Congenital muscular torticollis is the most common musculoskeletal condition in newborns after hip dysplasia. It is caused by shortening or tightness of the sternocleidomastoid muscle, which runs from behind the ear to the collarbone and breastbone.
The result is a very characteristic posture: the head tilted towards the affected side and the face turned to the opposite side. The baby can't comfortably turn to one side, so they stop doing it.
Why it happens
There isn't always a single identifiable cause. The most common are the position of the foetus in the womb, especially in pregnancies with little space or breech presentation, assisted deliveries, and in some cases an injury to the muscle itself during birth that leaves a small palpable mass, known as a sternocleidomastoid pseudotumour.
Signs worth getting checked
Always turns their head to the same side
Both awake and asleep, and resists or cries if you try to turn them the other way.
The head is constantly tilted
It is easiest to see by looking at the baby from the front, with their shoulders level.
Feeds better from one breast than the other
Because on that side the posture is comfortable, while on the other they have to force the rotation.
A lump appears in the neck
Firm, along the muscle, painless. It isn't serious, but it should be assessed.
The head is flattening on one side
Direct consequence: if the baby always rests on the same spot, the skull becomes misshapen.
The link with plagiocephaly
It is the most common complication and the reason not to wait. A newborn's skull is malleable. If the baby always rests on the same area because they can't turn their head, that area flattens and positional plagiocephaly appears.
Plagiocephaly isn't treated only with a helmet or position changes: if the neck restriction is still there, the baby will keep resting on the same spot. The cause has to be resolved.
What we do in the clinic
The first session is an assessment. We measure how many degrees of rotation and tilt the baby has to each side, palpate the muscle, check the shape of the skull and observe overall motor development: how they hold themselves on their tummy, whether they use both hands equally, whether there are asymmetries in the trunk.
From there, treatment combines several lines of work:
Gentle manual techniques
Mobilisations and stretches of the shortened muscle, always within the range the baby tolerates without crying or resisting. It is never forced.
Encouraging active turning
With play, light, sound and voice placed on the restricted side, so the baby turns their head by themselves. Active movement achieves more than passive movement.
Neck and trunk control work
Exercises in different positions so they strengthen symmetrically and don't compensate with the healthy side.
Guidelines for home
This is the most decisive part. How to position the cot, which side to approach to pick the baby up, how to hold them, how to make the most of nappy changes and tummy time. It happens several times a day, every day, and that is what drives the result.
How long it takes
It depends a lot on the age at which treatment starts. Cases assessed in the first two or three months usually resolve in a few weeks with spaced-out sessions and work at home. From six months, the muscle has been shortened for longer, the skull may have changed shape and the process takes longer.
That is the only reason we insist on early consultation: not because the problem is serious, but because the sooner it is assessed, the less needs to be done.
