Video 32 – Diagnostics Cervical Spine Active – Passive
Diagnostics Cervical Spine Active - Passive
Source: Alex Tiemes, 3DMT
Instruct the person to sit in a comfortable position, upright, with feet on the floor and hands relaxed on the lap. To assess active movement possibilities, guide them in rotating their head by looking over one shoulder and then the other. It is crucial to emphasize the use of the eyes during this action. When initiating a head turn or rotation, there is a necessity to focus on something or respond to a noise behind them, as in the case of being called. Initially, the eyes will move towards the direction of the sound or the object to be seen, covering an approximate 8-degree movement.
During this eye movement, the muscles in the neck, particularly within the C0C1-C2 complex, increase tension on one side and decrease tension on the other ( m. semispinalis capitis, m. obliquus capitis superior, m. obliquus capitis inferior, m. rectus capitis posterior major, m. rectus capitis posterior minor, m. rectus capitis lateralis, m. rectus capitis anterior, m. longus capitis). When rotating to the right, the eyes lead the movement, followed by the muscles in the C0C1-C2 complex completing the rotation. When muscle tension is too high, encourage the person to use their eyes for only a few degrees. After actively performing the rotation, the therapist should gently emphasize the rotation at the end of the movement, known as the 'end feel.'
Following the rotation, instruct the person to move their head sideways, paying attention to possible accompanying movements such as lifting one shoulder or the thoracic spine moving accordingly in the same direction. Passive gentle emphasis should be performed in both directions to ascertain the 'end feel.' Imitate the person's movement, even if it is not a physiological way of moving. After this passive emphasis, perform a lateral flexion of the cervical spine with a manual shift of the spine in the opposite direction, ensuring the head maintains its balance, and the cervical spine joints move physiologically. Be attentive to compensatory movements in the shoulder(s) and the thoracic spine.
Next, instruct the person to flex the head (cervical spine) and then extend it. Passive emphasis should be performed in both directions to determine the 'end feel' and assess whether all parts of the cervical spine actively participate in the movement or can be moved passively. Additionally, ask the person to move their eyes in the same direction to increase and decrease tension in the muscles involved in this movement. Be mindful of compensatory movements in the thoracic spine.
Especially during cervical spine extension, observe for an extreme extension, which is a common occurrence when asked to look up. A physiological movement for looking up involves an extension of the cervico-thoracic transition (CTT), encompassing C6, C7, and Th1. Trigger increased CTT extension by applying a soft touch in the cranial direction on the manubrium sterni, which is physiologically connected to C7 (clavicle), Th1 (costa I), and Th2 (costa II).
While fixing C3, C4, and C5, instruct the person to flex and extend their head, focusing on the C0, C1, and C2 complex. Evaluate whether the mid-cervical part wants to move in sync with the C0C1-C2 complex, which may indicate a decreased range of movement in the C0C1-C2 complex or unfamiliarity with such a movement in that part of the cervical spine.
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