Torticollis, also known as twisted neck or wryneck, is a condition where the head tilts to one side due to muscle tightness or other underlying causes. Treatment focuses on restoring normal neck movement, preventing complications like head flattening, and improving daily comfort and function.

How Medical Care Helps People with Torticollis

When a baby or child is diagnosed with torticollis, the main goals of treatment are to help the neck muscles become more flexible, restore the full range of motion in the head and neck, and prevent long-term complications such as facial asymmetry or delayed motor development. Treatment also aims to reduce discomfort and improve the child’s ability to participate in normal activities like feeding, playing, and interacting with caregivers.^[1][2]

The type and intensity of treatment depend on several factors. The age when torticollis is noticed plays a significant role—infants diagnosed early tend to respond better and faster to treatment than those diagnosed later. The underlying cause also matters greatly. Congenital torticollis, which is present at birth, usually results from tight neck muscles and responds well to gentle stretching and positioning. Acquired torticollis, which develops later, may be caused by infections, injuries, or other medical conditions and may require different approaches.^[1][6]

There are established treatment methods that doctors and physical therapists have been using successfully for many years. These are considered standard approaches and are recommended by medical societies and pediatric specialists around the world. At the same time, researchers continue to explore new ways to treat torticollis, particularly in cases that do not respond to standard treatment. Some of these newer methods are being tested in clinical studies to see if they can offer better results or work faster than existing options.^[3][12]

Standard Treatment Approaches

The foundation of treatment for most infants and children with congenital muscular torticollis is physical therapy. This involves gentle, repeated stretching exercises designed to lengthen the shortened sternocleidomastoid muscle (SCM), which is the large muscle running down the side of the neck from behind the ear to the collarbone. When one SCM is tight, it pulls the head into a tilted position. By carefully stretching this muscle several times a day, the muscle gradually becomes longer and more flexible.^[5][10]

Parents are usually taught these stretching exercises by a trained pediatric physical therapist so they can continue them at home. The exercises are most effective when done consistently, several times throughout the day. Typically, a therapist will check the baby’s progress every two to four weeks and adjust the exercise program as needed. Most babies who start physical therapy early—ideally before they are a few months old—show significant improvement within several months.^[5][10]

Another crucial part of standard treatment is positioning strategies. This means encouraging the baby to turn their head in both directions during daily activities. For example, when the baby is lying down, toys or interesting objects can be placed on the side they tend to avoid looking toward, encouraging them to turn their head that way. During feeding, whether breastfeeding or bottle-feeding, parents can alternate sides to promote head turning. When carrying the baby, caregivers can position the baby so they naturally look toward the less-preferred side.^[5][10]

Tummy time is especially important for babies with torticollis. Spending time on the stomach while awake helps strengthen the neck muscles and encourages the baby to lift and turn their head. This activity should be supervised and done several times a day, starting with just a few minutes and gradually increasing as the baby’s strength improves.^[5][10]

In children and adults with acquired torticollis, treatment often includes pain management. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can help reduce pain and inflammation in the neck muscles. Applying gentle heat to the affected area and performing light massage can also provide relief. Muscle relaxants may be prescribed in some cases to reduce muscle spasms.^[4][17]

For temporary torticollis in older children and adults—the kind that might occur after sleeping in an awkward position—symptoms usually disappear within seven to ten days with rest, gentle activity, pain relief medications, and sometimes light traction (a technique where gentle pulling is applied to create space in the neck). Most people recover fully without any lasting effects.^[4][17]

When the underlying cause is an infection or inflammation, treating that primary condition is essential. Antibiotics may be needed for bacterial infections, and anti-inflammatory medications can reduce swelling. If torticollis is related to vision problems, corrective lenses might help. When it’s associated with gastroesophageal reflux (GERD), treating the reflux often improves the neck symptoms.^[1][9]

For a specific form of torticollis in adults called cervical dystonia, where muscles contract involuntarily causing the head to twist, treatment often includes botulinum toxin injections (commonly known as Botox). These injections work by temporarily blocking the nerve signals that cause muscle contractions. The medication is injected directly into the overactive neck muscles, usually providing relief for several months before repeat injections are needed. This treatment has become the preferred choice for many cases of cervical dystonia because it targets the problem muscles directly and has fewer side effects than oral medications taken throughout the body.^[12]

Anticholinergic medications such as trihexyphenidyl or benztropine may be tried in cervical dystonia, though they are often less effective than botulinum toxin. Other medications that have been used include muscle relaxants like baclofen or benzodiazepines such as clonazepam. Beta-blockers like propranolol or anticonvulsants like primidone may help if there are tremor-like movements. Each person responds differently, and finding the right medication or combination often requires patience and adjustment.^[12]

