Episode 007 — Torticollis: A Pain in the Neck!
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Title: Torticollis:  A Pain in the Neck!

Episode Number: 007

Host: Dr. Thomas Lamar

Show Date: 02/26/2010

Run Time: 16:12

Description:  While it may have a funny name, those who have had torticollis can attest that it is no laughing matter.  And while you may never experience torticollis yourself, chances are someone in your life will.  Dr. Lamar describes this painful, and posturally disturbing, neck condition and what to do about it.

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Spinal Column Radio, episode number seven .

Coming up on Spinal Column Radio — Torticollis:  A Pain in the Neck!


[intro theme music]

Welcome back to another exciting and information packed episode of Spinal Column Radio.  My name is Dr. Thomas Lamar, chiropractor and Dad of 6.   And this is the podcast that gets you to think.  To think about your health in a whole new way.  We’re the podcast for your backbone… the podcast with backbone.  Who knew that spinal education could be this much fun?

We’d like to invite you to visit our podcast website at spinalcolumnradio.com where you can learn more about us, check out our world-renown “What’s a Podcast?” page, and can access the show notes for this episode.  Also, we encourage you to leave comments and ask questions through our website, or, if you prefer, you can email me using DrLamar AT spinalcolumnradio DOT com.


[transitional sound effect]

Logan: So, what are we talking about today Dad?

Dr. Lamar: He speaks!  Whooa!  Ladies and Gentleman, allow me to introduce to you my audio engineer and 9 year-old son, Logan Lamar.

Logan: Hi there.

Dr. L: Logan it’s nice to add you voice to our show.  You know, son, I’d just like to say publicly that you are doing a great job learning the ropes of the mixer board there.  I’m proud of you.

Logan: Thanks.

Dr. L: And now, we have one more element to add to our sound board… coming in on channel 2… it’s our brand new… well, why don’t you tell them.

Logan: Sure.  We just added another microphone to our studio.

Dr. L: Not just any microphone… another Heil PR-40… which, if you were to bring in any of the other microphones that I used to play around with as a teen… well, they just don’t hold a candle to the quality of this microphone…. Anybody interested in podcasting should check it out.  And I’d encourage you to do so at PodcastAnswerman.com.  I’ve got a link in the show notes.

Anyway, we actually have a reason for adding another microphone to our set up — other than the fact that you and I can banter back and forth…

Logan: Yes, that’s right.  Listeners will want to tune in next time for episode 008 to hear our first interview here on Spinal Column Radio.

Dr. L: Yes, we had the opportunity to interview one of my patients for our upcoming “Pregnancy and Chiropractic” episode.  And that show is set to come out the second Friday of March.  So, something to look forward to… and a great reason to tune in next time.

But, to get back to your original question, Logan…

Logan: Oh yeah.

Dr. L: Today on the program we are talking about Torticollis.

Logan: Torticollis… Is that sort of like spaghetti or tortellini?

Dr. L: No… although it does sort of sound similar.  No, actually, Torticollis is a neck condition.

Logan: Oh.  What is it exactly?

Dr. L: Well… imagine waking up one morning with your neck cocked off to one side and your head turned slightly in the opposite direction.  It would be like if you were trying to cradle a telephone receiver between your ear and your shoulder… only there is no telephone involved… And, your neck is literally “locked” in that position… not to mention that it is incredibly painful to try and move it.

Logan: Yikes!

Dr. L: It’s a pretty big deal.  Not the most comfortable situation and certainly not something that you can hide very well.

Logan: I bet you are going to tell us how chiropractic can help… right?

Dr. L: Well… that depends.  You see, the causes of Torticollis are not always the same… and that’s where some potential confusion can arise, as well as why it’s so important that the doctor involved (whether it’s a chiropractor, medical doctor, naturopath, or other health care provider) conduct a thorough evaluation.  Because you see, even though we use it as such, the word “Torticollis” is really not much of a diagnosis.  It’s more of a description.

Logan: What do you mean?

Dr. L: The word “torticollis” is one of those fancy “Latin Doctor Words” that literally means “twisted neck.”

Logan: Twisted neck?

Dr. L: Yep.  Not too scientific, is it?

