Torticollis is a condition that affects the neck, affecting adults and infants. When you have torticollis, it causes the neck to bend to the side and rotate the neck. This means that the ear of the affected side is brought down to the affected shoulder, with the head, turning to the opposite side.
There are 4 different types of Torticollis:
Acute Torticollis: sudden onset of torticollis that is generally painful with movement. This is where trigger points are activated in certain muscles that force the neck into this position. It can be triggered due to being a secondary condition, such as from an infection/inflammation to the throat or lymph nodes, trauma to C1-C2 vertebrae, or cervical DDD. However, it can also be triggered by a chill to the muscle or even sleeping wrong.
Spasmodic Torticollis: This is where the muscles in the neck spasm, causing the neck to twitch and jerk. This form of Torticollis occurs in adults and has a very successful recovery rate. Though there are times that it is difficult to resolve depending on what the trigger is. Such triggers include depression, severe stress, Parkinson’s treatment, other CNS conditions, the position of the head while working; physical trauma; or malformation of C1 and the skull.
Congenita Torticollisl: This is where an infant has torticollis, which may progress into adulthood if there is no intervention. The reason why congenital torticollis happens is still unknown, but it affects the SCM muscle by fibrosing and shortening
Pseudotoricollis Torticollis: affects all the muscles in the neck that cause torticollis, but because all are affected, it doesn’t present itself in a regular torticollis position. The reason for it happening is always unknown, as there is no obvious trauma to the neck or other cause. Generally a person just ‘wakes up’ with it.
Treatment for Torticollis
When it comes to treatment, using massage therapy, they are treated in the same way, minus the length of time, especially when it comes to congenital torticollis, and the treatment is being done on an infant. Even with this, treatment is always done with you lying face up. This keeps from straining the neck and potentially causing you to spasm even more than you were before the session.
Muscles that are affected in torticollis are categorized into 2 types. The affected muscles on the same side of the neck and the affected muscles that are on the opposite side. This is because some muscles move the head to the same side as they are on, whereas other muscles make you move or turn to the opposite side.
The muscles that are worked on, that are on the same side of the neck are SCM (sternocleidomastoid), upper traps, levator scapula, and scalenes. The muscles that are working, on the opposite side, are splenius capitis, splenius cervicis, multifidus, rotatores, and suboccipitals. These muscles will be treated for trigger points, hypertonicity, muscle spasms, and facial restrictions.
Even though these muscles are the affected muscles of torticollis, on the unaffected side, some treatment is done. Mainly this is because the unaffected muscles are overstretched and weak, thus they too need some form of treatment, but very different compared to the affected muscles. In this case, muscles aren’t being relaxed and stretched, rather they are stimulated and will have some resistance training done to them. This is so they will be able to oppose the affected muscles and bring the neck back into place. If this isn’t done, the affected muscles will always be stronger, and pulling the neck into their primary action, rather than stabilizing the neck. View it like a tent pole that has 2 strings connected to it. If one side is too loose and the other is too tight, the pole will always lean towards the tighter side. Even when you loosen the tightened string, that tent pole will still lean to the originally tight side, until you tighten the loose side. There has to be balance.
At the same time, treatment will go slow, especially for treatment done on infants, which may start as 10-minute sessions and slowly increase. As for adults, unless you are used to having a massage, the treatment is about 30 minutes long. This is to make sure that you don’t feel overworked, and too tired to be able to do anything. This is also why the massage starts as a relaxation massage. This will help with decreasing pain, increasing some range of motion, and increasing blood flow to the area.
Once the client has become accustomed to the therapist’s touch, passive range of motion of the neck is done, and in later treatments resistance range of motion is also done to help strengthen the weaker side. But at no point should this treatment be painful, as it could trigger muscle spasms again. It is very important for there to be communication between the therapist and the client. If the client is an infant, then the therapist has to watch their facial expressions and body language closely for any indications that the treatment is uncomfortable for them.