We've been treating torticollis wrong this whole time!

Torticollis is one of the most commonly referred diagnoses for physical therapy. The definition of torticollis is the tightness of the sternocleidomastoid muscle. But what if we’ve been treating this so called torticollis wrong for centuries?

You see, many babies are born with tension these days due to in utero constraint. In utero constraint means that babies a baby picks a spot and hangs there for a while, creating a tension pattern down that whole side of the body. These babies typically curl up like a “c” or a “shrimp” which mimic this pattern. So right here we are looking at the presence of a whole body tension pattern rather than a singular muscle strain.

Now let’s add anatomy into play. The diagnosis of tongue ties or tethered oral tissues has gotten much better over the past few decades. The incidence is also on the rise due to epigenetics. The deep fascial chain consists of tongue, neck, diaphragm, hips, pelvic floor, inner thighs, calves, feet. When the tongue fascia is short, it pulls on the entire chain, neck included. In fact, the neck and the floor of the mouth share muscles and fascia. Because of this reciprocal pattern, you cannot treat one without the other. When a tongue tie is present it will literally pull on the head which will typically then give into the position of ease in utero.

I personally love the diagnosis of torticollis. Do you know why? Because it gets babies in my door. From there I can determine which muscles of the body are actually affected and what to work on.

If your baby was diagnosed with torticollis and you continue to suspect oral issues that were not addressed like open mouth breathing, poor sleep, picky eating, meltdowns, etc feel free to reach out ! As always, my website littlemoverspt.com is where you can book a chat with me or take one of my many ecourses.

Elizabeth Morel, PT

@littlemoverspt

Why are pediatricians gaslighting new parents so frequently these days?

Whether it’s in my physical therapy office or a DM through instagram I have at least one family a week that gives me the same story. “Beth, my baby is so gassy, they hate being put down on their back, they arch their back and go stiff while being fed, and I have to walk the halls for hours in the night. My pediatrician told me the baby will grow out of it and it’s probably just colic.” How can it be that in 2024 we are giving parents the same BS answer of “It’s just colic”?

First of all, colic is a way to describe a group of symptoms whether that be bloating and gas, excessive crying, silent reflux with arching or swallowing, consistent spit up, and the need to be constantly held. But colic isn’t the actual DIAGNOSIS. There is a reason that the baby has one or all of these symptoms. Let’s discuss them.

Low Muscle Tone: When a baby has low muscle tone it will typically be in both skeletal and smooth muscles. The oral muscles that are lax will allow air to enter when feeding, causing aerophagic reflux. In addition, the sphincter between the stomach and esophagus has low tone, allow reflux to come up easier.

Tethered Oral Tissues (tongue/lip/cheek ties): TOTs will pull the tongue off the nipple, retract the tongue, and use a compensatory pattern to eat, leading to aerophagia and body tension. TOTs also contribute to speech, solid feeding, oral hygiene issues, and sleep difficulties. TOTs dont allow the tongue to rest on the roof of the mouth which leads to mouth breathing and light flutter sleep rather than deep restorative sleep. The lack of good sleep contributes to the domino affect of the “colic” symptoms.

GI Distress: Babies stomachs can be upset for an array of issues. The baby may have a food allergy or intolerance, leading to reflux. They may inherit gut dysbiosis from their mother. They may have an immature gut, especially when delivered via cesarean. These all contribute to colic symptoms and are a core issue.

Tension: all of the above root causes also lead to body tension. When the body is tense you then develop more compensatory feeding and sleeping patterns, leading to a never ending cycle.

So the ultimate question is, if we know what actually causes colic, why aren’t we treating the root causes? The problem lies in the backlash of these diagnoses. Many doctors have named tongue ties and food allergies as “fads”. There have been articles speaking out against frenectomies by big publishers which lead to fear mongering. What most medical providers look for when considering a diagnosis is research. The good news is that we have the entire hierarchy of research on these issues, including the gold standard double blind research studies. We can’t expect all doctors to be feeding and sleep experts but what should be included in a standard plan of care are appropriate referrals when difficulties arise. As the years go on the research is becoming more and more robust and the hope is that we can get all providers on the same page. For now, I’ve taken it upon myself to educate and empower the families themselves so they can seek out the providers who are right for their families. In addition, empowering families with research to show their providers help bring more awareness. The good ol’ case study when the baby gets better with therapy doesn’t hurt either.