Logan: No.

Dr. L: You see, what the doctor needs to determine is what is causing the neck to twist in the first place.  And that’s where the art of diagnosis comes in… through history taking, physical examination, and conducting any other necessary tests like blood work or X-rays.

Logan: So what are some things that can cause a neck to twist Dad?

Dr. L: Well… lots of things.  Oh, I should probably also mention that there is another name that is sometimes attached to this condition — and this is more of a lay term… but, it’s sometimes called “wry neck” — as in the neck has “gone awry.”

So, what can cause a neck to twist or go “awry”?…. well, fortunately a lot of the “nasty things” that can cause a neck to twist are really relatively rare in most instances… things like fractures, tumors, infections….  sometimes people can have issue with their 4th cranial nerve… which is a nerve that comes from the brain to operate some of the eye muscles.  When this nerve does not function properly, the person will sometimes have to tilt their head to avoid having double vision.

Logan: Wow, that’s interesting!

Dr. L: Here’s another one that’s kind of strange… sometimes antipsychotic medication can create a torticollis condition as a side effect.

Logan: Whoah!

Dr. L: Fortunately, though, most of the cases of torticollis — especially the ones that end up in a chiropractor’s office — are mechanical in nature and involve a “locking” of the neck joints… otherwise known as a cervical subluxation.

Most of the time, there is a mechanical locking of the joints in the neck with a shift of the center-most part of the disc.  This in turn causes the tissues of the joint to become painfully inflamed and for the muscles of the neck (mainly the sternocleidomastoid muscle — SCM for short) to clamp down in a state of prolonged spasm.

Now a lot of schools of thought will focus their attention on the muscle spasm itself — after all, it’s the “squeaky wheel” here.  And while this might be the case in certain situations, focusing treatment efforts on the muscle alone fails to address the underlying mechanical disorder that is spurning on the shortened muscle in the first place.  So, in other words, trying to massage and stretch out the spastic muscle is not going to remedy this problem.  On the other hand, a carefully administered adjustment aimed at rectifying the mechanical dysfunction by a chiropractor with torticollis experience will often bring about relief and correction in short order.

Logan: Well, that’s good to know.

Dr. L: It is Logan.  And what I can tell you is that, in my experience, chiropractic can be extremely effective in helping patients with torticollis.

I remember the first time I every encountered a patient with torticollis.  I was still a chiropractic student, and I was working at a chiropractic office.

Logan: Was that Dr. Schmitz?

Dr. L: Exactly.  Dr. Jack Schmitz.  Great chiropractor.  Anyway, a young woman presented to his office with a good case of torticollis.  Now, I knew exactly what this was.  After all, I was the resident expert on torticollis for my chiropractic class.  It was I that chose torticollis out of the hat as my research topic — to write on and then share with my class.  So, I was up on what the books had to say about it.  But when I actually saw it face to face, so to speak…. I lost all confidence.  After I assisted Dr. Schmitz with his evaluation, I pulled him aside into the back office and asked him, with somewhat of a concerned look on my face, “Can we help her?”  Dr. Schmitz, looked back at me with a gleam in his eye and said, “You just wait.  She will be a new woman in a few visits.”

Logan: And was she?

Dr. L: She was!  It really worked.  And it worked well.

Logan: Here’s a question for you Dad.  You mentioned that most cases involve a subluxation in the neck.

Dr. L: Yes.

Logan: Well, what causes the neck subluxation?

Dr. L: Ah, yes.  Excellent question. And you read it just the way I wrote it.

The causes of torticollis for the most part are relatively unknown.  Now, I mentioned some of the nasty, odd ball circumstance already, and those are of course mostly known.  But for the mechanical locking that we see in so many of these cases, there are some factors, or common patterns, that we doctors see in our torticollis patients… that, while we can’t point to them as causes, necessarily, they do tend to be, what we call, precipitating factors.

So here they are:

Number one.  Many patients will have been exposed to some sort of draft, say from a fan or an open window.  And it’s theorized that the torticollis comes about from the neck being chilled unevenly.

