The Influence of Lower Cervical Joint Pain on Range of Motion and Interpretation of the Flexion-rotation Test

Overview

Journal J Man Manip Ther

Specialty Rehabilitation Medicine

Date 2011 Sep 3

PMID 21886422

Citations 10

Authors

Toby Hall

Kathy Briffa

Diana Hopper

Affiliations

Soon will be listed here.

Abstract

Objective: The purpose of this study was to investigate the impact of lower cervical facet joint pain (CFP) on the flexion-rotation test (FRT).

Methods: A single blind, comparative group design was used to investigate whether lower CFP influences FRT mobility and examiner interpretation. Twenty-four subjects were evaluated, 12 with cervicogenic headache (age 26-63 years) and 12 with lower CFP (age 44-62 years), confirmed by therapeutic cervical facet joint intervention. A single blinded examiner conducted the FRT, reporting the test state (positive or negative) before measuring range of motion using a goniometer. Subjects with lower CFP were evaluated by the FRT prior to therapeutic intervention and were excluded from analysis if they did not gain complete symptomatic relief following the procedure. Only subjects with immediate complete relief were included.

Results: The average range of unilateral rotation to the limited side during the FRT was 26 and 37.5° for the cervicogenic headache and lower CFP groups respectively. The difference between groups was significant (P<0.01). Sensitivity and specificity for cervicogenic headache diagnosis was 75 and 92% respectively. A receiver operating curve revealed that an experienced examiner using the FRT was able to make the correct diagnosis 90% of the time (P<0.01), with a positive cut-off value of 32°.

Discussion: These findings provide further evidence for the clinical utility of the FRT in cervical examination and cervicogenic headache diagnosis.

Citing Articles

Utilization of the Cervical Flexion Rotation Test to Confirm Rotation Directional Preference in People With Neck Pain: A Case Series.

Post M, Schenk R, Fargnoli R Cureus. 2023; 15(10):e47389.

PMID: 38022134 PMC: 10657147. DOI: 10.7759/cureus.47389.

Association between age, sex and cervical and upper cervical rotation tests. Descriptive and correlational study in healthy volunteers.

Zarate-Tejero C, Hidalgo-Garcia C, Lucha-Lopez O, Hernandez-Secorun M, Krauss J, Rodriguez-Rubio P Ther Adv Chronic Dis. 2023; 14:20406223231170158.

PMID: 37152351 PMC: 10155033. DOI: 10.1177/20406223231170158.

Effects of SNAG mobilization combined with a self-SNAG home-exercise for the treatment of cervicogenic headache: a pilot study.

Paquin J, Tousignant-Laflamme Y, Dumas J J Man Manip Ther. 2021; 29(4):244-254.

PMID: 33541242 PMC: 8366674. DOI: 10.1080/10669817.2020.1864960.

Immediate and Short-Term Effects of Upper Cervical High-Velocity, Low-Amplitude Manipulation on Standing Postural Control and Cervical Mobility in Chronic Nonspecific Neck Pain: A Randomized Controlled Trial.

Gomez F, Escriba P, Oliva-Pascual-Vaca J, Mendez-Sanchez R, Puente-Gonzalez A J Clin Med. 2020; 9(8).

PMID: 32784959 PMC: 7463842. DOI: 10.3390/jcm9082580.

Concurrent validity and reliability of measuring range of motion during the cervical flexion rotation test with a novel digital goniometer.

Luedtke K, Schoettker-Koniger T, Hall T, Reimer C, Grassold M, Hasselhoff-Styhler P BMC Musculoskelet Disord. 2020; 21(1):535.

PMID: 32781990 PMC: 7422569. DOI: 10.1186/s12891-020-03525-6.

References

Hall T, Briffa K, Hopper D . Clinical evaluation of cervicogenic headache: a clinical perspective. J Man Manip Ther. 2009; 16(2):73-80. PMC: 2565113. DOI: 10.1179/106698108790818422. View

Hall T, Briffa K, Hopper D, Robinson K . Long-term stability and minimal detectable change of the cervical flexion-rotation test. J Orthop Sports Phys Ther. 2010; 40(4):225-9. DOI: 10.2519/jospt.2010.3100. View

Boswell M, Singh V, Staats P, Hirsch J . Accuracy of precision diagnostic blocks in the diagnosis of chronic spinal pain of facet or zygapophysial joint origin. Pain Physician. 2006; 6(4):449-56. View

Bogduk N . Diagnostic nerve blocks in chronic pain. Best Pract Res Clin Anaesthesiol. 2003; 16(4):565-78. DOI: 10.1053/bean.2002.0252. View

Takasaki H, Hall T, Oshiro S, Kaneko S, Ikemoto Y, Jull G . Normal kinematics of the upper cervical spine during the Flexion-Rotation Test - In vivo measurements using magnetic resonance imaging. Man Ther. 2010; 16(2):167-71. DOI: 10.1016/j.math.2010.10.002. View

Sjaastad O, Fredriksen T, Pfaffenrath V . Cervicogenic headache: diagnostic criteria. The Cervicogenic Headache International Study Group. Headache. 1998; 38(6):442-5. DOI: 10.1046/j.1526-4610.1998.3806442.x. View

Zweig M, Campbell G . Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine. Clin Chem. 1993; 39(4):561-77. View

Hall T, Robinson K, Fujinawa O, Akasaka K, Pyne E . Intertester reliability and diagnostic validity of the cervical flexion-rotation test. J Manipulative Physiol Ther. 2008; 31(4):293-300. DOI: 10.1016/j.jmpt.2008.03.012. View

Ogince M, Hall T, Robinson K, Blackmore A . The diagnostic validity of the cervical flexion-rotation test in C1/2-related cervicogenic headache. Man Ther. 2006; 12(3):256-62. DOI: 10.1016/j.math.2006.06.016. View

10.

Hall T, Briffa K, Hopper D, Robinson K . The relationship between cervicogenic headache and impairment determined by the flexion-rotation test. J Manipulative Physiol Ther. 2010; 33(9):666-71. DOI: 10.1016/j.jmpt.2010.09.002. View

11.

Hall T, Robinson K . The flexion-rotation test and active cervical mobility--a comparative measurement study in cervicogenic headache. Man Ther. 2004; 9(4):197-202. DOI: 10.1016/j.math.2004.04.004. View

12.

Hall T, Briffa K, Hopper D, Robinson K . Comparative analysis and diagnostic accuracy of the cervical flexion-rotation test. J Headache Pain. 2010; 11(5):391-7. PMC: 3452271. DOI: 10.1007/s10194-010-0222-3. View

13.

. The International Classification of Headache Disorders: 2nd edition. Cephalalgia. 2004; 24 Suppl 1:9-160. DOI: 10.1111/j.1468-2982.2003.00824.x. View

14.

Niere K, Robinson P . Determination of manipulative physiotherapy treatment outcome in headache patients. Man Ther. 2001; 2(4):199-205. DOI: 10.1054/math.1997.0300. View

15.

Antonaci F, Ghirmai S, Bono G, Sandrini G, Nappi G . Cervicogenic headache: evaluation of the original diagnostic criteria. Cephalalgia. 2001; 21(5):573-83. DOI: 10.1046/j.0333-1024.2001.00207.x. View

16.

Smith K, Hall T, Robinson K . The influence of age, gender, lifestyle factors and sub-clinical neck pain on the cervical flexion-rotation test and cervical range of motion. Man Ther. 2007; 13(6):552-9. DOI: 10.1016/j.math.2007.07.005. View