxygen starvation of the fetus, which means a deterioration in the nutrition of its organs and tissues with subsequent abnormalities in their development. - Birth injury. During a difficult birth, hemorrhage occurs into it, followed by the formation of a compaction and even a scar in the muscle. The use of obstetric forceps, vacuum extraction or cesarean section by doctors can also have a negative impact. You can learn more about birth trauma here.
If a child was born healthy and torticollis appeared some time after birth, then the reason may be related to:
– Inflammation of the sternocleidomastoid muscle, both independently and against the background of other diseases; – Spondyloarthritis of the cervical vertebrae as a result of infection of the ENT organs (Grisel’s torticollis); – Neuralgia, for example, as a result of hypothermia, infectious diseases or compression of the spinal cord roots; – Diseases of the organs of hearing (otitis) and vision (strabismus), when the head is tilted specifically to reduce pain in the first case or to see better in the second; – Trauma, such as a fall, a blow to the head, or a burn.
Acquired torticollis can occur at any age, incl. in adults, for example, as a result of a forced position during professional activity or exposure to harmful environmental factors (drafts).
Will massage help a baby with a sloping head?
Sometimes people ask me, if a baby has a sloping head, what should they do, what kind of massage would you recommend. But massage does not play the first role in the treatment of a sloping nape in an infant, and this problem cannot be corrected by massage itself. Massage will not be able to bend the bone, even though it is soft. With the help of massage, we make the child more mobile, and mobility is already the most important healing factor for this problem. It is the prolonged lying of a child with an unevenly fixed head that most often leads to the formation of a slanted, flattened head. Therefore, massage for a child with a beveled head is aimed specifically at general physical development, in which the baby will not lie in one position for a long time, but will constantly move. In this way, the harmful factor is minimized and the beneficial factor is increased.
How does torticollis manifest?
With torticollis, its characteristic signs attract attention:
– the neck is deformed, the head is tilted; – mobility is limited, the child cannot hold his head straight or tilt it in the opposite direction; – the shoulder and shoulder blade on the affected side are higher than on the healthy side; – when trying to straighten the child’s head, he cries and resists; – facial asymmetry - the ear, eyebrow and eye on the affected side are lower compared to the healthy side. – already at 2–3 weeks of a child’s life, thickening and shortening of the sternocleidomastoid muscle can be felt to the touch.
By 1–1.5 months of life, the seal may disappear - it will become thinner and shorter than healthy. Therefore, attempts to straighten the child’s head will cause him pain and crying. This indicates that torticollis has become fixed and its treatment will require a special approach.
Facial asymmetry helps distinguish congenital torticollis from acquired. It takes time to form, so if the baby was born with asymmetry, then the pathology is congenital. If his face was normal and then changed - acquired.
What else should you pay attention to?
Deformation of the back of the head can be not only oblique (this is only when the head is turned), but also in the frontal plane. This is possible with rickets, or the inability to turn the head. Tight cocoons, cribs, cradles are not the best place for a child. Try sleeping all night in one position yourself. Increased attention to the case of rickets, because in this case, deformations form faster. The most dangerous period for the formation of a sloping nape is up to 3 months of age. Children older than three months usually lie on their stomach or side more often, move more, roll from side to side, having learned to roll over from back to stomach, they regulate their position, i.e. the head does not lie in one place for a long time.
Treatment of torticollis - which methods are safe for a child
The main goal of treatment is to ensure normal position and mobility of the child’s head, strengthen muscles, restore normal blood flow and prevent the development of complications.
The method of treating torticollis depends on how severe the shortening of the muscle is. In advanced cases, surgery may be necessary. To limit yourself to conservative methods, it is important to begin therapy immediately after diagnosis.
At the Quality of Life clinic, we use only conservative treatment to correct torticollis in newborns, older children and adults.
Osteopathy and exercise therapy are the most effective. Let's take a closer look at how they help in the treatment of torticollis. Moreover, these methods are effective and are indicated even after surgery for quick recovery.
Osteopathy
The goal of osteopathic treatment is to eliminate the true cause of the disease and set the body on the path to recovery.
Now you know that congenital torticollis is caused by damage to the sternocleidomastoid muscles or vertebrae of the newborn as a result of complicated pregnancy and childbirth. To stop the progression of the deformity, the osteopathic doctor uses gentle manual techniques that are safe even for infants.
Knowing perfectly the structure and features of the human body, with his own hands, without any tools, drugs or devices, he finds the causes of diseases in it, eliminates them and restores the structure and function of damaged organs:
– normalizes blood circulation; – eliminates muscle tension and spasm; – returns normal mobility to organs and tissues; – corrects the asymmetry of the skull bones; – balances the spine and pelvic bones.
An osteopath removes all obstacles to the full development of the musculoskeletal system as a whole, and not just the sternocleidomastoid muscle and the cervical spine. The baby’s body begins to develop correctly, and its organs begin to function normally.
You can learn more about osteopathy, its treatment principles and indications here.
Our specialists believe that any problem must be solved comprehensively, therefore, to consolidate the effect of osteopathic correction of torticollis in a child, we definitely recommend a course of exercise therapy.
Exercise therapy methods
Physical therapy is necessarily included in the treatment program for patients with torticollis. It effectively corrects deformation and also promotes the growth and development of a healthy body.
Goals of exercise therapy for torticollis:
– improve blood supply to muscles (both affected and healthy); – eliminate contracture; – normalize muscle tone; – ensure full neck mobility; – prevent the development of complications that are dangerous for torticollis (poor posture, skull asymmetry); – increase the nonspecific resistance of the child’s body to diseases.
