Torticollis: A Review

(From the December 2003 The “G”Note)

Acquired torticollis is caused by contraction of the cervical musculature that results in a stiff or wry neck, and often, excruciating pain. Its Latin root words are tortus (twisted) and collum (neck). (Calliet)

There are several types of torticollis. Basically, the primary categories are clonic/spasmodic or tonic. A further break-down of types includes congenital postural, congenital muscular, benign paroxysmal, spasmotic, acute, hysterical, and some uncommon forms due to underlying factors, such as, tumors, infections, trauma, and developmental malformations. (Bolton)

If it was precipitated by trauma, a x-ray examination is wise to conduct in order to rule out vertebral dislocations and/or fractures. If there is nuchal rigidity or a spastic sternocleidomastoid muscle, particularly if there is fever or infection, one must rule out an underlying infectious condition. When an infant is found with torticollis, it may be a congenital form. Some rare neurologic conditions may lead to torticollis. Hysteria or other psychological manifestations are known causes of torticollis.

The typical torticollis presentation to the chiropractic office is associated with vertebral subluxation. Typically, the patient presents a stiff and painful cervical spine that is maintained in lateral flexion. Many times, the patient is a child. The subluxation may be anywhere from the pelvis to the occiput. The subluxation is commonly found in the lower cervical or upper thoracic spine, although there might be a concomitant subluxation in the mid-thoracic spine or lower.

References & Resources

Bolton PS. Torticollis: A Review of Etiology, Pathology, Diagnosis and Treatment. J Manipul Physiol Ther March 1985; 8(1):29-32.

Calliet R. Neck and Arm Pain. (2d ed). F.A Davis. 1981. pp.46-48.

Collin N. Congenital Muscular Torticollis: A Review, Case Study, and Proposed Protocol for Chiropractic Management. Top Clin Chiro Sept. 1998; 5(3):27-33.

Hyman CA. Chiropractic Adjustments and Congenital Torticollis with Facial Asymmetry: A Case Study. ICA Review Sept./Oct.1996; 52(5):40-45.

Shaefer RC. Basic Principles of Chiropractic: The Neuroscience Foundation of Clinical Practice. Arlington VA: The American Chiropractic Association. 1980. pp.334-6.

Loder RT, Hensinger RN. Development Abnormalities of the Cervical Spine. IN: Weinstein SL (ed). The Pediatric Spine: Principles and Practice. Philadelphia: Lippincott Williams & Wilkins. 2001. pp.303-314.