Difficulties in an Infant Following Subluxation Based Chiropractic Care

Objective: To present a case study of conservative chiropractic care of an 8-month-old infant presenting with torticollis and plagiocephaly. Clinical Features: The patient was an 8-month-old male twin who presented to the office after being diagnosed by his pediatrician with torticollis and plagiocephaly. He received one month of physical therapy prior to his initial presentation, with no resolution. His mother brought him in for an alternative method of treatment after a family member recommended chiropractic. Intervention/Outcome: The patient received adjustments utilizing the Activator method, a high-velocity, low-amplitude specific adjustment in addition to cranial work. The treatment resulted in complete resolution of the patient’s torticollis and plagiocephaly following two chiropractic adjustments. Conclusion: This study describes complete resolution of torticollis and plagiocephaly in an 8-month-old male following subluxation based chiropractic care. More evidence is needed to prove the effectiveness of the management of torticollis and plagiocephaly in a pediatric patient. Key terms: Chiropractic, plagiocephaly, torticollis, pediatric, adjustment, birth injury, birth trauma, Spinal Manipulation Technique, subluxation, head protective device, facial asymmetry, deformational, helmet, congenital muscular torticollis, deformational plagiocephaly, positional plagiocephaly, flat head syndrome J. Pediatric, Maternal & Family Health April 24, 2014 14 Plagiocephaly causes. The prenatal causes include uterine compression and intra-uterine constraint, and the postnatal causes include the sleeping position and congenital muscular torticollis. 3 Plagiocephaly in the U.S. has dramatically increased since the implementation of the “Back to Sleep” campaign, one of the regimens suggested by the American Academy of Pediatrics for preventing the sudden infant death syndrome. 3-4 It is reported that 1 in 300 newborns need appropriate treatment for nonsynostotic plagiocephaly. 3 Known treatment options for plagiocephaly include head repositioning, helmet therapy, and surgery. 3 Past studies have reported that helmet therapy achieved about 3 times faster and better correction than head positioning alone. 3-5 However, it could be possible that helmet wearing would result in developing severe complications, such as focal pressure injury. 3 Collett et al suggested that children with deformational plagiocephaly might have developmental delays persisting into school-age. Torticollis in Latin means, “twisted neck”. It was first defined by Tubby in 1912. 6 Forty-six thousand infants are born each year in the United States with congenital torticollis. It is the third most frequent congenital malformation following hip dysplasia and talipes equinovarus (clubfoot). 7 Torticollis presents as lateral flexion and rotation of the head with the head tilted to the involved side and the chin tilted toward the opposite side of involvement. 7 Torticollis is due to contracture/shorting of the neck musculature, especially the sternocleido-mastoid (SCM) and trapezius muscles. Other involved muscles may be the splenius capitis, scalenii, levator scapulae, semispinalis, and paraspinal erector muscles. 6-7 Congenital torticollis is associated with hip dysplasia; the reported incidence varies from 0.4% to 1.9%. Up to 20% of children with congenital muscular torticollis have CDH. 8 Talipes equinovarus (club foot); Erb’s Palsy, lower extremity rotary positional anomalies, scoliosis, decreased cervical rotation, and upper cervical subluxation complexes are all associated complications. Congenital torticollis also occurs commonly with facial asymmetry, congenital anomalies of the cervical spine, and plagiocephaly following difficult labors and deliveries. 7 Torticollis is classified into two main groups congenital and acquired. These groups are further subdivided: 9 1) Congenital Torticollis: a) Congenital Postural Torticollisappears at or soon after birth, and does not affect the sternocleido-mastoid muscle. Although there is no contraction of the sternocleido-mastoid, some flattening of the opposite side of the head and deformity on the involved side is often present. Congenital postural torticollis is present in 2/3 cases and treatment is never required. b) Congenital Muscular Torticollisby far the most famous, commonly seen with a hard lump 10 days post birth. CMT is most commonly a birth injury of the sternocleido-mastoid forming a hard fibrous contraction. This is followed by the development of facial asymmetry and ocular disturbance due to horizontal changes in vision. 9 2) Acquired Torticollis a) Skeletal Disordertrauma to the cervical spine, deformation of bone, or inflammatory lesions of the cervical spine. b) Neurological and Psychological Disordersspasmodic torticollis, seen in middle aged and elderly people. It is a neurological disorder where the tonic and clonic muscles on the neck contract. c) Ocular torticollisis an over active inferior oblique. Ocular torticollis causes an elevation and lateral rotation of the eye. d) Atlantoaxialrotatory subluxation is a rare condition, which was described for the first time by Sir Charles Bell in 1830. Chronic atlantoaxial rotatory fixation is defined typically as rotatory fixation of the axis on the atlas with duration in excess of 2 to 3 months. 10