The Effect of Manual Stretching and Positioning and Developmental Treatment in Congenital Muscular Torticollis: randomized Controlled Trials

선천성 근성 사경 환아에서 수기신장과 자세와 발달을 이용한 치료의 효과에 대한 무작위 연구

  • Lee, In-Hee (Healthcare Information and Technology Center, Keimyung University)
  • 이인희 (계명대학교 보건의료정보기술연구소)
  • Received : 2008.09.22
  • Accepted : 2009.01.13
  • Published : 2009.02.19


The purpose of this study is to compare the outcomes of manual stretching treatment with those of motor development and positioning physical therapy (MDPPT) for congenital muscular torticollis (CMT). This study was designed to be randomized controlled trials and to evaluate the outcomes of 43 consecutive patients with CMT who were first seen when they were average 26 days old. Before treatments, the patients were unintentionallv classified into two clinical groups along with the treatment methods. Among the 43 patients, 22 were classified to the manual stretching group and 21 to the MDPPT group. By means of independent t-test on the result. the duration of treatment according to methods was not significantly different in two groups (p>.05). The duration of treatment in accordance with head tilt level was not significantly different in two groups (p>.05). There was change of mass diameter, between at the beginning day of treatment and after treatment in manual stretching group with a strong positive linear correlation (p=.000, r=.734), but slightly positive linear correlation in MDPPT group. The result of this study indicates that two therapeutic methods make little difference in effectiveness.


Supported by : 산업자원부


  1. Binder H, Eng GD, Gaiser JF, et al. Congenital muscular torticollis: Results of conservative management with long-term follow-up in 85 cases. Arch Phys Med Rehabil. 1987;68(4):222-225.
  2. Canale ST, Griffin DW, Hubbard CN, Congenital muscular torticollis. A long-term follow-up. J Bone Joint Surg Am. 1982;64(6):810-816.
  3. Celayir AC. Congenital muscular torticollis: Early and intensive treatment is critical. A prospective study. Pediatr Int. 2000;42(5):504-507.
  4. Cheng JC, Au AW. Infantile torticollis: A review of 624 cases. J Pediatr Orthop. 1994;14(6):802-808.
  5. Cheng JC, Metreweli C, Chen TM, et al. Correlation of ultrasonographic imaging of congenital muscular torticollis with clinical assessment in infants. Ultrasound Med BioI. 2000(a);26(8):1237-1241.
  6. Cheng JC, Tang SP, Chen TM. Sternocleidomastoid pseudotumor and congenital muscular torticollis in infants: A prospective study of 510 cases. J Pediatr. 1999;134(6):712-716.
  7. Cheng JC, Tang SP, Chen TM, et al. The clinical presentation and outcome of treatment of congenital muscular torticollis in infants - A study of 1,086 cases. J Pediatr Surg. 2000;35(7):1091-1093.
  8. Cheng JC, Wong MW, Tang SP, et a!. Clinical determinants of the outcome manual of stretching in the treatment of congenital muscular torticollis in infants. A prospective study of eight hundred and twenty-one cases. J Bone Joint Sung Am. 2001;83-A(5):679-687.
  9. Collins A, Jankovic J, Botulinum toxin injection for congenital muscular torticollis presenting in children and adults. Neurology. 2006;67(6):1083-1085.
  10. Coventry MB, Harris LE. Congental muscular torticollis in infancy: Some observation regarding treatment. J Bone Joint Surg Am 1959;41-A(5):815-822.
  11. Demirbilek S, Atayurt HF. Congenital muscular torticollis and sternomastoid tumor: Results of nonoperative treatment. J Pediatr Surg. 1999;34(4):549-551.
  12. Dudkiewicz I, Ganel A, Blankstein A. Congenital muscular torticollis infants: Ultrasound-assisted diagnosis and evaluation. J Pediatr Orthop. 2005;25(6):812-814.
  13. Emery C. The determinants of treatment duration for congenital muscular torticollis. Phys Ther. 1994;74(10):921-929.
  14. Ferkel RD, Westin GW, Dawsen EG, et al. Muscular torticollis. A modified surgical approach, J Bone Joint Surg Am. 1983;65(7):894-900.
  15. Golden KA, Beals SP, Littlefield TR, et al. Sternomastoid imbalance versus congenital muscular torticollis: Their relationship to positional plagiocephaly. Cleft Palate Craniofac J. 1999;36(3):256-261.<0256:SIVCMT>2.3.CO;2
  16. Hummer CD, MacEwen GD. The coexistence of torticollis and congenital dysplasia of the hip. J Bone Joint Surg Am. 1972;54(6):1255-1256.
  17. Hsu TC, Wang CL, Wong MK, et al. Correlation of clinical and ultrasonographic features in congenital muscular torticollis. Arch Phys Med Rehabil. 1999;80(6):637-641.
  18. Lee EH, Kang YK, Bose K. Surgical correction of muscular torticollis in the older child. J Pediatr Orthop. 1986;6(5);585-589.
  19. Leung YK, Leung PC. Tne efficacy of manipulative treatment for sternomastoid tumours. J Bone Joint Surg Br. 1997;69(3):473-478.
  20. Lung CM, Low YS. Strnmomastoid tunmor and muscular torticollis. Clin Orthop Relat Res. 1972;86:144-150.
  21. Morrison DL, MacEwen GD. Congenital muscular torticollis: Observations regarding clinical findings. associated conditions, and results of treatment. J Pediatr Orthop. 1982;2(5):500-505.
  22. Netter FH. The CIBA Collection of Medical Illustrations. Vol 8. Musculoskelectal system. Part II. Developmental Disorders. Tomors, Rheumatic diseases and Joint Replacement. Summit. NJ, Ciba-Geigy Co., 1990.
  23. Oleszek JL, Chang N, Apkon SD, et al. Botulinum toxin type A in the treatment of children with congenital muscular torticollis. Am J Phys Med Rehabil. 2005;84(10):813-816
  24. Rahlin M. TAMO therapy as a major component of physical therapy intervention for an infant with congenital muscular torticollis: A case report. Pediatr Phys Ther. 2005;17(3):209-218.
  25. Taylor JL, Norton ES. Developmental muscular torticollis: Outcomes in young children treated by physical therapy. Pediatr Phys Ther. 1997;9(4):173-178.
  26. van Vlimmeren LA, Helders PJ, van Adrichem LN, et al. Torticollis and plagiocephaly in infancy: Therapeutic strategies. Pediatr Rehabil. 2006;9(1):40-46.