Skip to main content

Success of nonoperative treatment for congenital muscular torticollis is dependent on early therapy


Congenital muscular torticollis (CMT) begins in infancy, and exercise treatment is often recommended. There is controversy about the type, length, and effectiveness of conservative treatment. We have used a standard technique of passive stretching exercises (PSE) in 126 children with CMT seen over 30 years. We reviewed the results and compared the rate of surgical treatment with the age at which PSE began. In 88 infants who began PSE prior to 3 months of age, outcome was excellent or good in 92%, with none needing surgery. In comparison, 45% of older children required sternomastoid myotomy (P <.005). The likelihood of surgery was directly related to the age at initiation of PSE. We conclude that PSE are effective for early CMT, and should be continued until a full passive range of neck motion is achieved and maintained. Success is dependent on frequent follow-up and parental encouragement.

This is a preview of subscription content, access via your institution.


  1. 1.

    Armstrong D, Pickrell K, Fetter B, Pitts W (1965) Torticollis: an analysis of 271 cases. Plast Reconstr Surg 35: 14–25

    PubMed  Google Scholar 

  2. 2.

    Binder H, Eng GD, Gaiser JF, Koch B (1987) Congenital muscular torticollis: results of conservative management with long-term followup in 85 cases. Arch Phys Med Rehabil 68: 222–225

    PubMed  Google Scholar 

  3. 3.

    Bredenkamp JK, Hoover LA, Berke GS, Shaw A (1990) Congenital muscular torticollis; a spectrum of disease. Arch Otolaryngol Head Neck Surg 116: 212–216

    PubMed  Google Scholar 

  4. 4.

    Canale ST, Griffen DW, Hubbard CN (1982) Congenital muscular torticollis; a long-term follow-up. J Bone Joint Surg Am 64: 810–816

    PubMed  Google Scholar 

  5. 5.

    Chandler FA, Altenberg A (1944) Congenital muscular torticollis. JAMA 125: 476–483

    Google Scholar 

  6. 6.

    Clarren SK (1981) Plagiocephaly and torticollis: etiology, natural history, and helmet treatment. J Pediatr 98: 92–95

    PubMed  Google Scholar 

  7. 7.

    Coventry MB, Harris LE (1959) Congenital muscular torticollis in infancy; some observations regarding treatment. J Bone Joint Surg Am 41: 815–822

    PubMed  Google Scholar 

  8. 8.

    Reference deleted

  9. 9.

    Horton CE, Crawford HH, Adamson JE, Ashbell TS (1967) Torticollis. South Med J 60: 953–958

    Google Scholar 

  10. 10.

    Jones PG (1967) Torticollis in infancy and childhood. Charles C Thomas, Springfield

    Google Scholar 

  11. 11.

    Jones PG (1986) Torticollis. In: Welch KJ, Randolph JG, Ravitch MM, O'Neill JA Jr, Rowe MI (eds) Pediatric surgery, 4th edn. Year Book Medical Publishers, Chicago, pp 552–556

    Google Scholar 

  12. 12.

    Kiesewetter WB, Nelson PK, Palladino VS, Koop CE (1955) Neonatal torticollis. JAMA 157: 1281–1285

    Google Scholar 

  13. 13.

    Knapp ME (1969) Physical medicine and rehabilitation in pediatrics, part 1; congenital torticollis. Postgrad Med 46: 173–176

    PubMed  Google Scholar 

  14. 14.

    Langer JC (1991) Lumps and bumps in kids: distinguishing the common from the unusual. Can J Diagn 4: 75–87

    Google Scholar 

  15. 15.

    Lawrence WT, Azizkhan RG (1989) Congenital muscular torticollis: a spectrum of pathology. Ann Plast Surg 23: 523–530

    PubMed  Google Scholar 

  16. 16.

    Ling CM (1976) The influence of age on the results of open sternomastoid tenotomy in muscular torticollis. Clin Orthop 116: 142–148

    PubMed  Google Scholar 

  17. 17.

    Ling CM, Low YS (1972) Sternomastoid tumor and muscular torticollis. Clin Orthop 86: 144–150

    PubMed  Google Scholar 

  18. 18.

    Minamitani K, Inoue A, Okuno T (1990) Results of surgical treatment of muscular torticollis for patients >6 years of age. J Pediatr Orthop 10: 754–759

    PubMed  Google Scholar 

  19. 19.

    Morrison DL, MacEwen GD (1982) Congenital muscular toticollis: observations regarding clinical findings, associated conditions, and results of treatment. J Pediatr Orthop 2: 500–505

    PubMed  Google Scholar 

  20. 20.

    Moseley TM (1962) Treatment of facial distortion due to wryneck in infants by complete resection of the sternomastoid muscle. Am Surg 28: 698–702

    PubMed  Google Scholar 

  21. 21.

    Staheli LT (1971) Muscular torticollis: late results of operative treatment. Surgery 69: 469–473

    PubMed  Google Scholar 

  22. 22.

    Tom LWC, Rossiter JL, Sutton LN, Davidson RS, Potsic WP (1991) Torticollis in children. Otolaryngol Head Neck Surg 105: 1–5

    PubMed  Google Scholar 

  23. 23.

    Wolfort FG, Kanter MA, Miller LB (1989) Torticollis. Plast Reconstr Surg 84: 682–692

    Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Brian H. Cameron.

Additional information

This paper was originally presented to the Canadian Association of Pediatric Surgeons, Quebec City, September 1991.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Cameron, B.H., Langer, J.C. & Cameron, G.S. Success of nonoperative treatment for congenital muscular torticollis is dependent on early therapy. Pediatr Surg Int 9, 391–393 (1994).

Download citation

Key words

  • Torticollis
  • Sternomastoid tumor of infancy
  • Physical therapy