Cervical Spine Rotation Assessment

When assessing the body, there are few orthopedic physical tests that have good validity, sensitivity and specificity. This holds true in the cervical spine as well. It is important to determine which tests may be helpful in ruling in or ruling out a given pathology or dysfunctional segment. The following discussion will consist of two tests that have been shown to be of credible use in the cervical spine.

We frequently perform joint mobilization and accessory glides in an attempt to determine hypomobility or dysfunction at a given cervical joint or segment. Once you find the segment that is believed to be dysfunctional, that is generally an excellent place to target some of your treatment. In a study by Fernandez-de-las-Penas in 2005, an assessment of C3-C7 was performed and compared to radiologic assessment. It was found that a lateral glide test for C3-7 was as good as radiological assessment for the diagnosis of intervertebral dysfunctions in the cervical spine. The lateral glide test is a very quick and simple test that can easily be done in supine performing some side glides to the lower cervical spine. Take note of the amount of movement and stiffness noted with each segment as it is moved laterally. When a decreased amount of translation is suspected, you may then direct passive joint mobilizations, mobilizations with movement, or manipulation to the given segment or segments.

Next, we will discuss assessing the upper cervical spine as it relates to cervicogenic headaches (CGH). According to the International Headache Society in 2004, a CGH is defined as “pain, referred from a source in the neck and perceived in one or more regions of the head and/or face”.

Before discussing the performance of this test, we will briefly touch on the reasoning behind its use. The first and second cervical segments have been found to be the main pain generating segments in the following studies:

Hall et al 2010 – 63% of the time
Hall and Robinson 2004 – 80% of the time
Zito 2006 – 72% of the time

Therefore, the C1-C2 Flexion Rotation Test will be directed at these particular segments. In order to perform this test you will:

Have the patient laying supine.
Flex the cervical spine fully with the chin nearing the chest or on the chest depending on that patient's mobility and morphology. The idea is that you are attempting to lock out all of the lower cervical spine segments to allow movement only at the C1/C2 segment.
From there, you will rotate the head to one side. Note the amount of rotation and then proceed to rotate the head to the opposite side.
Compare the amount of rotation between both sides. If a firm resistance is encountered, pain is provoked, and range is limited then the test is considered positive with C1/C2 being the presumed affected segment.

Normative values and positive test values include:

Hall and Robinson 2004. Normal = 45 degrees

Ogince et al 2007. Normal = 39 degrees. Average positive test ROM Right or Left = 20deg for CGH patients versus migraine or controls. 32 degrees is the cut off for a positive flexion rotation test with a sensitivity of 91% and a specificity of 90%.

In conclusion, the lateral glide test to C3-C7 and the flexion rotation test to assess C1-C2 mobility are both reliable and valid to include in your assessment for the cervical spine.

BIO

Eric graduated from the University of Findlay in 2013 with a Doctorate degree in Physical Therapy. Since that time, Eric has continued his training and progressed his skills in order to provide the most optimal care for those who have low/mid back, neck, shoulder, elbow, and wrist/hand pain, as well as headaches and jaw pain. He is one of just over a hundred Physical Therapists in the nation to have earned his Diploma in Osteopractic Physical Therapy. Eric is the co-owner of Advanced Therapy and Performance.