Expert Congenital Torticolis Treatment in Delhi
What is Congenital Torticolis ?
Congenital Muscular Torticollis (CMT) is a condition present at birth where an infant holds their head tilted to one side and rotated to the opposite side. This is primarily caused by tightness or shortening of the sternocleidomastoid (SCM) muscle on one side of the neck.
Causes of Congenital Muscular Torticollis
While the exact cause is not always clear, the most common theories suggest:
- Intrauterine Positioning: Prolonged or cramped positioning in the womb (e.g., breech presentation, multiple births, primigravida) can put pressure on the SCM muscle, leading to shortening or injury.
- Birth Trauma: Difficult or assisted deliveries (e.g., forceps delivery, vacuum extraction) can sometimes injure the SCM muscle, leading to bleeding and subsequent fibrosis (scarring) and shortening.
- Ischemic Injury: Reduced blood supply to the SCM muscle during development or birth, leading to muscle damage and fibrosis.
- Genetic Predisposition: While not directly genetic, there might be a subtle predisposition in some cases.
- Presence of a Fibrotic Mass: A palpable mass (often called a “pseudotumor” or “sternomastoid tumor”) may be felt in the SCM muscle in some infants with CMT, usually appearing between 2-4 weeks of age and often resolving on its own. This mass consists of fibrotic tissue.
Symptoms of Congenital Torticolis
- Head Tilt: The infant’s head tilts toward one shoulder (the affected side).
- Chin Rotation: The chin turns toward the opposite shoulder (the unaffected side).
- Limited Range of Motion: Difficulty fully turning the head to one side or tilting it to the other side.
- Preferential Head Posture: The infant consistently favors looking in a particular direction.
- Palpable Lump (Pseudotumor): A soft or firm lump may be felt in the SCM muscle on the affected side, typically appearing 2-4 weeks post-birth and resolving by 4-6 months.
- Asymmetrical Facial Features: Prolonged head tilt can cause facial asymmetry or flattening on one side of the face over time if untreated.
- Developmental Delays: Severe or untreated cases may lead to delays in milestones like rolling, sitting, and crawling due to restricted head movements and asymmetrical body use.
- Difficulty with Feeding: Infants may have trouble latching or feeding on one side.
Advanced Physiotherapy Management for Coccydynia
Manual Therapy
- Gentle Passive Stretching: The cornerstone of treatment. The therapist (and trained parents) gently stretch the tight SCM muscle to lengthen it. This involves specific movements:
- Side Bending: Tilting the head towards the unaffected side.
- Rotation: Rotating the chin towards the affected side.
These stretches are performed slowly and gently, ensuring the infant is comfortable.
- Soft Tissue Mobilization: Gentle massage and mobilization of the SCM muscle and surrounding neck and upper back muscles to release tightness and improve tissue extensibility. This helps to release any palpable fibrotic mass.
- Joint Mobilization: While less common in infants, very gentle and specific mobilizations of the cervical spine may be considered by highly experienced pediatric physiotherapists if there are specific joint restrictions, always adhering to pediatric precautions.
Myofascial Release (MFR)
- Applying sustained, gentle pressure to the fascial restrictions within and surrounding the SCM muscle, as well as associated muscles in the neck and upper chest (e.g., scalenes, trapezius, pectorals).
- MFR aims to release the connective tissue restrictions that contribute to the muscle shortening and improper head posture, improving overall tissue mobility and reducing tension.
Instrument-Assisted Soft Tissue Mobilization (IASTM)
- While less commonly used directly on infants due to their delicate skin and tissues, IASTM (using specialized tools) could be applied by an experienced practitioner on older infants or toddlers with persistent SCM tightness, if appropriate.
- It helps to address stubborn fascial restrictions and break down fibrotic tissue in the SCM muscle.
Active Release Techniques (ART®):
- It treats problems with muscles, tendons, ligaments, fascia, and nerves. For CMT, it would involve applying tension to the SCM muscle while the therapist moves the infant’s head and neck through specific ranges of motion to lengthen the muscle and release adhesions.
- This requires specialized training and gentle application in infants.
Muscle Energy Techniques (MET)
- MET involves the infant actively (or reflexively) contracting a muscle against a precisely directed counterforce provided by the therapist.
- For CMT, the infant might be encouraged to gently resist a stretch or move their head into a specific position, which helps to relax and lengthen the tight SCM muscle through post-isometric relaxation or reciprocal inhibition. This is often done through engaging the infant in play.
Dry Needling
- Dry needling involves inserting fine needles into myofascial trigger points to release muscle tension and alleviate pain.
- Generally NOT used for infants with CMT due to their age, small muscle size, and the non-painful nature of most CMT presentations. It might be considered in much older children with very stubborn, chronic muscle tightness related to CMT, and only by a highly specialized and experienced practitioner.
Kinesiology Taping
- Kinesiology tape is an elastic therapeutic tape that can provide gentle support, facilitate muscle activation, or inhibit muscle activity.
- For CMT, it can be applied to:
- Inhibit the Tight SCM: Applied with light tension from insertion to origin to help relax the overactive muscle.
- Facilitate the Weak Opposite SCM: Applied from origin to insertion to encourage activation of the muscle on the unaffected side, promoting head righting.
- Promote Midline Head Posture: Taping strategies can provide sensory feedback to help the infant maintain a neutral head position.
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