Congenital torticollis

You've just noticed that your baby always keeps their head tilted to the same side. It's normal to be concerned. As pediatric physical therapists, we see this concern in many parents. Congenital torticollis (stiffness of the neck muscle) affects 2 to 16% of newborns. It is one of the most common conditions in infants.¹

Good news: This condition is very treatable. With treatment within three months, the success rate is 98 to 100% without surgery.² The vast majority of babies regain full neck mobility. What the research shows:

- Congenital torticollis is not painful for your baby (unlike torticollis in adults). - The earlier treatment begins, the shorter it will be: approximately 1.5 months if started before 1 month of age. - Pediatric physical therapy is the treatment recommended by clinical guidelines³ - Exercises at home, such as tummy time, speed up recovery

This guide will help you understand this condition, recognize the signs in your baby, and discover how physical therapy can help. To learn more about our services, visit our pediatric physical therapy page.

What is congenital torticollis in infants?

Congenital torticollis is a contracture of the sternocleidomastoid muscle (SCM), the large muscle on the side of the neck. This stiffness tilts the baby's head to one side and turns it to the other. The condition affects 2 to 16% of newborns. It is the third most common congenital musculoskeletal abnormality, after hip dysplasia and clubfoot.¹

The SCM muscle runs from the bone behind the ear (the mastoid) to the collarbone and sternum. Normally, this muscle allows the head to be tilted to one side and turned to the other. In congenital torticollis, the muscle is shortened or contracted, limiting head movement.

One reassuring point for parents: this condition is not painful for your baby. It is different from torticollis in adults, which is very painful. Your baby is not in pain, even if they maintain an asymmetrical posture.

This condition may be present at birth or appear in the first few weeks of life. The good news is that it responds very well to physical therapy, especially when treatment begins early.

What are the three types of congenital torticollis?

The three types are postural torticollis (20% of cases), muscular torticollis without mass (30%), and torticollis with a nodule in the muscle (50%). The type influences the duration of treatment, but not the success rate if intervention is early.²

Postural torticollis is the mildest form. The baby prefers to turn their head to one side, but can still move it in the other direction. This type responds quickly to repositioning and simple exercises.

Muscular torticollis involves actual shortening of the muscle. The physical therapist may feel tension in the muscle during the evaluation, but there is no lump. This type requires more regular stretching.

Torticollis with nodule (also called pseudotumor) presents as a small lump in the neck muscle. This lump usually appears 2 to 4 weeks after birth and gradually diminishes with treatment. Although it may seem more worrisome, this type also responds very well to physical therapy.

The physical therapist determines the type during the initial assessment in order to tailor the treatment plan to your baby's needs.

What are the causes of congenital torticollis?

Causes include position in the mother's womb, difficult delivery (forceps, vacuum extraction), weak neck muscles, and postnatal factors such as lack of variety in positioning. In many cases, the exact cause remains unknown.¹

In some cases, no specific cause can be found despite a thorough evaluation. The good news is that regardless of the cause, physiotherapy treatment remains the same and is just as effective.

How can you recognize congenital torticollis in your baby?

Signs include always tilting the head to the same side, a preference for looking in one direction, difficulty breastfeeding on one side, flattening of the skull, and using the same hand to reach for toys.

Checklist for parents:

- Always looks in the same direction - Often tilts their head in their car seat - Head always tilted to the same side - Appears to have a flat skull at the back or on one side - Always uses the same hand to reach for toys or their mouth - Does not like lying on their stomach - Difficulty breastfeeding from one breast (always prefers the same side)

If you notice several of these signs, a pediatric physical therapy consultation is recommended. The earlier the diagnosis is made, the more effective and shorter the treatment will be.

Associated signs to watch for:

Plagiocephaly (flat head syndrome) accompanies torticollis in 67 to 90% of cases.² The flattening of the skull develops on the side where the baby rests their head most often. You may also notice a slight asymmetry of the face or one ear that appears to be more prominent than the other.

