For many families, seeing their baby make progress in Physical Therapy for torticollis is exciting
and encouraging. As head positioning improves, neck movement increases, and babies begin
reaching developmental milestones, parents often wonder if therapy is still necessary.
While early improvements are certainly worth celebrating, discharging Physical Therapy too
soon can sometimes lead to regression, delayed motor development, persistent asymmetries,
and ongoing movement challenges that become more noticeable as babies grow.
At Crawl Walk Jump Run Therapy Clinic (CWJR), our Physical Therapists understand that
torticollis treatment is about much more than improving neck range of motion. Successful
treatment involves ensuring that babies develop symmetrical movement patterns,
age-appropriate motor skills, and a strong foundation for future development.
What Is Torticollis?
Torticollis, often called “twisted neck”, occurs when a baby’s neck muscles become tight or
imbalanced, causing the head to tilt to one side and rotate toward the opposite side.
Babies with torticollis may:
● Consistently look in one direction
● Have difficulty turning their head both ways
● Prefer feeding on one side
● Show flattening on one side of the head (plagiocephaly)
● Demonstrate asymmetrical movement patterns
● Have difficulty with tummy time
● Experience delayed motor milestones
Without proper intervention, torticollis can affect overall development and movement quality.
Early Improvements Can Be Misleading
One of the biggest reasons families consider ending therapy early is because their baby
appears significantly better.
Parents may notice:
● Improved head positioning
● Better neck movement
● Increased tolerance for tummy time
● More symmetrical play
While these improvements are important, they do not always mean the underlying issues have
been fully resolved.
As babies grow and new motor skills emerge, previously hidden weaknesses or movement
asymmetries may become more apparent.
Torticollis Is More Than a Neck Problem
Many people think Physical Therapy ends once a baby can turn their head equally in both
directions.
However, torticollis often affects multiple areas of development, including:
Postural Control
Babies may develop compensatory movement patterns that continue even after neck range of
motion improves.
Strength
One side of the body may become stronger than the other due to prolonged asymmetrical
positioning.
Balance
Asymmetries can impact the development of balance reactions and body awareness.
Motor Development
Rolling, sitting, crawling, and walking all require symmetrical movement patterns.
If therapy ends before these skills are fully established, developmental challenges may persist.
Regression Can Occur During New
Developmental Stages
A baby’s body is constantly changing during the first year of life.
As babies learn to:
● Roll
● Sit
● Crawl
● Pull to stand
● Cruise
● Walk
New physical demands are placed on the body.
A baby who appeared symmetrical at 4 months may begin showing asymmetries again when
learning to crawl or walk if the underlying issues were not fully addressed.
Physical Therapists monitor these transitions to ensure healthy movement patterns continue
developing.
Common Signs of Regression
Families may notice:
Return of Head Preference
The baby begins looking primarily in one direction again.
Persistent Head Tilt
A subtle head tilt becomes more noticeable as the child grows.
Uneven Crawling Patterns
The baby favors one side while crawling or scooting.
Delayed Motor Milestones
The child struggles to achieve age-appropriate developmental skills.
Asymmetrical Movement
One arm or leg is used more frequently than the other.
Difficulty with Balance
Challenges may emerge as standing and walking skills develop.
These signs can indicate that therapy ended before the child’s movement patterns were fully
integrated.
The Connection Between Torticollis and
Plagiocephaly
Many babies with torticollis also develop plagiocephaly, or flattening of one side of the head.
When torticollis is not fully resolved:
● Head positioning preferences may continue
● Pressure on one side of the skull may persist
● Helmet treatment outcomes may be affected
● Head shape improvements may plateau
At CWJR, our therapists often collaborate closely with orthotists and families to support both
torticollis and plagiocephaly treatment goals.
Why Ongoing Monitoring Matters
One of the most valuable aspects of continuing therapy is ongoing assessment.
Physical Therapists evaluate:
● Neck range of motion
● Muscle strength
● Head positioning
● Postural symmetry
● Gross motor development
● Movement quality
● Achievement of developmental milestones
This comprehensive approach ensures that progress is maintained as the child grows and
develops.
The Importance of Symmetrical
Development
Babies learn through movement.
When movement patterns are symmetrical, children develop a strong foundation for:
● Rolling
● Sitting
● Crawling
● Walking
● Running
● Climbing
● Balance
● Coordination
If asymmetries remain, children may develop compensations that can affect future motor
development.
The goal of therapy is not simply to eliminate a head tilt—it is to support healthy, efficient
movement throughout the body.
Parent Education Is Critical
Physical Therapy extends far beyond weekly treatment sessions.
Families play a vital role in maintaining progress through:
● Positioning strategies
● Stretching programs
● Strengthening activities
● Tummy time recommendations
● Developmental play activities
As babies grow, home programs often need to be updated to address new developmental
challenges.
Ongoing therapy provides families with the guidance needed to support continued progress.
When Is a Baby Truly Ready for
Discharge?
A baby may be ready for discharge when they demonstrate:
✅ Full and symmetrical neck range of motion
✅ Symmetrical head positioning
✅ Age-appropriate motor skills
✅ Equal use of both sides of the body
✅ No significant movement compensations
✅ Strong postural control
✅ Consistent developmental progress
Physical Therapists consider all of these factors—not just neck flexibility—when determining
readiness for discharge.
The Cost of Early Discharge
While ending therapy early may seem convenient, it can sometimes result in:
● Regression of skills
● Delayed developmental milestones
● Continued asymmetries
● Additional therapy needs later
● Increased frustration for families
Addressing challenges early and thoroughly is often easier than correcting longstanding
movement patterns later in development.
How CWJR Can Help
At Crawl Walk Jump Run Therapy Clinic, our pediatric Physical Therapists specialize in
evaluating and treating infants with torticollis and plagiocephaly.
We focus on:
● Neck range of motion
● Strength development
● Postural control
● Motor milestone achievement
● Symmetrical movement patterns
● Parent education
● Collaboration with orthotists when appropriate
Our goal is not simply to help babies feel better today—we strive to build a strong foundation
that supports healthy development for years to come.
Progress Is More Than a Milestone
Seeing improvements in your baby’s torticollis is exciting, but lasting success requires more
than temporary gains. True recovery involves developing symmetrical movement patterns,
achieving developmental milestones, and ensuring those skills remain consistent as your child
grows.
By continuing Physical Therapy until all developmental goals are achieved, families can help
reduce the risk of regression and support long-term success.
At Crawl Walk Jump Run Therapy Clinic, we’re committed to helping babies build strong
foundations for movement, development, and lifelong success—one milestone at a time.
💙💚👶�
