The Successful Chiropractic Care of Three Pediatric Patients with Acquired Torticollis

Wendy Owers, DC

Wendy Owers, DC (1), Joel Alcantara,DC (2)
1. Private Pracitce of Chiropractic, Kitchener, Ontario, Canada.
2. Research Director, International Chiropractic Pediatric Association, Media, PA.

This study was funded by International Chiropractic Pediatric Association, Media, PA and Owers Chiropractic, Kitchener, Ontario.

Abstract

Objective: To describe the successful chiropractic care of three pediatric patients with
acquired torticollis.

Clinical Features: The pediatric patients were all brought in by their mothers for chiropractic evaluation and resolution of their acquired torticollis. All three patients had woken with this condition and all claimed no trauma. Later determined that all cases had either one significant trauma or a series of lesser traumas.

Intervention and Outcomes: The patients were cared for with chiropractic adjustments to the sites of vertebral subluxations and distraction/traction in office and at home. All were asymptomatic within three adjustments.

Conclusions: These case reports provide supporting evidence of the effectiveness of chiropractic care in children with acquired torticollis.

Key Indexing Terms: chiropractic, acquired torticollis

Introduction

Torticollis is known by several different names such as wryneck, atlanto-axial rotatory fixation, atlanto-axial rotatory subluxation, and atlanto-axial rotatory dislocation.1. It is more common in children than adults. The head is non-voluntarily positioned laterally and rotated contra laterally, there is significant pain both at rest and worsening with both passive or active motions. This condition involves the cervical nerves and musculature, most notably the sternocleidomastoid muscles (SCM).

A thorough history and physical examination will help to differentially diagnose this condition as vertebral subluxation based, related to viral or bacterial infections 2., tumor of posterior fossa 3., osteomyelitis, retropharyngeal carcinoma 4., Grisel's syndrome 2., intervertebral disc calcification 5., or another pathology. Radiographs could also aid in the diagnosis. The literature suggests that if after I week of "conservative care" there is not resolution of the symptoms, further diagnostic studies are required to further investigate the condition 6.

This condition has been managed successfully by chiropractors for over 100 years, based on the anecdotal reports.

We describe the pediatric chiropractic care of three patients with acquired torticollis.

Case 1: Eight year old male presented by his mother with acquired torticollis (left) upon wakening. It was determined that he had fallen off a bed onto the floor during a ''wrestling'' match the previous evening. He was in significant pain and could not voluntarily move his head. Physical exam revealed vertebral subluxations at C1 and C4; inflammation and hypertonicity of left SCM; tenderness to palpation over entire cervical area. He was adjusted at C1 using Toggle Recoil technique and at C3-4 using posterior anterior Thompson technique; cervical distraction was utilized both prior to and following the adjustments. His mother was shown how to perform the distraction and was advised to use hot showers alternating with ice packs and the distraction at home. The next day there was slight improvement and he was again examined for vertebral subluxations. We found and adjusted VS at C0, C2, and C4 using the Thompson technique, again performing cervical distraction before and after. Same post-care instructions to mother. The next day the patient presented with some neck pain (significantly reduced). His physical exam was performed this day along with radiographs. Ranges of motion of the cervical spine were reduced to the right side. Radiographs were unremarkable. He was chiropractically examined again and adjusted at C0, C2, and C4 as previous day. Three days later he was again presented this time with no pain. Examination revealed subluxation at C2, which was adjusted. Episode resolved.

Case 2: Six year old female presented by her mother with acquired torticollis (left) upon wakening. Two days previous she had fallen hard onto her knees and suffered a "neck whipping"; the previous day she had been hit in the face with a basketball; that morning she turned her head ''too quick" and had a coughing episode. She was in significant pain on the right side of her neck; passive ranges of motion to the right were significantly reduced, left lateral flexion and flexion and extension were also reduced; left rotation was within normal range; cervical compression was positive. Physical exam revealed vertebral subluxation at C1; hypertonicity of left SCM; tenderness of right cervical region; left shoulder 2" higher than right. Cervical distraction was performed pre and post adjustment of C1 by Toggle Recoil technique. Mother was advised to limit activities and use ice as needed. Three days later she had no signs or symptoms. She was checked for vertebral subluxations and none were found. Episode resolved.

Case 3: Seven year old male presented by his mother with acquired torticollis (right) upon wakening. Fell from top of a slide onto his head, neck and shoulder at age six, which resulted in bruising on his head (checked at ER and released); hit his head at hockey a few weeks ago; had a soccer practice last night; has recently complained of neck pain. He was in significant pain on the left side of his neck at the mid-cervical region; all active and passive ranges of motion in the cervical spine were nil (due to
pain) except forward flexion. Physical exam revealed vertebral subluxations at C1 and C4; positive Valsalvaa to area of chief complaint; hypertonicity of right SCM, tenderness of left cervical region. Adjustment of C1 by Toggle Recoil technique and C4 by Thompson technique; distraction performed pre and post adjustment. Mother advised to limit-activities, use hot bath/shower and ice for pain control. Presented the next day with same subjective and objective findings. Adjusted as previous with exception that the right first rib was also adjusted. Mother shown how to perform distraction at home. Presented the next day showing improvement. Adjusted as previous except C1 was not adjusted and C2 was by Toggle Recoil. Radiographs were performed the next day. Same adjustments as previous day. No symptoms reported. Radiographic findings: C1 lateral flexion, head tilt right, right clavicle 14 mm higher than left. Day 5 presented with no symptoms; C1 and C4 adjustments as previous with distraction. Day 8 presented with stomach ache, vomiting (determined unrelated), adjusted C1 and C4 as previous and recommended massage therapy. Day 11 presented with no signs or symptoms (played hockey on day 9); Progress exam this date reveals all ranges of motion within normal limits: Episode resolved.

Discussion

Traditional medical care for such cases would include waiting for spontaneous recovery 5.; conservative care consisting of rest, neck collar, analgesics, antibiotics, muscle relaxants and Halter traction 6.; analgesics and antibiotics for suspected bacterial infections 7., cervical neck traction 7., reduction under anesthesia and plaster fixation for 8 weeks 8., re-dislocation 8., surgical interventions such as fusion of the atlanto-axial joint 6., micro-vascular decompression 9., and di-section of the SCM 3. Conservative chiropractic care appears to be a safe, timely, and cost effective treatment option in these cases as compared to the traditional medical approach. The diagnosis is key to the outcome. There are many causes of acute acquired torticollis which need to be ruled out if resolution has not been produced within a short period of time.

Conclusion

These cases add to the growing body of evidence that conservative care utilizing chiropractic adjustments is safe and effective in resolving these episodes of acute acquired torticollis. More investigation is indicated in order to prove this effectiveness.

References

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