If you’re stuck in a similar situation and want to become an advocate for your child, check out my courses at https://littlemoverspt.vipmembervault.com/

Elizabeth Morel has been a physical therapist since 2008 helping babies move to improve feeding and sleep. Her passion is educating families about the importance of building an airway from the first days of life.

Why is pre-op care needed BEFORE a frenectomy?

So your baby was diagnosed with TOTs (tethered oral tissues) and a frenectomy was recommended, right? But did the provider discuss the benefits of pre-frenectomy evaluation and treatment? Assessment of Functionality: A functional evaluation helps assess how well a baby's oral muscles are functioning in their current state. This evaluation provides valuable information about the baby's ability to perform essential tasks like breastfeeding, bottle-feeding, and later, speech development.

1. Identifying the Impact of the Frenulum: The assessment helps determine the extent to which the tongue or lip tie is affecting the baby's ability to move their tongue or lips. Some babies may have a visible tongue tie but may not be experiencing significant functional issues, while others may have less apparent ties that are causing problems.

2. Tailored Treatment Plans: A thorough evaluation allows healthcare professionals to create a customized treatment plan based on the baby's specific needs. Not all babies with tongue or lip ties require a frenectomy, and the decision should be based on the functional impact of the tie.

3. Optimizing Success: For babies who do require a frenectomy, understanding the functionality of their oral motor muscles before the procedure helps ensure the best possible outcome. A pre-frenectomy evaluation helps healthcare providers plan the surgery and determine the extent of the release required.

4. Preventing Complications: In some cases, babies may have compensatory muscle patterns due to their tongue or lip tie. These patterns can lead to difficulties with feeding, swallowing, and speech even after a frenectomy. A functional evaluation can identify these issues and guide post-frenectomy therapy if needed.

5. Parent Education: A functional evaluation is an opportunity for parents to better understand their baby's specific oral motor challenges and how a frenectomy may or may not address those challenges. It allows parents to make informed decisions about the procedure and any necessary follow-up care.

Here’s the trick question, how long does a baby need to go to OT/PT/SLP before the green light is given for frenectomy? It’s more of a loaded question than anything. Every baby is individually assessed and treated. The main factors that impact the number of weeks a baby needs therapy before frenectomy include their: resting muscle tone, baseline strength, head/body turning preference, total body tension, and nervous system regulation. For some babies only one session and a weeks worth of parent homework may be necessary but for others it may be months. During that time it is important to make sure the baby stays fed, moms milk supply stays stable if applicable, and reduce the home stress levels. The team of therapists, IBCLC, and frenectomy providers will all work together to ensure optimal outcomes.

Want to get started on the home program that gets your baby ready for a frenectomy? https://littlemoverspt.vipmembervault.com/ has it all ready for ya.

Elizabeth Morel is a physical therapist specializing in infant movement for feeding. She’s the owner of Little Movers PT and Little Movers Education. Helping parents since 2008, educating families about the importance of building an airway is her passion.

To sleep train or not to sleep train, that is the question!

Reflux-related sleep disturbances are a common concern among parents, and here's how it can impact your baby's sleep:

1. Discomfort and Irritation: When stomach acid flows back into the esophagus, it can cause irritation and discomfort in the baby's throat and upper chest. This discomfort may lead to pain or a burning sensation, making it challenging for the baby to fall asleep or stay asleep for extended periods.

2. Frequent Waking: Babies with reflux may experience more frequent waking during the night. The discomfort they feel from the acid reflux can cause them to wake up crying or in discomfort, disrupting their sleep cycle.

3. Shorter Sleep Periods: Reflux-related discomfort may result in shorter sleep periods for your baby. They may have trouble settling into deep sleep phases, leading to more shallow and fragmented sleep throughout the night.

4. Difficulty Lying Flat: Babies with reflux may find it uncomfortable to lie flat on their back, which is the recommended sleep position to reduce the risk of sudden infant death syndrome (SIDS). This discomfort can make it difficult for the baby to stay asleep when placed on their back.

5. Increased Spit-Up: Infants with reflux often have a tendency to spit up more frequently, even during sleep. This can lead to wakefulness as the baby may be awakened by the sensation of regurgitation.

6. Associations with Sleep: Babies are excellent at forming associations with sleep. If they experience discomfort or pain associated with sleep due to reflux, they may come to associate sleep with discomfort, making it harder for them to settle down for sleep in the future.

