Torticollis

Article written by: RUXANDRA AURSULESEI, MD, Pediatric neurologist

Actualizat: 17-03-2025 / Publicat: 01-08-2019

General information about torticollis
Types of torticollis
Causes
Symptoms
Treatment

This article was written by Dr. Aursulesei Ruxandra, specialist pediatric neurologist with extensive experience in diagnosing and treating neurological conditions. Pediatric neurology plays an important role in the periodic neurological evaluation of premature babies, as well as of all newborns at risk of developing neurological sequelae, with the goal of early detection and treatment of any impairment of the nervous system.

General information about torticollis

A stiff neck can develop over time. It can also occur after an injury to the area or due to a reaction to medication. A person who has torticollis feels pain when trying to straighten their head or bend their neck on the unaffected side.

Torticollis in infants is common, with some sources saying it affects 3 out of 100 children. In most newborns, the condition is easy to treat. Benign paroxysmal torticollis is a much rarer disorder in infants, manifesting as recurring episodes of the head tilting to one side.

If you have symptoms of torticollis, read this article or schedule a consultation to establish a complete treatment plan here.

Types of torticollis

There are several types of torticollis. The type of torticollis can be described based on symptoms and the timing of the condition's onset. Torticollis can be common, congenital, spasmodic, or symptomatic. Babies can also develop this condition after birth. In this case it is called "acquired" torticollis, rather than congenital. Acquired torticollis can be linked to other, more serious medical problems.

Common torticollis

Common torticollis usually affects people for a short period of time. It can occur following an incorrect head position during sleep, or after a sudden neck movement. In general, common torticollis does not require specific treatment. Affected people should sleep with the neck as still as possible.

Congenital torticollis

Congenital torticollis is a condition detected in infants, at birth or shortly after. It is usually discovered in the first 6-8 weeks of life, when a newborn begins to gain more control over their head and neck. It is characterized by rotational deformity of the cervical spine with secondary tilting of the head. Congenital torticollis is characterized by unilateral contraction of the sternocleidomastoid muscle, which forces the child to keep the head tilted toward the affected side. When left untreated, the condition can cause fibrosis of the cervical musculature with progressive limitation of head movement, craniofacial asymmetry, and compensatory scoliosis that worsens with age.

Experts do not know exactly what causes the shortening of the neck muscle. The muscle may be injured before or during birth, may bleed, and may swell. Scar tissue may replace part of the muscle, making it shorter.

Some cases of congenital torticollis are caused by a bone problem in part of the cervical spine. This is known as a congenital malformation of the cervical spine.

Spasmodic torticollis

Spasmodic torticollis is a painful condition in which the neck muscles contract involuntarily, causing the head to twist or turn to one side. Spasmodic torticollis can also cause uncontrolled tilting of the head forward or backward. It is a rare disorder that can occur at any age, but occurs most often in middle-aged people, in women more than in men. Symptoms generally begin gradually.

There is no cure for spasmodic torticollis. The disorder sometimes resolves without treatment, but sustained remissions are less common. Injecting botulinum toxin into the affected muscles often reduces the signs and symptoms of spasmodic torticollis. Surgery may be an option in certain cases.

The most common type of twisting associated with spasmodic torticollis is when the chin is pulled toward the shoulder. Some people experience a combination of abnormal head positions. A tremor of the head may also occur. Many people who have spasmodic torticollis also suffer from neck pain that can radiate into the shoulders. The disorder can also cause headaches. For some people, the pain can be exhausting.

Symptomatic torticollis

Symptomatic torticollis can occur spontaneously, due to underlying physiological abnormalities, such as: infections, certain debilitating tumors that affect the nerves in the head, or other conditions that lead to damage to the neck muscles. Symptomatic torticollis is a symptom of an underlying disease, and can occur as a result of injuries, inflammation, spasms, or trauma.