In the case of torticollis with nodules, parents or doctors may sometimes feel a small, firm lump in the neck muscle. This lump is not painful and disappears with treatment.

What is the link between torticollis and plagiocephaly (flat head syndrome)?

Torticollis and plagiocephaly (flat head syndrome) often go hand in hand: 67 to 90% of cases. When a baby always keeps their head turned to the same side, prolonged pressure flattens that part of the skull. Treating torticollis early also helps prevent or improve flat head syndrome.²

An infant's skull is still malleable during the first few months of life. When a baby keeps their head turned to one side due to torticollis, the constant pressure on that area causes it to gradually flatten.

The vicious circle:

1. Torticollis causes the baby to keep their head turned to one side. 2. Prolonged pressure flattens one side of the skull. 3. The flat surface becomes more comfortable for the baby. 4. The baby keeps this position even more. 5. The flattening becomes more pronounced.

The solution:

Treating torticollis breaks this vicious cycle. By restoring mobility to the neck, the baby can vary their head positions, allowing the skull to return to a more symmetrical shape. This is why early treatment is doubly important: it treats torticollis AND prevents or improves flat head syndrome.

If your baby already has plagiocephaly, the physical therapist will assess both conditions and adapt the exercise program accordingly.

Why is it important to treat congenital torticollis early?

Treatment before 3 months of age offers a success rate of 98 to 100% without surgery. After 6 months, only 40% of babies respond well to treatment. Treatment started before 1 month of age resolves on average in 1.5 months. After 6 months, it can take 9 to 10 months.²

The message is clear: earlier = shorter and more effective.

What can happen if you wait too long:

- Facial asymmetry that may remain - Severe flat head (sometimes requiring a corrective helmet) - Possible delay in motor development - Higher risk of surgery - Postural compensation (scoliosis)

Good news:

You do not need a medical prescription to consult a physical therapist in Quebec. As soon as you notice signs of torticollis in your baby, you can make an appointment directly. This accessibility allows for rapid intervention, when treatment is most effective.

How does physical therapy treat congenital torticollis?

Pediatric physical therapy includes gentle neck muscle stretching, strengthening exercises, positioning techniques, and teaching parents how to do exercises at home. The success rate is 90 to 95% with an average of 6 to 12 sessions.²

The initial assessment includes:

- Assessment of neck mobility (rotation and tilt) - Measurement of neck muscle strength - Observation of overall motor development - Checking the neurological and visual systems - Examination of the shape of the skull (to see if there is a flat head)

Treatment techniques: Gentle stretching The physical therapist gently stretches the neck muscles to gradually increase the range of motion. Never force the stretch. Strengthening exercises : Exercises tailored to the baby's age to strengthen neck muscles and improve head control. Positioning techniques The physical therapist shows you how to position your baby to encourage movement toward the restricted side. Teaching parents:

A large part of the treatment relies on exercises that you will do at home between sessions. The physical therapist will teach you: - Specific exercises to do every day - Playing positions that promote development - Strategies for breastfeeding or bottle feeding - Changes to make to your baby's environment

At Physioactif, we take the time to practice each exercise with you so that you feel confident and comfortable repeating the techniques at home.

What exercises can I do at home for my baby's stiff neck?

Home exercises include tummy time (30 to 60 minutes per day in small doses), stimulation of the non-preferred side, varied positioning during wakefulness, and gentle stretches taught by the physical therapist. These exercises speed up recovery between sessions.

Tummy time:

Tummy time is essential for strengthening neck muscles and avoiding pressure on the skull. Aim for 30 to 60 minutes a day, in small doses of a few minutes at a time.

