Craniocervical Flexion Test

The Craniocervical Flexion Test (CCF Test) is an invaluable diagnostic tool used to assess the function of deep cervical flexor muscles, which are crucial for maintaining proper neck posture and stability.

What is the Craniocervical Flexion Test?

The Craniocervical Flexion Test is specifically designed to evaluate the strength and endurance of the deep cervical flexors: the longus capitis and longus colli muscles. These muscles are not only vital for neck movement but also play a significant role in supporting the cervical spine.

See Also: Cervical Spine Range of Motion

How is the Craniocervical Flexion Test Performed?

To conduct the Craniocervical Flexion Test, the following steps are typically followed:

1. Setup: The patient lies on their back (supine position) with their knees bent. This position is often referred to as “crook lying”. The head and neck are kept in a neutral position, aligned with the spine, sometimes with the aid of towels placed for support.
2. Equipment: A pneumatic pressure device, equipped with an inflatable pressure sensor, is placed under the neck at the level of the cervical spine. The device is initially inflated to a baseline pressure of 20 mm Hg to conform to the natural curve of the cervical spine.
3. Execution: The patient performs a series of nodding movements with their head, which flexes the cervical spine. This is done in five incremental stages, increasing the pressure from 22 mm Hg up to 30 mm Hg, with each stage held for 10 seconds. There is a 10-second rest period between each stage.
4. Observation: Throughout the test, it is crucial that the patient does not use their superficial neck muscles (such as the sternocleidomastoid or platysma). The focus should solely be on engaging the deep cervical flexors.

Why is the Craniocervical Flexion Test Important?

The Craniocervical Flexion Test is not just a measure of muscle strength but also muscle coordination and endurance within the neck. This test helps in:

• Diagnosing Dysfunctions: Identifying weaknesses in the deep cervical flexors can help pinpoint issues that may contribute to neck pain and headaches.
• Evaluating Progress: For patients undergoing rehabilitation for neck injuries, the CCF Test can be used to track improvement in muscle function over time.
• Preventing Injuries: By strengthening the deep cervical muscles, individuals may reduce their risk of neck injuries and improve their overall posture.

Interpretation of Results

• Normal Performance: Typically, young to middle-aged adults should be able to reach and maintain pressures between 26 and 30 mm Hg without engaging the superficial neck muscles.
• Elderly Considerations: Older adults may rely more on superficial muscles like the sternocleidomastoid, which is considered normal due to age-related changes in muscle function.
• Signs of Concern: Inability to increase pressure beyond 26 mm Hg, hold contractions for the required duration, or maintaining steady pressure are signs of reduced endurance and possibly underlying muscular issues.

Conclusion

The Craniocervical Flexion Test is a sophisticated, yet essential tool in the repertoire of tests used to assess neck function and health. By understanding and utilizing this test, healthcare providers can offer better care, tailored treatments, and preventative measures for neck-related issues. For patients, being informed about such tests can aid in understanding their own bodies better and participating actively in their treatment processes.

References & More

1. Orthopedic Physical Assessment by David J. Magee, 7th Edition.
2. Jull GA, O’Leary SP, Falla DL. Clinical assessment of the deep cervical flexor muscles: the craniocervical flexion test. J Manip Physiol Ther. 2008;31:525–533. Pubmed
3. Jull G, Barrett C, Magee R, et al. Further clinical clarification of the muscle dysfunction in cervical headache. Cephalalgia. 1999;19:179–185. Pubmed
4. Jull G, Falla D. Does increased superficial neck flexor activity in the craniocervical flexion test reflect reduced deep flexor activity in people with neck pain? Man Ther. 2016;25:43–47. Pubmed
5. Uthaikhup S, Jull G. Performance in the cranio-cervical flexion test is altered in elderly subjects. Man Ther. 2009;14:475–479. Pubmed