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Torticollis

Torticollis



Abnormal positioning of neck and head relative to body

Cause of Acute acquired torticollis

Activation of latent TrP
Subluxation of C1 on C2
Facet jt irritation
Infection
Disc-related pain

Symptoms

They might “Just woke up with it”
Pain with especially movement
TrP in SCM are affected
Tinnitus, Nausea, tearing of eyes on the shortened affected side may be present
May present facet joint irritation
DDD in C/S may present

Treatment

Check health Hx
Postural assessment
Palpation can find tenderness, firmness, increased tone, tender to touch, feels colder d/t ischemia
Maxilla,zygoma and temporal bones on the affected side are more posterior, making the eye on the affected side appear more recessed

Testing

AROM, Mxl strength testing 
(Contralateral anterior and anterolateral neck mxl and ipsilateral posterolateral neck extensors may be assessed)
Vertebral artery test
Spurring test
Cervical compression and distraction test

Treatment goal for this acute condition

Lengthen the shorten Mxl which is the affected side and stretching
Strengthen the unaffected side
Regain full ROM
Diaphragmatic breathing 

Agonist contraction for Left scalenes when the neck is in spasm

  • To inhibit spasm of Left middle scalene, client isometrically resist side bending to right side
  • To inhibit spasm of left anterior scalene, client isometrically resist right side bending and then isometrically resist Left rotation
  • To inhibit spasm of left posterior scalene, client isometrically resist right side bending then isometrically resist Right rotation

Stretches for Left SCM

Clavicle head: Rotate head to the right side and stabilize clavicle 
Sterna head: Rotate the head to the left side and with the therapist’s hand on the occiput, elevate the left mastoid process, tucking the chin into the left shoulder

Self care

Diaphragmatic breathing, Hydrotherapy, Self-massage, Stretching
Mxl strengthening if necessary
If subluxation, refer them to Chiropractic

Congenital Torticollis

Hydrotherapy to the affected structures applied unilaterally
Diaphragmatic breathing (if patient is old enough to understand the explanation)
Initially, gentle Fascial stretching is applied to the affected SCM in the segmental fashion

Self Care for Congenital Torticollis

Passive stretching
Referral to craniosacral therapist

Massage for Congenital Torticollis

Hydrotherapy to reduce hypertonicity
Reduce sympathetic nervous system firing bad spasm
Restore ROM
Full body relaxation massage
Direct massage on the neck is Contraindicated
Gentle C/S distraction




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