Did you hear the above 6 from your pediatrician? I certainly did. But here’s what we aren’t talking enough about. We aren’t talking about the root causes of this so called reflux. Infant reflux can be caused by aerophagia. Aerophagia means the baby is taking in too much air. Typically the air is getting in when a baby has a poor latch on the bottle or breast. You may notice this by way of clicking sounds, dribbling milk, hearing air sounds, or even seeing the tongue poke out of the corners of the mouth. When air gets in during drinking there are layers that build up of milk and air. As the air rises under the layers it will push the milk up as silent reflux into the throat or all the way up as spit up. What causes the poor latch? Well that may come from low muscle tone, poor oral strength, or a tongue tie tethering the tongue down which doesn’t allow an adequate seal.

Another reason baby may have reflux is due to food sensitivities or food allergies. The difficulty with food allergies in babies is that the only way of knowing is through an elimination diet.

Last but not least, let’s talk about constipation. When a baby is constipated the intestines are full. They tend to have more silent reflux or spit up based on the sheer volume of liquid that they may or may not be able to handle.

So what does this have to do with sleep training? The problem with addressing sleep concerns with sleep “training” is you’re not fixing the root cause of the issue. Typically if you can decrease aerophagia, reduce food triggers, and improve strength in the stomach sphincters sleep will improve. Don’t forget to get the right amount of calories in for that baby! Lastly, it is biologically normal for a baby to wake up every two hours until 2+ years old. Whether thats to roll over or grab a sip of water, it is still appropriate. Having an understanding of biological norms is super helpful so we don’t get a false sense of hope OR disappointment.

If you’re interested in working on the aerophagia or sphincter control, meet me over at Little Movers Education for 1:1 coaching. https://littlemoverspt.vipmembervault.com/

Does tummy time improve feeding?

Hello, parents! I want to talk to you about a crucial activity that can greatly benefit your baby's development: tummy time. Tummy time is when you roll your baby onto their stomach while they are in a calm state. It might seem simple, but it has a significant impact on your baby's growth and well-being.

First and foremost, tummy time is essential for strengthening your baby's muscles, especially the muscles in their neck, shoulders, and upper body. When babies spend time on their tummy, they have to work on lifting their head and pushing up with their arms, which helps build the core strength necessary for important milestones like rolling over, sitting up, and eventually crawling.

But did you know that tummy time can also play a vital role in improving your baby's oral motor skills? Oral motor skills refer to the strength and coordination of the muscles involved in speech, feeding, and swallowing. When your baby is on their tummy, they engage in various movements that indirectly contribute to the development of these crucial oral motor skills.

For instance, while in the tummy time position, babies often engage in head turning and neck strengthening exercises as they explore their surroundings. These movements are essential for head control and the development of the muscles used in chewing and swallowing.

Additionally, tummy time encourages babies to engage their facial muscles, which are important for oral motor skills. They use their mouths and tongues to interact with objects during tummy time, promoting sensory awareness and stimulating the muscles needed for speech articulation and feeding.

Furthermore, as your baby starts to move and explore their environment, they develop spatial awareness and hand-eye coordination. These skills are also fundamental for feeding, as they allow your baby to bring food to their mouth and self-feed when they are ready.

In summary, tummy time is not only about physical development but also about enhancing your baby's oral motor skills. It strengthens the muscles needed for head control, chewing, swallowing, and speech articulation. So, by making tummy time a regular part of your baby's daily routine, you are not only supporting their physical and motor development but also laying the foundation for healthy oral motor skills, which are crucial for their future communication and feeding abilities.

Check out the courses at Little Movers Education where you can learn to be an advocate for your baby’s gas and tension issues, remedy their oral motor/feeding difficulties, and turn them into the baby hulk so posture will never be an issue for them! https://littlemoverspt.vipmembervault.com/

Elizabeth Morel is a Physical Therapist licensed in NY and NJ specializing in infant movement for feeding. She is a tongue tie expert, practices CST and hold certificates through DMI level B.

What is "bodywork" for a baby?

When it comes to addressing a tongue tie in a baby, "bodywork" refers to a collection of therapeutic techniques and interventions aimed at improving the overall well-being and functioning of your baby's body, particularly focusing on their tongue and related muscles and structures which includes aspects from the head all the way to the toes.

