Execution
- 1Have the patient sit in a safe supported position.
- 2Explain the maneuver and screen for contraindications such as cardiovascular risk, dizziness, or intolerance to breath holding.
- 3Have the patient take a deep breath and hold it.
- 4Have the patient bear down as if trying to move the bowels.
- 5Ask whether the maneuver reproduces or increases the familiar neck or arm symptoms and stop if dizziness occurs.
Positive outcome
Increase or reproduction of familiar radicular symptoms during bearing down is positive. The response may reflect increased intrathecal pressure from a space-occupying lesion such as disc herniation, stenosis, tumor, or osteophyte.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Wainner et al. (2003) | 0.69 | 22 | 94 | 3.66 | 0.83 |
CommentValsalva is subjective and has low sensitivity, so a negative result does not rule out cervical radiculopathy. Use caution because breath holding and bearing down may provoke dizziness or syncope in susceptible patients.
Moderate Clinical Value