Tot Collar

Original price was: $86.25.Current price is: $79.00.

The TOT Collar is an effective therapy aid for congenital muscular torticollis. It is added to conservative management & produces a stimulus to the side of the head, where the patient reacts by moving away from the stimulus towards a new corrected position.

Providing the progressive ability to reset horizontal perception, & maintain the corrected head position. Child (4 months to 10 years) | Adult (10 years & up)

Pre-assembled, ready to customize & fit. Comes with additional tubes/struts of different lengths for customization as well as an extra connecting strap. It Is Not A Head Support Collar. It is recommended that a Qualified Professional should fit this Collar! Tot Collar Instructions

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Tot Collar For Treatment Of Congenital Muscular Torticollis In Children & Adults

The Tot offers a comfortable and progressive means to assist in torticollis treatment. Providing initial treatment support that you can customize and allowing for changes in your condition or positioning with the supply of bracing tubes that can easily be changed. No need to buy a new tot collar, the bracing tubes are easily changed. There is a supply of these that come with the collar, including an extra easy snap fastener. The collar comes with everything you need.

Child (4 months to 10 years) | Adult (10 years & up): Qualified Professional Assistance Recommended

Fitting Instructions

The collar is already assembled, ready to customize and fit for torticollis treatment. Comes in Child & Adult sizes. The tubing comes in a length about two times the measurement around the neck, plus 4 to 6 inches or 10 to 15 cm. An end connector securely joins the tubing.

Soft tubing, which is gentle to the skin as well as non-toxic and washable, is looped and connected with Velcro for a secure and comfortable fit. The Tot Collar provides a custom level of support by supplying you with bracing tubes which vary in length and connect the tubing which forms the collar, providing stabilization in front and back of the shoulder area.

It is used as an addition to the conservative torticollis treatment in adults with the larger size collar, and with infants diagnosed with congenital muscular torticollis starting at 4 months.

In adults, it is lightweight and discrete in and outside the home. Like the Child version, this collar is a therapy aid – and is NOT meant to act as a stand-alone support. The collar is designed to provide a “prompt” or stimulus that the wearer will pull away from. Quite honestly – most adults will not wear, nor benefit hugely from this collar. Some adults do find it useful when actively working to correct a torticollis –like contracture, as it acts (as intended) as a “reminder” to hold their head up straight, but unless the adult is “working” it, it’s generally not the right choice. So if you are an adult looking to correct torticollis (or similar contracture) you would benefit more from a bracing system for torticollis.

For torticollis treatment in infants and children, there should be sufficient motion range to lift the head from the side of the collar, along with a consistent tilting of the head equal to or greater than 5 degrees.

The infant or child should additionally have adequate righting reactions from the side in order to lift the head away from the higher side of the tot collar.

How Does The Tot Collar Work?

The idea behind the collar is to assist in torticollis treatment. The tot collar produces a negative stimulating sensation on the high side of the collar as it contacts the side of the head. New muscular patterns are stimulated as the wearer will move the head away from this sensation using the neck muscles to a more balanced position. This new position allows normal perception regarding visual input and, along with muscle training, helps to restore a new, balanced posture.

For the adult, torticollis treatment may take longer, there may be a slight amount of correction or none at all. Whatever the case, the Tot Collar will provide treatment support without having to rely on rigid and uncomfortable collars. No delays with returning collars to exchange size, since this has the ability to be customized to the exact amount of support you need, as well as having the capability to be modified for whatever life situation demands. Additionally, you can get all parts as replacements as you need. Furthermore, it is an economical torticollis treatment, costing about half as much as more rigid, bulky and unforgiving collars.

Congenital Muscular Torticollis is often diagnosed early in life, usually within six to eight weeks. The problem is with a neck muscle called the sternocleidomastoid. The name of the muscle gives a clue to the locations and actions. The muscle connects from the sternum and clavicle to the mastoid bone of the skull behind the ear. As this muscle becomes contracted, is results in the head being side bent to the problem side and turned to the opposite side.

In adults, problems with this muscle can a painful neck condition and involvement can produce headaches. A problems with this muscle can be triggered by looking up for long periods or from doing activities like reading in bed and having the head turned to one side as often happens when there is inadequate light.

It can be irritated from a shirt collar or tie that is excessively tight or from a poorly supportive pillow or sleeping on your stomach.

With torticollis treatment, it is advised as early as possible in order to prevent a curvature of the spine called scoliosis or problems in physical development.

