What 18+ years of treating infant torticollis has taught me
- Melissa
- Jun 5
- 5 min read
As a pediatric physiotherapist, I have treated infants with torticollis and plagiocephaly for almost two decades. During that time, my understanding of these conditions has evolved significantly.
When I graduated, I was taught that torticollis was primarily a problem of tight neck muscles. The standard treatment was stretching the neck to restore movement. While this approach could be effective, I quickly noticed that many babies disliked it. They cried, resisted the stretches, and parents often found the exercises stressful to perform at home.
Over the years, clinical experience taught me that torticollis is often much more than a neck issue. While the head position is what we see, the underlying pattern frequently involves the entire body. Restrictions and asymmetries through the trunk, ribs, and hips can influence how a baby moves, rests, and positions their head.
As my approach evolved, I moved away from traditional stretching to a focus on restoring symmetry in the movements of the trunk. This shift in approach has led to faster outcomes, improved tolerance/comfort in therapy, and better long-term results. In my experience, trunk asymmetry is often a key piece of the puzzle. This targeted approach helps improve whole body development with efficiency and ease.
What Is Torticollis?
Torticollis is a name we use when an infant develops a preference for turning their head to one side or tilting their head in one direction. It is often associated with plagiocephaly, which is a flattening of one side of the head.
Some signs of torticollis include:
Looking in one direction more than the other
A head tilt
Difficulty looking to one side
A flat spot developing on the head
Not liking tummy time
Preferring to bend into one side of the body
Looking Beyond The Neck
When I first graduated, the standard treatment for torticollis was stretching the neck muscles. While many babies improved with this approach, it often caused a lot of distress for both the baby and the parents. The neck is an incredibly sensitive area and many babies did not tolerate frequent stretching programs. I found myself looking for a better way.
I began moving away from passive neck stretching and focused more on active movement to improve neck alignment. I noticed improved engagement in treatment sessions, less crying and improved outcomes.
Years later, I completed training in the TMR Tots and Teens approach. This course provided a framework for something I had been clinically observing for years. I had noticed as babies became more symmetrical through their trunk and body, their neck movement improved without direct stretching.
So what if the neck isn't always the primary problem? What if torticollis comes from what is happening in the trunk and body?
A Whole-Body Understanding
What I have found over time is that there is often tightness in the trunk and body that contributes to what we observe in the neck. Sometimes these patterns may develop from positioning in utero. Sometimes they are influenced by the birth process. Sometimes the exact cause is unclear.
I focus my assessment on what is happening in the body. I look at trunk rotation, side bending patterns, extension or flexion preferences and hip mobility to help guide the intervention. With torticollis there is always a direction preference that runs through the body.
The way I understand what is going on is through the fascia system. Fascia is a thin layer of connective tissue that forms a continuous web throughout the body. It covers the muscles, bones, nerves and organs. Sometimes this fascia becomes a bit "sticky" and doesn't glide smoothly. When this happens it can cause an area of tension or restriction. Because the fascia is interconnected from head to toe, an area of tension in one part of the body can influence movement and posture elsewhere.
In many cases, the head position is a result of what is happening throughout the body, rather than simply a tight neck muscle. By improving the body restrictions, the head position begins to resolve naturally.
Why Babies Tend to Love This Approach
Many babies I have worked with absolutely love the whole body approach. It is extremely gentle and I find many babies 'melting' into the movements.
Rather than stretching into discomfort, we move into the baby's preferred movement preferences to help release and "unstick" the fascia. When we figure out the most impactful directions of movement we often see changes immediately. Families find these activities and positions fit naturally into daily routines so they don't feel like a burden. And the babies respond to treatment quicker than they did before.
What I Have Noticed Over The Years
After treating many babies, several patterns have stood out.
First, babies respond faster with this approach and the treatment seems to target the root cause of the issue, leading to better long term outcomes.
Tummy time becomes easier. Many times babies are uncomfortable on their tummy because of asymmetries in the trunk, causing them to feel stuck. As symmetry improves, so does comfort and enjoyment of tummy time.
Rotational preferences through the trunk often improve first, while the side bending preferences can be a bit more persistent and take longer.
Sometimes rapid growth or illness can bring back old patterns of neck positioning if there are still directional preferences in the body.
And finally, I have learned that it is important to follow babies beyond the point where their head appears normal to ensure there is no lingering tightness in the trunk. Some families have stopped coming to therapy when the neck is in alignment, only to return a few months later when their child can only roll in one direction or only uses one leg to pull up to stand.
Why Early Physiotherapy Intervention Matters
The earlier we identify and address asymmetrical patterns of movement in the body, the easier they are to change. This also helps to minimize compensatory movement patterns that can become ingrained early.
When we improve symmetry and alignment, we create a strong foundation for rolling, sitting, crawling, standing, walking and future motor development such as balance and hopping.
Torticollis is not simply a neck problem. It is an indicator of what is happening in the body.
Treatment can be gentle, efficient and effective when we target the root cause, leading to optimal long term motor development.
If you are concerned about your baby's head position, neck movement, tummy time, or overall development, I would be happy to help.
Through a gentle whole-body assessment, we can identify the movement patterns contributing to torticollis and create a treatment plan that fits naturally into your family's daily routine.
The earlier we address these patterns, the easier they are to change.
To book an assessment at NeuroAlchemy Wellness, contact neuroalchemywellness@gmail.com
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