Here are some key aspects of bodywork for a baby with a tongue tie:

1. Tongue Tie Assessment: The first step often involves a thorough assessment by a healthcare provider, such as a pediatrician, dentist, or ENT, to confirm the presence and severity of the tongue tie. A tongue tie occurs when the thin strip of skin beneath the baby's tongue (lingual frenulum) is shorter than usual, restricting the tongue's movement.

2. Frenotomy or Frenuloplasty: In some cases, a healthcare provider may recommend a procedure called a frenotomy or frenuloplasty to release the tongue tie. This minor surgical procedure involves snipping or lasering the tight band of tissue to allow the baby's tongue greater mobility. It is typically a quick procedure.

3. Oral Motor Therapy: This is a form of bodywork where a specialist, often an occupational therapist, physical therapist, or speech therapist, works with your baby to improve their tongue and oral muscle function. They may use exercises and techniques to help the baby strengthen and coordinate their tongue movements.

4. Chiropractic Care: Some parents choose to explore chiropractic care for their baby as a form of bodywork. Chiropractors may use gentle adjustments to improve the alignment of the baby's spine and neck, which can affect their tongue tie and overall comfort.

5. Craniosacral Therapy: This is a gentle hands-on bodywork technique that focuses on the craniosacral system (the membranes and fluid that surround the brain and spinal cord). It is believed to help release tension and improve overall body function, including issues related to tongue ties, tension patterns from the head to toes, relieve stress along the cranial bones from birth, and release any trauma held in the fascia.

6. Lactation Support: Bodywork may also include working with a lactation consultant who can help with breastfeeding techniques, positioning, and latching to ensure that the baby can feed effectively before and after the tongue tie is addressed.

7. Massage and Gentle Stretching: Parents should incorporate gentle massage and stretching exercises into their baby's routine to promote relaxation and improve muscle function in the mouth and tongue area, the neck, diaphragm, hips and pelvic floor, thighs, calves and even feet.

Beth from Little Movers is a physical therapist who practices craniosacral therapy. She utilizes transitional therapeutic exercises, DMI therapy, stretching, massage, CST, and oral motor therapy all in one session to achieve the correct postural and motor control in each child. She performs bodywork on children of all ages but will additionally refer out to other specialities to add to the team when necessary like feeding therapists, neuro, GI, allergy, and more. If you’re interested in performing bodywork in your own home, check out her education company Little Movers Education that has a platform of online courses and 1:1 coaching. As always, book a FREE high level chat with Beth with further questions.

What are intensives?

The intensive model of physical therapy is an approach to rehabilitation that focuses on providing high doses of targeted and repetitive therapy to individuals with neurological conditions, low or high muscle tone, poor executive function, and difficulty motor planning. This approach aims to maximize the potential for recovery by capitalizing on the brain's ability to adapt and reorganize itself, a concept known as neuroplasticity.

Here's an explanation of the key components of the intensive model of physical therapy and why neuroplasticity and blocked practice are important within this framework:

1. High Dose and Frequency: In the intensive model, patients receive physical therapy sessions more frequently and for longer durations compared to traditional therapy approaches. Sessions may occur multiple times a day, several days a week, or even on a daily basis. This high dose of therapy is intended to provide the brain with consistent and repeated opportunities to relearn and rewire neural pathways damaged by injury or disease.

2. Task-Specific Training: Therapy sessions are highly focused on specific tasks or activities that are relevant to the patient's goals and functional needs. This task-specific training helps patients regain and improve their ability to perform everyday activities, such as sitting, crawling, walking, and eating.

3. Neuroplasticity: Neuroplasticity refers to the brain's ability to adapt and reorganize itself by forming new neural connections or strengthening existing ones. In the context of physical therapy, neuroplasticity is crucial because it allows the brain to compensate for lost function by rerouting signals and functions to undamaged areas of the brain. The intensive model takes advantage of neuroplasticity by repeatedly engaging the affected areas of the brain during therapy, promoting the reestablishment of neural connections and improving function.

4. Blocked Practice: Blocked practice involves repeatedly practicing a single task or skill before moving on to the next. In physical therapy, this means focusing on one specific exercise or activity for an extended period during each session. Blocked practice is important because it helps consolidate learning and facilitates the formation of new neural pathways. By practicing the same task repetitively, patients reinforce the brain's ability to control and execute the necessary movements, leading to improved motor skills and functional outcomes.

