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Evaluations and Treatment of the Cervical Spine, 2nd Edition: Summary
SPECIAL TESTS Special Test Craniocervical Flexion test
Purpose
Technique
Result Interpretation
To assess the recruitment of the deep neck flexors of the cervical spine
In supine hook lying, place a biofeedback unit such as the Stabilizer (Chattanooga Group, Inc.) or a blood pressure cuff under the lordotic curve of the cervical spine; inflate to 20 mm Hg; the client is to nod head as if to say “yes” to increase the reading to 22 mm Hg; hold for 10 seconds if able In supine, passive cervical flexion followed by passive rotation to end range; examiner notes the difference in range of motion, also observing for pain and/or guarding; it is acceptable to determine if a difference of rotation passive ROM exists visually, though measuring with an inclinometer or goniometer with a second clinician’s assistance will give an objective value
Positive test = unable to maintain 22 mm Hg for 10 seconds Clinical significance: Failure of a 10-second hold indicates poor endurance of the deep neck flexors
Cervical Flexion- Rotation test
To assess cervical rotation at C1–C2
A positive test is pain with rotation and/or difference of 10° right versus left Normal values are 45° of PROM cervical rotation while the cervical spine is maximally flexed Shown to be beneficial in supporting the diagnosis of cervicogenic headache, thus differentiating it from a migraine
When Treatment May Not Be Appropriate • Cervical myelopathy (undiagnosed) : L’hermitte’s sign • Cancer : Tumor can cause myelopathy and/or cervical mobility restrictions: ○ Screen for cancer differential diagnosis: Constant pain that is unable to be relieved or pain at night, for example • Neck fracture : Mechanism of injury (MOI), odontoid fracture test: ○ Supine position, cough, or sneeze • Vascular compromise : Vertebral artery test • Cervical instability : Alar ligament test, transverse ligament test, or Sharp-Purser test: ○ Possible causes: History of trauma, Down syndrome, rheumatoid arthritis • Systemic disease : Referral often necessary if undiagnosed rheumatoid arthritis, ankylosing spondylitis (bamboo spine), infection, and so on
Active Range of Motion (ROM) Norms: • Inclinometer : ○ Flexion = 50° (double inclinometer)
○ Extension = 50°–70° (double inclinometer) ○ Lateral flexion/side bending = 48° (single inclinometer) ○ Rotation = 80° (supine, single inclinometer) • Goniometer: ○ Flexion = 50° ○ Extension = 50°–70° ○ Lateral flexion/side bending = 48° ○ Rotation = 50° seated; 70°–90° supine Functional ROM • Most ADLs require combined cervical movements • Looking up at the ceiling requires 40°–50° ○ Compensation: Trunk extension • Looking over your shoulder (backing up a vehicle) requires 60°–70°
○ Compensation: Trunk rotation • General ADL functional AROM: ○ Flexion: 32° ○ Extension: 32° ○ Lateral flexion (side bending): 21° ○ Rotation: 57°
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