Congenital Torticollis

Congenital muscular torticollis (CMT) is a condition in which an infant’s head tilts to one side and rotates in the opposite direction, caused by tightness or shortening in the sternocleidomastoid (SCM) muscle of the neck. It is one of the most common musculoskeletal conditions in newborns, affecting approximately 0.3-2% of infants. Early physiotherapy is the first-line treatment, and outcomes are consistently better when intervention begins in the first few months of life.

What causes congenital torticollis?

The SCM is a long muscle that runs from behind the ear down to the collarbone on each side of the neck. In CMT, one side is shorter, tighter, or contains a palpable fibrous mass (called a sternocleidomastoid tumour or pseudotumour - a benign finding, not a tumour in the oncological sense). The cause is not fully understood but is associated with:

• Positioning in the womb (intrauterine constraint) - particularly in multiple pregnancies or oligohydramnios
• Difficult or assisted delivery (forceps, vacuum) - which may cause SCM injury and subsequent fibrosis
• Birth position or prolonged pressure on one side of the neck

A paediatrician or GP should evaluate your baby to rule out bony causes of neck tilt (such as atlanto-axial instability or Klippel-Feil syndrome) before physiotherapy begins. In uncomplicated CMT, physiotherapy is the primary treatment.

What happens if torticollis is not treated early?

Without treatment, tight SCM tissue does not reliably self-resolve. Persistent torticollis can lead to:

• Plagiocephaly (positional head flattening): because the infant consistently rests and turns their head on the same side
• Facial asymmetry: the bones of the skull and face model in response to asymmetric forces during early growth
• Delayed gross motor development: a baby who cannot easily turn their head in both directions will compensate in movement and may reach developmental milestones asymmetrically

The critical window for conservative management is the first year of life - and within that, the sooner the better. Babies who begin physiotherapy before 3 months of age have the highest rates of full resolution.

What does a session at Goji involve?

Our physiotherapist will take a detailed history of your pregnancy, delivery, and your baby’s current movement patterns. The assessment includes:

• Cervical range of motion: measuring how far your baby can rotate and tilt their head in each direction, and noting the end-feel (soft stretch vs. firm resistance)
• SCM palpation: feeling for a fibrous mass, diffuse tightness, or muscle belly differences between sides
• Head shape and facial symmetry: screening for plagiocephaly or facial asymmetry
• Developmental screen: observing how your baby is using their body in the context of their age

Treatment involves manual stretching of the tight SCM, facilitated active exercises appropriate for your baby’s age and tolerance, and - crucially - detailed parent education on stretching technique and positioning strategies for home. The home programme is as important as clinic sessions; our physiotherapist will ensure you are confident doing it safely between appointments.

How long does treatment take?

Most infants who begin treatment before 3 months resolve fully within 2-6 months of consistent physiotherapy. Older babies and children with more established tightness or fibrosis typically take longer and may require more sessions. Resolution is defined as symmetrical cervical range of motion and resolved postural asymmetry - not simply “close enough”.

Frequently asked questions

My baby was just diagnosed with torticollis. How quickly should we start physio?

As soon as possible. The earlier treatment begins, the faster and more completely the SCM responds. If your baby is under 3 months, contact us promptly - the first few months are the highest-leverage window for conservative management.

Can I do the stretches at home myself?

Yes - and you will need to. The home programme is a central part of treatment: typically several stretching sessions per day, integrated into nappy changes, feeds, and playtime. Our physiotherapist will teach you the technique hands-on at your first appointment and check your confidence and accuracy. Incorrect stretching technique can cause discomfort or injury; it should always be taught by a physiotherapist first.

My baby also has a flat spot on their head. Is that related?

Yes - positional plagiocephaly (head flattening) is a common secondary finding in babies with torticollis, because they consistently turn and rest their head on the same side. Treating the torticollis (and therefore the asymmetric positioning) is the most important intervention for plagiocephaly. Our physiotherapist will advise on repositioning strategies and, where the flat spot is significant, discuss whether a referral for helmet assessment is appropriate.

My child is 18 months old and has not had any treatment. Is it too late?

No, but the intensity and duration of treatment will likely be greater. Older children with established CMT may need a combination of physiotherapy and monitoring by an orthopaedic surgeon or paediatric specialist. Our physiotherapist will assess the degree of restriction and advise on an appropriate management plan and whether specialist referral is warranted.

Will my baby need surgery?

The large majority of infants with CMT resolve with physiotherapy alone. Surgical release of the SCM is considered only when conservative management has been adequately trialled (typically 12+ months in older children) and significant restriction persists. It is not a first-line intervention.

Can torticollis come back after treatment?

True recurrence after full resolution is uncommon. However, resuming a good variety of head positions and tummy time after resolution helps maintain symmetry. Our physiotherapist will advise on what to watch for and when to re-present if you notice asymmetry returning.