Congenital muscular torticollis (CMT) is a condition characterized by the shortening of the sternocleidomastoid muscle, leading to restricted cervical motion, postural asymmetry, and potential motor development delays. The 2024 Clinical Practice Guideline for CMT highlights the importance of early intervention, including passive stretching, active motor stimulation, postural training, and caregiver education. However, there is a need for structured studies assessing the impact of a combined home and supervised intervention program on active and passive cervical range of motion (ROM).

To evaluate the feasibility and preliminary effectiveness of a structured physical therapy intervention aimed at improving active and passive cervical lateral flexion ROM in infants with CMT, following the recommendations from the 2024 CMT Clinical Practice Guideline.

A single-group prospective experimental pilot study with repeated measures. Participants: Eight infants aged 3 to 4 months diagnosed with CMT, presenting with restricted passive and/or active cervical lateral flexion. Parental consent was obtained for participation in a home-based program combined with weekly supervised physical therapy sessions. The intervention consisted of five components: (1) Passive stretching: Low-intensity, sustained stretches of the sternocleidomastoid (SCM) muscle. (2) Active range of motion training: Stimuli for head-righting responses during exercises in various postures. (3) Symmetry-based activities: Encouragement of midline head alignment and equal use of both sides of the body during play. (4) Environmental modifications: Positioning strategies for sleep, feeding, and other activities in the home setting. (5) Caregiver education and adherence monitoring: Weekly supervised sessions (60 minutes) to assess progress, reinforce techniques, and implement an individualized home program for each child based on the criteria of the 2024 Clinical Practice Guideline. Outcome Measures: Passive cervical ROM (lateral flexion) was measured using an arthrodial protractor, while active cervical ROM was assessed through visual/photographic tracking and the Muscle Function Scale (MFS).

The intervention period ranged from 3 to 4 months, with a follow-up evaluation conducted 3 months after its completion. All four children who initially presented with more than 5° of asymmetry in passive ROM showed improvement in the final assessment, reducing asymmetry to less than 5°. Similarly, among the five children with more than 5° of asymmetry in active ROM, three (60%) demonstrated improvement, achieving a final asymmetry of less than 5°.

A structured physical therapy intervention effectively improved active and passive cervical lateral flexion ROM in infants with CMT. All infants with passive ROM asymmetry showed improvement. Regarding active ROM, 60% (3) of the infants exhibited improvement in the MFS. However, active ROM assessments are more influenced by the infant's cooperation, and evaluating the MFS on different days may provide a more accurate assessment.

This study demonstrates the feasibility and preliminary effectiveness of a structured physical therapy intervention for improving active and passive cervical lateral flexion ROM in infants with CMT in clinical practice.