29/06/2025
Congenital muscular torticollis (CMT) is a condition in infants where the sternocleidomastoid (SCM) muscle is shortened or tightened, causing the head to tilt to one side and the chin to rotate to the opposite side. Physiotherapy is a primary treatment to address muscle imbalance, restore range of motion (ROM), and prevent long-term complications.
*Goals of Physiotherapy*
1. 👉 Lengthen the affected SCM muscle to improve head alignment.
2. 👉 Restore full cervical ROM (rotation and lateral flexion).
3. 👉 Strengthen neck and trunk muscles to support symmetrical posture.
4. 👉 Prevent secondary complications (e.g., plagiocephaly, facial asymmetry).
5. 👉 Educate caregivers on home exercises and positioning.
*Physiotherapy Management*👇
1. ✅ Assessment
• Evaluate head tilt, cervical ROM (active and passive), SCM tightness, and muscle strength.
• Assess for associated conditions (e.g., plagiocephaly, hip dysplasia).
• Monitor developmental milestones and posture.
2. ✅ Stretching Exercises
• Passive stretching: Gently stretch the tight SCM by tilting the head laterally (ear to shoulder) and rotating the chin toward the affected side. Perform 3-5 repetitions, holding each stretch for 10-30 seconds, 2-3 times daily.
• Caregiver training: Teach parents to perform stretches safely during diaper changes or feeding.
3. ✅ Positioning and Handling
• Encourage active head movement by positioning toys or stimuli on the side that promotes rotation toward the affected side.
• Use tummy time to strengthen neck and trunk muscles and reduce pressure on the skull.
• Alternate feeding positions to promote symmetrical head movement.
• Use a firm mattress and avoid prolonged use of car seats or swings to prevent worsening of head shape.
4. ✅ Strengthening Exercises
• Promote active neck rotation and lateral flexion through play-based activities (e.g., tracking toys visually).
• Encourage weight-bearing activities to strengthen neck and core muscles.
5. ✅ Manual Therapy
• Gentle myofascial release or soft tissue massage to reduce SCM tightness.
• Ensure techniques are age-appropriate and performed by a trained pediatric physiotherapist.
6. ✅ Environmental Modifications
• Adjust crib or sleeping position to encourage head turning toward the restricted side.
• Use positioning aids (e.g., rolled towels) to support neutral head alignment during sleep, if needed.
7. ✅ Parental Education
• Train caregivers on stretching, positioning, and handling techniques.
• Emphasize consistency with home exercise programs.
• Educate on monitoring for developmental delays or worsening asymmetry.
8. ✅ Monitoring and Progression
• Reassess every 2-4 weeks to track ROM, head shape, and developmental progress.
• Adjust treatment based on improvement (e.g., reduce stretching frequency as ROM normalizes).
• Refer to specialists (e.g., orthotist for helmet therapy, surgeon for severe cases) if no progress after 6-12 months or if severe plagiocephaly develops.
PGR - Residency of Anesthesia
