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Physical Therapy Management of Congenital Muscular Torticollis: An Evidence-Based Clinical Practice GuidelineFROM THE SECTION ON PEDIATRICS OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION

Kaplan, Sandra L. PT, DPT, PhD; Coulter, Colleen PT, DPT, PhD, PCS; Fetters, Linda PT, PhD, FAPTA

doi: 10.1097/PEP.0b013e3182a778d2
Special Communication

Background: Congenital muscular torticollis (CMT) is an idiopathic postural deformity evident shortly after birth, typically characterized by lateral flexion of the head to one side and cervical rotation to the opposite side due to unilateral shortening of the sternocleidomastoid muscle. CMT may be accompanied by other neurological or musculoskeletal conditions.

Key Points: Infants with CMT are frequently referred to physical therapists (PTs) to treat their asymmetries. This evidence-based clinical practice guideline (CPG) provides guidance on which infants should be monitored, treated, and/or referred, and when and what PTs should treat. Based upon critical appraisal of literature and expert opinion, 16 action statements for screening, examination, intervention, and follow-up are linked with explicit levels of evidence. The CPG addresses referral, screening, examination and evaluation, prognosis, first-choice and supplemental interventions, consultation, discharge, follow-up, suggestions for implementation and compliance audits, flow sheets for referral paths and classification of CMT severity, and research recommendations.

The authors provide Clinical Practice Guidelines for providing physical therapy to infants with congenital muscular torticollis.

Department of Rehabilitation and Movement Sciences (Dr Kaplan), Doctoral Programs in Physical Therapy, Rutgers, The State University of New Jersey, Newark, New Jersey; Children's Healthcare of Atlanta (Dr Coulter), Orthotics and Prosthetics Department, Atlanta, Georgia; Division of Biokinesiology and Physical Therapy at the Herman Ostrow School of Dentistry, Department of Pediatrics (Dr Fetters), Keck School of Medicine, University of Southern California, Los Angeles, California.

Correspondence: Sandra L. Kaplan, PT, DPT, PhD, Doctoral Programs in Physical Therapy, Rehabilitation and Movement Sciences, Rutgers, The State University of New Jersey, 65 Bergen Street, Room 718C, Newark, NJ 07107 (

Grant Support: The Section on Pediatrics, American Physical Therapy Association, provided funds to support the development and preparation of this document.

The authors declare no conflicts of interest.

The American Physical Therapy Association Section on Pediatrics welcomes comments on this guideline. Comments may be sent to the corresponding author or to This guideline may be reproduced for educational and implementation purposes.

Reviewers: Andrea Perry Block (Parent and public representative); Carol Burch, PT, DPT, MEd; Fernando Burstein, MD; Elaine K. Diegmann, CNM, ND, FACNM; Joe Godges, PT, DPT; Didem Inanoglu, MD; Lynn Jeffries, PT, DPT, PhD, PCS; Anna Ohman, PT, PhD; Scott Parrott, PhD; Melanie Percy, RN, PhD, CPNP, FAAN; Alex Van Speybroeck, MD.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins and the Section on Pediatrics of the American Physical Therapy Association.