Execution
- 1Have the patient lie supine with the head supported.
- 2Fully flex the cervical spine to lock out the lower cervical segments.
- 3While maintaining full flexion, examiner gently rotates the head to the left and right.
- 4Estimate or measures available rotation in each direction, normally around 45° each way.
- 5Note restriction, symptom reproduction, and side-to-side asymmetry.
Positive outcome
A positive test is restricted rotation in full cervical flexion, commonly less than about 32° to 33° or clearly asymmetrical, especially when it reproduces the patient's headache. Restriction suggests upper cervical, particularly C1-C2, hypomobility.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Ogince et al. (2007) | NA | 91 | 90 | 9.10 | 0.10 |
| Hall et al. (2008) | high intertester agreement | 90 | 88 | 7.50 | 0.11 |
CommentThe flexion-rotation test has relatively strong evidence for identifying C1-C2-related impairment in cervicogenic headache populations. It is less appropriate as a general cervical pain screen unless the clinical presentation suggests upper cervical involvement.
High Clinical Value