Also Known As: Congenital torticollis, Congenital muscular torticollis
Congenital muscular torticollis
The etiology of congenital muscular torticollis is unclear. Birth trauma or intrauterine malposition is considered to be the cause of damage to the sternocleidomastoid muscle in the neck. This results in a shortening or excessive contraction of the sternocleidomastoid muscle, which curtails its range of motion in both rotation and lateral bending. The head is typically tilted in lateral bending toward the affected muscle and rotated toward the opposite side. Noncongenital muscular torticollis can result from scarring or disease of cervical vertebrae, adenitis, tonsillitis, rheumatism, enlarged cervical glands, retropharyngeal abscess, or cerebellar tumors. It may be spasmodic (clonic) or permanent (tonic). The latter type may be due to Pott's Disease (tuberculosis of the spine).
The reported incidence of congenital torticollis is 0.3-2.0 %. Sometimes a mass, such as a sternocleidomastoid tumor, is noted in the affected muscle at the age of two to four weeks. Gradually it disappears, usually by the age of eight months, but the muscle is left fibrotic.
Initially, the condition is treated with physical therapies, such as stretching to release tightness, strengthening exercises to improve muscular balance, and handling to stimulate symmetry. A TOT Collar is sometimes applied. About 5–10% of cases fail to respond to stretching and require surgical release of the muscle. 
Infants with torticollis have a higher risk of plagiocephaly. Altering the head position and using a pillow when supine and frequently lying prone when awake help reduce the risk.
Uncommon causes such as tumors, infections, ophthalmologic problems and any other abnormalities should be ruled out before treatment begins Ocular torticollis due to cranial nerve IV palsy, for one, should not be treated with physical therapy. In that case, the torticollis is a neurological adaptation to maintain binocularity. Treatment should instead aim to improve extraocular muscle imbalance.
If torticollis is not corrected, facial asymmetry often develops.  Head position needs to be corrected before about the age of 18 months for there to be improvement. Younger children show the best results.
Congenital torticollis manifests in infancy but may not be diagnosed until childhood or even adulthood.
The word torticollis means wry neck: Acquired torticollis is not the same as congenital torticollis and may develop at any age.
Common treatments might involve a multi-phase process:
- Low-impact exercise to increase strong form neck stability
- Manipulation of the neck by a Doctor of Chiropractic, Physical Therapist, or Doctor of Osteopathic Medicine.
- Extended heat application.
- Repetitive shiatsu massage.