What are we dealing with here?
Congenital Muscular Torticollis (CMT) is a condition that is a postural and musculoskeletal deformity that is evident at or shortly after birth.
CMT results from one-sided shortening or stiffness of the sternocleidomastoid muscle which is located from your baby’s (and your) chest and goes to the back of their head. Your baby will have a sideward bend of the head to the side and often also a turning of their face towards the other side.
It is really interesting to note that the incidence of CMT has been reported to range from as little as 0.3% to 16% of all new-borns. This might shock you, but this kind of finding is fairly common in medical research because researchers use different systems to classify a condition.
What can be said, however, is that CMT is fairly common.
Even though the latest research on this does not agree with how common it is, they agree with two different facts:
- The earlier it is treated the better (less treatments and a better chance of it fully resolving), and
- If CMT is left untreated it may require more invasive interventions (cutting the muscle) in later life.
I will come back to these facts later in this blog, but let’s discuss the suspected origin of the condition first.
Although many hypotheses have been proposed including muscle trauma at birth or repetitive microtrauma (meaning small injuries to the muscle) such as prolonged foetal positioning, the cause of CMT remains uncertain.
What the research has found, is that 13% of the babies that had CMT had a breech presentation at birth. This means that they were not in the optimal position to have a natural birth and were, so to speak “upside down”. Also, they found that a large number (90.1%) had a craniofacial asymmetry.
When we are talking about the “craniofacial” bones we mean the head (and face) and this does not seem surprising given that this muscle is attached to your occiput, the back of your head.
So what can be done about it, you might ask?
There are good quality studies that show that physical therapy, sometimes combined with a stretching home-exercise protocol is effective at helping babies with CMT. They found that most of the infants needed 10 sessions of therapy, however, few needed 20-40.
Other sources showed that the average duration of treatment was around 4 months. Even though the research does not agree with what treatment is the most effective and how long it takes to resolve CMT, one thing seems to be a common theme: the younger the child is at the initiation of treatment the better the chances of it resolving fully.
This blog is not designed to scare you, but instead, I have written this blog to INFORM you. CMT is treatable and it is important for the future of your child that this issue is being addressed, if present.
Carenzio, G., Carlisi, E., Morani, I., Tinelli, C., Barak, M., Bejor, M. and Toffola, E, 2015. Early rehabilitation treatment in newbornd with congenital muscular torticollis. European Journal of Physical and Rehabilitation Medicine, 51 (5), 539-545.
Cheng, J., Tang, S., Chen, T., Wong, M. and Wong, E., 2000. The clinical presentation and outcome of treatment of congenital muscular torticollis in infants—A study of 1,086 cases. Journal of Pediatric Surgery, 35 (7), 1091-1096.
Heidenreich, E., Johnson, R. and Sargent, B., 2018. Informing the Update to the Physical Therapy Management of Congenital Muscular Torticollis Evidence-Based Clinical Practice Guideline. Pediatric Physical Therapy, 30 (3), 164-175.
Hahn, H., Cook, K., Lee, I., Park, D. and Park, M., 2017. Use of Acellular Dermal Matrix in Treatment of Congenital Muscular Torticollis in Patients Over Eight Years of
Age. Journal of Craniofacial Surgery, 28 (3), 610-615.
He, L., Yan, X., Li, J., Guan, B., Ma, L., Chen, Y., Mai, J. and Xu, K., 2017. Comparison of 2 Dosages of Stretching Treatment in Infants with Congenital Muscular
Torticollis. American Journal of Physical Medicine & Rehabilitation, 96 (5), 333-340.
Hu, C., Fu, T., Chen, C., Chen, C., Lin, Y. and Hsu, C., 2017. Longitudinal follow-up of muscle echotexture in infants with congenital muscular torticollis. Medicine, 96 (6), e6068.