Causes

The exact cause of torticollis is not known. Congenital muscular torticollis is present in newborns. This may also be accompanied by a congenital dislocation of the hip. The cause is probably the position of the fetus in the uterus, which results in injury to the neck muscles. Symptomatic torticollis can be caused by irritation of the cervical ligaments, a viral infection, injury, or a forceful movement. Other causes may include:

Torticollis can also be a secondary condition resulting from the following:

Symptoms

Based on the fact that torticollis appears as a position in which the head is turned to one side, this is the first thing you should notice. You will also probably feel tenderness or pain in the neck and shoulder muscles. It may be painful or difficult, if not impossible, to try to move your head to the side opposite the one it is locked toward. Other things to consider include: headaches, back pain, shoulder pain, and burning sensations. If you have these symptoms, see your doctor.

The symptoms of torticollis vary from person to person. The most apparent sign of the condition is the twisting or tilting of the neck to one side. People with the condition may also experience:

pain and tension in the neck muscles
neck cramps or burning sensations in the neck
inability to turn or bend the head and neck to the opposite side
uncontrolled gaze
muscle spasms and movements of the head and neck
back pain
headaches

In infants, symptoms include:

tilting the head to one side
flattening on one side of the head behind the ear
limited head and neck movement
asymmetric facial features
a small, soft lump in the neck
musculoskeletal problems, such as hip dysplasia

In cases of torticollis that develop after birth, a child may seem tired, irritable, and may vomit during episodes of head tilting.

Treatment

The goal of most treatments for torticollis is to release the neck muscles from spasms or contractions. Typical treatments include medication, physical therapy, stretching, the use of physical devices, and surgery. Common medications given to people with torticollis include muscle relaxants and anti-inflammatory drugs.

Treatment may include:

Neck brace
Heat therapy
Ultrasound therapy
Physiotherapy
Surgery

If you have torticollis, there are a number of things you can do to help manage the condition. Some of these measures include:

Keep moving your neck normally. You should try not to make sudden movements, but try to continue with your usual routines and move your head and neck, to prevent stiffness.
Try moving your neck in circles, forward and backward.
Apply a heating pad or an ice pack, which can ease neck stiffness and pain.

Early intervention and physical therapy can help successfully treat both newborns and children, as well as prevent the condition from worsening. In more severe cases, surgery on the nerves and muscles of the neck is an option, although the condition may return.

Medication treatment

Medications can help control the pain caused by spasms. Anticholinergic medications, which block specific nerve impulses, and benzodiazepines, which are tranquilizers, are commonly used. Muscle relaxants are also used. Antidepressants may be used, but the effect is usually mild and modest.

The substance that causes botulism has been known to be effective in reducing pain and spasms, if injected several times. It also allows the head to be held in a more natural (less tilted) position. Improvement as a result of this treatment can take more than a few months. After absorption, the substance inhibits the release of acetylcholine and blocks the transmission of impulses in the neuromuscular tissue.

Benzodiazepines increase the frequency of chloride channel opening after binding to GABA A receptors, which ultimately facilitates inhibitory signals. The medications used are:

Clonazepam
Diazepam

Physical exercises

Passive stretching and correct positioning of the head are used in infants and children. In passive stretching, a support is usually used to hold the head in a certain position. These treatments are often successful, especially if started within 3 months of birth. Applying heat, neck traction, and massage can help relieve neck and head pain. Stretching exercises and neck braces can help with muscle spasms.

Start by warming up the area with a hot towel or a heating device for 10 minutes, to increase blood flow in the area, and begin by moving the chin back toward the neutral position. If you are able to move the head to the neutral zone, try moving it slightly into the opposite zone, away from the side of the spasm.

Rest

In some cases, torticollis can go away within a few days if the person rests and avoids moving the neck. Symptoms may disappear during sleep, so rest is highly recommended in treating torticollis.

At Centrokinetic, the best doctors and therapists are available to help with any joint or musculoskeletal problem, from the initial consultation and complete investigations within the clinic, to treatment and complete medical recovery for spinal, traumatic, or post-surgical conditions.

Common torticollis

Congenital torticollis

Spasmodic torticollis

Symptomatic torticollis

Medication treatment

Physical exercises

Rest

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