5. Feedback and Progress Tracking: In the intensive model, therapists provide continuous feedback to patients, helping them refine their movements and techniques. This feedback loop is essential for optimizing motor learning and ensuring that the patient is performing tasks correctly. Additionally, progress is regularly assessed and tracked to adjust the therapy plan and set new goals based on the patient's evolving abilities.

6. Individualized Treatment Plans: Each patient's rehabilitation program is tailored to their specific needs, goals, and abilities. Therapists work closely with patients to develop personalized treatment plans that take into account their unique challenges and strengths.

Overall, the intensive model of physical therapy capitalizes on neuroplasticity and utilizes principles such as blocked practice to maximize the effectiveness of rehabilitation for individuals with neurological conditions. By providing a high dose of targeted therapy and promoting neural adaptation, this approach aims to help patients regain as much function and independence as possible.

How do we implement intensives at Little Movers? Here at LMPT we use a combination of treatments during each session. This would include head to toe assessment, intra oral work, craniosacral therapy, myofascial release, traditional therapeutic exercises, along with DMI therapy protocols. Sessions are one or twice daily depending on how much your little can handle. Treatment is individualized. Therapy is also set up for one to two weeks in a row. Within the intensive the parents will be given a plethora of homework including exercise and “bodywork”. They will take videos of the therapist performing the work and then themselves performing the exercises so they will be able to remember it from both angles. Written instructions can be given when necessary as well. All intensives are based on the needs of the client and the therapist so an intro call is suggested to make sure it’s the right fit for the situation. If you’re interested in an intensive book a “high level call” with Elizabeth Morel from Little Movers today!

Common v Normal!

“Aweee look at little Joey totally passed out, he’s so cute” mom says to dad as Joey is wide mouth catching flies in his sleep. This line is far too common in our world today. The question is, where is the line between common and normal? The incidence of oral motor dysfunction in children has exponentially risen over the last decade. Some examples of oral motor dysfunction include difficulty nursing, difficulty with solids, late or poor speech, oral hygiene issues, and poor/restless sleep. We are currently treating these problems under the rehabilitation model, only working on them when the signs are glaringly obvious. What if we started looking at this issue with the preventative model? What if we started working the moment a baby is born and you notice that open mouth posture? What are the issues we could change?  Though it seems rather simple, the tongue sitting on the palate with the lips closed has a ton of functions. 

1. The tongue forms the roof of the mouth (palate) starting at 10 weeks in utero. The tongue forming the palate is how we create our face shape. When the tongue sits properly the palate is formed low and wide. This allows wide cheekbones, proper jaw growth, and all of the adult teeth to come down with enough space. When the tongue does not sit on the roof of the mouth over the first few years of life, the face becomes long and narrow and the teeth don’t have enough space to fit without crowding. 

2. The tongue creating the palate is creating the space for the upper airway. The wider the palate, the bigger the upper airway. The more narrow the palate, the smaller the upper airway. In the same fashion, the tongue resting on the palate with ease is also what opens the airway during sleep. Poor tongue rest posture can lead to inadequate air exchange, poor sleep, and even sleep apnea down the road. We all know the effects of poor sleep on the body which include but are not limited to impulsivity, irritability, brain fog, fatigue, increased meltdowns, constant movement, hyperfocus, anxiety/depression, and executive dysfunction. 

3. The vagus nerve is on the roof of the mouth. This nerve is responsible for calming the nervous system down. It also controls the smooth muscles which means its helpful for digestion. When the tongue is up on the roof of the mouth it stimulates the vagus nerve, calming the nervous system and moving the smooth muscles along. When poor tongue rest posture is present we often find babies utilizing pacifiers or sucking their fingers to get the same stimulation but without the benefits of the tongue shaping the palate. 

4. The tongue is the base of the postural control system. Tongue to palate is critical for maintaining alignment and posture

5. Proper tongue lift is critical in creating speech sounds. The tongue hits many places on the palate to create varying sounds. Children with poor tongue rest posture often have articulation errors and sometimes other issues like lisps or stutters. 

6. Proper tongue lift is also essential for manipulating food and drink within the mouth. Proper elevation, side to side movement, pulling tongue back and forward are all necessary for proper mastication. 

