Management of Infants with Congenital Muscular Torticollis

Abstract

Congenital muscular torticollis (CMT) is a deformation characterized by unilateral shortening of the sternocleidomastoid muscle resulting in lateral inclination of the neck associated with contralateral torsion. The purpose of this study was to assess the role of physical therapy in infants with CMT according to the age when treatment was started. The study was conducted in the Physical Therapy Clinic “Therapy” in Pristina for a period of 1 year from June 2016 to June 2017. The number of infants diagnosed with a CMT was 130 (71 girls and 59 boys). The infants were examined two times during the study period. The first visit was at the baseline and the second after the intervention. Three comparative groups are created based on time to start treatment. The infants were treated for 3 consecutive weeks with five sessions per week with the same therapeutic procedure. In the first examination of infants, there was no significant difference between the groups (chi-square test = 0.78, p = 0.08), whereas in the second examination after the 15 therapeutic sessions there was significant difference in the improvement of all the groups treated with physical therapy. Significant result was achieved in mean range of motion in infants of the group aged 3.1 to 6 months (mean = –35.9 ± 12.3, 95% confidence interval [CI], –39.3 to –32.4, p < 0.001) and in the mean side flexion of group aged 3.1 to 6 months (mean difference = –24.5 ± 7.9, 95% CI, –16.9 to –9.7, p < 0.001). While exercises in the 6- to 9-month age group have shown less success, because the time of appearance for physical therapy has been delayed (mean difference = –23.5 ± 10.7, 95% CI, –15.6 to –8.4, p < 0.001). From the results obtained from this study, we can conclude that the early start of the physical therapy gives much better results.

Effectiveness of the Treatment of Physiotherapy in the Congenital Muscular Torticollis: A Systematic Review

“…On the other hand, Keklicek et al (2018) [15] and Pastor-Pons et al (2021) [16] included children under 6 months and 28 weeks, respectively. And the investigation of Durguti et al (2019) [17] selected children between 1 and 9 months, establishing follow-up based on age group. The sex of the participants was recorded (in total 165 girls and 161 boys).…”

“…Cervical ROM was the most analyzed study variable and had the greatest impact on CMT dysfunction [12][13][14][15][16][17], which includes the assessment of rotation [12][13][14][15][16][17] and lateral flexion [12,15,17] movements. Also, head tilt was measured with photographic methods [15].…”

“…Regarding the assessment time, most of the selected articles develop a short-term follow-up, with baseline and post-assessment [12][13][14]16,17]. Only the study of Keklicek et al (2018) [15] includes follow-up at 6, 12, and 18 weeks; and the investigation of Kwon et al (2023) [13] incorporates the assessment of ROM in a month later treatment in group 1, and immediately after the last treatment in groups 2 and 3, and thickness was measured 3 months post-treatment.…”

“…Passive stretching techniques were focused directly on stretching the sternocleidomastoid muscle [12][13][14][15]17]; the protocol of Durguti et al (2019) [17] includes stretching held for 10 to 30 s, performing 10 repetitions in each session after the massage treatment to increase blood flow (this treatment was followed in the three groups, analyzing the changes depending on the age of the patients). Other studies describe protocol stretching based on three sets of 15 repetitions of 10 s with 5-10 s of rest [13]; stretching exercise in periods of 30 s with 10 s of rest [15]; and sternocleidomastoid muscle elongation and strengthening of the contralateral side through position changes and stimuli to induce movement or 10 to 20 repetitions of 10 s stretches, with one minute of rest [14].…”

“…Massage maneuvers or soft tissue mobilization were based on rhythmic muscle mobilization techniques with a pincer grip and associated with rotation movement [15], effleurage techniques [17], or manual therapy to mobilize the occiput, atlas and axis, specifically, myofascial induction techniques to relax the cervical myofascial structures, applying gentle traction and movement assistance [16].…”