Execution
- 1Screen the history for trauma, connective tissue risk, inflammatory disease, congenital risk factors, or symptoms suggesting instability.
- 2Ask about intolerance to static postures, fatigue or inability to hold the head up, relief with external support, frequent self-manipulation, instability sensations, and sudden sharp episodes.
- 3Observe cervical movement quality for poor control, segmental hinging, aberrant motion, or non-smooth movement.
- 4Perform cautious neurological and vascular screening before any end-range cervical testing.
- 5If instability is suspected, avoid provocative end-range loading and refer for appropriate medical assessment or imaging.
Positive outcome
The screen is positive when several subjective instability identifiers occur with objective findings such as poor neuromuscular control, abnormal joint play, aberrant movement, or segmental hinging. Serious neurological or vascular features require urgent escalation rather than further manual testing.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Cook et al. (2005) | Delphi consensus | NA | NA | NA | NA |
CommentNot a diagnostic accuracy test; it is a consensus-based clinical screening construct. Its value is mainly risk recognition and decision-making about whether to avoid end-range testing or manipulation.
Low Clinical Value