Number two.  Quite a few patients have had some sort of occupational activity in which their necks were in a prolonged twisted posture.  For example, the farmer who drives a tractor and is constantly looking over his shoulder as he plows his field.  Or, the person who is doing a lot of data entry into her computer and having to constantly look off to one side at the copy that she is transcribing.

Logan: And number three?

Dr. L: Number three.  In some cases trauma is involved.  Whiplash, sports injuries, heavy lifting, or even fetal delivery can be culprits.

Logan: Oh, like when I was born?

Dr. L: Well, not exactly… but your birth story is certainly one worth talking about… and we will devote a whole show to it.  But sometimes the physical act of fetal delivery alone can force the tiny bones of an infant’s neck out of alignment causing some of the muscles to spasm.  They call this “congenital torticollis.”  Infants with this condition will constantly favor turning their heads to one side.  And if it’s not corrected, the infant can develop facial asymmetry due to malformed cranial bone development — not to mention, infants with this condition will often have difficulty, or refuse, to nurse on the unfavored side.

Logan: How do they treat it?

Dr. L: Well, medical doctors will often refer the infant to physical therapy, which will often include a brace-like contraption to attempt to help the problem.  If that does not work, though, surgery to “lengthen” the shortened muscle is considered.

Logan: Oooh.  What about chiropractic?  Can that help?

Dr. L: Often times it does.  And we’ve seen it a number of times in our office.

To get back to the different factors that tend to be present with patients who suffer from torticollis, many of them seem to have been  “primed and ready” for the event because of a longstanding spinal curve issue… such as a reversed curve in their neck or a scoliosis in their back.

Now, I want to mention that, unfortunately, chiropractic cannot help all torticollis cases out there.   And I’ll admit that there have been some that I have not completely helped.  Some people have cases of torticollis that are chronic, and for the most part, we really don’t know why. — let alone how to effectively treat them.  These more severe cases tend to fall under the name of “Cervical Dystonia”  or “spasmodic torticollis.”  For many of these patients, chiropractic may not have the dramatic results that it does for the “garden variety” torticollis patient.  But that’s not to say that chiropractic cannot offer them potential for improvement.

Logan: Have you ever had a patient like that?

Dr. L: Yes.  He had suffered with Cervical Dystonia for nearly two years.  And while I was unable to fully resolve his problem, I was able to offer him some  improvement.  But it took some work.

I think that point that I want to make here regarding chiropractic and torticollis, is that it can be extremely helpful.  Yes, it is true that some will get better on their own with a healthy dose of time… usually a couple of weeks.  But chiropractic can usually handle it in a much shorter timeframe.  And when you are walking around with your ear stuck to your shoulder, most people opt for the shorter route.

And, if that weren’t enough… when you consider what the more invasive medical options are, chiropractic begins to look like the option of first choice.

Logan: Invasive?

Dr. L:  Yes, that means that the treatment is more aggressive.  Beyond the methods of stretching and massaging out the spastic muscle that I touched on earlier, and that would be conservative (the opposite of invasive) medicine will often shift into high gear and will focus on ways to temporarily or permanently take the spastic muscle out of the picture.  One way they do this is by injecting the muscle with the same bacterial toxin that causes botulism (now popularly known as Botox) to temporarily paralyze the affected muscle.  The only problem with this method — other than the fact that you are essentially having botulism injected into you — is that the spastic muscle often returns once the toxin wears off.  So clearly, this should show that the muscle is not the culprit.   But, never fear, there’s the permanent surgical solution, and that is to selectively sever the nerves that go to the spastic muscle.  In other words… cut the power.  Who needs a spastic muscle anyway?

Logan: Wow!  That seems so drastic.

Dr. L: Well, it often is.  Now, I’m sure there are cases in which it is the necessary option.  But I’d exhort that before anyone even puts the surgical options on the table for consideration, that a consultation with a chiropractor who is experienced with torticollis cases be sought out.

By the way, for those who are interested, I just authored an article on this topic for our local newspaper.  You can find it on SpinalColumnBlog.com.  I’ll put the link in the show notes.

And before we sign off, I wanted to share with you that right after I handed my article off to the editor of the paper, guess what walked into my office?

Logan: What?  A case of torticollis?

