Male1: Sometimes kids are born and their head is like tilted to a side and you feel like a little knot in the muscle and kids do not move their head away from that side. Should we be stretching that muscle a little bit to get to get it to move so it does not get more and more stiff.
Male2: Absolutely.
Male1: What will be a technique that you would feel in a mother and a new baby—we have to be sure that is the reason, you have got to be careful with the thing, what would you suggest?
Male2: Well, once they see the pediatrician and the fact that they get a prescription that says a child has what we call a torticollis or you get a prescription that does not say torticollis, but says stretching, maybe the physician feels that it is not torticollis, but it is safe to do so.
Very often, what happens is, it involves the sternocleidomastoid muscle which will bend the neck to one side, but rotate it to the other side, so very often, you will have a child walking and they will present with a side bent left, but the rotator looking as I explain to the parents right. This is very, very confusing for most parents and we explain it to them.
Male1: So how would you tell them or what would you tell them to do?
Male2: What I would do is I would go ahead and show the parent, let us say the child needed to learn how to rotate or look to the left, I would say, why do you not lay the child on their stomach and give them a pacifier and turn a nice DVD or something and put your hands on one on each side of their head and slowly rotate it so that their eyes are now looking at that or looking to the child’s left.
I also warn the parents to stay above the mastoid bone to stay over here, and not to start yanking on the jaw, which is a more mobile joint and bone and of course—
Male1: So that will stretch the muscle in the opposite direction?
Male2: If you are side bent left and rotate it to the right, you need to be side bent right and rotated left.
Male1: The complete opposite.
Male2: Yes. Because that muscle, the sternocleidomastoid muscle as you know—
Male1: Some people talk about having the ear touch their shoulder, is that a bad technique?
Male2: Not at all. So basically what they are saying to do is if I am side bent left and rotated right, I want to work on the side bending component, I will say to mom, okay, we need to stretch the right ear so it goes towards the right shoulder. And again, it is just the mom who understands it.
Male1: And it should not be forceful. It should be done consistently, smoothly, gently.
Male2: Yes, I always tell mom. Let the baby win. This is not a fight. The baby is fragile.
Male1: And maybe sing to the kid why you are doing it, make it look like you are playing with the kid and make it like—
Male2: Absolutely!
Male1: And do that once a day, but frequently?
Male2: Do it three to five times during the day. I would say, you know, help bring the head that way to look at whatever it is that you want to get them involved in, 30 seconds eventually, I would like you to get them up to five minutes. It is going to get easier and easier. Let them watch it for five minutes. I have a kid who is—
Male1: So torticollis—the technique that we are talking is do it slow, smooth, do not create a lot of pain, try to stretch the muscle, do it more than once a day. And maybe you begin this for a few seconds, gradually increase the time, but the doctors always check that is the reason. There are other things that could do it, but usually physiotherapy is the best approach.
Male2: Absolutely. Again, if it is confirmed that it is torticollis, it has nothing to do with gastrointestinal or other types of reactions and yes, that is what we do. Another thing that we do in physical therapy is we will approach it as a soft tissue problem, which is it, but also as a weakness because very often, the torticollis side is also a bit weak, so we will go ahead and work with the child against gravity to go ahead and strengthen the child because otherwise, it can turn to a developmental issue a few months down the line.
Male1: If a kid has a problem with it and some of the best PTs to train this will always look at the hips because sometimes, the pressure here could be a pressure below, just a little tip, so we should check that very carefully and it makes the hips-you move them in a direction and there is no clicking or something like that.
Male2: Yes, we always do Ortolani sign or what not on a child that comes in for that type.
Male1: Good faith of the doctor to make sure that there are no up skews and down skews at the same time.
Male2: Another thing that we will look for is any neurological responses, hypothetically, sometimes a pediatrician can miss a simple ATNR. The kid comes in presenting—
Male1: What is that?
Male2: Asymmetric Tonic Neck Reflex. It is also called the fencer’s reflex. If you go ahead and turn the child’s head toward the left at a young age—a newborn child will actually extend the arm on the side they are looking towards and then the arm on this side—
Male1: That is the one that came from monkeys. The monkey is reaching for the vein to go and we have different names for it, but that is okay. So in other words, that is proof that you, in particular came from a monkey, is that true?
Male2: My mother in law would agree.
Male1: The point is, you look for different reflexes and make sure there is no neurological basis. That is called good sound evaluations, and sometimes, you look at the head and there could be something in the neck, and sometimes you have to do a complete evaluation, but generally, the reason that most of the time, they are very benign, is that true?
Male2: Right. I tell the parents that torticollis is easily treated. Not that anything is taken lightly, but I explain to them that your child has something that can be rectified almost always rather simply by some decent therapy and some decent home exercise follow up. If a parent goes home, I give them a printout of what to do at home, basically these are two or three exercises. They do it readily. They come in and within a short while, you see a marked improvement.
Transcription by:
Scribe4you Transcription Services