Alexis Hannigan, PT, DPT, is a physical therapist at the Orthopedic Specialty Center at the University of Vermont Medical Center.

Alexis Hannigan, PT, DPT, is a physical therapist at the Orthopedic Specialty Center at the University of Vermont Medical Center.

Torticollis, or “twisted neck” refers to a tightening of the muscles on one side of an infant’s neck. It results in a side-bent and rotated head and neck position. In babies, torticollis is common, and can range from mild to extreme. The good news is that through physical therapy, the effects of torticollis can be minimized, and babies can be well on their way to growing, moving, and exploring their surroundings.

Before and Immediately After Birth

Infants can be born with torticollis already present. This is referred to as congenital muscular torticollis. It can result from the infant’s position in-utero, and is often seen with larger babies or in cases of multiples, such as twins.

Torticollis can also develop in the months following birth. This is referred to as idiopathic muscular torticollis. Regardless of when your little one’s neck muscles shortened and tightened up, the treatment approach is similar.

The Flat Spot

The cranial bones that make up an infant’s skull are very thin, soft and flexible, increasing the risk of developing a flat spot, or plagiocephaly.

This flat spot can develop from pressure over time on the same spot of the head, as with the head and neck staying in the same position in cases of torticollis. Plagiocephaly can be seen when a baby has difficulty turning to look to both sides. A baby with plagiocephaly may have an oblique-shaped head, and some facial asymmetries may be observed. Fortunately, the thin, soft and flexible properties of a baby’s skull also generally make for a safe, conservative and effective treatment.


Physical therapy is a common and appropriate treatment for torticollis and plagiocephaly.

When provided early on (around 2-4 months of age), physical therapy can be very successful. Often just a few sessions are needed to evaluate an infant, and teach parents and caregivers the techniques for home care. As the head and neck position improve and a baby’s neck strength and head control improve, his or her head shape tends to improve as well.

Physical therapy will begin with a thorough evaluation to assess your infant’s neck range of motion, strength of neck muscles, and general gross motor development. Your infant’s therapist will work with you and your baby on identifying contributing factors that may have led to torticollis, such as positioning in car seats and sleeping positions. The treatment program will focus on positioning recommendations, range of motion exercises, and tummy time ideas. It is personalized for each infant and their parent and or caregiver. If necessary, gentle stretching techniques will also be taught to help improve your little one’s range of motion.


Torticollis and plagiocephaly can often be prevented, and mild cases can be resolved easily, with an increased awareness of your baby’s position throughout the day.

Some other things we’ll address in physical therapy include:

  • Making sure that all caregivers switch which side they hold the baby on.
  • Varying which side they feed the baby on (when bottle fed).
  • Avoiding prolonged use of swings and or car seats, which can contribute to torticollis and plagiocephaly if an infant is developing a preference for holding their head to one side.
  • Increasing tummy time throughout the day, even in small spurts, which can develop good neck muscle strength, and help your infant to move and turn their head both ways.

If you have any concerns, talk to your infant’s pediatrician and get a referral to physical therapy for a quick recovery and to keep your infant moving and exploring their world with ease.

Learn more about Orthopedic Care at the University of Vermont Medical Center. 

Alexis Hannigan, PT, DPT, is a physical therapist at the Orthopedic Specialty Center at the University of Vermont Medical Center. 

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