C2 Flexion for Arm With Again Cues

April 04, 2022 Posting Komentar

J Man Manip Ther. 2015 May; 23(2): 61–67.

The flexion–rotation test performed actively and passively: a comparison of range of motility in patients with cervicogenic headache

Abstract

Limitation in cervical spine range of motion (ROM) is ane criterion for diagnosis of cervicogenic headaches (CHs). The flexion–rotation test, when performed passively (FRT-P), has been shown to be a useful test in diagnosis of CH. Few investigations have examined the flexion-rotation test when performed actively (FRT-A) by the private, and no studies have examined the FRT-A in a symptomatic population. The purpose of this written report was to compare ROM during the FRT-A and FRT-P in patients with CH and asymptomatic individuals and to compare ROM between sides for these two versions of the examination. Twelve patients with CH and 10 asymptomatic participants were included in the study. An viii-camera Move Assay organization was used to measure head motion relative to the trunk during the FRT-P and the FRT-A. Cervical rotation ROM was measured in a position of full cervical flexion for both tests. No significant divergence was observed betwixt right and left sides for cervical rotation ROM during the FRT-P nor the FRT-A when performed by asymptomatic participants. In patients with CH, a significant divergence was observed between sides for the FRT-P (P = 0.014); however, the FRT-A failed to reveal bilateral descrepancy in rotation ROM.

Keywords: Flexion rotation exam, Headache diagnosis, Range of motion, Upper cervical

Introduction

Differential diagnosis of cervicogenic headaches (CHs) from other headache types is an essential factor in guiding clinicians to the development of advisable intervention plans. The diagnostic criteria for CH, as established by the International Headache Order (IHS), facilitates this process.¹ ^, ⁱⁱ Facet joints at Occiput/C1, C1/C2, and C2/C3 have been found to refer localized symptoms to the occipital and suboccipital region, which can exist associated with CH pain.ⁱⁱⁱ ^– ⁵ Headache type is often misdiagnosed^vi and this is complicated by the fact that many subjective features of headaches are common among differing headache types.² ^, ⁷ The IHS criteria for diagnosis of CH comprise factors related to limitations in cervical range of motion (ROM), making the examination of the cervical spine an important component of differential diagnosis.¹ ^, ^viii These ROM criteria include bear witness of limited global active cervical ROM, passive intervertebral joint play,⁹ ^– ¹¹ and passive ROM specifically at the C1/C2 spinal segment in patients with CH.¹² ^, ¹³ Although global limitations in agile ROM and passive limitations in intervertebral motion take been institute in this population, agile ROM limitations specific to the upper cervical spine have non been investigated in patients with CH.

The flexion–rotation test has been described as a method to differentiate rotational motions taking identify at the upper versus lower cervical spine.¹⁴ ^– ¹⁶ The test is unremarkably performed passively. The passive flexion–rotation test (FRT-P) is performed with the patient supine. An examiner passively positions the patient's neck into total flexion to pre-tension the structures of the heart and lower cervical spine, then the patient's head is passively rotated each direction while the flexed position is maintained.¹⁵ Since the C1/C2 motility segment accounts for 40–lx% of the total cervical ROM, this test is intended to isolate move at that segment.¹⁷ ^, ^eighteen Criteria for a positive exam consists of ROM restriction with business firm resistance, a x-caste divergence in motility betwixt painful and non-painful sides, and pain provocation.¹² ^, ¹⁹

The FRT-P has been found to take a high degree of sensitivity (ninety–91%) and specificity (88–90%) when used to examine patients with CH.¹² ^, ^xx Hall and Robinson¹⁹ constitute the FRT-P to exist positive in patients with CH originating from C1/C2. Meaning differences have been shown in FRT-P results when comparison unilateral rotation ROM in patients with CH to those with migraine headaches and multiple headache forms.²⁰ Although the FRT was originally designed to assess C1/C2 rotation ROM passively, an active version of the examination (FRT-A) has been evaluated for its reliability in healthy individuals. It was constitute highly reliable in regards to ROM measurement.¹⁵ Despite the reliability of the FRT-A, this test has not been compared to the FRT-P in patients with CH.

