Cervical Spine: How to Create a Reliable Examination

The Cervical Spine is Not Scary! 

The cervical spine is a sensitive region relative to other parts of the body; however, you should not be scared or less confident performing an evaluation in this region! When performing a cervical examination, it is important to assess for vertebral artery dysfunction, upper cervical instability, and other non-musculoskeletal pathology. Once you have cleared these regional red flags, proceed as you would with any examination. The KEY to creating a reliable cervical examination is to follow the same general steps for every new cervical evaluation you perform. These tests and measures are performed in a systematic, reproducible manner.  While the clinician may add or remove testing as needed, the general framework for formulating their diagnosis is consistent.  This consistency allows for efficiency and reproducibility.

Cervical Examination Main Points

1. Minimal positional changes for the patient. It is inefficient to have the patient constantly rolling over, standing, and sitting. A patient in high levels of pain will not be able to tolerate multiple positional changes.
   
2. Always assess for transverse and alar ligament stability. Even in the absence of cervical trauma, it is prudent to perform upper cervical ligamentous testing on anyone you will be performing manual therapy. 
   
3. ​Examiner must assess regional joints, muscles, and nervous system tissue. The body is a single kinetic chain. Movement at one joint increases the demands on local tissue. In the cervical spine, I highly recommend assessing the thoracic spine and CT junction, the shoulder, and the TMJ (see last week's post from Dr. Chris Fox on the TMJ).

Cervical Examination Sequence

Cervical Day 1 Interventions (Post-Evaluation)

Similar to my shoulder evaluation post and lumbar evaluation post, my Day 1 cervical interventions heavily focus on desensitizing the painful tissue through graded tissue exposure. Additionally, I spend a significant amount of time educating the patient on pain science and specific postures to temporarily limit due to pain. 

Cat/ Cow

Cues and Main Focus Points

• Cat: Press through your shoulders and tuck your hips
• Cow: Drop middle back to your mat and tuck your chin
• Light abdominal engagement during both cat and cow

Thoracic Extension over Foam Roller

Cues and Main Focus Points

• Find an area of tension in the middle back
• Arch over the foam roller while keeping your core engaged
• Use your hands to support your neck

Many physical therapists are hesitant to perform a cervical spine evaluation due to a lack of confidence. Do NOT be one of them! Practice and perform the mental repetitions required to consistent and confident during your cervical examination.
-Jim Heafner PT, DPT, OCS

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