Torticollis (Infant and Adult)
Over 45,000 infants are born with congenital
torticollis in the US each year. This twisted or tilted neck,
the so-called "fixed wry neck" is often ascribed
to problems during birth. The condition causes painful, involuntary
spasms, impedes normal growth and development and disturbs
vision.
The medical approach to this condition is often surgery
on neck muscles, nerves and tendons, and intensive physical
therapy and drug therapy.
The consequences of birth trauma:
a case report of failure to thrive in an infant with cephalohematoma
and congenital torticollis. Anderson, C. International Chiropractors
Association Review, Fall 2001 pp. 79-84.
This paper discusses
birth trauma such as facial paralysis, brachial plexus damage,
Erb’s Palsy, torticollis and
cephalohematoma among others. Cephalohematoma is bleeding
beneath the cranial bones due to ripping of veins during
delivery and affects about 1% of newborns. This occurs as
a result of prolonged labor, vacuum extraction or a forceps
delivery and generally disappears after a few weeks or months.
This
is the report of a 7 week-old-male who was brought to the chiropractor
with complaints of: poor suck, little weight gain, torticollis
and cephalohematoma. The mother had taken the baby to a torticollis
clinic where the parents were told to stretch his neck with
every diaper change. It resulted in little change.
Craniosacral
therapy was performed on the occipital bone for restoring movement
to the parietal and sphenoid bones. Spinal adjustments were
given to C1, C2, T9, L5 and sacrum.
After the first visit, the
mother remarked that the baby was sucking better, sleeping
better and for longer stretches. By two weeks of care, the
hematomas decreased markedly in size and the torticollis had
resolved. By the end of a month’s
care, there was almost complete resolution of the hematomas.
Chiropractic
care of the newborn with congenital torticollis. Fallon JM
and Fysh PN. Journal of Clinical Chiropractic Pediatrics Vol
2, No.1 1997. P. 113-115.
Congenital torticollis has been estimated
to affect approximately two percent of newborn infants. The
frank breech birthing position has been reportedly associated
with the highest incidence of torticollis, with up to 34 percent
of infants born in this position being affected…the most common
type of congenital torticollis is that associated with subluxation
of the upper cervical spine. Chiropractic management of congenital
torticollis is primarily directed at reducing cervical spine
subluxations, which have been identified as commonly present
with this condition….
Chiropractic management of congenital
torticollis, using a combination of spinal adjustments, cranial
re-alignment and soft tissue therapies can produce rapid resolution
in many cases of congenital torticollis and plagiocephaly (an
asymmetrical and twisted condition of the head and face due
to irregular closure of the cranial sutures, frequently occurs
in conjunction with congenital torticollis) in the newborn
infant. Spinal adjustments have been demonstrated to be efficacious
to the resolution of the congenital torticollis….
The
medical approach to a protracted torticollis is surgical intervention.
While surgical intervention is typically a solution of last
resort, it is frequently the only solution considered by the
medical community. Chiropractic care is considered essential
to the health and maintenance of the child’s spine and
nervous system. It is therefore important that the doctor of
chiropractic become part of the multi-disciplinary team and
that medical doctors become aware of chiropractic management
as a solution to the most common causes of congenital torticollis.
Osteopathic
manipulative treatment applications for the emergency department
patient. Paul, FA, Buser BR Journal of the American Osteopathic
Association, 1996;96:403-409.
From the abstract:
The emergency department (ED) setting offers
osteopathic physicians multiple opportunities to provide osteopathic
manipulative treatment (OMT) as either the primary therapy
or as an adjunct to the intervention. In doing so, osteopathic
physicians can decrease or eliminate the morbidity and symptoms
associated with protracted dysfunction. Low back pain, chest
pain, torticollis, asthma and sinusitis are some of the illnesses
in which OMT should be implemented as part of the management
plan….
Torticollis in infants and children: a report
of 3 cases. Aker PS, Cassidy DJ J Can Chiro Assoc Mar 90;34(1):13-19.
From
the abstract:
Three cases of torticollis are recorded, one of
a child with congenital muscular torticollis and two of infants
with acquired torticollis caused by neurogenic tumors. All
were treated by chiropractors before the correct diagnosis
was made.”
“Benign causes of torticollis, such as
atlantoaxial joint dysfunction, usually resolve quickly with
appropriate treatment. If childhood torticollis is long-standing,
resistant to treatment or progressive, the clinician should
carefully search for more serious causes of this disorder.
In some cases, delay of the diagnosis can result in permanent
disability or even death.
Spastic torticollis and the relationship
to spinal scoliosis. Mawhiney R.B. The American Chiropractor
April 1980. Pp. 14-18
The is the case of a 39 year-old woman
who was suffering from painful neck spasms, dystonia, palpable
muscular rigidity and restricted range of cervical motion.
The
patient was listed as totally disabled and “was
unable to perform household tasks and some personal hygiene.” She
was on pain killers, muscle relaxants and Botulinum toxin
injections under medical care. After 8 weeks of chiropractic
care she had a reduction in her scoliosis from 22 ° to
11 °, a 50% reduction in medication, 75% increase in
cervical mobility. Patient continues to improve and is now
off all daily medication and travels without restrictions.
Congenital
muscular torticollis: a review, case study, and proposed
protocol for chiropractic management. Colin N. Top Clin Chiro
(1998); 5(3):27-33.