Performance of the FRT-A has been previously described in a healthy population. Participants were seated in a chair and actively aptitude their neck downwardly to introduce cervical flexion. While maintaining this position, they rotated their head every bit far as possible in each direction.¹⁵

The FRT-P has been shown to exist a valid exam to diagnose CH;¹² still, in that location may be a benefit to performing the FRT actively. The FRT-A is performed with the patient in a seated position which incorporates functional weight-bearing, as opposed to the FRT-P, which is performed with the patient in a supine position.¹⁵ The weight-bearing position is advocated in some approaches to segment-specific examination and intervention of the cervical spine.²¹ ^, ²⁵ This position too affords an culling for patients who are unable to lie supine comfortably. In patients with considerable pain, the agile neck motion may be preferable, since they can control the motion compared to a passive movement performed by the clinician. In this case, at that place is potential for muscle guarding to occur confronting passive testing. An additional potential advantage for the FRT-A is that it is not dependent upon the clinician's transmission skill to determine the end-experience.

Despite the loftier reliability of the FRT-A measurements,¹⁵ its power to find bilateral rotation ROM differences has not been investigated. Additionally, FRT-A measurements have non been compared to the FRT-P in patients with CH. Thus, the diagnostic value and the clinical utility of the FRT-A is unknown. Therefore, the aim of this study was to compare ROM during the FRT-A and FRT-P in patients with CH and asymptomatic participants and to determine if the FRT-A tin be used to identify side-to-side differences in ROM in patients with CH.

Methods

Participants

This study was registered at Clinicaltrials.gov ({"type":"clinical-trial","attrs":{"text":"NCT02070172","term_id":"NCT02070172"}}NCT02070172). Participants were recruited through ads posted on the institutional website. The sample size estimates for FRT-P measurements were derived a priori using a statistical power and alpha level set at 0.95 and 0.05, respectively. The mean and standard deviation information for the between groups comparisons were taken from Hall and Robinson,^xix Ogince et al.,¹² and Hall et al.^thirteen The maximum required full sample size was 16 participants (eight in each group), based on a calculated issue size range ii.10–3.06 and a standard deviation range 5.8–11. For the within-group (between sides) differences, a maximum sample size of six participants was required based on information bachelor from Hall and Robinson^nineteen for a calculated event size range 1.78–three.57. A total of 24 male person and female participants between the ages of 22 and l years were recruited to participate in the study (fifty% more than required co-ordinate to sample size estimation). Data were analyzed on just 22 of the 24 participants due to limitations related to marker visibility.

Demographic data including symptom duration are shown in Tabular array i. Symptom duration in the CH group ranged from half-dozen to 156 months (mean±SD = 96.17±91.34 months). Participants in the asymptomatic group were excluded from the written report if they reported a history of headaches or neck pain. Patients in the CH group were subjectively screened initially through an interview before beingness invited for an objective screening. Patients were allowed to continue any electric current headache medications during their participation in the study. Patients with CH were required to run into the following inclusion criteria, which fulfills five of vii criteria for diagnosis of CH.¹ ^, ²⁰ ^, ²⁶ These five criteria have been used previously in a written report of the FRT-P:¹² ^, ²⁰

Table one

Demographics and functional ability

Group	Male person	Female	Age (years)	Elapsing (months)	NPQ
Asymptomatic (n = 10)	5	5	29.08±8.25	N/A	N/A
CH (due north = 12)	5	7	29.41±9.76	96.17±91.34	18.05±seven.38

unilateral headaches that do not shift sides;
atmospheric precipitation of headaches from neck motility or sustained head positioning;
ipsilateral neck, shoulder, or arm pain;
intermittent headaches of varying duration and hurting level at the rate of one headache per calendar week for greater than 2 months;
headaches of moderate intensity.

Participants in both the CH and asymptomatic groups were excluded from the study if they met any of the following exclusion criteria:

a diagnosis of rheumatoid arthritis;
current pregnancy;
IHS criteria for other headache forms, such as tension type or migraine;^one,2,xix,22
cervical radiculopathy;
treatment for headaches past a concrete therapist, chiropractor, massage therapist, or osteopath in the past month;
positive examination for vertebral artery insufficiency or cranio-vertebral ligament instability.

