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Torticollis AKA "Wryneck"- Kids & Chiropractic pt. 4


Torticollis is a condition seen in both children and adults. It is described as a twisting or tilting of the cervical spine, or neck. Torticollis is seen in 20-25% of newborns who experienced breech presentations and in-utero constraint.1,2 Birth trauma has also been shown to be related to the issue.3,4,5 Many medical providers leave this condition alone and claim that the child will “outgrow” it; not to blame them, frankly, they have “bigger fish to fry.” Sometimes torticollis patients may be referred out for therapy, but the literature suggests that these therapeutic approaches have little to no effect on these cases.6 From a chiropractic perspective, we love solving problems like this, and we can fix this issue in the majority of cases. While it is true that most torticollis cases eventually go away, or the child “outgrows” it, the problem with leaving the issue uncorrected is that the brain will develop asymmetrically due to the child’s perception that the world is “tilted.” Eventually, the child will become used to the tilt, and the amazing brain will interpret the world as if it is right-side up and level with the horizon. Although it is an incredible phenomenon to observe, this leads to imbalance in occipital cortex and frontal lobe development, which affects the child’s overall posture, muscle tone, coordination, and physiological function. We always reiterate to our practice members that structure determines function, so in this case, we should not leave children to “outgrow” torticollis, rather, we need to fix the cause of the issue so the brain can develop properly and balanced throughout the foundational childhood years.


There are two types of acquired torticollis: spasmodic and non-spasmodic. In spasmodic torticollis, a spasm exists in one or more muscles of the neck, most often the sternocleidomastoid (SCM) muscle. The spasm will pull the head towards the side of the contracted muscle, and the chin will rotate away from the effected side. This occurs because of irritation to the nerves in the upper cervical region of the spine and/or the eleventh cranial nerve originating from the lower brainstem, also known as the spinal accessory nerve, which innervates and controls the SCM muscle. Since the muscle is in spasm, if you try to straighten the child’s head and neck back upright into a more neutral position, they will experience pain on the side of the spasm. If left uncorrected, significant adhesions can develop in the muscle belly of the SCM and is sometimes given a frightening description of “tumor” by medical diagnosticians. In these cases, a gentle and specific adjustment to the upper cervical region can fix the problem in 1-2 visits, as the pressure is removed from the nerve causing the muscle spasm.


Non-spasmodic torticollis has a different etiology. Most of us have either experienced this type of problem directly, or know someone who has – a low back injury where the person leans slightly forward and to one side. This is termed an “antalgic” lean because the person is leaning away from the problem due to pain. This is exactly what is happening in the low neck, upper back in non-spasmodic torticollis cases. A disc in the lower neck or upper thoracic spine in inflamed due to injury, and the person’s head leans away from the side of the lesion. This is not due to a muscle spasm. These cases will take longer to correct because a disc is involved, but with gentle and specific corrections to the involved vertebra, as well as lifestyle modifications to reduce stress to the spine – e.g. changing pillows or sleeping position – this issue can also be fixed over time.


References:

1. Graham JM. Smith’s recognizable patterns of human deformation. 2nd ed. Philadelphia: WB Saunders, 1988.

2. Dunn PM. Congenital postural deformities. Br Med Bull 1976;32:71-76.

3. Byers RK. Spinal-cord injuries during birth. Develop Med Child Neurol 1975;17:103-110.

4. Gutmann G. Blocked atlantal nerve syndrome in infants and children. ICA Int Rev Chiro 1990;July/Aug:37-42.

5. Eilert RE. Orthopedics. In: Kempe HC, Silver HK, O’Brien D, Fulginiti VA, eds. Current pediatric diagnosis and treatment. 9th ed. Norwalk, CT: Appleton & Lange, 1987:622-644.

6. Lowenstein DH, Aminoff MJ. The clinical course of spasmodic torticollis. Neurology 1988;38:530-32.

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