Intensive Course on Congenital Muscular Torticollis​

• Why clinical history-taking guides the treatment process and saves time during the first appointment.

• Preliminary questionnaire: what to ask and how to submit it, including prenatal, perinatal, and postnatal history, breastfeeding or feeding, previous treatment, and the baby’s environment.

• Turn family concerns into functional, observable, short-term goals.

• Onset and progression: key questions for differential diagnosis.

• Fears, beliefs, and expectations: how to identify them and encourage adherence.

• Initial working hypothesis: five or six plausible causes, a mental framework for assessment, and red flags requiring referral.

• Why congenital muscular torticollis may present risks to neurodevelopment and when structured screening is required.

• A six-step protocol: vision, hearing and communication, automatic responses and reflexes, postural-motor development, standardized scales, and environmental factors.

• Vision and hearing: fixation, tracking, facial expression, response to sound, asymmetries, and warning signs.

• Automatic responses, reflexes, and postural-motor development: quality of movement, milestones by age, use of the arms and hands, and detection of asymmetries.

• Standardized scales such as AIMS, HINE/SINDA, TIMP, IMP, Bayley, and Denver II: practical criteria for choosing the appropriate tool for each case.

• Environmental factors that affect outcomes and adherence, family education, and red flags requiring referral.

• The importance of a detailed assessment of functions and structures to confirm diagnostic hypotheses and distinguish functional conditions from structural conditions.

• Active mobility: observation of spontaneous head rotation, visual, auditory, and tactile stimulation, and objective measurement in degrees.

• Passive mobility: cervical reference ranges, detection of barriers and resistance, and differentiation between structural limitations and functional deficits.

• Alignment: analysis in supine and prone positions, classic postural reactions such as pull-to-sit, Landau, and the Muscle Function Scale, and detection of compensations and asymmetries with neuromotor implications.

• Tissues: observation and palpation of the cervical region, detection of nodules in the sternocleidomastoid muscle, associated tension, signs suggesting malformations, and referral criteria.

• Neuromeningeal tension: clinical signs such as extension patterns, irritability, and rigidity; baby-adapted tests such as the egg test and modified Landau; clinical applications and relationship with meningitis.

• Skull shape: assessment of plagiocephaly and brachycephaly using observation, cephalometric measurements, cranial indices, digital tools, the Argenta classification, and referral criteria.

• Oral function: resting posture, facial symmetry, oral reflexes, tongue tone, and sucking; impact on breastfeeding and the need for interdisciplinary referral.

• Pain: the importance of recognizing pain in babies with torticollis, the use of validated tools such as FLACC and NIPS, interpretation criteria, and clinical follow-up.

• Torticollis does not occur in isolation. It is often accompanied by associated conditions affecting the hips, arms, thorax, mouth, and skull.

• Hips: observation of the more restricted side, the Galeazzi test, asymmetrical opening test, and referral for imaging where required.

• Arms: detection of adduction, mobility assessment, abduction testing, and external rotation testing.

• Thorax: analysis of thoracic convexity at rest and during head rotation, with early identification of asymmetries.

• Mouth: assessment of resting position, facial symmetry, lateral tongue movement, rooting reflex, and non-nutritive sucking quality.

• Plagiocephaly: global analysis of skull shape, detection of flattening or asymmetry, measurement of circumference, length, width, and diagonals, cranial index calculations, and the use of digital tools such as HeadShape.

• Craniofacial conditions: the importance of identifying these early as part of screening for congenital muscular torticollis.

• The importance of clinical reasoning as the basis for designing an effective intervention plan.

• Confirm or rule out the initial hypothesis and review possible causes, including ocular conditions, Sandifer syndrome or reflux, congenital malformations, neurological conditions, joint dysfunctions, and abscesses.

• Understand the etiopathogenesis of congenital muscular torticollis: severity levels, prevalence, and theories of origin, including compartment syndrome, intrauterine changes, and perinatal positioning.

• Distinguish between musculoskeletal torticollis and motor-control torticollis.

• Musculoskeletal factors: restrictions or blocks, tissue or joint limitations, and the need for manual therapy.

• Motor-control factors: sensory, muscle-tone, or motor changes and the need for stimulation and exercises.

• Do not focus solely on the presence of a nodule in the sternocleidomastoid muscle. Torticollis exists on a continuum and is not limited to a palpable mass.

• Establish a progressive intervention plan:

• First, address the musculoskeletal component.

• Then address the neurosensory-motor component.

• Involve the family in the therapeutic process:

• Listen to and understand their concerns.

• Explain the plan using clear materials.

• Practice exercises together with caregivers.

• Prepare families for difficulties they may encounter at home.

• Manual therapy in pediatric care: clarify common misconceptions, review the IFOMPT definition, and apply key principles. Treatment must be comfortable, adapted, gentle, safe, and supportive.

• Intervention objectives: improve active and passive range of motion, improve movement quality and symmetry, optimize cranial symmetry and morphology, support respiratory and orofacial functions, and promote motor and sensory development.

• What must not be done: precautions for specific conditions such as KISS syndrome.

• Myofascial therapy and massage: tissue mobilization techniques involving the sternocleidomastoid muscle and cervical tissues, with mapping in the supine position.

• Stretching or mobilization: analyze the differences, combine rotation and tilt techniques, apply safety precautions for hard end-feel and injury risk, understand the limitations of passive range-of-motion gains, work on the tissues first, respect barriers, and use stimulation to encourage active movement.

• ATNR and hand-to-mouth coordination: use the cervical asymmetric tonic reflex and hand-eye-mouth coordination to integrate manual therapy with neurosensory development.

• Advanced PIMT techniques: occipital neuromeningeal techniques, plagiocephaly and cranial deformity approaches, and integration with orofacial physiotherapy.