The objective screen was performed past a physical therapist who was blind to the results of the FRT-P and FRT-A. This examiner too performed passive segmental mobility testing.¹² In addition to meeting the subjective criteria above, symptomatic C1/C2 dysfunction was an inclusion requirement for those in the CH grouping; this method has previously been used past Ogince et al. ¹² as a reference standard to diagnose CH. Each participant completed a Northwick Park Neck Questionnaire (NPQ). This questionnaire was developed based on the Oswestry Disability Index and has been used in previous studies to examine disability in patients with CH.²² ^– ²⁴

Each participant was informed of the purpose and procedures involved with the study and signed a written informed consent to participate. This written report received approval by the Institutional Review Lath.

Measurements

Data were collected in the Des Moines University Movement Analysis Laboratory. Kinematic information were collected to measure upper cervical ROM during the FRT-P and FRT-A using a 3D eight-photographic camera Motion Assay arrangement (Move Assay Corporation, Santa Rosa, CA, USA).²⁷ A 3D laboratory coordinate system was used with the positive z-axis in the vertical direction pointing up. The laboratory reference frame was established by using a horizontally leveled 50-frame with four markers at known locations with respect to each other. A 500 mm long iii-marking wand was moved throughout the measurement volume to calibrate the system and scale the individual camera views. The linear/angular measurement accurateness of the motility capture system is calibration based. The precision in measurement is smaller than 1 mm over a known length of 500 mm, which is equivalent to an angular precision measurement of better than 0.two% (corresponding to 0.12 of a degree). These angular precision values highlight potential measurement errors of <0.5 of a degree when computing flexion-rotation angles in the upper cervical region. This provides confidence that the 3D movement analysis methodology enables detection of small upshot sizes of around 1°.

The degree of upper cervical rotation ROM in the position of maximum cervical flexion was measured using relative segmental motion of the head with respect to the upper thorax. A total of 10 reflective markers were securely affixed using double sided adhesive tape (five on each participant's head and five on the upper thorax). A tight fitting swimming cap was used to secure the caput markers. Specifically, one marker was placed on the center of the forehead, one on each parietal bone, and 1 on each temporal bone. The 5 markers on the upper body were placed on the sternum, one on each acromion procedure, and one on the mid-shaft of each clavicle (Fig. 1).

An external file that holds a picture, illustration, etc. Object name is jmt-23-61-g001.jpg

(A) The Active Flexion-Rotation Test (FRT-A); (B) The Passive Flexion-Rotation Test (FRT-P)

2 3D local reference frames were created — 1 for the caput and ane for the trunk, from the respective markers. The position orientation of each local reference frame was evaluated with respect to the lab reference system (global frame). Flexion and rotation were assessed every bit the relative motion betwixt the two local reference frames (head and trunk) using in- firm written code in MATLAB. The flexion angle and the rotation ROM (right and left) were assessed as the average flexion maintained during the rotation interval to the left and right and the peak rotation to the left and right, respectively (Fig. ii).

An external file that holds a picture, illustration, etc. Object name is jmt-23-61-g002.jpg

Typical single trial data recorded during the FRT. Peak flexion angle, bottom rotation angle versus fourth dimension. Illustration of the flexion angle calculation: average flexion maintained during the rotation interval to the left and right. Measurement of acme rotation to the left and correct is also shown.

Process

Cervical rotation ROM was measured from a position of end-range cervical flexion during the FRT-P and FRT-A. This process was washed for participants in both the CH group and the asymptomatic grouping. The FRT-P was performed past a fellowship trained transmission physical therapist of the American Academy of Orthopedic Manual Physical Therapists; this examiner also provided educational activity to participants on functioning of the FRT-A. This examiner was blind to the participants' group allotment. The two tests were performed in a random gild.

For the FRT-P, participants laid supine on a plinth. The examiner cradled the occiput between thenar eminences with thumbs over the temporal bones and passively flexed the cervical spine fully (Fig. 1A). While maintaining this flexed position, the examiner passively rotated the individual's caput in each direction to the end of the available range.¹⁵ The examiner determined the end of range through a business firm end feel as previously described.¹² The individual'due south cervical spine was brought dorsum to neutral and the caput was returned to the support of the plinth between trials.

