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For Advanced ID Providers Only: Seriously. These methods and structures are rarely necessary.

Cervical Rotation and End Range Motions: Using selective tension principles

When assessing cervical rotation you may notice compensations or changes in the head position at the end of the motion. This can be a clue as to what tissue is restricting the movement. You can also ask the patient to perform an additional motion at the end of the motion.

  • Upper Cervical Flexion: If the patient can perform upper cervical flexion while at end range the splenius capitis can be put at the bottom of the list.
  • Lateral Flexion: If the patient can perform ipsilateral lateral flexion while at end range the inferior oblique and splenius capitis goes to the bottom of your list.
  • Extension: If the patient goes into extension while at end range the rotatores and miltifidus go to the top of your list.
  • Shoulder Shrug: If the patient is able to “power through” or push past restriction, often recruiting the ipsilateral levator and causing the shoulder to elevate, serratus posterior superior goes to the top of the list. What’s happening? All the cervical structures are relatively healthy and can generate enough force to overpower the serratus restriction.

These motions are just additional data points and not highly sensitive or specific. There is too much interdependence in the cervical/upper thoracic spine for these motion to be highly reliable.

Advanced providers may also find they occasionally need to palpate and treat: 

MAR Inferior Oblique

MAR Splenius Capitis