Torticollis Stretching

NOTICE: The information presented is for your information only, and not a substitute for the medical advice of a qualified physician.

Torticollis is generally treated using physical therapy and a home exercise regimen. However, curing tort can be a different journey for each family who experiences it, depending on the severity of the tort and plagio and the choices of additional therapies that work the best for the child. But in all cases, physical therapy is critical.

Find a good physical therapist (preferably one who has experience with pediatric torticollis) and maintain an exercise program at home that combines stretching exercises along with exercises to strengthen the weaker neck muscle (the muscle on the opposite side of the neck from the tight muscle). Your PT will show you age-appropriate exercises as they change as the child grows and hits various "milestones" such as sitting, crawling, walking, etc. Generally, tort kids are in PT until they walk well--even if the tilt is gone before then--since tilt tends to return or get worse at various milestones and when a baby is sick, tired, or teething.

Tummy Time

If your baby has torticollis they probably won't like it much! Roll a blanket or towel and put it under the baby's chest to slightly elevate their head. They should tolerate the time better with this easy adjustment! Please remember that ALL tummy time should be supervised! Start with 30 seconds once every hour (this is easy to communicate with care providers and not too overwhelming). Gradually increase the length of each tummy session. You will know when you can increase the length by the amount of complaining. Get down on the floor with baby. Your baby NEEDS time on their tummy while awake. Ideally you would work up to half of baby’s playtime is on their tummy. Start small and work your way up.

Keep that head up straight!

Prop up the baby's head whenever feasible. You will help your child to see the world straight on so they don't get used to the sideways view they have now. Try using rolled towels or blankets for head support. Also, don’t forget to reduce the pressure on the head to prevent worsening of plagio (think memory foam).

Car Seats/Bouncy Seats/Swings

Limit time spent. Use head supports to keep baby’s head midline. One thing that may work well in the car seat is cutting up a large bath sponge to fit between bay’s head and the car seat, on both sides, to make the head stay straight (think “U” shape). Also, don’t forget to reduce the pressure on the head to prevent worsening of plagio (think memory foam).

Exersaucers/Walkers/Jumpers

Your baby will progress faster if he/she doesn't spend any time in a saucer/walker, especially in the beginning when they are still trying to gain neck strength. PLEASE STAY AWAY FROM JUMPERS - these things are really hard on any child's neck - and a baby with a weak neck will suffer more.

Balance Ball (any exercise ball or large beach ball should work)

1. Introduce ball into environment first. They are rather large comparatively and may be scary. After baby is comfortable around ball try these exercises.

2. Place baby on tummy on ball. Sit on floor behind the ball, and hold baby's hips for stability. Slowly roll ball towards floor so that baby's head is moving towards floor. They will use their neck muscles to pull their head up, trying to keep it perpendicular to the floor. It also helps to have someone sit in front of the ball encouraging baby to look up. Rolling the ball back and forth also helps them get a sense of movement/balance.

3. Do the same thing as above, only instead of rolling the ball totally forward move the ball slightly forward and then gently side to side. This will encourage baby to use one arm and then the other (depending on which way you are rolling) to stabilize their body on the ball.

4. Sit baby on top of ball in a V leg position with you sitting on floor behind. Hold baby's hips for stability. Place baby's hands inside the V legs and roll ball forward. This will cause baby to stabilize self with arms and hands. Builds up those wee muscles!

5. Sit baby on top of ball in slight V leg position. Place hands on outsides of legs. Roll ball gently from right to left. Baby will use arms to stabilize.

6. For work on crossing over midline, place baby on top of ball in V leg. Show baby how to move legs into a side-sit position so that knees are bent and both feet are pointing towards the right. Hands should both be to the left on the ball, over the left knee. Like baby is getting ready to get themselves up into a crawling position. Roll ball to the left and they will use their arms for stability. Do the same on the other side.

7. For work on crawling, place baby in crawling position on hands and knees on top of ball, you kneel behind ball and place your hands on baby's hip to stabilize. Roll ball back and forth and side to side. This helps with strength and helps to give baby a sense of movement and balance while on hands and knees.

8. Website that sells baby exercise balls and videos. http://www.geniusbabies.com/weeexgipa.html

I
NSTRUCTIONS FOR STRETCHING AND POSITIONING STERNOMASTOID TORTICOLLIS

LEFT TILT = tilts left, prefers to look right

RIGHT TILT = tilts right, prefers to look left

Stretching

• For the following stretching exercises, the parent sits with the back against the wall and knees bent.

• Place the child in your lap, with the child on her back and knees tucked.

• Or place baby on flat surface (bed, couch, floor) while you kneel above.

LEFT TILT

LEFT TILT Sidebending

• Hold the child’s LEFT shoulder down with your RIGHT hand

• Place your LEFT hand on top of the LEFT side of the child’s head, and slowly bend her head towards her RIGHT shoulder

• H
  old the position for 10 seconds. Repeat 15 times, 4 to 6 times a day.

LEFT TILT Rotation

• Place your LEFT forearm against the child’s RIGHT shoulder, and cup the child’s head with the same hand.

• Use your RIGHT hand to hold the child’s chin.

• Slowly rotate the child’s face to her LEFT.

• Hold the position for 10 seconds. Repeat 15 times, 4 to 6 times a day.

