Efficacy of non-surgical, non-pharmacological treatments for congenital muscular torticollis: a systematic review and meta-analysis.

When a baby is born with congenital muscular torticollis, a tightness or asymmetry in the neck muscle that tilts and turns the head, clinicians commonly use manual therapy, stretching, electrophysical agents, Tuina massage and other conservative approaches, but how well these actually work has not been clear. This review pooled randomised controlled trials testing non-surgical, non-drug treatments in children up to age five, drawing on 100 trials and over 8000 participants, mostly from China. Adding manual therapy to an active control treatment was associated with short-term improvements in neck rotation, head posture symmetry, and the size of the muscle lump often seen in this condition, and adding electrophysical agents or an optimised Tuina technique also reduced tumour size more than comparator treatments. These results are interesting because they point toward possible benefit from several widely used approaches, but the authors rate the certainty of evidence as very low to low throughout, reflecting high risk of bias and small, inconsistent studies, so the findings should be read as preliminary rather than settled.

If your child has been diagnosed with congenital muscular torticollis, a condition where a neck muscle is tight or shortened, pulling the head to one side, you may be offered treatments like manual therapy, massage, stretching exercises, or devices using heat or electrical stimulation. This review looked at all the randomised trials testing these kinds of non-surgical, non-drug approaches in young children, combining data from 100 studies and more than 8000 children, mostly conducted in China. The review found that adding manual therapy to standard treatment was linked to short-term improvements in how far the baby could turn and tilt their head, how symmetrical their head posture looked, and the size of the muscle lump some babies develop.

Adding certain other therapies also seemed to reduce the size of that lump. However, the researchers rate the overall quality of this evidence as very low to low, meaning the studies had design weaknesses and were quite inconsistent with one another, so these results should be seen as encouraging rather than conclusive.

Information on side effects was also lacking in most studies.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This review addresses a genuine gap in paediatric practice: despite conservative management being the default approach for congenital muscular torticollis, the actual efficacy of manual therapy, movement therapy, electrophysical agents, Tuina and other non-surgical interventions has lacked rigorous synthesis. Drawing on 100 randomised controlled trials (8125 participants, 80 conducted in China, published 1990 to 2023), the review found that adding manual therapy to an active control was associated with short-term improvements across several outcomes, including passive cervical rotation (OR 9.79), passive lateroflexion (OR 2.66), active rotation (OR 3.94), symmetric head posture (OR 4.55), sternocleidomastoid tumour thickness (MD -2.12mm) and development of symmetrical movement.

Electrophysical agents added to active controls also reduced tumour thickness (MD -2.03mm), and optimised Tuina outperformed traditional Tuina on this same measure (MD -1.20mm). What this contributes is a signal, not a settled answer: every pooled estimate carries very low to low certainty because of high risk of bias, small trials and substantial heterogeneity, which limited how much data could even be pooled. Adverse event reporting was absent in 71% of studies, so no safety conclusions can be drawn.

The review does not establish which specific technique is superior, nor does it rule out that some benefit reflects additional therapist contact rather than the intervention itself, and it underscores the need for larger, better-designed trials before these findings can inform firm clinical guidelines.