Clinical Cervical Instability | Cervical Motor Control Impairment

In another post, we presented a similar list of subjective and objective features for clinical instability of the lumbar spine. Cook et al. (2005) conducted a second Delphi study to identify which subjective and objective signs and symptoms could be indicative of clinical cervical spine instability/cervical motor control impairment. So here’s the list of the top 5 subjective symptoms:

1. Intolerance to prolonged static postures 
2. Fatigue and inability to hold head up
3. Symptom decrease with external support, including propping on hands or wearing a collar
4. The Frequent need for self-manipulation
5. Feeling of instability, shaking, or lack of control

The top 5 objective identifiers are:

1. Poor coordination or neuromuscular control, including poor recruitment and dissociation of cervical segments with movement
2. Abnormal joint play
3. Motion that is not smooth throughout range (of motion), including segmental hinging, pivoting, or fulcruming
4. Aberrant movement
5. Hypomobility of the upper thoracic spine

As mentioned in our previous video on lumbar spine instability, it is important to recognize that there is no valid clinical test to diagnose spinal instability. Therefore, a Delphi study is the best available evidence we have.

Other common tests to assess for a cervical motor control impairment are:

• Craniocervical Flexion Test
• Deep Neck Flexor Endurance Test / Test of Harris
• Cervical Extensor Endurance Test

21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE

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Cook, C., Brismée, J. M., Fleming, R., & Sizer Jr, P. S. (2005). Identifiers suggestive of clinical cervical spine instability: a Delphi study of physical therapists. Physical Therapy, 85(9), 895-906.