Assesses alar ligament integrity and upper cervical stability.

  • Side Bending Stress Test

  • Upper cervical instability

Patient Position
  • Seated
Examiner Position
  • Standing beside patient
Steps of Performance
  1. Stabilize C2 with a pincher grip on the articular pillars and spinous process
  2. Passively laterally flex the patient’s neck
Alternative Methods

Lateral Procedure

  • Patient Position: Supine, lying with the head rested on the examination table (supported by a pillow) in neutral alignment
  • Examiner Position: Standing at the head of the table
  • Steps:
    1. Gently lift the patient’s head/neck
    2. Stabilize the C2 with a wide pinch grip around the lamina and spinous process
    3. Passively laterally flex the patient’s head

Lateral flexion of the head and C1 against a stabilized C2 will place stress on the alar ligaments, assessing their integrity.

General

Positives

Excessive movement

  • Instability

Sharp lateral pain at the stretched ligament

  • Ligament strain

Recreation of neurologic symptoms (myelopathy, radiculopathy)

  • Alar ligament instability

Pertinent Negatives

DATA
TAGS
References
Harry Von P, Maloul R, Hoffmann M, Hall T, Ruch MM, Ballenberger N. Diagnostic accuracy and validity of three manual examination tests to identify alar ligament lesions: results of a blinded case-control study. J Man Manip Ther. 2019 May;27(2):83-91. doi: 10.1080/10669817.2018.1539434. Epub 2018 Nov 15. PMID: 30935337; PMCID: PMC6484502.

Assesses alar ligament integrity and upper cervical stability.

  • Upper cervical instability

Patient Position
  • Seated
Examiner Position
  • Standing beside patient
Steps of Performance
  1. Stabilize C2 with a pincher grip on the articular pillars and spinous process
  2. Passively laterally flex the patient’s neck
Alternative Methods

Lateral Procedure

  • Patient Position: Supine, lying with the head rested on the examination table (supported by a pillow) in neutral alignment
  • Examiner Position: Standing at the head of the table
  • Steps:
    1. Gently lift the patient’s head/neck
    2. Stabilize the C2 with a wide pinch grip around the lamina and spinous process
    3. Passively laterally flex the patient’s head

Lateral flexion of the head and C1 against a stabilized C2 will place stress on the alar ligaments, assessing their integrity.

General

Positives

Excessive movement

  • Instability

Sharp lateral pain at the stretched ligament

  • Ligament strain

Recreation of neurologic symptoms (myelopathy, radiculopathy)

  • Alar ligament instability

Pertinent Negatives