The Tot Collar is available in both Adult and Child sizes. The Child size fits a 4 month to 10 year old child. The Adult size is often used for spasmotic torticollis and fits an average 10 year old to adult. Note: When using for infants or children, they should not be left unattended while using the collar for torticollis treatment.

The collar is recommended by expert opinion in the 2018 practice guideline from APTA Academy of Pediatric Physical Therapy.

Benefits For Torticollis Treatment

Fitting: Fitting is simple and easy. Easily adjusts with various tube lengths. Longer length tubes used for optimal alignment. Every part is individually obtainable for replacement if necessary – you do not have to buy a whole new collar

Wearing: Comfortable and allows air circulation for gentleness to skin. Easily Taken off and put on. Original design for discrete use. Easily cleaned with just mild soap and water. Adjustable and customizable level of support

How To Use The Tot Collar

tot collar & strutsThe vertical or stabilizing tubes for support are chosen from the variety supplied to achieve the appropriate side support head level. A variety of these tubes are included, allowing a custom fit and these may even be cut to precise levels of side tilting.

tot detailsThe (A) tube goes from the back of the trapezius muscle to the back of the head. The (B) tube goes from the front of the trapezius muscle to under the mastoid process behind the ear. Try not to place pressure on the jaw bone. Begin with the shorter tubes, replacing with longer ones as gradual correction takes place.

tot collar instructionsFor best fitting, have the wearer hold his/her head straight, just off the verticle tubes, allowing room for a finger to be comfortably placed in between the collar and the neck. The collar should be loose initially, ensuring the side tubes are of the appropriate length and fitted on the affected side. Make sure the collar is correctly fit by hand.

cut tubingTake the collar off and fit the tubing to size, removing excess. Cut tubing to the correct length using a sharp scissors and fasten it again using the end connector. Place the collar on following every adjustment to make sure it is fitted correctly for torticollis treatment. Note: Take special care in cutting the tubing. If it’s cut too much, it will not be able to be reconnected.

Final Checks

  • Ensure the vertical tubes are positioned correctly around the trapezius
  • Make sure a the collar can be positioned correctly by a caregiver or parent – place a mark on the top end of the Collar if needed
  • Take note of any irritation where the tubes contact the skin
  • The Collar can be with a stockinette – 2 inches to make it more comfortable
  • Cleaning should be done frequently using soapy water
  • Take collar off when user is sleeping

Use the collar with a stretching regime for best treatment results. Caution: Make sure not to leave a child unattended while wearing this Collar!

We recommend creating a daily routine for therapy, which should involve stretching and stationary use of the TOT Collar. Stationary use could involve wearing the collar during a stationary activity such as use in a high chair or other seat, so that movement from crawling does not affect the positioning of the stays. The collar isn’t designed for use with a lot of active movement and is more effective when the child is in a sitting or supine position.

Torticollis Treatment

If your child has been diagnosed with torticollis, a therapist often recommends the collar as part of the rehabilitation and congenital muscular torticollis treatment.

  • A 2000 study in Pediatrics International indicates early and intensive treatment is critical. The study concludes, “In patients with early treated congenital muscular torticollis, there is no place for surgical treatment.”

tot collar drawing 1

Congenital muscular torticollis is a problem which may cause your child’s head to tilt and using the tot collar will help train your child or infant to hold his or her head straight.

Effects of the Tot Collar

The collar uses a clear and non-toxic plastic tubing and has plastic posts which are placed on the side of head tilt. These vertical posts make contact with the head of your child as it falls to one side. The collar stimulates the infant or child to raise the head and acts to strengthen the weak muscles responsible for the tilt.

Wearing The Collar

For treatment of torticollis, the collar reminds your child to lift the head, therefore, it is effective only when the child is awake. Therefore, the tot should be removed when napping and when sleeping at night. It is also important to remove the collar your child is in the car seat in case he/she falls asleep.

When your child or infant is feeding, it is your decision if you want to use the collar. The collar should also be removed for the range of motion exercises and it can remain on for any tilt and strength exercising.

What If Your Child or Infant Is Sick

When sick, torticollis treatment with the collar can be used for a portion of the day as long as the child is comfortable. This has the benefit of allowing him or her to remain accustomed to the collar. When quite ill, there is no requirement to keep the collar on when uncomfortable and/or too restless and can be put on when feeling better.

How To Help My Child Adjust?

