Neck & Shoulder

What It Is

Torticollis, which is commonly called wry neck or twisted neck, is a condition in which a baby's head is tilted. The head tilts towards one shoulder and the chin turns towards the opposite shoulder (American Academy of Orthopaedic Surgeons, n.d.). Treatment is needed to prevent the face and skull from growing unevenly and to prevent long-term limited movement in the neck. "Congenital" means present at birth: this condition is present at birth or develops soon after, and is usually noticed in the first 6 to 8 weeks of life (American Academy of Orthopaedic Surgeons, n.d.).

The cause of congenital muscular torticollis is unknown. It may be related to the baby's position in the womb, such as a breech position, or to the baby being "crowded" in the womb, which is more common in first-born babies (American Academy of Orthopaedic Surgeons, n.d.). Other possible contributing factors include a forceps delivery or other trauma during birth (Royal Berkshire NHS Foundation Trust, 2023).

Signs of Congenital Torticollis

In more noticeable cases you will see that the head and neck do not look straight. In milder cases the tilt may be less obvious, but the baby will usually prefer to turn their head one way and have less movement in the neck when turning to the other side (Sargent et al., 2019). Signs include (Royal Berkshire NHS Foundation Trust, 2023; American Academy of Orthopaedic Surgeons, n.d.):

mostly looking to one side, or difficulty holding the head in the middle
difficulty turning the head to breastfeed
a soft, painless lump in the side of the neck in the first few weeks
flattening of one side of the head from always lying the same way

If you notice your baby holds their head tilted or favours looking to one side, speak to your family doctor or nurse practitioner. Treatment works best when it starts early, and your baby may be referred to a paediatric physiotherapist (Sargent et al., 2019).

Congenital Muscular Torticollis Anatomy

Torticollis is caused by tightening and shortening of the sternocleidomastoid muscle (American Academy of Orthopaedic Surgeons, n.d.). The sternocleidomastoid gets its name because it starts from the breastbone (sternum) and collarbone (clavicle) and attaches to the mastoid process of the skull, just behind the ear. Its main job is turning the head to the opposite side, and it also helps bend the neck forwards.

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Treatment

Self-Care & Treatment

How to Treat Congenital Muscular Torticollis

I can support the plan from your baby's doctor and paediatric physiotherapist, with gentle hands-on work and help with the stretches and positioning they show you. See the My Approach tab for how I work.

1. Paediatric Physiotherapy

A paediatric physiotherapist will assess your baby, check how well the neck moves, and teach you stretching exercises and ways of positioning and handling your baby (Sargent et al., 2019). Your baby's doctor should also check for hip dysplasia, which some babies with torticollis also have (American Academy of Orthopaedic Surgeons, n.d.).

2. Exercises

The main treatment for congenital muscular torticollis is a stretching programme for the sternocleidomastoid muscle. Stretches include gently turning the baby's head side to side so the chin moves towards each shoulder, and gently tilting the head to bring the ear on the unaffected side down towards the shoulder. These exercises need to be done several times a day (American Academy of Orthopaedic Surgeons, n.d.). Always have a physiotherapist, a doctor or me show you how to do them first, and follow their advice on how often to do them.

Other things you can do at home (American Academy of Orthopaedic Surgeons, n.d.; Royal Berkshire NHS Foundation Trust, 2023):

Place toys where your baby has to turn their head to see them.
Carry your baby so they look away from the side they find harder. Your physiotherapist may show you a side-lying carry that gently stretches the tight neck muscle.
Position the cot and changing table so your baby has to look away from the limited side to see you.
Give your baby tummy time (lying on their front while awake and supervised) to strengthen the neck muscles, and encourage them to look towards the harder side while they play.

3. Surgery

If non-surgical treatment doesn't correct the torticollis, surgery may be needed. About 10% of children with the condition need an operation, usually once they reach preschool age (American Academy of Orthopaedic Surgeons, n.d.). See "Treatments you may want to discuss with your family doctor or nurse practitioner" below.

Treatments you may want to discuss with your family doctor or nurse practitioner

Options outside my scope

Surgery: an operation to lengthen the tight sternocleidomastoid muscle, which may be done as a day case (American Academy of Orthopaedic Surgeons, n.d.).

