Physical Therapy Management of Congenital Muscular Torticollis: A 2018 Evidence-Based Clinical Practice Guideline From the APTA Academy of Pediatric Physical Therapy.
Sandra L Kaplan, Colleen Coulter, Barbara Sargent
PMID 30277962WHAT IT FOUND
Start physical therapy within the first month of life for infants with congenital muscular torticollis.
This guideline emphasizes that early intervention leads to faster resolution and reduces the need for surgery, while recommending a comprehensive approach that includes parent education and environmental adaptations.
Key findings
01The guideline recommends initiating physical therapy intervention as soon as asymmetry is noted, as earlier treatment is associated with shorter episodes of care and lower rates of surgical intervention.
02First-choice intervention must include five specific components: neck passive range of motion, neck and trunk active range of motion, development of symmetrical movement, environmental adaptations, and parent/caregiver education.
03Supplemental interventions like kinesiology tape showed no added value over exercise alone in a randomized trial, whereas microcurrent therapy demonstrated reduced treatment duration in two studies.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The evidence base is largely composed of Level II-IV studies, cohort studies, and case reports, with only a few randomized controlled trials. There is no consensus on the optimal dosage, frequency, or duration of stretching interventions, leading to intentional vagueness in some recommendations. Long-term follow-up data on the effectiveness of early physical therapy intervention and the rate of recidivism are limited. The guideline does not provide specific protocols for the administration of supplemental interventions like microcurrent or soft tissue mobilization, other than citing the studies used.
Declared interests
The authors declare no conflicts of interest. The work was supported by the American Physical Therapy Association Academy of Pediatric Physical Therapy.
The easy way to misread this
Do not assume that kinesiology tape or cervical manipulation are effective treatments for congenital muscular torticollis. The guideline explicitly states that kinesiology tape showed no added value over exercise alone in a randomized trial, and cervical manipulation is not recommended due to insufficient evidence and potential safety risks.