Physical therapy (PT) can be an essential component of managing plagiocephaly, also known as deformational plagiocephaly or positional plagiocephaly, particularly when the condition is associated with torticollis, a condition where the neck muscles are tight and cause the head to tilt to one side. Torticollis often contributes to the development of positional plagiocephaly because the baby prefers to turn their head to one side, putting pressure on a particular area of the skull and causing flattening.
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Role of Physical Therapy in Treating Plagiocephaly
Physical therapy can help to address underlying issues, improve the range of motion of the neck, and promote better head positioning to alleviate pressure on the skull. Here’s how physical therapy can help in the management of plagiocephaly:
1. Addressing Torticollis
- Torticollis is a condition that frequently coexists with positional plagiocephaly. In babies with torticollis, the sternocleidomastoid (SCM) muscle in the neck is shortened or tight, causing the head to tilt to one side and making it difficult for the baby to turn their head to the other side.
- Physical therapy is focused on stretching and strengthening the neck muscles to improve neck mobility and ensure the baby can freely move their head in both directions. This allows the baby to naturally alternate head positions, reducing the pressure on the flattened area of the skull.
2. Promoting Symmetrical Head Positioning
- Physical therapists teach parents how to safely reposition the baby during waking hours to avoid excessive pressure on one side of the head.
- By encouraging tummy time (supervised time spent on the stomach) and using techniques to promote side-lying and reaching exercises, PT helps the baby strengthen their neck muscles and avoid remaining in one position for extended periods.
- A therapist may also teach techniques like encouraging the baby to look toward toys, lights, or sounds on both sides of their body to promote even movement of the head and neck.
3. Improving Range of Motion and Neck Strength
- The therapist will assess the baby’s range of motion and may teach stretching exercises that focus on the sternocleidomastoid (SCM) and other neck muscles.
- Neck strengthening exercises are used to help the baby develop better control over their head and improve their ability to turn it to both sides. Strengthening the neck muscles will also help with postural control, ensuring that the baby is not relying too heavily on one position, which can worsen the flattening of the skull.
4. Repositioning Techniques
- Parents are taught how to gently reposition the baby during sleep and awake periods to reduce pressure on the flat side of the head. This can include gently rotating the baby’s head to the opposite side or using positioning devices that help maintain the head in a more neutral position.
- The therapist may also provide positioning recommendations during feeding or playtime, such as encouraging the baby to lie in different positions or hold their head in different orientations.
5. Tummy Time and Developmental Milestones
- Tummy time is crucial for healthy head and neck development. It encourages babies to lift their heads and strengthen muscles that are important for motor milestones like rolling, sitting, and crawling.
- Physical therapists often guide parents on how to incorporate tummy time into the baby’s routine, even for short periods, gradually increasing the time as the baby grows stronger.
- Tummy time also helps to relieve pressure from the back of the head, reducing the risk of plagiocephaly and promoting more even skull growth.
6. Parental Education and Home Exercise Program
- One of the primary roles of physical therapy in treating plagiocephaly is educating parents on how to manage the condition at home. Parents will typically be given a home exercise program that includes stretching and positioning exercises.
- A physical therapist will guide parents on how to safely perform these exercises and integrate them into the baby’s daily routine. Regular follow-up appointments help ensure that progress is being made and that the home exercise program is being implemented correctly.
7. Monitoring Progress
- Throughout physical therapy, therapists will track the baby’s improvement in head movement, neck flexibility, and posture. Regular visits allow the therapist to adjust treatment strategies and exercises as needed.
- In some cases, if plagiocephaly does not improve with physical therapy alone, the therapist may recommend referral to a specialist for additional treatments, such as helmet therapy or consultation with a craniofacial surgeon.
Key Exercises Often Used in Physical Therapy for Plagiocephaly:
- Neck Stretching: Gently stretching the affected side of the neck to improve the range of motion and reduce tightness in the SCM muscle.
- Head Turning Exercises: Encouraging the baby to turn their head to both sides, using toys or visual stimuli to guide the baby’s gaze.
- Tummy Time Activities: Helping the baby to hold their head up while lying on their stomach, which strengthens the neck and upper body.
- Side-Lying: Supporting the baby in side-lying positions to encourage head rotation and reduce pressure on the flattened area of the skull.
- Reaching and Visual Tracking: Using toys or other objects to encourage the baby to turn their head in different directions, which also stimulates visual tracking and motor development.
When to Start Physical Therapy for Plagiocephaly:
- Early intervention is key to improving outcomes. Physical therapy can often begin as soon as torticollis or plagiocephaly is diagnosed, usually during the first few months of life. This is because the baby’s skull and neck muscles are still malleable, and early therapy can often prevent more severe deformities from developing.
- Parents should consult a pediatrician if they notice signs of neck stiffness, a preference for turning the head to one side, or if they see a flat spot on the baby’s head. The pediatrician may refer the child to a physical therapist if necessary.
Conclusion:
Physical therapy plays a critical role in the treatment of positional plagiocephaly, especially when it is associated with torticollis. By focusing on neck muscle stretching and strengthening, promoting symmetrical head positioning, and encouraging early developmental milestones, physical therapy can help reduce or prevent further flattening of the skull. If you suspect your baby may have plagiocephaly or torticollis, it is important to consult with your pediatrician and consider referral to a physical therapist to begin early intervention and improve the baby’s outcomes.