If your baby doesn't like lying on their stomach:

- Start on your chest (skin to skin) - Use a pillow or rolled-up towel under their chest - Place colorful toys in front of them - Stay on the floor with them, at eye level - Increase the duration gradually

Stimulation of the non-preferred side:

- Position yourself on the side toward which your baby turns their head less easily - Place toys, mobiles, and light sources on that side - When breastfeeding or bottle-feeding, alternate sides - Talk to your baby from that side to attract their attention

Varied positioning:

- Favor positions where the head is not supported (baby carrier, Bumbo seat, stomach) - Vary positions often during wakefulness - Alternate the side of the room where the bed is located - Change the direction in which you lay your baby down

Stretching at home:

The physical therapist will show you safe stretching techniques. These stretches should always be gentle, never forced. Practice them during quiet moments, such as after a bath or before bedtime.

How long does treatment for congenital torticollis take?

The duration depends on the age at the start of treatment. Treatment started before 1 month of age resolves in 1.5 months on average. Between 1 and 3 months: 3 to 4 months. After 6 months: 9 to 10 months. Most babies regain normal mobility with physical therapy.²

Factors influencing treatment duration: The type of torticollis: Postural torticollis resolves more quickly than the nodular type. Severity: A more significant limitation of movement takes longer to correct. Home exercises: Babies whose parents regularly do the exercises progress faster. The presence of a flat head: If there is a skull deformity, treatment may take a little longer. What to expect:

The first few weeks are used to establish an exercise routine and see how your baby responds. Most parents notice an improvement within the first 2 to 4 weeks. The physical therapist regularly reevaluates progress and adjusts the program as needed.

Sessions gradually become less frequent as mobility improves. Towards the end of treatment, you may see the physical therapist once a month to ensure that gains are maintained.

When is surgery necessary for congenital torticollis?

Surgery is rarely necessary: less than 5 to 10% of cases treated early. It is considered if treatment has not worked after 6 months or more of intensive physical therapy, or if severe cranial deformation persists. Physical therapy remains the first-line treatment.³

When considering surgery:

- Failure of treatment after 6 months or more of intensive physical therapy - Persistent restriction greater than 15-20 degrees despite treatment - Severe cranial deformity that does not improve - Age greater than 12-18 months with significant restriction

Types of operations:

Surgery usually involves releasing or lengthening the neck muscle. Less invasive techniques are also available. After the operation, post-operative physical therapy is necessary to optimize results.

Don't worry:

The vast majority of babies treated early will never need surgery. That's why early treatment is so important. If you seek medical advice as soon as the first signs appear, the chances of your baby needing an operation are very low.

Next steps

If you notice signs of torticollis in your baby, don't wait. Pediatric physical therapy is effective and gentle, and the earlier treatment begins, the shorter and simpler it will be.

At Physioactif, our physiotherapists trained in pediatrics gently assess your baby and support you every step of the way. We practice the exercises with you so that you feel confident doing them at home.

You do not need a doctor's referral to consult with us. Schedule an appointment now for an evaluation.

References

1. StatPearls. Congenital Torticollis [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2026 Jan 16]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549778/

2. Kaplan SL, Coulter C, Fetters L. Physical Therapy Management of Congenital Muscular Torticollis: A 2018 Evidence-Based Clinical Practice Guideline. Pediatric Physical Therapy. 2018;30(4):240-290. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8568067/

3. APTA Academy of Pediatric Physical Therapy. Physical Therapy Management of Congenital Muscular Torticollis: 2024 Evidence-Based Clinical Practice Guideline [Internet]. 2024 [cited 2026 Jan 16]. Available from: https://pubmed.ncbi.nlm.nih.gov/39356257/

4. Choose PT (APTA). Physical Therapy Guide to Torticollis [Internet]. [cited 2026 Jan 16]. Available from: https://www.choosept.com/guide/physical-therapy-guide-torticollis

5. HAS France. Preventing plagiocephaly without increasing the risk of sudden infant death syndrome [Internet]. 2020 [cited 2026 Jan 16]. Available from: https://www.has-sante.fr/jcms/p_3160772/fr/prevenir-la-plagiocephalie-sans-augmenter-le-risque-de-mort-inattendue-du-nourrisson