Physical therapy techniques for adults may include stretching exercises, massage, application of local heat, sensory biofeedback (where patients learn to control muscle activity through electronic monitoring), and transcutaneous electrical nerve stimulation (TENS), which uses mild electrical currents to reduce pain and muscle spasms.^[12]

When Surgery Becomes Necessary

Surgery is reserved for cases that do not improve with conservative treatment. For congenital muscular torticollis in children, surgery is typically considered only if physical therapy and stretching exercises have not produced sufficient improvement after at least six months of consistent effort, usually by the time the child is around one year old or older.^[7][15]

The most common surgical procedure for congenital torticollis is called a sternocleidomastoid release. In this operation, the surgeon carefully cuts or lengthens the tight SCM muscle to allow the head to move more freely. The procedure can be done at one attachment point (unipolar release) or at both ends of the muscle (bipolar release), depending on where the tightness is located. Some surgeons use techniques to elongate the muscle rather than completely cutting it, which helps preserve the muscle’s function and maintains a more natural appearance of the neck.^[12][15]

A recent study following children, adolescents, and young adults who underwent surgical treatment for congenital muscular torticollis found significant improvements two years after surgery. Patients showed better range of motion in the neck, reduced deformities, and high levels of satisfaction with the results. Clinical scores improved from “fair” before surgery to “excellent” after treatment. The study also found that quality of life improved significantly following surgery, suggesting that surgical intervention can make a meaningful difference when conservative treatment has not been sufficient.^[15]

After surgery, patients follow a strict rehabilitation protocol that includes stretching exercises, physical therapy, and positional exercises for at least six months. This post-surgical therapy is crucial for achieving the best possible outcome and preventing the neck muscles from becoming tight again.^[15]

For adults with severe cervical dystonia that doesn’t respond to medications or botulinum toxin, surgical options may include selective denervation, where specific nerves that control the overactive muscles are cut, or deep brain stimulation, where electrodes are implanted in specific areas of the brain to help control abnormal muscle contractions. Deep brain stimulation has gained approval from the U.S. Food and Drug Administration (FDA) for treatment of dystonia, particularly with electrodes placed in the globus pallidus or subthalamic nucleus regions of the brain.^[12]

Innovative Approaches Being Studied

While most research on torticollis focuses on refining existing treatment methods rather than testing entirely new drugs, there are ongoing investigations into various therapeutic approaches, particularly for cervical dystonia in adults. Researchers are exploring different types of medications and interventions to find more effective ways to manage this challenging condition.^[12]

Some studies are investigating unconventional dopamine-related medications. Unlike traditional dopamine medications used for conditions like Parkinson’s disease, researchers are testing drugs that work on different dopamine receptors in the brain. Medications like pramipexole and ropinirole, which primarily target D2 dopamine receptors, are being evaluated. Similarly, newer antipsychotic medications such as olanzapine and risperidone, which block D2, D3, and D4 receptors, are being studied for their potential to reduce abnormal muscle contractions.^[12]

Researchers are also exploring medications that affect glutamate, another important chemical messenger in the brain. Glutamate plays a role in muscle control, and medications that either inhibit glutamate release (such as riluzole) or block glutamate receptors (such as high-dose amantadine, lamotrigine, or memantine) are being investigated for cervical dystonia. These medications work differently from traditional muscle relaxants and might offer benefits for people who don’t respond to standard treatments.^[12]

Studies on surgical techniques continue to evolve as well. Researchers are refining deep brain stimulation methods, testing different electrode placements and stimulation patterns to maximize benefit while minimizing side effects. They are also studying which patients are most likely to benefit from surgical interventions and at what point in the disease course surgery should be considered.^[12]

For infant torticollis, research focuses more on optimizing physical therapy approaches. Studies are investigating how different stretching techniques, timing of interventions, and combinations of positioning strategies affect outcomes. Some researchers are exploring whether certain types of manual therapy or specialized massage techniques might speed recovery or improve results when combined with traditional stretching exercises.

There is also growing interest in understanding the genetic factors that may contribute to torticollis. Specific genetic mutations, including those in genes called GDF6, GDF3, MEOX1, CIZ1, ANO3, and GNAL, have been associated with increased risk of developing torticollis. Understanding these genetic connections might eventually lead to new targeted treatments, though this research is still in early stages.^[6][11]

