Cervical Flexion-Rotation Test = CFRT:

The Cervical Flexion-Rotation Test = CFRT in contrast to other forms of the manual examination.
It is an easily applied clinical test for purportedly biased to assess the dysfunction at the motion segment of C1-C2.
The C1-C2 cervical spine motion segment is accounted for 50% of the rotation in the cervical spine.

Manual examination of this test sensitivity = high & specificity which is detect to the presence /absence of cervical joint dysfunction for the neck pain & headache patients.
So that these tests are involved a high degree of skill on the part of the examiner & reliability of this is questioned.

In this Cervical Flexion-Rotation Test procedure, so that the cervical spine is fully flexed, into the attempt to isolate the movement of to the C1-C2 of the cervical spine, which is unique for the ability to rotate in the flexion movement. The normal range of rotation motion = ROM in the end range of flexion movement is shown to be 44° to each side. In the contrast, the subjects are suffering from headaches with the C1-C2 of cervical spine dysfunction for an average of 17° in less rotation.

Smith et al.
It is concluded that age does not significantly influence the mobility during the CFRT = Cervical Flexion-Rotation Test One explanation for this test is could be that the upper cervical spine is undergoing minimal age-related degenerative changes & in comparison to the joints which is lower in the cervical spine.
Also, many lifestyle factors are including that time spent sitting, sleep position, & side dominant lifestyle which does not appear to influence variability in cervical mobility.

Table of Contents

What is the purpose of the Cervical Flexion-Rotation Test = CFRT?

The patient is in the supine lying position.
The examiner [ therapist] sits or stands at the head of the patient & flexes the cervical spine fully.
While holding the flexed position, the examiner [ therapist ] then rotates the head left & right.
Normal rotation in the flexed position should be about 45′ each way.
Maintaining the flexed position is more likely to isolate the rotation to the C1 -C2 area so that C1 -C2 area so that C1 -C2 dysfunction may be evident if the rotation is less [ hypo-mobility ] or more [ hyper-mobility ] than normal.

Hall et al.
It is shown that sensitivity, diagnostic accuracy & specificity of the CFRT = Cervical Flexion-Rotation Test is very high 90% & 88% with the 92% agreement for the experienced examiners P<.001.
Furthermore, although the inexperienced examiners reported a greater range for the CFRT = Cervical Flexion-Rotation Test than the experienced examiners, sensitivity, specificity & agreement is still within the clinically acceptable levels.
The CFRT= Cervical Flexion-Rotation Test is a useful clinical measure in cervical movement impairment & it assists in the differential diagnosis of Cervicogenic Headache.

Good levels of inter & intra-observer reliability are established by Takasaki et al.
Comparing the manual test outcome with the MRI measurement of cervical segment rotation.
ICCs is greater than 0.7 with the narrow 95% confidence interval values for a mean range of rotation = ROM.
These data lend support to the content validity of the CFRT = Cervical Flexion-Rotation Test as a clinical test of atlanto-axial mobility.

It is important to recognize that the CFRT = Cervical Flexion-Rotation Test.
It is a relatively isolated test of the movement impairment of the C1-C2 motion segment & may not adequately test the other motion segments.

Recently, it is shown that the impairment of cervical movement, in association with the palpable upper cervical joint dysfunction & impairment in the craniocervical muscle control
in the sensitivity of = 100% & the specificity of = 94% to identify Cervicogenic Headache from the Migraine.
This is clinically important since for example physiotherapy is found to be effective for Cervicogenic Headache CGH but not for migraine.

The range is most restricted in the subjects with the CGH = 25° significantly more important impairment than either group’s Migraine (42′ or Multiple Headache forms to MHF = 35°.
It appears that the presence of the aura is a minimal effect on the range of motion during the CFRT= Cervical Flexion-Rotation Test.

As stated previously, the CFRT = Cervical Flexion-Rotation Test is been shown negative in the subjects with the CGH where the pain arises from the cervical levels other than C1-C2 of the cervical spine.

This test is used to test the tectorial membrane.
The patient lies with the head in a neutral position.
The examiner [ therapist ] applies gentle traction to the head.
Provided no symptoms are produced, the patient’s head is lifted forward, flexing the spine & traction is reapplied.
If the patient complains of symptoms, like pain or paresthesia in the second position, then the test is considered positive for a laxtectorial membrane.