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  • Cori E.

Twisted Necks and Flat Spots

Can Craniosacral Therapy treat Torticollis and Plagiocephaly?

Yes! Parents bring their children in for craniosacral therapy to treat a wide variety of concerns and conditions, but flat-head syndrome and torticollis are some of the most common reasons. Craniosacral therapy (CST) is a gentle yet effective way to treat these conditions.

What is flat-head syndrome and torticollis?

Flat Head Syndrome, medically knowns as Positional Plagiocephaly [play-jee-oh-SEF-uh-lee], is when a flat spot develops on the back the head. This happens in infants when pressure on their soft skull causes the skull bones to shift or change shape. It may occur in the womb if their head was hanging out in one spot constantly, or it can be a result of laying constantly with the back of their head on firm surfaces – mattresses, car seats, carriers, strollers, bouncers, etc. Flat spots are also frequently seen in babies with torticollis.

Torticollis [tawr-ti-kol-is] is a twist in the neck, caused by a shortened muscle. One sign of torticollis parents notice initially is that their baby constantly tilts its head to one side, with their chin pointing to the opposite shoulder. Another sign is that babies prefer to breastfeed on one side over the other. As baby grows, it becomes more obvious that the movement of their head is limited. They may have a difficult time controlling their head to move it side to side or up and down. A flat spot can develop on the side of the head the baby prefers to look, just behind their ear, and the shape of their head and face may change. They may also develop a soft lump or bulge in their neck muscle.

How does it happen?

Torticollis happens when one of the neck muscles is restricted and shortened and it pulls the head into a tilt or rotation, or both. The muscle is the sternocleidomastoid, often referred to as SCM, and it connects from the collarbone (clavicle) and sternum (manubrium) to the skull just below the ear (mastoid process of temporal bone). When present at birth it is called Congenital Muscular Torticollis. The most common reason this develops is that the SCM becomes tight or shortened from the way baby was positioned in the uterus, such as being cramped in the womb or sharing a space with a twin. It can also be the result of strain on the muscles of baby’s neck during birth, or more rarely is caused by abnormal bone fusions in the neck. Acquired torticollis is less common and can be caused by trauma to head or neck, abnormalities in the cervical spine, reactions to certain medicines, or other rare conditions.


Craniosacral therapy (CST) helps babies unwind abnormal tensions in their muscles and connective tissues that are holding their neck and head in a twisted position, and to release restrictions that prevent the bones of the cranium from moving freely. CST additionally addresses any other restrictions and related asymmetry that can occurs elsewhere in the body. CST also helps booster the functions of all of the important functions of our bodies that babies are learning about: sensory, neuromotor, eating, digesting, and sleeping. Typically, the earlier craniosacral therapy is introduced, the more rapid the outcomes. Other beneficial treatments are chiropractic adjustments and physical therapy.

At home, you can take some actions right away that will can make a difference in a short amount of time. First is awareness. Become more aware of your baby’s head position. Second is repositioning. Gently reposition their head to avoid putting pressure on the flat spot. If they fall asleep with their head in their favored position, gently move it while they slumber. Make sure to alternate sides when feeding, or while holding them in your arms or on your shoulder. At diaper changes and during playtime, position yourself opposite to their favored side. This will encourage them engage the less developed muscles and stretch the tight muscle. They love to look at your face and will always try to turn to face you. And third is lots and lots of tummy time! Aim for at least three sessions of tummy time in a day. Increase the frequency and duration as much as your baby will tolerate. Tummy time engages and strengthen the muscles around the neck, arms, and shoulders that are necessary to control their heads as well as to develop the strength needed to roll and crawl. There are some other ways to you can help your baby stretch and strengthen their neck that I’ll be happy to discuss when you bring your baby in for treatment.

What about helmets?

One concern regularly brought up by parents is how to avoid a helmet for their baby. Most cases of plagiocephaly and torticollis are mild and do not require a helmet. Doctors usually recommend helmets for more severe cases, but sometimes parents are given the option for a helmet in moderate or mild cases. Helmets are custom fit, with a hard shell and a lightweight but firm foam inside that forms to the baby’s skull to mold it into proper shape. The helmet is worn all-day and night. Many babies adapt to wearing it quickly, hardly noticing it’s there, but some parents report numerous side effects, such as skin irritation, unpleasant smell, sweating, and less commonly, pain. However, the question of a helmet may be entirely avoided if action is taken as soon as the signs of torticollis or a flat spot is noticed. The soft bones of the infant’s cranium become less malleable as they age, so treatment is essential as early as issues are detected to avoid possible complications of untreated torticollis and plagiocephaly, such as delays or issues with big motor skills such as rolling, sitting, crawling and walking.

If your baby has a helmet, or once wore a helmet, CST is highly beneficial. A helmet can change the shape of the head outwardly but it doesn’t necessarily correct the underlying internal issues of the problem. CST addresses those deep internal issues and releases any new internal issues that may arise as a side effect from the helmet itself.  

How Many Treatments? The amount of sessions will vary by body and by how complex and chronic the patterns are. Some babies have mild cases of torticollis or phagiocephaly but respond slowly to treatment, while others have more severe cases but respond quickly, and everything in between. Response to CST varies because everybody’s body is unique, with unique healing responses. Once the symptoms of the condition are alleviated it is recommended that “maintenance” CST sessions are scheduled as babies reach developmental milestones and growth spurts. Even though symptoms no longer remain, there may be some underlying restrictions that remain. Babies will grow into these restrictions - not out of them. CST make sure that former restrictions are still freed so that their bodies won't be hindered by them as they grow.

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