The root causes for poor tongue rest posture include poor strength, low muscle tone, and the super hot topic of tethered oral tissues (tongue/lip ties). Some children even have a combination of all of these issues. Other issues like in utero constraint and birth trauma can also compound the above dysfunctions. If the tongue-palate complex has all of these functions that come to fruition over the first few years of life, then why aren’t we encouraging the correct tongue position from day 1 to all families? Shouldn’t everyone have a chance at avoiding feeding, sleep, oral hygiene, and posture/tension issues their whole lives?The habilitative model (rather than rehabilitative) would save families both thousands of hours and dollars as opposed to  the wait and see approach which can lead to weekly feeding or speech therapy, orthodontia, sleep dentistry, and difficulty with attention and schooling. In order to address the tongue resting posture a functional evaluation must take place. For lactation issues a board certified lactation consultant, IBCLC is the first line of defense. Therapists such as PT/OT/SLP can all be trained to perform oral and head to toe evaluations when specialty coursework is done. Once compensatory patterns have been minimized other referrals can be made to specialists such as the ENT or Pediatric Dentist where applicable. With the advancements in modern medicine and thorough research performed we, as parents, shouldn’t be settling for the “wait and see model” to come bite us in the rear. 

What do your baby’s mouth resting posture and supplements have in common?

Establishing a supply early in the fourth trimester is critical to being able to make breastmilk long term. There are many factors that determine how supply is created including mom’s hormones, the amount of actual duct tissue, and the amount that the breast is being stimulated. The need for lactation supplements like legendairy brand, majka, or the like, has risen exponentially over the last few years and the reasons behind it are not often spoken about. 

The incidence of open mouth posture and oral motor dysfunction has also exponentially risen. 

The truth is that our genes are changing in real time in response to our environment, the foods we eat, and the stresses placed on our bodies. This is called epigenetics. The more toxic our environment becomes, the more our genes are affected. These gene changes are then also passed down to our offspring and therefore it is understandable that there is a rise in dysfunction. Issues like tethered oral tissues (tongue and lip ties) are not a new concept. They have been written about as far back as in the bible. But they too are part of the rise in oral motor dysfunction. 

So what do oral motor difficulties and lactation supplements have to do with each other? Babies who have open mouth posture, low tongue resting positions, and high palates often have difficulty nursing and/or bottle feeding. This difficulty often leads to less stimulation at the breast in the early days which leads to less supply. Thankfully we have supplements that can help bring us back to status quo along with adequate support from lactation consultants and breast stimulation.

Fixing your supply, however, is only half of the equation.The tongue should glue onto the palate from tip to back when at rest. When the tongue is only partially up or not at all, it leads to dysfunction. Because the tongue is formed at 10 weeks in utero and many babies have low tongue resting posture, many babies are born with high palates. Why do we care so much? For many reasons:

1. The tongue forms the palate (maxilla) with the forces placed upon it. 

2. The tongue resting on the palate is what opens the airway. There is a direct correlation between that and the amount of oxygen that is getting to the brain. The lower and wider the palate, the bigger the upper airway. The more narrow and higher the palate, the smaller the upper airway. 

3. The brain is 75% of the way formed by the age of three. We want max oxygen to the brain for development.

4. The vagus nerve (the nerve that controls your parasympathetic nervous system and takes you out of fight or flight) is on the roof of the mouth. The more it’s stimulated by the tongue, the cooler, calmer and collected you are. 

5. We want deep, restful sleep which comes from nasal breathing. Open mouth posture is linked to rapid breathing, increase of anxiety/depression, and ADHD tendencies. 

6. When the tongue is down the airway is partially blocked which is what prompts people to mouth breathe. This allows air to come into the mouth without a filter leading to dust/bacteria/viruses/allergens entering the system and swelling tonsils/adenoids. The swelling then furthers the need to mouth breathe vs nasal breathe. 

7. The tongue resting position is also an indicator of general use of the tongue (lateral movements, extension, elevation, etc). We need proper tongue movements for feeding, speech, oral hygeine, and to jump start our postural control system. 

When we are talking about supply, there will be an endless battle if we do not address the oral motor issues that are still affecting the supply vs demand cycle. In order to address the above concerns, it is important to seek out a therapist for a tongue-to-toes evaluation. The therapist can help reduce compensatory patterns, improve feeding, and send out for further diagnostics if anatomical issues like tongue-tie are also at play. Fixing these deeply routed genetic issues often takes a team of lactation, PT/OT or SLP therapist, and frenectomy providers. Together they can set your baby up for lifelong success of better feeding and sleep with a cooler and calmer nervous system rather than battling each milestone along the way. 

