Case Study: Physiotherapy Management of Congenital Torticollis in an 8-Month-Old Infant

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Clinical Experience (2010–2012 – Pediatric Outpatient Setting)

Presenting Complaint:

An 8-month-old female infant was brought to the clinic by her parents with a visible tilt of the head to the right side and difficulty turning her head to the left. The parents reported that the condition had been present since early infancy and was becoming more noticeable as she began to sit and attempt crawling. They were concerned about her head posture and its possible effect on her development.

History and Background:

The infant was diagnosed with congenital muscular torticollis, suspected to have resulted from intrauterine positioning. There was no history of trauma or birth complications. On initial observation, the child exhibited a consistent right-side head tilt with limited cervical rotation to the left.

Despite her condition, she was a bright, playful, and cheerful infant, and from the very first session, she responded positively to interaction. I took special care to build rapport through playful techniques, incorporating toys, songs, and gentle physical handling to ensure a comfortable and safe environment.

Assessment:

On clinical assessment:

• Observation:

o Right lateral flexion of the neck

o Mild flattening of the right occiput (positional plagiocephaly)

• Palpation:

o Tightness and mild thickening of the right sternocleidomastoid (SCM) muscle

• ROM Assessment:

o Passive cervical rotation to the left was limited

o Lateral flexion to the left was restricted and mildly resisted

• Motor Milestones:

o Age-appropriate sitting and rolling milestones were being achieved

o Mild asymmetry during reaching and head righting reactions

Treatment Plan:

The intervention was carried out through regular sessions over an extended period, with treatment focused on gentle stretching, positioning, and strengthening—all delivered in a playful and interactive manner suitable for the infant’s age.

Key Interventions:

1. Gentle Passive Stretching:

  • Manual stretching of the right SCM with careful stabilization
  • Repeated throughout sessions with soothing voice and rhythmic play to minimize discomfort

2. Positioning Techniques:

  • Advised parents on tummy time, side-lying, and play positions to promote turning to the restricted side
  • Educated on feeding positions and crib placement to encourage symmetrical movement

3. Facilitated Active Movement:

  • Used brightly colored toys, rattles, and mirrors to encourage active head turning to the left
  • Engaged her in reaching tasks to stimulate head righting and trunk rotation

4. Postural Control and Strengthening:

  • Encouraged midline orientation and bilateral arm use during sitting and supported play
  • Assisted trunk control development to support neck symmetry

5. Parental Involvement:

  • Taught her parents home stretching techniques and play-based activities
  • Provided regular feedback and progress updates, involving them in every stage of care

Outcome Measures:

• Neck Range of Motion: Significantly improved within the first few weeks

• Head Posture: Achieved midline alignment during play and sitting

• Symmetry in Movement: Noticeably better hand use and head turning to both sides

• Parental Feedback: Expressed great satisfaction and confidence in continuing the exercises at home

Prognosis:

The infant showed steady and encouraging progress with therapy. Due to early intervention, regular follow-up, and strong parental involvement, the prognosis was excellent. Her motor milestones continued to develop normally, and the head tilt was no longer noticeable by the time therapy concluded.

“This case deepened my appreciation for pediatric physiotherapy, where patience, creativity, and empathy are as crucial as clinical skill. The joyful connection I built with this little one—earning her trust through playful engagement—was one of the most rewarding aspects of my practice. Watching her progress, and her parents' joy, reinforced my commitment to early intervention and family-centered care.”


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