The FRT-A was performed in a seated position, as has been previously reported.¹⁵ Participants were seated in a straight-back chair with their feet flat on the floor and with their hands in their lap. Instructions were given to each individual on performance of the FRT-A. Beginning in an upright position, participants were asked to focus on a stock-still point on the wall in front end of them. They were instructed to first motion into full cervical flexion and were provided the following instruction: 'Curve your neck downwardly, as if to bring your chin toward your breast as far as yous tin'. Each person determined his/her own endpoint in the FRT-A for both rotations. Flexion was maintained throughout a full bicycle of the movements (Fig. 1B). Participants were given the following instruction: 'While keeping your neck bent downwards, turn your head as far every bit you can to the left'. In one case the participant reached that point, which they adamant was as far as they could get, the instruction was repeated for rotation to the correct; the flexed position was maintained throughout a full cycle of combined flexion with rotation each direction. Three practice trials were done prior to recording iii trials; the average was used for assay.

Statistical assay

Trial-to-trial reliability analysis was done using boilerplate intra-class correlations on the three trials inside each test condition. Paired t-tests were washed to make up one's mind ROM differences between the left and right sides in the asymptomatic group and between the asymptomatic and symptomatic sides in the CH grouping. This was washed for both the FRT-P and the FRT-A. Contained t-tests were done to determine if differences be in ROM between the asymptomatic group and CH group for both the FRT-P and FRT-A. The data analyses were done using SPSS version 17.0 (SPSS Inc, Chicago, IL, USA). The benchmark for significance was set at an blastoff level ≤0.05.

Results

Twenty-2 individuals were included in the analysis, 12 CH and x asymptomatic participants (Table 1). Following data drove, 2 individuals from the asymptomatic group were dropped from the study because their markers were non visible, and therefore, their data could non be analyzed. Age and gender characteristics were similar for the two groups (CH and asymptomatic). Patients in the headache group had a mean NPQ score of 18.2% disability.

Intraclass correlation coefficients (ICCs) for trial-to-trial reliability of the FRT-A were 0.90–0.95 for the asymptomatic group and 0.97–0.98 for the CH group. ICCs for trial-to-trial reliability of the FRT-P were 0.93–0.95 for the asymptomatic grouping and 0.91–0.96 for the CH grouping. All ICC measures were higher than 0.81, which according to Landis and Koch,²⁸ tin can exist classified as 'almost perfect' (ICC: 0.81–1.00). The average standard errors of measurement values for the asymptomatic grouping were 2.08° and 2.07° for the FRT-A and FRT-P, respectively, with the corresponding values for the CH group i.46° and 3.91°, respectively. Interestingly, the CH group showed the highest reliability values when performing the FRT-A exam and the least reliable values during the FRT-P test. Group mean and standard difference for rotation ROM in each direction achieved during the tests tin exist found for FRT-A in Table 2 and for FRT-P in Table 3.

Table ii

Range of motility for the active flexion rotation exam (FRT-A)

Group	Side: left/asymptomatic	Side: right/symptomatic	Paired t-examination (between sides)
Asymptomatic (northward = 10)	29.5 (eight.five)	27.four (six.9)	P = 0.305
CH (n = 12)	29.2 (nine.2)	26.6 (nine.3)	P = 0.188
Independent t-test (between groups)	P = 0.931	P = 0.809

Table three

Range of motion for the passive flexion rotation examination (FRT-P)

Group	Side: left/asymptomatic	Side: right/symptomatic	Paired t-test (between sides)
Asymptomatic (northward = 10)	43.2 (eight.0)	43.8 (9.0)	P = 0.738
CH (northward = 12)	47.1 (fifteen.4)	37.0 (15.ix)	*P = 0.014
Independent t-test (between groups)	P = 0.451	P = 0.290

The ROM values were significantly greater for the FRT-P for all participants, as reflected by the group values in Tables 2 and three. For the FRT-A, at that place were no significant differences found between left and correct sides for the asymptomatic group (P = 0.305), nor between the asymptomatic and symptomatic sides for the CH group (P = 0.188), (Table 2). Additionally, there were no significant differences found in FRT-A ROM between the asymptomatic group and the CH group, regardless of the side (P = 0.931 and P = 0.809 for the asymptomatic and the symptomatic sides, respectively). For the FRT-P (Table three), there were no side-to-side differences constitute in the asymptomatic grouping ROM: 43.2±eight.0° for the left versus 43.8±ix.0° for the correct side (P = 0.738); notwithstanding, pregnant (P = 0.014) limitations towards the symptomatic side were found for the CH group (ROM: 47.1±15.4° for the asymptomatic side versus 37.9±xv.ix° for the symptomatic side).

