Assesses hypomobility or dysfunction of the upper cervical spine, specifically at the C1-C2 segment.

  • Upper Cervical Spine Rotation

  • Upper cervical pain
  • Headache

Patient Position
  • Supine
Examiner Position
  • Standing or seated behind patient’s head
Steps of Performance
  1. Passively bring the cervical spine into maximal flexion
  2. While maintaining full flexion, passively rotate the cervical spine to end-range bilaterally (an average of 44 degrees)
  3. Range of motion (ROM) may be limited due to pain or physical resistance
Alternative Methods

End-range flexion limits concurrent rotation of the mid to lower cervical spine. Thus, maintaining end-range flexion will isolate subsequent rotation of the cervical spine to the C1-C2 joints, allowing dysfunction such as local pain, headache, or limited ROM to be more confidently attributed to upper cervical joint dysfunction.

General

Positives

Upper cervical hypomobility

  • ≥10 degrees reduced ROM from the anticipated 44 degrees increases suspicion of movement dysfunction at the C1-C2 joint

Recreation of patient's headache pattern

  • Increases likelihood of cervicogenic headache

Pertinent Negatives

DATA
TAGS
References
Ogince M, Hall T, Robinson K, Blackmore AM. The diagnostic validity of the cervical flexion–rotation test in C1/2-related cervicogenic headache. Manual Therapy. 2007;12(3):256-262. doi:10.1016/j.math.2006.06.016.
Lefebvre R, Novak C. Cervical Orthopedic Tests. University of Western States. Published 2021. Accessed April 17, 2022.
Hall T, Briffa K, Hopper D, Robinson K. Long-term stability and minimal detectable change of the cervical flexion-rotation test. Journal of Orthopaedic & Sports Physical Therapy. 2010;40(4):225-229. doi:10.2519/jospt.2010.3100.
Hall T, Robinson K. The flexion–rotation test and active cervical mobility—a comparative measurement study in cervicogenic headache. Manual Therapy. 2004;9(4):197-202. doi:10.1016/j.math.2004.04.004.
Hall TM, Robinson KW, Fujinawa O, Akasaka K, Pyne EA. Intertester reliability and diagnostic validity of the cervical flexion-rotation test. Journal of Manipulative and Physiological Therapeutics. 2008;31(4):293-300. doi:10.1016/j.jmpt.2008.03.012.

Assesses hypomobility or dysfunction of the upper cervical spine, specifically at the C1-C2 segment.

  • Upper cervical pain
  • Headache

Patient Position
  • Supine
Examiner Position
  • Standing or seated behind patient’s head
Steps of Performance
  1. Passively bring the cervical spine into maximal flexion
  2. While maintaining full flexion, passively rotate the cervical spine to end-range bilaterally (an average of 44 degrees)
  3. Range of motion (ROM) may be limited due to pain or physical resistance
Alternative Methods

End-range flexion limits concurrent rotation of the mid to lower cervical spine. Thus, maintaining end-range flexion will isolate subsequent rotation of the cervical spine to the C1-C2 joints, allowing dysfunction such as local pain, headache, or limited ROM to be more confidently attributed to upper cervical joint dysfunction.

General

Positives

Upper cervical hypomobility

  • ≥10 degrees reduced ROM from the anticipated 44 degrees increases suspicion of movement dysfunction at the C1-C2 joint

Recreation of patient's headache pattern

  • Increases likelihood of cervicogenic headache

Pertinent Negatives