To achieve these goals, it is important to treat torticollis immediately after diagnosis.
Doctors and exercise therapists at the Quality of Life clinic use active and passive means of physical therapy: corrective exercises, positional therapy, massage, Vojta therapy. Let's take a closer look at how each of these methods helps correct torticollis.
Therapeutic exercises The complex is selected individually for each patient, depending on his age, motor capabilities, and whether he has right or left-sided torticollis. Infants cannot perform the exercises themselves, so they are carried out by a physical therapy methodologist.
Conduct 15–20 classes (daily or every two days). The break between courses is 4–6 weeks. In total, to correct torticollis, there should be 3-4 courses in the first year of life, then another 2-3 until the patient reaches the age of seven.
Correction by position In the first year of life, children lie almost all the time, so to cure torticollis, different types of placing the child in bed are widely used. It is important to consider the position of toys, lights and sounds. When performed properly, the baby's head is in the correct position.
The type of placement depends on the exact diagnosis and is determined by a specialist. To achieve the effect, they are used for 1.5–2 hours 2–3 times a day.
Massage Gentle massage techniques help relax tense muscles and relieve spasm caused by torticollis. To do this, the exercise therapy methodologist carefully, so as not to cause pain, performs stroking, rubbing, and continuous vibration techniques.
On the opposite side, the massage is given to the child more intensely than on the patient in order to strengthen the muscle and increase its tone. Neck massage is combined with a massage of the arms, legs, back, chest, and abdomen.
Vojta Therapy The method is specially designed for the correction of neurological disorders and diseases of the musculoskeletal system. Its essence lies in the activation of motor reflexes in compliance with the starting positions.
The therapeutic effect is achieved through the natural movements that the child has, according to his age (turns, rolls over, crawls, etc.). Read more about Vojta therapy, its principles, indications and contraindications here.
Some parents try to correct the deformity by watching videos on the Internet, and further harm the child’s health. Each technique requires special knowledge and skills, so treatment should be carried out only by specialists.
You can learn more about exercise therapy methods, their effects and indications here.
Reviews
According to parents, in 80% of cases it is possible to completely eliminate the deformity if you consult a doctor in time and carry out complex therapy. Although in some cases it was not possible to get rid of torticollis without consequences.
Karina, 27 years old: “My daughter was diagnosed with torticollis on the 17th day after birth. The doctor prescribed massage, paraffin baths, electrophoresis with lidase solution. In general, the treatment lasted six months, 2 weeks with a month break. At the same time, they did gymnastics and massage at home. The deformity has disappeared, the child is growing and feels great.”
Marina, 30 years old: “My son was diagnosed with spastic torticollis. To correct the deformity, they visited a massage and a swimming pool. Literally after 8 weeks the neck straightened out. The orthopedist confirmed that the treatment worked.”
Irina, 32 years old: “At first we didn’t notice the torticollis, but noticed 2 large nodes on the neck. As it turned out, the deformity began to develop after a difficult birth. My daughter’s skull began to deform, one eye became smaller, her arm, chest and shoulder were tightened. In addition, the collarbone began to bulge and a hump formed. The child cannot lie straight; the body tilts to the left. As the doctor said, improperly formed muscles compress many blood vessels. We visited a massage therapist every day, did gymnastics, and applied ozokerite. In general, the treatment lasted 10 months. However, it was not possible to completely correct the deformation.”
The most important
Torticollis in most cases can be treated conservatively. However, it needs to start as early as possible. Therefore, you should be extremely careful with your child and periodically visit a pediatrician who will help detect the deformation. Complex therapy, which consists of massage, exercise therapy, and body position correction, will help correct torticollis. If conservative treatment does not produce positive results throughout the year, then surgery is prescribed. After surgery, there is a risk of complications, so it is worth periodically visiting an orthopedist who will monitor the child’s condition.
Types of disease
As soon as spastic torticollis is identified, treatment is prescribed immediately after clarifying the type of disease and symptoms. There are four types of dystonia anomalies:
- retrocollis - nerve impulses do not pass correctly to the trapezius muscle, and the head falls back;
- antecollis - the defect is observed in the cleidosternal-mastoid region (the head is tilted predominantly forward);
- torticollis - turning and tilting the head to one side;
- laterocollis - the head is tilted towards one of the shoulders.
Diagnostics
To diagnose torticollis, you should make an appointment with an orthopedist, neurologist or surgeon. At the appointment, the doctor first palpates and examines the neck, checks muscle tone, head mobility, and assesses the presence of deformation in the bone tissues of the skull.
After the examination, hardware diagnostics of torticollis may be needed for a more detailed assessment of the disorder in the tissue structures.
Hardware diagnostic methods:
- X-ray. One of the simplest and most accessible ways to diagnose torticollis. Allows you to assess the presence of bone deformation in the neck and skull;
- MRI. The most detailed diagnostic method. Allows you to visualize the condition of not only bones, but also muscles, blood vessels and nerve fibers. MRI is painless and can be performed multiple times within a short period of time;
- Dopplerography of the vertebral arteries. Allows you to assess the condition of the walls and patency of arteries and vessels;
- electroneurography. Detailed examination of the condition of the nerve fibers of the head and neck.
The doctor can prescribe one or more hardware diagnostic methods to the patient, after which he can accurately determine the presence and degree of torticollis, as well as prescribe treatment.