I distinctly remember the first few times I performed manual therapy on the cervical spine. My hands were sweatier than normal, and I had an unusual shakiness in my fingers. For some reason, I thought everyone with cervical pain was on the verge of having upper cervical instability. While this mindset was irrational, it may have been something that was instilled in me during physical therapy school. This fear was likely due to a lack of experience with the cervical examination and techniques.
While performing a cervical spine examination may seem intimidating, it is very similar to any other body region. The main objectives should be to determine if the patient is appropriate for physical therapy and to identify the primary impairments that will have the greatest effect. The key to each evaluation is efficiently completing this process so that more time can be spent on treatment!
In many instances, the examination begins in sitting following the subjective history. Depending on the subjective information, various safety tests and measures may need to be completed. While all safety tests may not be completed on every cervical evaluation, having them accessible is important. Assuming the patient is appropriate for physical therapy, many other tests can be performed in the seated posture to assist in making the appropriate physical therapy diagnosis. For example, shoulder active range of motion should be performed to determine if this region is a pain generator or contributing to the cervical pain. Additionally, a seated upper rib mobility assessment should be performed to determine if the ribcage is contributing the one's symptoms. The complete flow of tests and measures can be seen in the picture below.
In the Efficient Examination breakout, many special tests are left off the list. Being efficient means quickly determining the painful region and identify primary impairments. The cervical examination should includes a brief assessment of the thoracic spine, cervical spine, ribcage, and upper quarter. Quickly assessing each one of these regions will help determine the true cause of the patient's symptoms. Do not be intimated by the cervical examination!
Jim Heafner PT, DPT, OCS
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Last year Jim published 'The Guide to Efficient Physical Therapy Examination.' The Ebook takes readers through a step-by-step evaluation of the lumbar spine, cervical spine, knee, and shoulder. Each examination is centered around efficiency and clinical excellence.