Tuina plus Ultrasonic Therapy for Infantile Muscular Torticollis

Jiaxing Hospital of Chinese Medicine, Zhejiang 314001, China

CLINICAL STUDY

Tuina plus Ultrasonic Therapy for Infantile Muscular Torticollis

Shen Zhi-fang, Luo Kai-tao, Zhu Gao-feng, Jin Yue-qin

Jiaxing Hospital of Chinese Medicine, Zhejiang 314001, China

Author:Shen Zhi-fang, bachelor, Chinese medicine physician.

E-mail: shenzf08@163.com

Objective: To observe the clinical efficacy of tuina plus ultrasonic therapy in treating infantile muscular torticollis.

Methods: Seventy kids with muscular torticollis were intervened by tuina plus ultrasonic therapy, and the efficacy was evaluated after 8-month treatment.

Results: After 8-month treatment, 41 subjects were cured, accounting for 58.6%, 27 were improved, occupying 38.6%, 2 failed, occupying 2.8%, and the total effective rate was 97.2%.

Conclusion: Tuina plus ultrasonic therapy can produce a significant efficacy in treating infantile muscular torticollis, without adverse effects.

Tuina; Massage; Ultrasonic Therapy; Torticollis; Infant

As a common disease in kids, infantile muscular torticollis (IMT) is a congenital abnormality of the motor system, with incidence ranging from 0.3% to 0.5%. It’s caused by unilateral contraction or fibrosis of the sternocleidomastoid muscle, characterized by the head is tilted in lateral bending toward the affected muscle and face is rotated toward the healthy side. Delayed treatment will lead to asymmetric faces and eyes, even affecting the development of the kids. During recent years, our department adopted tuina plus ultrasonic therapy in treating IMT. The report is now given as follows.

1 Clinical Materials

1.1 Diagnostic criteria

By referring the diagnostic criteria of IMT from theShanghai Diagnostic and Therapeutic Guidelines of Traditional Chinese Medicine[1]: head tilt at birth or several months after birth; abnormal postures of head and neck, presenting head tilt towards the affected side, rotation of face to the healthy side, and chin points to the shoulder of the healthy side; usually affecting one side, lump or mass may be palpated along the sternocleidomastoid muscle, kids in later stage may present adaptive alterations of head, face, and spine, with restricted development of face of the affected side, flat occiput of the healthy side, and lateral curve of thoracic vertebrae; osseous torticollis caused by abnormal cervical vertebrae was ruled out by frontal X-ray examination of cervical spine.

1.2 Inclusion criteria

In conformity with the diagnostic criteria of IMT; the parents of the kid having signed the informed consent form.

1.3 Exclusion criteria

Neck skin lesions; torticollis caused by tuberculosis, tumor, or inflammation of cervical vertebrae, dysplasia of bones or joints, or vision disorders.

1.4 Elimination criteria

Receiving other treatments during the study process; failed to follow the treatment protocol in this study.

1.5 General data

Totally 70 participants were enrolled from the Tuina Department of our hospital, including 42 males and 28 females, aged from 9 d to 6 months, averaged at 1.2 months. Of the participants, 38 cases were from full-term natural birth, 30 cases by cesarean, and 2 cases by obstetric forceps. Twenty-five cases were affected on the left side, and 45 cases on the right side. Lump or mass was palpated in all participants, 8 cases on the upper segment of the sternocleidomastoid muscle, 51 cases on the middle segment, and 11 cases on the lower segment. Five cases had asymmetric faces.

2 Treatment Methods

2.1 Tuina

The kid took a supine position without a pillow, and the physician sat nearby the kid’s head.

An-pressing, Rou-kneading, and Tanbo-plucking manipulations: The physician Rou-kneaded along the sternocleidomastoid muscle from the origin to the insertion (Qiaogong point) repeatedly with the index, middle and ring fingers, and then gently Tanbo-pluck the sternocleidomastoid muscle, especially the origin and insertion points and/or the lump. The two manipulations were used alternately, totally for 10 min, by 100-120 times per minute (Figure 1).

Figure 1. An-pressing Rou-kneading and Tanbo-plucking manipulations

Na-grasping and Nie-pinching manipulations: The physician Na-grasped the affected sternocleidomastoid muscle with the thumb, index, and middle fingers, focusing on the lump and contraction sites, for about 2 min, by 11-120 times per minute. The force should increase gradually, within the kids’tolerance (Figure 2).

Figure 2. Na-grasping and Nie-pinching manipulations

Passive stretching manipulation: With one hand holding the kid’s shoulder on the affected, the physician held the kid’s head with the other hand and pushed the head to the healthy side, so that the kid was passively extending his neck on the frontal plane; afterwards, with one hand holding the kid’s occiput, the physician held the kid’s chin on the healthy side with the other hand to gently and gradually rotate the kid’s head towards the healthy side, for extending the affected sternocleidomastoid muscle. This manipulation should be gentle, 20-30 times for each session (Figure 3).

