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