I am a Doctor of Physical Therapy candidate and would like to address the concerns you have about the diagnosis of torticollis in your daughter. Torticollis is a clinical sign or symptom that can be caused by multiple underlying factors/disorders. The most common of these underlying disorders is congenital muscular torticollis (CMT) and what most infants who have a diagnosis of torticollis suffer from. CMT is a postural deformity that results primarily from the shortening of the sternocleidomastoid muscle (SCM). This muscle is located in the front of your neck and attaches to your collarbone and sternum (breast bone). An infant that suffers from torticollis will display a posturing of head tilt to one side and rotation to the other. In approximately 80-90% of infants with CMT there will be a coexisting condition present known as plagiocephaly (also known as "flattened head syndrome"). Positional plagiocephaly (which can be caused by torticollis) is a condition in which the back or one side of an infant's head is flattened, typically with decreased hair growth in that area. This will often cause some facial asymmetry. Since infants skulls are soft to allow for the growth of their brain in the first year of life they are more susceptible to being molded into a flat shape.
The goal for a child with a diagnosis of torticollis would be to correct the torticollis before plagiocephaly occurs or worsens. A physical therapist would be able to help with this because* they have the advantage of being clinicians who work from a macro-biological standpoint versus the micro-biological standpoint of a physician. To clarify, physical therapists are experts in the field of movement impairments and will use this knowledge to direct planned interventions to not only decrease symptoms but the underlying cause. Physicians often are focused on a clinical diagnosis and therefore can commonly miss the cause of the problem itself. A physical therapist will begin by examining your daughter to determine a differential diagnosis which consists of a medical screening and a review of systems which will help enable the physical therapist to determine if there are any medical conditions present that would necessitate a medical referral to another health care provider. For example, an ocular (visual) problem could also be the root cause of torticollis, and therefore in addition to physical therapy interventions your child would also need a referral to a medical doctor or pediatric opthamologist to address the underlying cause. By doing this you can you can rest assured that your daughter will be directed to the appropriate clinician for the best possible treatment. From the examination process the physical therapist will then determine a movement impairment diagnosis which will help guide the appropriate interventions to be used in her treatment. A stretching program may be set up in combination with simple positional strategies for when you are holding or laying down your child. The parameters of this will be set up by your physical therapist depending on the differential diagnosis and the conditions surrounding your child's condition.
The philosophy of physical therapy practice is to utilize the expertise of movement science to identify and treat the origin of the problem. A physical therapist's goal is to resolve the cause and not just the symptoms. Since torticollis is resolved in most cases by physical therapy intervention it would be advantageous to you to have your primary point of care be a physical therapist. In 49 states you can directly consult with a physical therapist prior to any physician intervention. This will help expedite the process for your child to get care as quickly as possible and hopefully prevent the condition from getting worse or from plagiocephaly developing.
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