Success of nonoperative treatment for congenital muscular torticollis is dependent on early therapy

Congenital muscular torticollis (CMT) begins in infancy, and exercise treatment is often recommended. There is controversy about the type, length, and effectiveness of conservative treatment. We have used a standard technique of passive stretching exercises (PSE) in 126 children with CMT seen over 30 years. We reviewed the results and compared the rate of surgical treatment with the age at which PSE began. In 88 infants who began PSE prior to 3 months of age, outcome was excellent or good in 92%, with none needing surgery. In comparison, 45% of older children required sternomastoid myotomy (P <.005). The likelihood of surgery was directly related to the age at initiation of PSE. We conclude that PSE are effective for early CMT, and should be continued until a full passive range of neck motion is achieved and maintained. Success is dependent on frequent follow-up and parental encouragement.