Dr. L: Yep.  And he’s not much older than you.  And I bet he’s listening right now… because I told him to.

He came in last week with his mother on Tuesday with his head tilted off to the left and in quite a bit of pain.  I adjusted him and his posture improved a bit.  I instructed him to ice and saw him the next day.

Logan: Then how was he?

Dr. L: Well, the next day his head tilt was just barely noticeable.  But, he was still in a good deal of pain.  I adjusted him again… this time, though, I got a lot more to adjust.

And by Friday, his third visit, he was pain-free, had normal posture, and was back to his old self.


[outro theme music]

Okay, that’s going to put a wrap on episode 007.  And now hopefully you are a little more knowledgeable when it comes to Torticollis.  Have questions or comments?  Send them through our website in the comments section of this podcast.  Also, for those of you listening to us via iTunes — and I know a decent percentage of you are… if you are enjoying our shows, help us out by giving us a rating on iTunes.com.

Spinal Column Radio would like to remind you that true health comes from the inside out — not outside in.  As such, the content of this podcast, along with the show notes and related links, is not intended to cure, diagnose, treat, or prevent any disease.  But, instead, is meant to inform and inspire you in asking better questions regarding your health.  Since the circumstances surrounding your particular situation are unique, you are encouraged to consult with a Doctor of Chiropractic — or other health care practitioner of your choosing.

Next time on Spinal Column Radio we’re going to talk about chiropractic and pregnancy… And to help us do that we’re bringing in a special guest.  You’ll want to tune in to hear her story.  That’s in two weeks. So, until then, for my son Logan, tweaking the knobs on the sound board, this is Dr. Thomas Lamar, your podcast chiropractor.


Spinal Column Radio is a production of Spinal Column Communications in conjunction with AnchorChiropractic.net.  Copyright 2010.

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3 Comments so far
Leave a comment

Just received an email from a worried mother in Malaysia. Unfortunately her story is all too common:

hi…my name is siti from malaysia. my son is diagnosed with mild torticollis since 3mths old when we went to see the paed for jab.i said mild because in my son case he still can turn his head right n left. it just that his head is titled to right and his chin to left. the paed asked us to wait till 5mths to confirm it and if the neck still tilt then we go to physio. and at 5mths we went to physio. the physio session took twice only and the rest we have to do it at home.first few mths its ok but then we had difficulty when my son shows resistance.now he is 12mths and he still has the tilt head.what i dont understand it only comes once in a while when he enters new month age.and it will takes like few days for his head to tilt then back to straight again perfect.seems that on and off….i dont know what to do know.i feel bad as a mom as i dont do nothing and i feel sorry for my son im afraid it gonna be permanent.hope u can advice me.

Here’s my response:

Hello Siti –

Thanks for writing. I’m so sorry to hear about your son. You must be very frustrated and concerned. My best advice to you is to find a chiropractor. I was unsure if you had chiropractors in Malaysia, but a quick Google search shows that you do. As my podcast on Torticollis explains, the treatment that you are getting through the physiotherapy is focusing on the muscle… not the underlying structure. And certainly the “wait and see” approach offered by your doctor did not help.

A chiropractor should be able to help get to the root of the problem…. and it shouldn’t take that long either. Try to find one that is comfortable working with children. I’m able to help infants with torticollis in just a handful of visits. It certainly is worth trying. Let me know how it goes and keep listening to SpinalColumnRadio.

Chiropractic is the only treatment that I am aware of that gets to the root of this problem. Why chiropractic is not offered up as a viable option when a pediatrician diagnoses this condition is beyond me. (And apparently this is a global problem).

I pray that she is able to find a Malaysian Chiropractor.

Comment by drlamar

Can you maybe refer me to a Doctor in South Africa Pretoria who is good in treating babies with torticollis

Comment by lorna

Hi Lorna – thanks for commenting. Unfortunately I do not know and South African Chiropractors personally. I would suggest, asking friends and/or acquaintances who they use…. but you want to especially seek out a chiropractor who is comfortable working with children. Some, unfortunately, limit their practice to adults. Do some searching. I am sure you will find someone in short order.
– Dr. Lamar

Comment by drlamar

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