Torticollis is a condition we hear of a lot in chiropractic circles. It’s characterised by muscle spasms (or cramps) that cause your neck to pull to one side. In fact, that’s how it earned its colloquial name – “twisted neck.” While chiropractors are likely to attest that they hear of it regularly in clinical practice, there’s a twist: we usually hear about it in babies due to the onerous task of being born. In fact, up to 16% of newborn babies have torticollis.
That’s not to say it doesn’t occur in adults! On the contrary, it can occur in adult patients due to an injury or trauma that causes the muscle to spasm, and it is estimated that 90% of us will have at least one episode of this condition over the course of our lives. However, the pain and disability in these cases usually ease within one to two days. When they don’t, healthcare providers may look deeper to see if there are neurological symptoms that underpin this condition. One such condition is dystonia – a movement disorder that causes muscle spasms.
There has been a significant amount of case report data on chiropractic care for infants with torticollis. However, data on adults with chronic torticollis is a much rarer thing. That’s what made a recent case report from the Journal of Contemporary Chiropractic such a fascinating read: the patient was a 23-year-old female, and she had suffered from right-sided torticollis from birth.
The latest case
In this case, the patient presented for chiropractic care after having been seen by numerous previous providers whose interventions were limited to stretching the affected muscles. Sadly, none of these interventions had helped, and the condition was affecting her activities of daily living as her reduced range of motion and muscle soreness contributed to difficulties doing everything from putting on particular items of clothing to carrying shopping or doing chores. The patient and her mother remarked that they had gone to huge lengths to solve this issue and had seen more than thirty providers over her 23 years of life. None of them had mentioned the words “ribs” or “chest” to them.
When the chiropractor did their examination, it was discovered that she was born via c-section after a difficult, 12-hour labour. Since then, she had two motor vehicle accidents, and sporting injuries that included low back and knee complaints. But in order to diagnose her properly, the chiropractor performed a Rib Cage Compression Test as well as a full chiropractic examination.
It was discovered that she had subluxations of the first through to fourth costosternal joints on her right sight, and there was a neuromuscular response to these unresolved subluxations which caused various muscle groups to spasm. Understandably, there were severe range of motion restrictions, as well as pain, disability and inability to easily carry out the activities of daily life. (The full details can be found at the reference below. [5] Given her young age, this was significant.
Her chiropractic care included cervical adjusting to correct subluxations in her cervical spine (neck area) and thoracic spine (upper back area). Rib adjustments were also deployed to target the injured area. This was done using an activator.
The chiropractor was careful to observe the rib cage injury as the patient walked, and it was observed that her alignment changed as she walked. Given she had suffered from this condition since birth, this was to be expected, and so a brace was used in the beginning to help the adjustment hold. This was found to help her maintain her rib alignment, and so she began wearing it as a preventative measure when she was doing strenuous activities.
Outcomes
While case report data is obviously written in research language, it does capture part of the impact chiropractic care can have on a person. In this case, it was the resolution of a decades long issue and the chiropractor was the first one to look at the ribs and chest as the root cause of the problem.
For this young woman, relief was felt after the first adjustment. Headache and restricted range of motion had been regular complaints which quickly resolved concomitant with chiropractic care. While she does use the rib belt when stressing the chest area, she has had no return of the head tilt or restricted range of motion common as part of the condition.
It’s worth noting that ribs play such an important part in the way we breathe and move. How they link to the scalene muscles and costosternal muscles is very important and, in this case, potentially life-changing. Once again, this case shows the power of the adjustment – whether cervical or thoracic spine, or subluxated ribs.
The original case report provides full details of the rib cage compression test and the shoulder squeeze test used in the diagnosis.
REFERENCES:
- Health Direct (2022). Torticollis. Health Direct. https://www.healthdirect.gov.au/torticollis
- Royal Childrens Hospital, (2007). Congenital Muscular Torticollis Fact Sheet. Royal Childrens Hospital. https://www.rch.org.au/uploadedFiles/Main/Content/ortho/factsheets/TORTICOLLIS.pdf
- Minghelli, B., & Vitorino, N. G. D. (2022). Incidence of Congenital Muscular Torticollis in Babies from Southern Portugal: Types, Age of Diagnosis and Risk Factors.International journal of environmental research and public health, 19(15), 9133. https://doi.org/10.3390/ijerph19159133
- Cunha B, Tadi P, Bragg BN. Torticollis. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.Available from: https://www.ncbi.nlm.nih.gov/books/NBK539857/
- Ruch W. RESOLUTION OF CHRONIC TORTICOLLIS. JCC. 2024;7(1):66-70.https://journal.parker.edu/article/117148-resolution-of-chronic-torticollis
