1. Introduction / Plain Theory

Torticollis — often called “wry neck” — refers to a condition where an infant’s head is persistently tilted to one side and rotated to the opposite side. It can be congenital (present at birth) or acquired/positional, developing during the first weeks or months of life.

The most common type, congenital muscular torticollis (CMT), occurs due to tightness or shortening of the sternocleidomastoid (SCM) muscle, which runs from the collarbone and sternum to the skull just behind the ear.

Prevalence estimates range from 0.3% to 2% of newborns, though mild postural preferences may be seen in up to 10–20% of infants. Torticollis often coexists with other mechanical findings such as plagiocephaly (flattened skull), feeding asymmetry, or restricted shoulder/neck motion.

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2. Typical Symptoms and Functional Impact

• Persistent head tilt to one side and rotation to the opposite side.

• Reduced ability to turn the head symmetrically during feeding or when lying down.

• Preference for breastfeeding or bottle feeding on one side only.

• Flattening of one side of the skull (plagiocephaly) due to asymmetrical pressure.

• In severe or untreated cases: facial asymmetry or delayed motor development.

Red flags: Acute onset of torticollis after illness, trauma, or accompanied by neurological symptoms (vomiting, eye deviation, irritability) requires immediate medical evaluation.

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3. Contributing Factors / Underlying Causes

Torticollis can result from prenatal, perinatal, or postnatal factors, including:

• Intrauterine position — limited space or constraint may lead to muscular imbalance.

• Birth trauma or assisted delivery — mechanical strain on the neck and upper shoulder region.

• Postural habits — infants who consistently look or sleep to one side.

• Muscle imbalance or fibrosis — within the SCM or surrounding soft tissues.

• Associated conditions — developmental dysplasia of the hip (DDH) is found in up to 20% of infants with torticollis.

In some infants, no single cause is found, suggesting a combination of mechanical and neuromuscular factors.

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4. Osteopathic Approach

Osteopathic care for torticollis focuses on gentle, non-invasive techniques to improve comfort, restore motion, and support symmetrical development.

An osteopathic assessment may include:

• Evaluating spinal, cranial, and shoulder girdle mobility.

• Observing head and neck movement patterns, muscle tone, and positional preference.

• Using gentle soft-tissue and functional techniques to ease tension in the SCM, upper cervical region, and surrounding fascia.

• Supporting parents with handling and positioning strategies that encourage symmetry during feeding, play, and sleep.

Osteopathic treatment aims to support natural mobility and comfort, working alongside physiotherapy, pediatric, and lactation professionals when indicated.

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5. Scientific Evidence & References

Evidence suggests that early identification and conservative management (manual therapy and physiotherapy) can effectively improve range of motion and reduce cranial asymmetries in infants with torticollis.
Osteopathic and gentle manual techniques have been shown to be safe when applied by trained practitioners.

While research quality varies, systematic reviews support manual therapy as part of a multimodal approach.

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References

1. Cheng JCY, Tang SP, Chen TM, Wong MWN, Wong EMC. The clinical presentation and outcome of treatment of congenital muscular torticollis in infants: a study of 1,086 cases. J Pediatr Surg. 2000;35(7):1091–1096. Link

2. Öhman A, Beckung E. Reference values for range of motion and muscle function in infants with congenital muscular torticollis. Physiother Theory Pract. 2008;24(5):327–336. Link

3. Stellwagen L, Hubbard E, Chambers C, Jones KL. Torticollis, facial asymmetry and plagiocephaly in normal newborns. Arch Dis Child. 2008;93(10):827–831. Link

4. Ho B, Lee EH, Singh K. Conservative treatment of congenital muscular torticollis: physical therapy and manual stretching exercise protocol. J Pediatr Orthop. 1999;19(6):842–846. Link

5. Cabrera-Martos I, Valenza MC, Valenza-Demet G, et al. Efficacy of manual therapy and stretching in infants with congenital muscular torticollis: a systematic review. Eur J Pediatr. 2018;177(8):1203–1213. Link

6. Castejón-Castejón S, de-la-Cueva-Reguera M, et al. Effectiveness and safety of osteopathic manipulative treatment in infants with congenital muscular torticollis: a randomized controlled trial. Int J Osteopath Med. 2021;40:9–15. Link

7. Williams K, Holland B, Shipton EA, et al. Manual therapy for congenital muscular torticollis: a systematic review and meta-analysis. BMJ Open. 2023;13:e071287. Link