How I can help (see the My Approach tab)

Gentle hands-on work for your baby's neck, shoulders and upper back, alongside their physiotherapy
Help with the stretches and positioning you've been shown
Gentle scar work after surgery, once the surgeon agrees

Tips

Torticollis happens when the sternocleidomastoid muscle on one side of the neck is shortened, pulling the head down and to the side (American Academy of Orthopaedic Surgeons, n.d.).
The muscle may be injured around the time of birth, and scar tissue forms as it heals, which makes it shorter. The amount of scarring affects how tight the muscle is (American Academy of Orthopaedic Surgeons, n.d.).
Some types of torticollis are not caused by a tight muscle but by changes in the bones of the upper spine or by vision problems. These need a doctor's assessment and will not respond to stretching (American Academy of Orthopaedic Surgeons, n.d.).
Torticollis can also develop later in childhood or in adults ("acquired" torticollis), which is a different condition with different causes (American Academy of Orthopaedic Surgeons, n.d.).
If your baby cannot move their head as other babies do, it could be torticollis. You may also notice a lump in the neck muscle.
Some babies with torticollis also have hip dysplasia (American Academy of Orthopaedic Surgeons, n.d.).

Treatment

My Approach

Babies with a tight neck muscle need a slow, gentle approach. Your baby's doctor and paediatric physiotherapist lead the treatment, and I work alongside their plan, checking what they've shown you and advised. If your baby has had surgery to lengthen the muscle, I need the surgeon's okay before any hands-on treatment.

You approve the treatment on your baby's behalf and stay with them throughout. I start by gently assessing how your baby's head and neck turn and tilt, how they lie, feed and play, and how their shoulders and upper back move.

In Sessions

Very short, light sessions at your baby's pace, pausing if they're unsettled
Gentle massage around the neck, shoulders and upper back, never forcing the tight muscle
Gentle, pain-free stretches that follow your physiotherapist's plan
After surgery, gentle scar work once the wound has healed, and easing any stiffness

At Home

Going over the stretches with you, so you feel confident doing them several times a day
Positioning, carrying and play ideas that encourage your baby to turn towards the harder side
Supervised tummy time to build neck strength

If your baby's head tilt is getting worse, or you notice other changes in how they move, speak to your family doctor or nurse practitioner.

What to Expect

Typical Course

Typical course: Visits are short and usually once or twice a week at first, then weekly, then spaced out as you get confident with the home programme, with a reassessment at about 4 to 6 weeks. Treatment usually runs over several months, following your baby's physiotherapist and doctor's plan.

What I Focus On

Working Alongside Your Baby's Team

Gentle, Pain-Free Work

Home Stretches

Positioning & Play

Tummy Time

Sources

References

American Academy of Orthopaedic Surgeons (n.d.) Congenital muscular torticollis (twisted neck). OrthoInfo. Available at: https://www.orthoinfo.org/diseases--conditions/congenital-muscular-torticollis-twisted-neck/ (Accessed: 7 October 2026).
Sargent, B., Kaplan, S.L., Coulter, C. and Baker, C. (2019) 'Congenital muscular torticollis: bridging the gap between research and clinical practice', Pediatrics, 144(2), e20190582. doi: 10.1542/peds.2019-0582
Royal Berkshire NHS Foundation Trust (2023) Congenital muscular torticollis (patient leaflet). Available at: https://royalberkshire.nhs.uk/media/ctxmja25/congenital-muscular-torticollis_dec23.pdf (Accessed: 7 October 2026).

Massage therapy · Kitchener–WaterlooCongenital Muscular Torticollis

What It Is

Signs of Congenital Torticollis

Congenital Muscular Torticollis Anatomy

Self-Care & Treatment

How to Treat Congenital Muscular Torticollis

1. Paediatric Physiotherapy

2. Exercises

3. Surgery

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

In Sessions

At Home

Typical Course

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooCongenital Muscular Torticollis

What It Is

Signs of Congenital Torticollis

Congenital Muscular Torticollis Anatomy

Self-Care & Treatment

How to Treat Congenital Muscular Torticollis

1. Paediatric Physiotherapy

2. Exercises

3. Surgery

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

In Sessions

At Home

Typical Course

References

Related Conditions

Cervical Somatosensory Dysfunction

Neck Pain

Shoulder Impingement Syndrome

Thoracic Outlet Syndrome

Book a session