Pediatric Therapy Services

Pediatric Therapy Services: Torticollis



Torticollis, neck tightness presenting as asymmetrical positioning, is often categorized into two types: congenital muscular torticollis and positional torticollis. Congenital muscular torticollis (CMT) results in a postural asymmetry evident shortly after birth, correlated with birth trauma or positioning in utero. It results in a shortening or excessive contraction of the sternocleidomastoid muscle in the neck. Positional torticollis often appears within the first few months after birth and is usually caused by asymmetrical positioning of an infant when sleeping or in supported sitting. Infants with both types of torticollis present with reduced cervical range of motion and an asymmetrical head or neck position.

Since June 1st, 2017, 2,099 children diagnosed with torticollis received physical therapy evaluations; of those children, 55.1% presented with left sided torticollis and 44.9% with right sided torticollis. 1049 patients were screened for co-morbidity at the time of evaluation: 22.1% of the patients had a breech presentation, 48% presented with reflux and 2.2% presented with hip dysplasia. 17% evaluations were multiple births, 14.8% were tongue tied and 14.4% were delivered with vacuum extraction or forceps.

Of the total patients, 1438 had completed treatments (evaluation through discharge). For this data, inclusion criteria included the following: a diagnosis code of M43.6 (torticollis, unspecified) or Q68.0 (congenital musculoskeletal deformities of sternocleidomastoid muscle), < 13 months of age at the time of the initial evaluation, pre-and post-assessments included the Muscle Function Scale (MFS), a measure of head righting and cervical range of motion.

Muscle Function Scale


The Muscle Function Scale (MFS) is a tool used to assess the function of the lateral flexors of the neck in infants, using a scale of 0 to 6, with higher scores indicating better muscle function. A favorable outcome for the MFS, is a Grade 6. 1,313 patients at evaluation had a MFS of 1, 2, or 3. Upon discharge, 1,137 patients achieved grades 4, 5, or 6. Of those 1438 patients, 555 of those patients improved to the highest grade (grade 6). These numbers indicate that 38.6% of patients had the best possible outcome. The majority of patients start therapy with a Muscle Function Scale of 1 and by discharge of physical therapy services have a score of 6 which is the best outcome. The mean improvement of Muscle Function Scale was 2.85 an improvement of 2 ½ grades.

++Muscle Function Scale Legend++

1=Head below the horizontal

2= Head in the horizontal

3= Head slightly over the horizontal

4= Head high over the horizontal but below 45◦

5= Head high over the horizontal and over 45◦

6 = Head very high over the horizontal

The scale runs from Grade 1 (most severe) to Grade 6 (least severe).

Length of Treatment relative to Age of Referral (N = 1438)


Since 2017, 81% of torticollis referrals occurred within the child’s first four months of life and 46% occur in the 0–2-month age range. Earlier referrals help support the claim that earlier access to care results in younger age at discharge. Based on the above inclusion criteria, the average age at referral was 3.56 months and average age at discharge was 9.82 months