It is best to put the collar on first when your child is well rested and you have the time to be playful with your child. Only allow the collar in place for about 30 minutes. This allows you to distract him or her with play because your child may be fussy. If your child is not in a playful mood, take off the tot collar and allow your child to rest some before trying again. It is possible your child will tolerate the collar for a few hours during the first use.

You can put the collar on 3 or 4 times each day for the first week, allowing it to remain on a little longer each time. It usually takes about a week for your child to get used to the collar. For the second week, most children can tolerate torticollis treatment with the collar on all the time when awake.

What Is The Best Way To Put On The Tot Collar

Put the collar on when your child is lying on his or her stomach or when sitting. Place the collar around the child’s neck, adjust the position of the posts and fasten the clip.

tot collar drawing 2

Where Do I Place The Posts On The Collar?

The picture shows the positioning for a right torticollis. The posts are positioned on the tilt side, which is the side where the muscle is short.

A post is placed in front of the shoulder with the top behind the ear, the other post is placed behind the shoulder with the top touching the back of the child’s head.

What Is The Right Fit?

It should stay in place without shifting. Two adult fingers should fit flat between the collar and the child’s neck at the back clip. At first, the tot collar can be loose, then second placement, adjusted to not move out of place.

It is possible for red areas to be on the skin of the child’s neck, and this should go away after 20 – 30 minutes after removing the collar. If the areas remain longer than 30 minutes, consult your therapist.

The collar can be placed under all clothing. Shirts and loosely fitting turtleneck sweaters can be worn over the tot collar.

If your child develops a heat rash, it may be beneficial to put the collar inside a sleeve. If your therapist does not have one, you can cut out the foot portion of a child’s cotton sock to place over the collar.

While choking is not a problem, watch your child just as a precaution similar to anything that goes around the neck.

How Long Should My Child Wear The Tot Collar

The time it takes will vary, but all children should wear the collar for at least 2 months for torticollis treatment.

Begin weaning from the collar when your child is capable of holding his/her head for about an hour with no tilt. Do not hasten weaning because it may require several months before the neck muscles strengthen enough to stabilize the head while walking and crawling.

For torticollis treatment, the tot collar helps learn movements in a more even and stable manner. Being frustrated when learning a new task like crawling or walking, you may take the collar off for a short time when playing.

Q & A

Q: We work with a lot of babies with torticollis (3-7 evals/week) and have fit many TOT collars. We’ve had great outcomes with our babies on the younger end of the spectrum (starting TOT collar around 6 months) but have noticed that the post attachments slide along the PVC tubing a lot with older babies or toddlers, especially if they still have a strong rotation preference. Additionally, it seems like when the taller posts are needed they will only last a few weeks before bending.

Do you have any recommendations for these issues? Right now, we’re marking post locations on the tubing with Sharpie so parents can reposition them between treatment sessions, but it does seem to decrease the effectiveness of the collars since they can’t be constantly repositioning posts.

A: This is the first time we’ve heard about the taller struts bending after a few weeks, and so I don’t have an official answer for that, although I’m thinking that a piece of nylon rod inserted into the long tube should provide good rigidity… I shall have to pitch this to our R&D crew for confirmation and potential implementation.

Regarding the migration of the struts along the PVC tubing – I have seen PT’s tape the struts into position using a sort of figure eight type taping pattern. (Although I was told this was mainly to stop parents from re-positioning them, I can’t see why it wouldn’t work for this as well.). It’s a fine line between having the T-Junctions be reposition-able and having them stay put.

tot collar parts

Replacement Parts Available For Purchase

The recommended code for the TOT collar is L0140. Professional fitting is recommended for best results.

More Information:

Tubular Orthosis for Torticollis (TOT): A new approach to the Correction of Head Tilt in Congenital Muscular Torticollis | TORTICOLLIS: Differential Diagnosis, Assessment and Treatment, Surgical Management and Bracing

Additional information


Child, Adult

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Author Bio

Stephen Ornstein, D.C. has treated thousands of neck, shoulder and back conditions since graduating Sherman Chiropractic College in 1987 and during his involvement in Martial Arts. He holds certifications as a Peer Review Consultant from New York Chiropractic College, Physiological Therapeutics from National Chiropractic College, Modic Antibiotic Spinal Therapy from Dr. Hanne Albert, PT., MPH., Ph.D., Myofascial Release Techniques from Logan Chiropractic College, and learned Active Release Technique from the founder, P. Michael Leahy, DC, ART, CCSP.