LEFT TILT Positioning

• When the child is on her stomach, position all toys so that the child has to turn her face to the LEFT.

LEFT TILT Carrying

• Hold the child facing away from you, in a side-lying position, with the child’s LEFT ear resting against your LEFT forearm.

• Place your RIGHT arm between the child’s legs and support the child’s body.

• Carry the child in this position as much as possible.

LEFT TILT Other Suggestions

• Hold toys so that the child has to look up and out to her LEFT

• Position child in crib so that activities in the room encourage her to look LEFT

• While bottle feeding the child, position her to face LEFT

• While holding the baby across the shoulder, position her to face LEFT

RIGHT TILT

RIGHT TILT Sidebending

• Hold the child’s RIGHT shoulder down with your LEFT hand

• Place your RIGHT hand on top of the RIGHT side of the child’s head, and slowly bend her head towards her LEFT shoulder

• Hold the position for 10 seconds. Repeat 15 times, 4 to 6 times a day.

RIGHT TILT Rotation

• Place your RIGHT forearm against the child’s LEFT shoulder, and cup the child’s head with the same hand.

• Use your LEFT hand to hold the child’s chin.

• Slowly rotate the child’s face to her RIGHT.

• Hold the position for 10 seconds. Repeat 15 times, 4 to 6 times a day.

RIGHT TILT Positioning

• When the child is on her stomach, position all toys so that the child has to turn her face to the RIGHT.

RIGHT TILT Carrying

• Hold the child facing away from you, in a side-lying position, with the child’s RIGHT ear resting against your RIGHT forearm.

• Place your LEFT arm between the child’s legs and support the child’s body.

• Carry the child in this position as much as possible.

RIGHT TILT Other Suggestions

• Hold toys so that the child has to look up and out to her RIGHT

• Position child in crib so that activities in the room encourage her to look RIGHT

• While bottle feeding the child, position her to face RIGHT

• While holding the baby across the shoulder, position her to face RIGHT

How To Make Tummy Time And Stretching More Enjoyable For All

• Blow bubbles in the direction you would like baby to look. Also good for strengthening because they tend to reach with the weak hand.

• Tickle, laugh, sing songs, make funny faces

• Have someone help distract baby. Older siblings work well as do pets.

• Use a mirror to capture baby’s attention.

• Kisses on the cheek to make the head turn.

• Blow in baby’s ear to make the head turn.

Alternative Stretches

• If you can’t do the stretches work on strengthening the weak side.

• Do the rotation stretch with baby sitting in you lap. Back to your chest. Do this in front of a mirror. Hold one arm across baby’s chest for support. Use free hand to gently turn head desired direction.

• Do the carrying hold on the floor. Place baby’s head against the floor instead of your arm. Support the body up away from the floor. The floor will do the stretch. Make this a game.

• Do stretches while baby is asleep. This is excellent. Try it a couple of times before completely ruling out. Wait until baby has been asleep 10-15 minutes.

• Remember that babies are much more flexible than adults. Their range of motion can be 110% (i.e. turn head slightly further than shoulder and touch ear to shoulder). It is highly unlikely you will over stretch your baby. If you feel uncomfortable check with your PT or Dr.

Crawlers

Crawling is a great muscle builder! Encourage your crawler to crawl. Buying the tubes, tumblers, and tunnel toys are great play toys that encourage crawling, and therefore strengthen those wimpy shoulders (not developed well due to tummy time aversion!). Get on the floor and “chase” your baby.

Fighting the Stretches

There is a difference between not liking the stretches and fighting them to the point of doing harm (i.e. strengthening the already strong muscle). A trained PT is really the only one who can truly tell the difference. However, around age 12 months (some earlier and some later) most babies are really fighting. If your baby really fights then talk to your PT about alternatives. Ask your PT if you should continue the stretches. Do not stop stretches without speaking to your PT. You will need to do extra strengthening moves to compensate. Not doing anything will do even more harm.

Additional Strengthening Moves

• Position baby so they have to look the hard way to see the fun stuff, i.e. TV, toys, other people, siblings, pets, etc.

• Do you own PT sessions 1-3 times each day. Get down on the floor with your baby and make them look and turn in the “right” direction. Tort babies like to cheat and turn their whole body. Make sure they are only using their necks (most of the time). If they start to turn the whole body, stop, get their attention straight ahead again and then move their attention to the correct side.

• Try to get older babies to reach with the hand opposite the tilt (on the weak side).

• Put finger foods closer to the weak side so baby uses the weak side.

• Do the exercise ball strengthening moves while baby sits on your legs or lap. You can move baby side to side and front to back without the ball. Baby will naturally want to “right” his/her head. Tilt baby towards the tilt, i.e. left tilt move towards baby’s left that will force baby to pull head towards right.

• Try head righting exercises in front of a mirror. Hold baby at waist and tip the body so baby has to work against gravity to right his/her head. This forces baby to hold his own head up. The goal is to go past midline.

• Blow bubbles to baby’s weak side encouraging him to reach with weak arm and look in “right” direction.

• Do the “wheelbarrow”. Basically you get on your knees and hold the baby's legs and support their
  abdomen/chest with one hand with their hands on the ground. Push forward slightly to get them to "crawl" forward with their arms. You can move the support hand closer to you as they gain more strength.