Bulletin of Orthopaedic and Neuromuscular Education Series

Torticollis and the Benefits of Therapy

Seen most often in infants, congenital muscular torticollis (CMT) is a postural condition typically characterized by a head tilt to one side and head rotation to the opposite side. The sternocleidomastoid is the muscle in the neck mainly responsible for this condition, often tight on one side and weak on the other side. It is important to treat this condition as soon as it is seen to improve achievement of developmental milestones, decrease the need for a helmet to treat plagiocephaly (flattened head), and increase strength and flexibility of the neck muscles. 


A physical therapist will determine the exercises you and your child will start with based off of their examination; however, here are 5 exercises to begin with:

  1. Football stretch: This exercise helps to improve flexibility of the sternocleidomastoid. If your child is tilted to the right, their right side will be down. If your child is tilted to the left, their left side will be down.
    Make it fun: Sing a song while they are being stretched and bounce them to the beat.
  2. Cervical rotation stretch: This exercise helps to improve flexibility of the sternocleidomastoid. If your child prefers to rotate their head to the right, you will stretch them to the left. If your child prefers to rotate their head to the left, you will stretch them to the right.
    Make it fun: Make sure that there is a flashy, musical toy for them to look at when they rotate their head.

  1. Side-lying positioning on both sides: This exercise helps to increase strength of the sternocleidomastoid. Make it fun: Have them reach for a bright beaded necklace on their side.
  2. Tummy time: This exercise helps to increase strength of the neck extensors. Make it fun: Have them look at shiny toys and rotate their head as they look at toys.
  3. Pull to sit: This exercise helps to increase strength of the deep neck flexors. Make it fun: Make a game out of them lifting their head to see you and make silly faces at them as they lift their head.

Some important everyday activities:

  1. When your child feeds, do they only feed on one side? Make sure you switch hands so that your child gets equal opportunities to rotate their head.
  2. How often is your child in a container seat or on their back? Make sure to give your child opportunities to be on their tummy to build their neck strength.

Frequently asked questions: 

  1. What should parents of newborns know in order to prevent torticollis? Physical therapists do recommend supervised tummy time when awake 3 or more times a day and encouraging full active movements of the body.
  2. When should a parent or patient be concerned and contact Growing Bones? If you start to see postural preferences (head tilt, rotation to one side), let your doctor know as soon as possible so a physical therapist can help treat the postural preference and optimize their movement patterns.

  1. These exercises are great but there are so many of them. When will I be have the time to complete them? We understand that being a parent is a full-time job. The best time to do the exercises are when you incorporate them into your routine! Whenever you change their diaper, whenever they wake up from their first and/or second nap, whenever you cuddle them to sleep, whenever you’re done feeding…start slowly and then build up more and more times for the exercises as you get comfortable.
  2. How long will my child be at physical therapy? Although your physical therapist will determine frequency and duration of treatment, the general recommendation is to follow the child for at least a year in order to ensure milestones are being achieved and postural asymmetries are addressed as these milestones are achieved.


Kaplan SL, Coulter C, Sargent B. Physical Therapy Management of Congenital Muscular Torticollis: A 2018 Evidence-Based Clinical Practice Guideline From the APTA Academy of Pediatric Physical Therapy. Pediatr Phys Ther. 2018 Oct;30(4):240-290. doi: 10.1097/PEP.0000000000000544. PMID: 30277962; PMCID: PMC8568067.