Elizabeth Morel is the owner of the physical therapy clinic Little Movers PT, LLC in New Jersey. She is also the CEO of Little Movers Education, an education LLC with oral, motor, and neurological coursework for families.

Real Talk: Torticollis

Sometimes we think it’s a cute attribute that our baby is always turning their head to pose for the camera. Sometimes it’s your best friend who said their kid did that “head turning thing” but it went away in a few weeks. Sometimes it’s the pediatrician who asks you if baby always looks that way. Then there’s the time that you have prepared yourself and you know when to ask, does my baby have torticollis?

What is torticollis? 

Technically speaking, torticollis is the tightening/shortening of the sternocleidomastoid muscle or SCM. It is a long muscle in the neck which starts behind the ear and has two attachments at the middle and sternal ends of the collarbone. The muscle rotates the head opposite the side of the muscle and laterally flexes (bends) the ear toward the shoulder on the same side of the muscle. When restricted, your baby will bring the ear to the shoulder on the tight side and they will then look in the opposite direction. Torticollis can also cause facial asymmetry and skull asymmetry as the head tilts in one direction, squeezing one side and lengthening the other. 

Why does my baby have torticollis?

The answer can be many reasons. Torticollis can begin in utero. If a baby is either stuck or comfortably sitting in one position for days or weeks at a time the muscles can begin to shorten before birth. Then when born the baby already has a preference to look in one direction or bring one ear toward the shoulder. Another reason a baby may have torticollis is sleeping position. If baby is in the bassinet from day one and positioned to look at mom or baby chooses to look at the tag on the bassinet wall, they will develop a preference for this position. A third reason for developing torticollis can be from “bucket syndrome”. The more time baby spends in car seats, rock and plays, bouncers, and strollers, the more time the neck is in a flexed or crunched position. A huge contributing factor to torticollis can be plagiocephaly. Plagiocephaly/brachiocephaly is flattening of the bones of the skull. If baby has a head preference then the bones that touch the bassinet/playmat can begin to flatten. Once the spot becomes flat its harder for baby to turn the head back and forth, thus allowing the torticollis to progress further. Lastly, your baby may have tethered oral tissues (ie: tongue tie). When the tongue is tied down to the bottom of the mouth (typically posterior tongue ties that can’t be obviously seen if not a professional) a one sided restriction/tightness can take place down the entire length of the body. This tightness can present itself as torticollis. In addition, a tethered tongue can block a baby’s airway. In this case, babies often bring their head and neck back into extension and to either side in order to open the airway again. 

How is torticollis treated?

Torticollis is treated in many ways. The most addressed way to treat torticollis is to stretch the muscle. This means bringing the ear away from the shoulder on the affected side. I find that solely stretching isn’t the most effective tool as the baby is often irritated by the action. I prefer to “stretch” through positioning. For example holding the baby football style in order to separate the ear from the shoulder while walking around the house is a gentle and soothing way to stretch. In addition, I like to focus on fascial release from the elbow up to the ear. There are spider webs of connective tissue which can be twisted and pulled from any direction. Addressing the whole fascial chain will allow the body to relax much more than just treating the neck. This theory also holds true for a technique called CranioSacral Therapy. CST will address the body as a whole, allowing fascia to be freed throughout the body and cerebrospinal fluid to flow smoothly, thus allowing the neck to correct. Positioning is key when treating torticollis. The family must be consistently paying attention to the way baby is holding their head. If the head is in the affected position, baby must change positions. This includes sleeping, in strollers, and car seats. It is also important to strengthen the unaffected side. When the SCM muscle is tightened on one side of the body, the opposite SCM becomes over stretched. It is important to activate the unaffected SCM through exercises such as tummy time and head righting. 

