A normative study of cervical range of motion measures including the flexion–rotation test in asymptomatic children: side-to-side variability and pain provocation

Abstract

Objectives: Cervical movement impairment has been identified as a core component of cervicogenic headache evaluation. However, normal range of motion values in children has been investigated rarely and no study has reported such values for the flexion-rotation test (FRT). The purpose of this study was to identify normal values and side-to-side variation for cervical spine range of motion (ROM) and the FRT, in asymptomatic children aged 6-12 years. Another important purpose was to identify the presence of pain during the FRT. Methods: Thirty-four asymptomatic children without history of neck pain or headache (26 females and 8 males, mean age 125.38 months [SD 13.14]) were evaluated. Cervical spine cardinal plane ROM and the FRT were evaluated by a single examiner using a cervical ROM device. Results: Values for cardinal plane ROM measures are presented. No significant gender difference was found for any ROM measure. Mean difference in ROM for rotation, side flexion, and the FRT were less than one degree. However, intra-individual variation was greater, with lower bound scores of 9.32u for rotation, 5.30u for side flexion, and 10.89u for the FRT. Multiple linear regression analysis indicates that movement in the cardinal planes only explains 19% of the variance in the FRT. Pain scores reported following the FRT were less than 2/10. Discussion: Children have consistently greater cervical spine ROM than adults. In children, side-to-side variation in rotation and side flexion ROM and range recorded during the FRT indicates that the clinician should be cautious when using range in one direction to determine impairment in another. Range recorded during the FRT is independent of cardinal movement variables, which further adds to the importance of the FRT, as a test that mainly evaluates range of movement of the upper cervical spine.

Effects of the Manual Therapy Approach of Segments C0-1 and C2-3 in the Flexion-Rotation Test in Patients with Chronic Neck Pain: A Randomized Controlled Trial

“…In our study, we found a significant reduction in NPRS for both rotations during the flexion-rotation test in the MT + E group. There is only one previous study that records NPRS during the flexion-rotation test [ 39 ], but the design of this study and the selection of the sample do not allow us to contrast our results.…”

“…The movement stopped when either the subject presented symptoms, or the evaluator found a firm end feel, whichever situation occurred first [ 1 , 9 ]. If any pain appeared during the test, it was recorded by a verbal numeric pain rating scale (NPRS) (scale: 0 = no pain/ 10 = worst pain) for each rotation [ 39 ]. A Cervical Range of Motion (CROM) device (floating compass; Plastimo Airguide, Inc, Buffalo Groove, IL, USA) was used, and three measurements were taken for each rotation.…”

Manipulation Under Anesthesia in Infants With Arthrogenic Newborn Torticollis: A Retrospective Case Series

“…The flexion-rotation test for the upper cervical spine showed 52.97°(flexion-rotation right) and 52.38°(flexion-rotation left) ranging from 45°to 63°and 40°to 63°, respectively. 13 The Wilcoxon test for matched pairs to see if there was a statistically significant difference in the before and after measurements for active and passive ROM within the same patient for the side showing restriction at baseline compared to after treatment was done using SPSS version 21 (IBM Corp, Armonk, New York). Furthermore, the mean change scores for the 3 movements were calculated.…”

Temporomandibular Joint and Cervical Spine Mobility Assessment in the Prevention of Temporomandibular Disorders in Children with Osteogenesis Imperfecta: A Pilot Study

“…Restriction to the active spinal mobility in children with OI can be affected by changes in the bone structure and neck pain. Thus far, few studies have been conducted that would enable the creation of standards with division by age and sex for the mobility of individual joints in children [24][25][26][27].…”