Most Common Treatment Methods

• Physical Therapy and Stretching
  • Gentle neck stretching exercises performed multiple times daily to lengthen the tight sternocleidomastoid muscle
  • Supervised tummy time to strengthen neck muscles and encourage head movement
  • Positioning strategies during sleep, feeding, and play to encourage turning the head to both sides
  • Progressive exercises adjusted every 2-4 weeks based on improvement
  • Manual therapy techniques including massage and sensory biofeedback
• Medication Management
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen for pain and inflammation
  • Muscle relaxants including benzodiazepines and baclofen to reduce muscle spasms
  • Anticholinergic medications such as trihexyphenidyl or benztropine for cervical dystonia
  • Beta-blockers like propranolol for cases with tremor-like movements
  • Anticonvulsants such as lamotrigine under investigation for certain types
• Botulinum Toxin Injections
  • Direct injection into overactive neck muscles to block nerve signals causing contractions
  • Considered the treatment of choice for cervical dystonia in adults
  • Effects typically last several months before repeat injections needed
  • Fewer systemic side effects compared to oral medications
• Surgical Interventions
  • Sternocleidomastoid muscle release (unipolar or bipolar) for congenital torticollis not responding to physical therapy
  • Selective denervation cutting specific nerves controlling overactive muscles
  • Deep brain stimulation with electrodes implanted in globus pallidus or subthalamic nucleus
  • Post-surgical physical therapy protocol lasting at least 6 months
• Supportive Care
  • Application of gentle heat to affected neck muscles
  • Light traction to create space in the neck joints
  • Transcutaneous electrical nerve stimulation (TENS) for pain management
  • Treatment of underlying conditions such as infections, GERD, or vision problems
  • Cervical braces in select cases to maintain proper positioning

What to Expect During Treatment

For infants with congenital muscular torticollis, the duration of treatment varies considerably depending on when treatment begins and how severe the condition is. Babies who start physical therapy in the first few months of life often see improvement within three to six months, with many achieving full recovery by their first birthday. Those who begin treatment later or have more severe muscle tightness may require treatment lasting up to a year or more.^[5][10]

Progress is typically gradual rather than sudden. Parents might notice that their baby can turn their head a little bit farther each week, or that the head tilt becomes less pronounced over time. Some babies develop a small lump in the neck muscle early in treatment, which usually disappears as the muscle lengthens. Facial asymmetries or head flattening, if present, may take longer to improve and might not completely resolve, especially if treatment starts later in infancy.^[5][10]

Children and adults with acquired torticollis due to minor muscle strain or mild infection typically recover within seven to ten days with appropriate treatment. More serious causes may require longer treatment periods depending on the underlying condition. Cervical dystonia in adults is usually a chronic condition requiring ongoing management, though symptoms can be well-controlled with regular botulinum toxin injections or other treatments.^[4][17]

Side effects from treatment are generally minimal. Physical therapy and stretching may cause temporary discomfort during the exercises, and babies often cry initially, but this should not be severe. If a baby seems to be in significant pain during stretches, the technique should be reviewed with the physical therapist. Medications can cause various side effects—NSAIDs may irritate the stomach, muscle relaxants can cause drowsiness, and anticholinergics may cause dry mouth or constipation. Botulinum toxin injections can occasionally cause temporary weakness in nearby muscles or difficulty swallowing if neck muscles are affected.^[12]

Surgical treatments carry the usual risks associated with any operation, including infection, bleeding, and anesthesia reactions. Specific to torticollis surgery, there is a risk of nerve damage, persistent neck stiffness, or cosmetic concerns if scarring is significant. Deep brain stimulation surgery carries risks related to brain surgery and the implanted device, including infection, bleeding in the brain, or device malfunction. However, when performed by experienced surgeons, these procedures generally have good safety profiles.^[12][15]

Long-term Outlook

The prognosis for congenital muscular torticollis is generally excellent when treatment begins early. Studies show that more than 90% of infants who receive consistent physical therapy starting in the first few months of life achieve complete recovery with no lasting limitations. The earlier treatment begins and the more consistently it is performed, the better the outcomes tend to be.^[7]

Even children who require surgery typically have very good outcomes, especially when surgery is followed by appropriate physical therapy. The recent study showing significant quality-of-life improvements after surgical treatment is encouraging for families facing this option. Younger patients tend to show better improvement in facial symmetry compared to older patients, highlighting again the importance of early intervention.^[15]

For acquired torticollis in children and adults, the outlook depends largely on the underlying cause. Simple muscle spasms resolve quickly with minimal treatment. Torticollis caused by infections improves as the infection is treated. However, cervical dystonia in adults is often a chronic condition that requires ongoing management. While it may not be curable, symptoms can usually be well-controlled with appropriate treatment, allowing most people to maintain good function and quality of life.^[12]

Some people with torticollis, particularly congenital cases, may have associated conditions such as hip dysplasia (where the hip joint doesn’t develop properly) or plagiocephaly (flattening of one side of the head). These conditions can often be addressed concurrently or separately, and having torticollis doesn’t necessarily mean other problems will develop.^[2][7]

Regular follow-up with healthcare providers is important to monitor progress and adjust treatment as needed. For babies undergoing physical therapy, check-ups every few weeks help ensure exercises are being performed correctly and are producing the desired results. For people receiving botulinum toxin injections, follow-up visits every few months allow for repeat injections before symptoms return. This ongoing relationship with healthcare providers helps optimize outcomes and catch any potential complications early.