The importance of tummy time:

Since the “back to sleep” program has been implemented babies spend very little time on their stomach. What most people don’t know is that “tummy for play” was implemented at the same time. This means that during waking hours, babies should be on their bellies to play. Purposeful tummy time (interacting with baby face to face) stimulates the neck to move in both directions. It works on strengthening the neck and back muscles. Tummy time brings awareness to the front of the body by rubbing on the floor. It also stimulates the emotional part of the brain through the vagus nerve which can help baby better acclimate to new and intense situations. Being on the stomach throughout most hours of the day can stimulate the weak side of the neck and actively stretch the tight side of the neck. In general, tummy time on mom/dad/family member will also help regulate a babies autonomic nervous system which will allow baby to heal better and faster from the torticollis. 

How do Iprevent torticollis? 

Preventing torticollis is easy. As soon as baby is born make sure they are turning their head in both directions. This includes when sleeping, on the play mat, and changing table. Make sure you limit the amount of time baby spends in buckets/containers including bounces, strollers, car seats, rock and plays. Place baby in tummy time (on your chest/lap/floor) as much as possible. Seek treatment early. If baby shows a slight preference for one side seek out a therapist who is trained as soon as possible. Mild torticollis is easy to treat but severe torticollis can take months to correct.

As always, feel free to reach out with questions!

~Beth~

Restore Your Core With The Pressureless Workout

Every mom has a goal of shedding baby weight, whether that be right away or over a few years. The problem is, women often are not properly educated on rehabilitating the pelvic floor BEFORE returning to exercise. The exercise trend these days is using High Intensity Interval Training or HIIT to get the maximal workout in the shortest period of time. These concepts also hold true for the popular brand of Crossfit, in which the WOD or workout of the day often includes heavy lifting and intense aerobic (such as burpees) mixed with anaerobic (such as sprinting) exercise. The pelvic floor takes a big hit during pregnancy and delivery, stretching out the muscles, and pushing organs such as the bladder and rectum down. When performing HIIT exercises women bear down, increasing the pressure in the abdomen. The increase in pressure in conjunction with weak abdominals pushes the organs in the pelvic floor down further. If intense exercises are performed before the pelvic floor has a chance to recover, women end up with problems such as stress incontinence while sneezing/coughing/laughing/exercising, low back pain, pain with intercourse, and even prolapse. 

Everyone has heard of Kegels, but many new moms lack the proprioception (feeling of body/space) to perform them correctly, which can cause more harm than good. So, what are the ways to heal the pelvic floor? First and foremost, allow the body time to heal. Next, don’t jump into anything until you feel ready both physically and mentally, lack of sleep causes extreme fatigue. Last, find the right program for you. 

In 2014 Tamara Rial and Piti Pinsach of Spain came up with the pressureless workout which changed the pelvic floor game. They branded it Low Pressure Fitness hypopressives. The goals of hypopressives are to restore the pelvic floor, improve posture, tighten the deep abdominals, improve respiratory parameters, and improve sexual intercourse. How do hypopressives differ from traditional pelvic floor restoration? Hypopressives concentrate on changing the breathing pattern from belly breathing to diaphragmatic breathing. With each belly breath, the abdominal organs are pushed outward ,and the pelvic organs are pushed downwards. With diaphragmatic breathing the abdominal organs remain stationary and the pelvic floor organs are pulled upwards. 

During Hypopressives, the mom is taught to move through different poses concentrating on opening the ribs, stabilizing the shoulder blades, and growing taller through the spine. After 3 full inhalations/exhalations the mom is then taught to perform an abdominal vacuum called an apnea. When performed correctly the apnea will suction and lift the pelvic floor high and the deep abdominals will continue to fire in order to keep it in place. A pressure-less workout may sound easy but it is a full body workout and will leave you sweating, heart pumping, and craving more. There is a mind/body component to these exercises and is meditative to many women. In addition, the exercises wake the body up and give you energy so you can take a 10 minute exercise break instead of reaching for that afternoon cup of coffee. 

Hypopressives are an exercise staple throughout Europe in South America. You can’t enter a gym without seeing someone practicing their poses. In Brazil, hypopressives earned the nickname “barriga negativa” because women’s bellies are becoming so flat that they are appearing concave. Trista Zinn has grown the Low Pressure Fitness brand throughout Canada. She also led the first training program in the U.S. in New Jersey this past summer. Physical Therapists, trainers, and bodyworkers gathered to learn the technique. Since then, founder Tamara Rial has flown in to teach classes across the country. Like any new technique, it takes time to catch on. This program however, is very special. Honestly, who doesn’t want to get a flat belly and have better sex from performing a few pressure-less exercises? Watch out burpees, there’s a new girl in town.