Discussion

The aim of this study was to examine upper cervical rotation ROM in individuals with CH compared to asymptomatic participants using the cervical FRT-P and FRT-A. ROM findings were different between the FRT-P and the FRT-A. A side-to-side rotation difference was institute in the CH grouping for the FRT-P, but not for the FRT-A.

Intra-rater reliability for the FRT-P has been reported as excellent (ICC = 0.93) when performed by experienced examiners, which is consequent with our results, and has slightly lower reliability when performed by inexperienced examiners (ICC = 0.76–0.84).¹² ^, ^thirteen Nosotros establish intra-rater reliability of the FRT-P to exist excellent for patients with CH (ICC = 0.91–0.96) and for the asymptomatic participants (ICC = 0.93–0.95). ICC values for the FRT-A ranged from 0.97–0.98 in the CH group and from 0.xc–0.95 in the asymptomatic group. This is consistent with the findings of Amiri et al. ¹⁵ who reported ICCs ranging from 0.85 to 0.95 for the FRT-A in healthy individuals.

The validity of the FRT-P has been previously reported in differential diagnosis of patients with CH, demonstrating high levels of sensitivity and specificity.¹² ^, ¹³ These studies, however, performed merely the FRT-P and their results cannot be practical to the FRT-A. Although the current report found both the FRT-P and FRT-A to be reliable in patients with CH, caution should exist used with estimation of the examination results clinically, since use of the FRT-A to assist in diagnosis of CH is unknown.

The degree of ROM present with the cervical FRT-A was different than the FRT-P in both the asymptomatic and CH groups. This report constitute a greater degree of motion bachelor with the FRT-P compared to the FRT-A in all cases. Dvorak et al. ²⁹ compared the results of the FRT performed actively and passively in asymptomatic individuals and found x.ii° more than move for the FRT-A compared to the FRT-P. The explanation given was that, nether the FRT-A, participants did not maintain the cervical spine flexed as consistently, therefore, the lower cervical segments were utilized resulting in a greater degree of motion.²⁹

The greater amounts of ROM produced during the FRT-P, as opposed to the FRT-A, may also exist deemed for past the principles related to the neutral and elastic zones of motion, equally described by Panjabi et al. ¹⁷ These authors defined the neutral zone as deportation from the neutral point to the beginning of elastic deformation. The rubberband zone is defined equally the displacement due to the awarding of a load across the neutral zone, and the ROM is the sum of the two. Panjabi et al. ¹⁷ found axial rotation ROM at C1/C2 in fresh cadaveric spines to be 9.3° greater each direction when measuring the entire ROM compared to that motion occurring in the neutral zone alone. It is possible that, in the current study, participants were maintaining their agile ROM within the neutral zone and the FRT-P carried the spine into the elastic zone completing the entire ROM. Additionally, information technology is possible that the caste of ROM during the FRT-A stressed contractile tissue, simply did not attain the range required to provoke the joint involved. Since the joint is idea to exist a pain source in CH,^three ^– ⁵ maybe the degree of motility required to reproduce the headache is only attainable through the FRT-P. Although the FRT-A may be more than functional, information technology may not stress the underlying tissue associated with this pathology. Another point to consider is the possibility that FRT-A was cocky-limited in the sense that patients with CH may avoid their true stop-ranges of move in an effort to avoid pain. A future written report may consider using different cues to the patient during the FRT-A, such as motivation or encouragement to achieve their full range.

