Pediatric Therapy Services


Torticollis, neck tightness presenting as asymmetrical positioning, is often categorized into two types: congenital muscular torticollis and positional torticollis. Congenital muscular torticollis (CMT) is an unknown cause of postural asymmetry evident shortly after birth, correlated with birth trauma or positioning in utero. It results in a shorting 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. These infants present with reduced cervical range of motion and an asymmetrical head or neck position.

Since June 1st, 2017, 525 children diagnosed with torticollis received physical therapy evaluations, of those children, 53.7% presented with left sided torticollis, 45.1% with right sided torticollis, and 1.2% variable, with direction of torticollis switching left or right.

Of the total patients evaluated, 274 had completed treatments (evaluation and discharge). For this data, inclusion criteria included the following: a diagnosis code of 723.5 (torticollis, unspecified) or 754.1 (congenital musculoskeletal deformities of sternocleidomastoid muscle), < 12 months of age at the time of the initial evaluation, and discharge due to improved muscle function and range of motion. Pre and post assessments included the Muscle Function Scale (MFS), a measure of head righting, and cervical range of motion.

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 5, with higher scores indicating better muscle function. Cervical range of motion is measured using a goniometer and reported in degrees of movement.

++Muscle Function Scale Legend++

1=Head below the horizontal

2= Head in the horizontal

3= Head slightly above the horizontal

4= Head high above the horizontal

5= Head Very High above the horizontal

The scale runs from Grade 1 (most severe) to Grade 5 (least severe).

Muscle Function Improvement After Torticollis Treatment (N = 29)


Of the 254 patients who competed treatment, including evaluation and discharge, only 186 were used for this data. Patients who were treated for 3 months or less were considered outliers. These outliers were removed due to not receiving adequate intervention to achieve desired outcomes. Of the 186 patients who completed treatment, the average age at referral was 3.69 months and average age at discharge was 11.88 months. The results indicate that earlier referral and treatment results in better outcomes and earlier discharge age.