• Pei-Te Hsu, I-Hsiu Liou, Shu-Fen Sun, Chiao-Wen Hwang, and Jue-Long Wang.
• *Department of Physical Medicine & Rehabilitation, Kaohsiung Veterans General Hospital, Taiwan, Republic of China; and †School of Medicine, National Yang-Ming University, Taiwan, Republic of China.
• Spine. 2013 Apr 20; 38 (9): E569-72.

Study DesignCase report.ObjectiveTo discuss a case of atlantoaxial rotatory fixation (AARF) successfully treated with manual therapy.Summary Of Background DataA 9-year-old girl experienced acute torticollis and neck stiffness after a traffic accident. Image studies revealed AARF, a cause of pediatric torticollis. She received closed reduction with the aid of C-arm fluoroscopy under general anesthesia. She was referred to the researchers' rehabilitation clinic because of unsolved torticollis and limited head rotation. At her initial visit, we found that her head tilted to the right and rotated to the left. Tenderness and muscle guarding over the right suboccipital region were also apparent. The first manual therapy significantly improved neck motion after soft tissue release applying to the suboccipital muscle group.MethodsWe arranged for her to enter a rehabilitation program including (1) soft tissue release technique to the suboccipital muscle group for 10 minutes and (2) muscle energy technique for neck flexion, extension, lateral bending, and rotation for 10 to 15 minutes.ResultsAfter 3 months' rehabilitation, her symptoms of torticollis, neck pain, and limited range of motion achieved near-total recovery.ConclusionThis case report presents the association between suboccipital muscles and AARF, suggesting that the soft tissue release of suboccipital muscle group may facilitate recovery from AARF. More studies are needed to verify the inferences of this case report.

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