Results of this study indicate that in that location is no significant difference in ROM between sides for the asymptomatic grouping during the FRT-P and the FRT-A. These findings are consistent with those of Hall and Robinson^nineteen for the FRT-P on healthy individuals. However, our findings during the FRT-A are in contrast to those of Amiri et al. They explicate the difference that they observed past the fact that participants did not fully maintain the flexed position of the cervical spine, thus allowing a greater contribution of motion from the lower cervical segments. However, it is unclear how the degree of flexion may bear upon correct-to-left differences. Information technology is possible that, if the individual's neck flexion was greater during rotation to one side compared to the other, that asymmetry may result. Panjabi et al.'s¹⁷ written report utilizing cadaveric spines found a iii° difference in right rotation compared to left at C1/C2. A possible caption offered is that asymmetry in normal individuals may reflect an anatomical variations since this asymmetry was seen in both within and between day trials.^xiv A study comparing FRT-P in patients with CH during episodes of pain compared to pain-free interludes may provide information to help clarify this issue. This may assist to differentiate whether ROM changes occur when symptoms resolve or whether the damage is consistent and potentially related to anatomical variation or other factors.

The electric current written report found no difference betwixt groups for the FRT-A, just did notice differences for the FRT-P. This finding is unique to this study as previous investigations of the FRT-A have been done only on good for you individuals. A limitation of this written report is the small sample size. Although a ability analysis was washed, and nosotros included more individuals than required, it is possible that the differences between tests observed in this study may non be reflected in a larger population of symptomatic individuals. Our study population included relatively young individuals and slightly more males than the typical CH population. Future studies should consider examination of the validity of the FRT-A for use in diagnosis of patients with CH.

Determination

Although the FRT-P can reveal limitations in ROM toward the side of symptoms in individuals with CH, the FRT-A failed to reveal such ROM discrepancies. Clinicians should apply the FRT-P in examination of patients with CH, but should use caution with interpretation of the FRT-A. This written report did not examine the power of the FRT-A to discover the presence of CH. Hereafter investigations should examine the sensitivity and specificity of the FRT-A. Additional studies are needed to determine the clinical usefulness of the FRT-A to assistance in diagnosis of patients with CH.

Disclaimer Statements

Contributors Petersen: inception of written report idea, study design, data collection, manuscript writing. Vardaxis: study blueprint, data collection and analysis, interpretation of data, manuscript writing.

Funding None.

Conflicts of interest In that location is no conflict of interest associated with this study.

Ethics approving This study received approving by the Des Moines University Institutional Review Board.

References

1. Sjaastad O, Fredriksen TA, Pfaffenrath Five. Cervicogenic headache: diagnostic criteria. Headache. 1998;38:442–5. [PubMed] [Google Scholar]

2. Classification Committee of the International Headache Society. The international classification of headache disorders, 2d edn. Cephalalgia. 2004;24((Suppl 1)):9–160. [PubMed] [Google Scholar]

three. Dwyer A, Aprill C, Bogduk N. Cervical zygapophyseal articulation pain patterns I: a study in normal volunteers. Spine (Phila Pa 1976). 1990;fifteen:453–7. [PubMed] [Google Scholar]

four. Dreyfuss P, Michaelsen M, Fletcher D. Alanto-occipital and lateral alanto-centric joint hurting patterns. Spine. 1994;19:1125–31. [PubMed] [Google Scholar]

v. Fukui S, Ohseto Thou, Shiotani M, Ohno K, Karasawa H, Naganuma Y, et al. Referred pain distribution of the cervical zygapophyseal joints and cervical dorsal rami. Pain. 1996;68:79–83. [PubMed] [Google Scholar]

half-dozen. Pfaffefnrath V, Kaube H. Diagnostics of cervicogenic headache. Funct Neurol. 1990;v:159–64. [PubMed] [Google Scholar]

7. Calhoun A, Ford Due south, Millen C, Finkel A, Truong Y, Nie Y. The prevalence of neck pain in migraine. Headache. 2010;fifty:1273–7. [PubMed] [Google Scholar]

viii. Antonaci F, Sances G, Guaschino E, De Cillis I, Bono Grand, Nappi G. Meeting patient expectations in migraine treatment: what are the cardinal endpoints? J Headache Pain. 2008;ix:207–13. [PMC free article] [PubMed] [Google Scholar]

9. Zwart JA. Neck mobility in different headache disorders. Headache. 1997;37:6–11. [PubMed] [Google Scholar]

10. Schoensee S, Jensen G, Nicholson G, Gossman M, Katholi C. The consequence of mobilization on cervical headaches. J Orthop Sports Phys Ther. 1995;21:184–96. [PubMed] [Google Scholar]