Figure 3. Passive stretching manipulation

An-pressing and Rou-kneading manipulations: The physician An-pressed and Rou-kneaded bilateral cervical muscle and trapezius muscle for about 2 min, and finally Na-grasped Jianjing (GB 21) as the ending stroke (Figure 4).

The physician also asked the parents to turn the kid’s head towards the healthy side when feedingmilk and during sleep, and also gently stretched the sternocleidomastoid muscle.

Figure 4. An-pressing and Rou-kneading manipulations

2.2 Ultrasonic therapy

The ultrasonic therapeutic apparatus HS-501 (HANIL-TM, South Korea) was adopted for treatment, frequency at 1 MHz, output intensity 0.5 W/cm2. With couplant applied on the surface, the ultrasonic probe closely clung to the topical site and moved evenly, 20 min for each time.

2.3 Treatment course

The tuina treatment and ultrasonic therapy were both given once every other day, and the therapeutic efficacy was evaluated 8 months later.

3 Observation of Therapeutic Efficacy

3.1 Criteria of therapeutic efficacy

The criteria of therapeutic efficacy were based on the relevant criteria for IMT from theShanghai Diagnostic and Therapeutic Guidelines of Traditional Chinese Medicine[1].

Recovery: The kid could continuously keep his head and neck at a neutral position and easily rotate and turn his head to both sides with normal motion range, and the abnormality was cured.

Improved: The kid was able to keep his head and neck at a neutral position, but slight torticollis was still existed (＜10°), or the torticollis was significantly improved (＞15°), and the kid could easily rotate and turn his head, basically with a normal motion range.

Invalid: The kid was unable to keep his head and neck at a neutral position, or the short-term efficacy was fine but the torticollis was back afterwards.

3.2 Result

After 8-month treatment, 41 cases of the 70 participants were recovered, accounting for 58.6%, 27 cases were improved, accounting for 38.6%, 2 cases failed, occupying 2.8%, and the total effective rate was 97.2%.

4 Discussion

In traditional Chinese medicine (TCM), IMT affects the tendons and belongs to the scope of tendon knot or tendon spasm. It’s mainly caused by congenital deficiency, topical compression, or trauma, leading to unsmooth blood circulation, stagnation of qi and blood, malnutrition of tendons, vessels, and muscles, and consequently the formation of knot in the local area. Western medicine holds that intrauterine malposition, intrauterine or perinatal osteofascial compartment syndrome, sternocleidomastoid muscle abnormal development of fetus, genetic factor, and hematoma may all contribute to the development of IMT[2].

The treatments for IMT include surgery and conservative treatments, conservative treatments mainly for kids ＜1 year old, and surgery for kids≥ 2 years old. As a major treatment for early-stage IMT, tuina therapy works to relax tendons and activate collaterals[3-4]. Modern researches show that manual stimulations can improve topical blood circulation, relieve muscular spasm, detach the adhesion, and the passive stretching can extend the sternocleidomastoid muscle, increase the flexibility of muscles, and further improve the microcirculation. Manipulations can work like histamines, to promote the intracellular proteolysis, healing and the recovery of biomechanical function of the muscles[5-6]. Through mechanical vibration, ultrasound can alternately contract and extend the tissues, promote the movement of intracellular substances, massage the cells, enhance the topical blood circulation and metabolism, and relax the contractural muscle fibers[7]. The two treatments combine together can produce a significant efficacy.

For the treatment of IMT, the earlier the treatment, the higher the therapeutic efficacy[8-9]. Meanwhile, it’s also important to change the daily postures for the treatment. In the current study, 2 out of the 70 participants were complicated with congenital subluxation of hip joint, accounting for 2.85%, and the incidence of this problem reaches 1.1‰-3.8‰[10]. It suggests that kids with IMT are at a higher risk of congenital subluxation of hip joint compared to the normal kids.

It’s found in this study that the therapeutic efficacy is significantly inversely proportional to the disease duration, and the size, rigidity, and location of the mass. Besides, it’s found that the one with mass in the middle site is comparatively easier to treat; while it’s difficult to detect and to treat when the mass is located below the clavicle. Considering the dedicate skin of kids, physician should be agile and stable when practicing tuina manipulations, and also payattention to the range and force when performing pulling stroke.

In a word, this study indicates that tuina plus ultrasonic therapy is effective in treating IMT, without causing adverse effects.

Conflict of Interest

The authors declare that there was no conflict of interest in this article.

Acknowledgments

This work was supported by Jiaxing Hospital of Chinese Medicine.

Statement of Informed Consent

Informed consents were obtained from all the study subjects’ guardians.

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Translator: Hong Jue

R244.1

: A

Date: August 2, 2014