Children with infant torticollis present with a tilt of the head to one side and rotation of the chin in the opposite direction. There are various causes of childhood torticollis ranging from the least serious, functional torticollis to the more serious, structural torticollis. Both conditions usually involve the sternocleidomastoid muscle which has the function of flexing and rotating the neck.
Various theories have been proposed for each of these conditions. It has been suggested that functional torticollis occurs as aresult of an unusual lie in the uterus, weakening sternocleidomastoid and resulting in other changes such as a altered shape of the cranium. Structural scoliosis is a change in the structure of the sternocleidomastoid muscle either due to a congenital shortening of the muscle or due to a fibrosis of the muscle belly due to the trauma of birth.
Tension in the sternocleidomastoid muscle may affect the structures to which it attaches; the occiput, the mastoid process, the cervical spine, the clavicle and the sternum. Left untreated there is the danger that the tension will result in asymmetry of the neck, basocranium and viscerocranium as the body continues to grow. Using knowledge of applied anatomy, osteopaths are able to relieve tension in and around the sternoceidomastoid.
The osteopath should begin by observing the position of the infant and how the child tends to hold the head observing which side the infant favours and where in the cervical spine the most torque occurs. Observation by the osteopath includes assessing the shape of the cranium to see whether tension in the sternocleidomastoid has effected the symmetry of the bones. Particular attention should be paid by the osteopath to the occiput to which the sternocleidomastoid attaches. observing any changes to the shape of the bone and its articulation.
All possible somatic dysfunction should be explored by the osteopath but specifically the upper dorsal spine, upper ribs, scapulae, pectoral muscles, clavicles and sternum. Sutherland felt that the osteopath must consider cranial nerve XI, the accessory nerve, for possible entrapment neuropathy due to its passage through the jugular foramen and the jugular foramen's close association with the sternocleidomastoid muscle.
Once the osteopath has made an evaluation of the infant, both direct and indirect osteopathic techniques can be applied. Needless to say these techniques are gentle and specific. Direct techniques in the form of gentle articulation to the cervical spine as well as sub-occipital inhibition to "disengage" the occipito-atlantal joint. Gentle springing using the thumbs and finger tips can be applied to the upper ribs and pectoral region releasing the upper ribs, pectoral muscles. With the child's anterior held against the shoulder of the parent, the osteopath can apply gentle pressure with the thenar emmenence to the exposed vertebrae articulating them into extension to reduce restriction in the spine, sacrum and hips.
Indirectly, the osteopath can use cranial techniques applied to the occiput and temporal bones with special attention to the quality of movement of the occipitomastoid suture which may be restricted due to its close association with the sternocleidomastoid muscle. Additionally the osteopath should evaluate the quality of the membranes in the upper thorax, mediastinum and gut, assessing facial strains occurring from the neck and causing strains distally.
Various theories have been proposed for each of these conditions. It has been suggested that functional torticollis occurs as aresult of an unusual lie in the uterus, weakening sternocleidomastoid and resulting in other changes such as a altered shape of the cranium. Structural scoliosis is a change in the structure of the sternocleidomastoid muscle either due to a congenital shortening of the muscle or due to a fibrosis of the muscle belly due to the trauma of birth.
Tension in the sternocleidomastoid muscle may affect the structures to which it attaches; the occiput, the mastoid process, the cervical spine, the clavicle and the sternum. Left untreated there is the danger that the tension will result in asymmetry of the neck, basocranium and viscerocranium as the body continues to grow. Using knowledge of applied anatomy, osteopaths are able to relieve tension in and around the sternoceidomastoid.
The osteopath should begin by observing the position of the infant and how the child tends to hold the head observing which side the infant favours and where in the cervical spine the most torque occurs. Observation by the osteopath includes assessing the shape of the cranium to see whether tension in the sternocleidomastoid has effected the symmetry of the bones. Particular attention should be paid by the osteopath to the occiput to which the sternocleidomastoid attaches. observing any changes to the shape of the bone and its articulation.
All possible somatic dysfunction should be explored by the osteopath but specifically the upper dorsal spine, upper ribs, scapulae, pectoral muscles, clavicles and sternum. Sutherland felt that the osteopath must consider cranial nerve XI, the accessory nerve, for possible entrapment neuropathy due to its passage through the jugular foramen and the jugular foramen's close association with the sternocleidomastoid muscle.
Once the osteopath has made an evaluation of the infant, both direct and indirect osteopathic techniques can be applied. Needless to say these techniques are gentle and specific. Direct techniques in the form of gentle articulation to the cervical spine as well as sub-occipital inhibition to "disengage" the occipito-atlantal joint. Gentle springing using the thumbs and finger tips can be applied to the upper ribs and pectoral region releasing the upper ribs, pectoral muscles. With the child's anterior held against the shoulder of the parent, the osteopath can apply gentle pressure with the thenar emmenence to the exposed vertebrae articulating them into extension to reduce restriction in the spine, sacrum and hips.
Indirectly, the osteopath can use cranial techniques applied to the occiput and temporal bones with special attention to the quality of movement of the occipitomastoid suture which may be restricted due to its close association with the sternocleidomastoid muscle. Additionally the osteopath should evaluate the quality of the membranes in the upper thorax, mediastinum and gut, assessing facial strains occurring from the neck and causing strains distally.
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