Cervical Flexion Rotation Test

The Cervical Flexion Rotation Test is used to determine the mobility of the upper cervical spine (C1–C2) and to determine if the upper cervical spine is the cause of a cervicogenic headache.
How to perform the Cervical Flexion Rotation Test?
The patient is in supine lying position. The examiner sits or stands at the head of the patient and flexes the cervical spine fully. While holding the flexed position, the examiner then rotates the head left and right.
Normal rotation in the flexed position should be about 45° each way. Maintaining the flexed position is more likely to isolate the rotation to the C1–C2 area so that C1–C2 dysfunction may be evident if the rotation is less (hypomobility) or more (hypermobility) than normal.
If the patient also has a headache, the restricted range of motion to one side is likely to be cervicogenic in nature, not a migraine or other type of headache.
See Also: Cervical Spine Range of Motion

Accuracy
Hall et al. showed that diagnostic accuracy, sensitivity, and specificity of the cervical flexion rotation test were very high (90% and 88% with 92% agreement for experienced examiners (P<.001)). Furthermore, although inexperienced examiners reported greater range for the cervical flexion rotation test than experienced examiners, sensitivity, specificity and agreement were still within clinically acceptable levels.
In a single-blind comparative group design aimed to investigate the sensitivity and specificity of the cervical flexion-rotation test in the diagnosis of C1/2-related cervicogenic headache, the sensitivity and specificity of the flexion-rotation test was 91% and 90%, respectively (P<.001), with an overall diagnostic accuracy of 91% (P<.001).

References & More
- Orthopedic Physical Assessment by David J. Magee, 7th Edition.
- Rubio-Ochoa J, Benitez-Martinez J, Lluch E, et al. Physical examination tests for screening and diagnosis of cervicogenic headache: a systematic review. Man Ther. 2016;21:35–40. Pubmed
- Hall T, Briffa K, Hopper D. The influence of lower cervical joint pain on range of motion and interpretation of the flexion-rotation test. J Man Manip Ther. 2010;18(3):126–131. Pubmed
- Hall TM, Robinson KW, Fujinawa O, Akasaka K, Pyne EA. Intertester reliability and diagnostic validity of the cervical flexion-rotation test. J Manipulative Physiol Ther. 2008 May;31(4):293-300. doi: 10.1016/j.jmpt.2008.03.012. PMID: 18486750. Pubmed
- Ogince M, Hall T, Robinson K, Blackmore AM. The diagnostic validity of the cervical flexion-rotation test in C1/2-related cervicogenic headache. Man Ther. 2007 Aug;12(3):256-62. doi: 10.1016/j.math.2006.06.016. Epub 2006 Nov 16. PMID: 17112768. Pubmed
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