Effectiveness of exercise therapy combined with traditional Chinese tuina manipulation in infants with congenital muscular torticollis: a randomized controlled trial

OBJECTIVE: To investigate the clinical efficacy of exercise therapy combined with traditional Chinese tuina manipulation in the treatment of congenital muscular torticollis (CMT) in infants. METHODS: In this randomized controlled trial, 70 infants with CMT were randomly assigned to receive either exercise therapy combined with traditional Chinese tuina manipulation (combined group, n = 35) or traditional Chinese tuina manipulation alone (control group, n = 35) for 3 months. The primary outcome was the post-treatment sternocleidomastoid muscle (SCM) thickness ratio (affected/unaffected side). Post-treatment outcomes were compared using analysis of covariance (ANCOVA), adjusting for baseline values and age at enrollment. Adjusted mean differences with 95% confidence intervals (CIs) were reported. RESULTS: Both groups showed improvements in structural and functional outcomes after treatment. After adjustment, the combined group demonstrated a significantly lower post-treatment SCM thickness ratio than the control group (adjusted mean difference, 0.441; 95% CI, 0.287 to 0.595; P < 0.001). The combined group also showed a significantly smaller SCM mass diameter (adjusted mean difference, 5.02 mm; 95% CI, 4.04 to 6.01; P < 0.001), a smaller head tilt angle (adjusted mean difference, 4.98°; 95% CI, 1.77 to 8.19; P = 0.003), greater cervical rotation range of motion (adjusted mean difference, -7.41°; 95% CI, -9.21 to -5.61; P < 0.001), and a higher muscle function scale ratio (adjusted mean difference, 0.148; 95% CI, 0.026 to 0.270; P = 0.018) than the control group. The overall response rate was significantly higher in the combined group than in the control group (94.3% vs. 65.7%, P = 0.003). CONCLUSION: Exercise therapy combined with traditional Chinese tuina manipulation was associated with improvements in muscle structure and cervical function in infants with CMT, leading to enhanced clinical efficacy and demonstrating promising potential clinical utility.