Comparison of range of motion during the cervical flexion rotation versus the side-bending rotation test in individuals with and without hyperlaxity

ABSTRACT

Objective: The flexion rotation test (FRT) is used to determine C1-2 involvement in individuals with neck pain and headaches. Some individuals present with generalized joint hyperlaxity (GJH) which could influence the results of this test, which relies on a soft tissue locking mechanism. The purpose of this study was to examine the side-bend rotation test (SBRT), which utilizes osseous locking, compared to the FRT.

Methods: Thirty-eight healthy individuals (25 female, 26.03 years) were assessed for GJH via the Beighton Hypermobility Index (BHI). A blinded examiner performed the FRT and SBRT bilaterally, measuring ROM using a digital goniometer device.

Results: Statistically significant differences in ROM were present for the FRT based on negative (0-3) and positive (4-9) BHI score: (Right 46.4±3.6, 49.6±4.8, p=.031), (Left 45.5±3.5, 49.0±5.2, p=.023); no differences were observed for the SBRT (Right 37.6±4.3, 38.9±3.4), (Left 37.7±4.2, 37.6±3.4).  When further stratifying the groups, a one-way ANOVA and post-hoc testing revealed significant differences of FRT range of motion between the BHI 7–9 group(52.4 ± 4.4 −53.9 ± 3.4) compared to BHI 0–3 (45.4 ± 3.6–46.2 ± 3.5) and 4–6 groups (46.0 ± 3.7–46.4 ± 2.2), p < .001; there were no significant differences between the 0–3 and 4–6 groups. There were no between group differences for the SBRT, BHI 0–3 (37.5 ± 4.4–37.7 ± 4.3), BHI 7–9 (39.9 ± 3.7–39.2 ± 3.5).

Discussion: Individuals with GJH demonstrated significant differences in ROM for the FRT, but not the SBRT. The SBRT may be a useful alternative to the FRT for individuals with hyperlaxity. However, further research needs to be conducted to assess the diagnostic ability of this test in individuals with cervical pathology.

KEYWORDS:

• Cervicogenic headache
• flexion-rotation test
• generalized joint hyperlaxity
• biomechanics
• upper cervical
• range of motion

Acknowledgments

We would like to acknowledge Mr. Michael Lawrence for his assistance with 3D motion capture and analysis at the University of New England Motion Analysis Lab.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Notes on contributors

Brian T. Swanson

Brian T. Swanson is a board-certified orthopaedic clinical specialist and a Fellow, American Academy of Orthopaedic Manual Physical Therapy. He is currently an Assistant Professor in the Department of rehabilitation Sciences, University of Hartford, West Hartford, CT, USA.