From the abstract:
A case study of a 7-month-old infant who
had been medically diagnosed with the disorder as birth-trauma
related.
Summary: Six sessions of chiropractic management involving
low force adjusting and gentle myofascial release work were
administered based on clinical mechanical findings derived
form an apparent right hand and right leg dominance in the
child. The child had not previously responded to several
weeks of physical therapy. Following chiropractic care, the
case completely resolved.
The response was sustained at one
year follow-up.
Pediatric traumatic torticollis:
a case report. McCoy Moore T, F, Pfiffner TJ, Journal of Clinical
Chiropractic Pediatrics 1997 (2)2 pp. 145-149.
This is the case
of a 4 year old male child who sustained a moderate trauma
(falling off a bed landing head first) with left lateral head
tilt and right lateral rotation the “cock
robin” position that is typical of atlantoaxial rotary
fixation.
Two weeks following the spinal adjustment, the patient
returned to the clinic reporting that complete resolution
had occurred.
From the conclusion:
Any child presenting with a recent upper
respiratory infection, sore throat, otitis media or minor trauma
with torticollis is a candidate for consideration of atlantoaxial
rotary fixation.
Chiropractic adjustments
and congenital torticollis with facial asymmetry: a case study.
Hyman C.A. International Chiropractors Association Review September/October
1996. Pages 41-45.
This is the case of a two-month-old female
presented with obstetrical brachial plexus injury (Erb’s
palsy) that had been under the care of several medical pediatricians
without resolution.
The condition showed complete resolution
under chiropractic care without any complications or residual
impairments.
Kinematic imbalances due to suboccipital strain
in newborns. Biedermann H. J. Manual Medicine 1992, 6:151-156.
More
than 600 babies (to date) have been treated for suboccipital
strain. One hundred thirty-five infants who were available
for follow-up were reviewed in this case series report. The
suboccipital strain’s main symptoms include torticollis,
fever of unknown origin, loss of appetite and other symptoms
of CNS disorders, swelling of one side of the facial soft
tissues, asymmetric development of the skull and hips, crying
when the mother tried to change the child’s position
and extreme sensitivity of the neck to palpation.
78 to 79 infants
with torticollis responded favorably to a short course of
conservative chiropractic care.
Most patients in the series
required one to three adjustments before returning to normal. “Removal
of suboccipital strain is the fastest and most effective way
to treat the symptoms...one session is sufficient in most cases.
Manipulation of the occipito-cervical region leads to the disappearance
of problems....”
Chiropractic correction of congenital
muscular torticollis. Toto BJ. Journal of Manipulative and
Physiological Therapeutics, 1993:16(8):556-559.
This is the
case of a 7-month-old male infant with significant head tilt
from birth.
The child’s health history included ear infections,
facial asymmetry (flattening of left side of face), regurgitation
(15 times per day), projectile vomiting (about once each
week), spasm of the left SCUM muscle and left trapezius muscles
and left lateral atlas and suboccipital joint dysfunctions.
The child cried frequently and rarely laughed.
Diversified chiropractic
adjustments were performed three times a week for three months.
After 5 months of chiropractic care head tilt and associated
muscle spasm were absent with dramatic improvement in child’s
general demeanor. Regurgitation became much less frequent with
some residual facial asymmetry remaining.
Chiropractic care
of the newborn with congenital torticollis, Fallon, JM, Fysh,
PN Journal of Clinical Chiropractic Pediatrics 1997 2(1):116-121.
From the abstract:
Chiropractic management of congenital torticollis
using a combination of spinal adjustments, cranial re-alignment
and soft tissue therapies can produce rapid resolution in
many cases of congenital torticollis and plagiocephaly in
the newborn infant. Spinal adjustments have been demonstrated
to be efficacious to the resolution of congenital torticollis.
Before commencing a course of conservative spinal care, however,
accurate identification of the cause of the torticollis must
be made to rule out complicating conditions which may result
in high morbidity or mortality. The typical course of spinal
adjustments for torticollis is usually of short duration
requiring just a few treatments. Early correction of congenital
torticollis should be the goal since prolonged contraction
of the SCUM can be the cause of cranial and facial anomalies
as well as scoliosis.
The medical approach to a protracted torticollis
is surgical intervention. While surgical intervention is typically
a solution of last resort, it is frequently the only solution
considered by the medical community. Chiropractic care is
considered essential to the health and maintenance of the
child’s spine and nervous system. It is therefore important
that the doctor of chiropractic become part of the multi-disciplinary
team and that medical doctors become aware of chiropractic
management as a solution to the most common causes of congenital
torticollis.
Blocked atlantal nerve syndrome in infants and
small children. Gutman G. ICA Review, 1990; July:37-42. Originally
published in German Manuelle Medizin (1987) 25:5-10.
From the
abstract:
Three case reports are reviewed to illustrate a syndrome
that has so far received far too little attention and which
is caused and perpetuated in babies and infants by blocked
nerve impulses at the atlas. Included in the clinical picture
are lowered resistance to infections, especially to ear-,
nose- and throat infections, two cases of insomnia, two cases
of cranial bone asymmetry and one case each of torticollis,
retarded locomotor development, retarded linguistic development,
conjunctivitis, tonsillitis, rhinitis, earache, extreme neck
sensitivity, incipient scoliosis, delayed hip development
and seizures.
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Koren, D.C.