Case Report: FSM’s Big Impact in Congenital Muscular Torticollis

The addition of frequency-specific microcurrent (FSM) stimulation to the standard congenital muscular torticollis (CMT) treatment regimen produced marked, exceptionally rapid improvements in a child who otherwise likely would have needed surgery to resolve his flexion and rotation limitations.

Despite late referral for therapy and his condition’s high grade of severity, the 19-month-old male patient recovered full range of motion, gained lateral flexor strength and displayed reduced head tilt after only eight weeks of care.

“To see a full passive range-of-motion recovery and nearly full strength recovery was remarkable. I was very surprised and pleased,” says Cleveland Clinic Children’s Hospital for Rehabilitation physical therapist Regina Thompson, PT, PCS, who co-authored a recent case report detailing the child’s treatment. It is the first known account in the medical literature of CMT outcomes resulting from the combination of FSM and conservative therapies.

Etiology and conventional treatment

CMT is a common musculoskeletal disorder characterized by asymmetric sternocleidomastoid (SCM) muscle length and/or strength, with or without SCM muscle mass. The shorter of the two SCMs has fibrotic tissue and disorganized muscle fibers; its counterpart may also have altered strength due to its excessive length. Etiology of CMT is uncertain, although abnormal fetal positioning, intrauterine venous occlusion of the SCM or trauma during delivery are all possibilities.

Treatment efficacy tends to decline as the patient’s age at referral to physical therapy increases. Children older than 12 months with any of postural or range of motion (ROM) asymmetry or an SCM mass are classified as CMT severity grade 8; patients in this age range at initial referral, with cervical rotation restrictions greater than 30 degrees and SCM nodules, do not usually experience complete recovery after conservative therapy and probably would be referred for surgical consult. Conservative CMT therapy consists of stretching to gain passive ROM, active ROM exercises, strengthening activities and parent/caregiver education to enable home replication of physical therapy.

Evolution from microcurrent to FSM

The patient in this report presented for physical therapy at age 19 months with longstanding untreated CMT characterized by 12 degrees of left head tilt in sitting position, 25 degrees restriction of passive left cervical rotation compared with the right, mild postural cervical hyperextension that increased with active left rotation, and left upper trapezius restriction compared with the right. Palpitation revealed two pea-sized nodules in his SCM. Prognosis for full recovery relying only on conservative methods was poor.

Weekly one-hour outpatient physical therapy sessions consisting of stretching, massage and strengthening were initiated, along with parental instruction regarding a home physical therapy program. After two weeks, FSM was added to the clinic regimen.

FSM is a modification of traditional microcurrent (MC) electrical stimulation, a technique that has proved effective in wound healing, tissue regeneration and pain reduction. Human muscle disease is associated with elevated levels of intracellular calcium ions (Ca2+), which are believed to disturb muscle tissue structure and trigger atrophy, among other effects. Microcurrent’s efficacy is theorized to be due to its ability to restore intracellular Ca2+ homeostasis, improving muscular function, and to reduce pain perception by altering cell signaling and endorphin output, which may enhance muscle stretching.

Like MC, FSM uses alternating current voltages of 1–600 microamperes, which matches the electrical current of human tissues. Unlike MC’s single-channel delivery, FSM is delivered via two channels: one channel’s stimulatory frequencies target a clinical condition (such as inflammation) while the other channel’s frequencies are directed to the tissue types affected by the clinical condition. When FSM frequencies achieve resonance with electromagnetic bonds in human tissue, the resulting oscillation is believed to disrupt those bonds, making tissue reorganization possible.

FSM practitioners have identified frequencies specific for many tissue types and conditions but these have not been studied in the CMT population. Ms. Thompson, an experienced FSM programmer, developed a custom protocol using frequency pairings intended to target Ca2+ dysregulation and SCM fibrotic tissue. To accommodate the young, energetic patient, FSM was delivered using a combination of skin-adhered gel electrodes on the toddler’s chest and leads attached to a wetted terrycloth bib draped around his neck. FSM stimulation lasted 20 minutes per clinical session.

Rapid progress with FSM

The duration of conservative CMT treatment for patients referred after the age of one year may range from seven to nine months.

In this case report, by week eight of the combination FSM/massage/conservative therapy, the patient had recovered full passive range of motion and demonstrated significantly improved cervical strength and posture. His two SCM fibrotic nodules were no longer palpable. Passive left cervical rotation increased from 75 to 110 degrees, passive right lateral cervical flexion increased from 50 to 70 degrees, and resting head tilt had decreased from 12 to 2 degrees. The patient’s ability to hold his head in right lateral flexion against gravity improved from 25 to 70 degrees above the horizon.

This sustained, rapid improvement occurred despite the parents’ inability to consistently conduct the patient’s home physical therapy program.

The outpatient sessions ended after week 10 when the parents relocated to a different area. “It’s tempting to think that if I had had another six or eight weeks to work with the patient, he would have achieved full strength recovery in addition to full range of motion,” Ms. Thompson says.

Clinical application and future plans

FSM has been incorporated into the therapeutic routine for CMT patients at Cleveland Clinic Children’s Hospital for Rehabilitation. Anecdotally, Ms. Thompson says, “we see rapid range-of-motion gains, especially in the grade one and two populations,” which are the majority of patients who present for care.

She plans to conduct a large study assessing FSM’s efficacy in young patients with a range of CMT severity grades.