11. Whorton R, Kegerreis S. The use of manual therapy and exercise in the treatment of chronic cervicogenic headaches: a series of case studies. J Man Manip Ther. 2000;8:193–2. [Google Scholar]

12. Ogince M, Hall T, Robinson K, Blackmore A. The diagnostic validity of the cervical flexion–rotation test in C1/C2 related cervicogenic headache. Man Ther. 2007;12:256–62. [PubMed] [Google Scholar]

13. Hall T, Robinson Thousand, Fujinawa O, Akasaka Thousand, Pyne Eastward. Intertester reliability and diagnostic validity of the cervical flexion–rotation test. J Manip Physiol Ther. 2008;three:293–300. [PubMed] [Google Scholar]

14. Beeton S, Jull 1000. Effectiveness of manipulative physiotherapy in the management of cervicogenic headache: a single case study. Physiotherapy. 1994;80:417–23. [Google Scholar]

xv. Amiri M, Jull G, Bullock-Saxton J. Measuring range of active cervical rotation in a position of full head flexion using the 3D Fastrak measurement arrangement: an intra-tester reliability study. Man Ther. 2003:176–9. [PubMed] [Google Scholar]

xvi. Petersen SM. Articular and muscular impairments in cervicogenic headache: a example study. J Orthop Sports Phys Ther. 2003;33:21–31. [PubMed] [Google Scholar]

17. Panjabi Chiliad, Dvorak J, Duranceau J, Yamamoto I, Gerber M, Rauschning W, et al. Iii-dimensional movements of the upper cervical spine. Spine (Phila Pa 1976). 1988;13:726–30. [PubMed] [Google Scholar]

18. Mercer S, Bogduk N. Joints of the cervical vertebral column. J Orthop Sports Phys Ther. 2001;31:174–82. [PubMed] [Google Scholar]

nineteen. Hall T, Robinson G. The flexion–rotation test and agile cervical mobility — a comparative measurement written report in cervicogenic headache. Man Ther. 2004;9:197–202. [PubMed] [Google Scholar]

20. Hall T, Briffa Thousand, Hopper D, Robinson Thou. Comparative assay and diagnostic accurateness of the cervical flexion–rotation examination. J Headache Pain. 2010;xi:391–vii. [PMC gratuitous article] [PubMed] [Google Scholar]

21. Mulligan B. Transmission therapy 'NAGS', 'SNAGS', 'MWMS'. 5th ed. Wellington: Aeroplane View Press; 1995. [Google Scholar]

22. Jull Thou, Trott P, Potter H, Zito G, Niere K, Shirley D, et al. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine (Phila Pa 1976). 2002;27:1835–43. [PubMed] [Google Scholar]

23. Jull G, Stanton Westward. Predictors of responsiveness to physiotherapy direction of cervicogenic headache. Cephalalgia. 2005;25:101–viii. [PubMed] [Google Scholar]

24. Leak A, Cooper J, Dyer South, Williams K, Turner-Stokes L, Frank A. The Northwick Park Neck Pain Questionnaire, devised to mensurate cervix hurting and inability. Br J Rheum. 1994;33:469–74. [PubMed] [Google Scholar]

25. Kaltenborn F, Evjenth O, Baldauf T, Morgan D, Vollowitz Eastward. Manual mobilization of the joints. Vol. Ii. Oslo: Orthopedic Physical Therapy Products; 2003. [Google Scholar]

26. Antonaci F, Ghirmai S, Bono G, Sandrini Thousand, Nappi G. Cervicogenic headache: evaluation of the original diagnostic criteria. Cephalalgia. 2001;21((5)):573–83. [PubMed] [Google Scholar]

27. Evart 4. 2 user's manual. Santa Rosa, CA: Motion Analysis Corporation; 2004. [Google Scholar]

28. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 2007;97((ii)):115–20. [Google Scholar]

29. Dvorak J, Antinnes J, Panjabi Thousand, Loustalot D, Bonomo Chiliad. Age and gender related normal motion of the cervical spine. Spine (Phila Pa 1976). 1992;17:393–8. [PubMed] [Google Scholar]

Articles from The Journal of Transmission & Manipulative Therapy are provided hither courtesy of Taylor & Francis

lippertamill1948.blogspot.com

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4461715/

Lippert Amill1948