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Understanding Torticollis: Causes, Symptoms, and Treatment Options

Oghenefejiro Okifo | MD

Medically reviewed by Oghenefejiro Okifo | MD, Harvard Medical School | Henry Ford Hospital - Detroit, MI on December 8th, 2023.

Key Takeaways

  • Congenital torticollis affects 1 in 250 newborns and occurs when the sternocleidomastoid muscle shortens during development, causing the head to tilt toward the affected side while the chin turns away.

  • The "golden window" for infant treatment is the first 6 months of life—90% of cases resolve with physical therapy during this period, but success drops to 20% after age 12 months.

  • Acquired forms can result from cervical spine injuries, dystonia, or infections like meningitis, with spasmodic torticollis being the most common type affecting adults between ages 40-60.

  • Physical therapy involves specific stretching exercises performed 15-20 times daily, including lateral neck flexion away from the tight muscle and rotation toward the affected side for 10-15 seconds each.

  • Botulinum toxin injections provide relief for 3-4 months in 85% of spasmodic cases when muscles don't respond to conservative treatment, with doses typically ranging from 100-300 units per session.

Torticollis, also known as wryneck or loxia, is a condition that affects the neck muscles, causing the head to tilt to one side. It can occur in infants, children, and adults, and the causes and symptoms may vary depending on the age group. In this article, we'll explore the different types of torticollis, their causes, symptoms, and treatment options.

Types of Torticollis

There are two main types of torticollis:

  1. Congenital muscular torticollis: This is the most common type, and it's present at birth. It's usually painless and caused by factors such as the baby's position in the womb or the use of forceps or vacuum devices during delivery.

  2. Acquired torticollis: This type develops after birth and can be linked to other medical issues. It may be painful and can affect both children and adults.

Causes of Torticollis

The causes of torticollis can vary depending on the type and age group. Some possible causes include:

  • Abnormal development or tightening of the sternocleidomastoid (SCM) muscle

  • Klippel-Feil syndrome, a rare birth defect that causes vertebrae in the neck to fuse

  • Hematoma or fibrosis in the neck muscles

  • Swelling in the throat due to infection, injury, or unknown causes

  • Vision problems or gastroesophageal reflux disease (GERD)

  • Reactions to certain medications

  • Arthritis in the neck or other underlying conditions

Symptoms of Torticollis

The symptoms of torticollis may not be noticeable in infants until they gain more control of their head and neck, usually around 6-8 weeks of age. Some common symptoms in infants include:

  • Head tilting to one side with the chin pointed to the opposite shoulder

  • Difficulty turning the head side to side or up and down

  • A soft lump in the neck muscle

  • Preference for looking over one shoulder or feeding on one side

  • Flat head on one or both sides (positional plagiocephaly)

  • Uneven shoulder height or facial features

In adults, symptoms of torticollis may include:

  • Neck pain, stiffness, or muscle spasms

  • Headaches or burning sensations in the shoulders, neck, or back

  • Tilting or turning of the head to one side

  • Tremors or twitching in the neck muscles

Understanding Torticollis: Causes, Symptoms, and Treatment Options

Diagnosis and Complications

If you suspect your baby has torticollis, it's essential to consult with your doctor for an examination. They may order imaging scans or blood tests to rule out other conditions. In adults, a physical exam and assessment of symptoms are usually sufficient for diagnosis, unless there are concerns about spinal cord compression or nerve damage.

Without proper treatment, torticollis can lead to complications such as:

  • Delays in motor skill development

  • Facial deformities or flat head syndrome

  • Balance and vision problems

  • Emotional issues or disability that interferes with daily life

Treatment Options

Treatment for torticollis depends on the type and underlying cause. In most cases, congenital torticollis can be treated with stretching exercises and positioning changes that parents can perform at home. These exercises help lengthen the tighter muscle and strengthen the opposite side. Physical therapy may also be recommended.

For acquired torticollis, treatment may include:

  • Medications to relieve pain and muscle spasms

  • Botox injections or trigger point injections

  • Braces or other devices to keep the neck in place

  • Surgery, in rare cases, to lengthen the SCM muscle or correct vertebral dislocations

Home remedies such as stretching, hot and cold therapy, and stress reduction techniques may also help alleviate symptoms in adults.

Prevention and Early Intervention

While it may not be possible to completely prevent torticollis, early intervention is key to avoiding complications. For infants, this means sticking to the prescribed treatment plan and attending regular check-ups with the doctor. Adults can reduce their risk by avoiding neck injuries, practicing good posture, and performing stretching exercises regularly.

When to Seek Medical Help

In most cases, torticollis is not a serious condition and responds well to treatment. However, it's important to seek medical help if you or your child experience symptoms that may indicate a more serious underlying issue, such as:

  • Sudden, high fever and chills

  • Severe headache or neck stiffness

  • Confusion or trouble concentrating

  • A skin rash

These symptoms may be signs of meningitis, a potentially life-threatening condition that requires immediate medical attention.

Conclusion

Torticollis is a relatively common condition that affects the neck muscles, causing the head to tilt to one side. While it can be concerning for parents and individuals experiencing symptoms, prompt diagnosis and treatment can help prevent long-term complications. By understanding the causes, symptoms, and treatment options for torticollis, you can work with your healthcare provider to develop an effective management plan and ensure the best possible outcomes.

The Bottom Line

Early intervention dramatically improves outcomes, especially in infants where prompt physical therapy can prevent permanent facial asymmetry and developmental delays. Adults with sudden onset neck stiffness and involuntary head positioning should seek evaluation to rule out underlying neurological causes. If you're experiencing persistent neck muscle spasms or head tilting, Doctronic can help connect you with appropriate specialists quickly.

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