Utilization of the Cervical Flexion Rotation Test to Confirm Rotation Directional Preference in People With Neck Pain: A Case Series

Despite the prevalence of neck pain, evidence is lacking regarding the relationship of pathophysiology to function in people with neck conditions. Although movement-based diagnoses based on directional preference (DP) are described for lumbar spinal conditions, how these diagnoses guide interventions is not supported in the Cervical Spine Clinical Practice Guidelines. To date, there are no case studies in the literature that demonstrate the efficacy of cervical spine management based on a rotation DP. This case series highlights patient response to repeated end-range neck movements to inform DP and how the cervical flexion rotation test (CFRT) was used as a clinical baseline to assess mechanical and symptomatic changes. Three consecutive patients were evaluated by a physical therapist fellow trained in orthopedic manual physical therapy and diplomaed in mechanical diagnosis and therapy. The patients’ baseline pain ranged from 3 to 7/10 on the Numerical Pain Rating Scale (NPRS), and disability scores ranged from 20% to 52.6% on patient-reported outcome (PRO) measures. All three cases demonstrated a limited and painful CFRT. Examination procedures included repeated end-range movement testing in the sagittal and frontal and transverse planes. Across five to six visits in five to eight weeks, a decrease in the primary outcome measures from baseline to discharge were observed: NPRS, 50-85%; PRO, 60-82%. The CFRT may be a key baseline when screening patients with neck pain for DP. Following repeated end-range sagittal and frontal plane movements, the rapid change in the CFRT following targeted upper cervical rotation techniques confirmed a rotation DP.