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Cervical Lateral Flexion Goniometry
Cervical lateral flexion goniometry is a method used to measure the range of motion of the cervical spine or neck. It is used to evaluate joint mobility and flexibility, as well as to diagnose stiffness and pain. During the measurement, the therapist will gently move the patient’s head laterally while recording the range of motion, or how far the head can be moved. This measurement helps therapists and doctors properly diagnose any underlying issues, as well as prevent injuries from occurring.
Transcript
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This is Brent of the Brookbush Institute
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at the independent training spot in New
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York City. Today we're going over cervical lateral flexion. So this is our
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first goniometric assessment video for the neck, potentially our last, definitely
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one of a very few that I use. The reason being is this is one of the very few
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goniometric assessments for the neck that actually has good inter and intra tester
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reliability. Some of the other ones like rotation, flexion and extension, not so
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great when we're trying to measure against our own numbers from a previous
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assessment. Really not good when two different testers take the same
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measurement. So cervical lateral flexion, firm and feel, that has to do with some
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of the ligaments in the spine itself coming to a hard stop, and 35 to 45
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degrees is optimal range of motion. Now I'm going to have my friend Melissa come
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out, she's going to help me demonstrate.
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So what we're measuring is lateral flexion right, what we have to make sure
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is happening so that we are just measuring our cervical dysfunction is
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that somebody has good posture, I generally have my patients sitting
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that's just so I'm consistent ,and then go ahead and turn sideways for me. What
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people love to do if you're not paying attention, and when I show you that how
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to do this and you're standing behind somebody, you'll see how easy it is for
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them to get away with it, but generally what people do is as they go into
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lateral flexion, they steal range of motion by going into that forward head
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translation. So you need to be doubly careful and when you're taking them into
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cervical lateral flexion that they're in good alignment, and
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that's the only thing that I'm measuring. Now I'm going to go ahead and have
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Melissa turn around and face me. You'll notice I have an orange dot over here
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over spinous prominence, or the spinous process of C7, that's the landmark we're
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using as our pivot point. The other thing you're going to find is your external
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occipital protuberance which is that bony notch in the back your head here,
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and the reason why melissa has a bun, which she wanted me to tell you that she
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normally wouldn't wear hair like this, I forced her to do it. Alright so external
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occipital protuberance, spinous prominence. I'm going to go ahead and pull
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into lateral flexion, and then what you do is your stability arm can either go
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straight down the spine, or straight up, and my movement arm is going to follow
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that external occipital protuberance. So I'm going to go ahead and come to the
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other side, show you guys how I would actually measure. For this one I do like
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to get them into position first, and then hold my goniometer up. So she's
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going to go into lateral flexion. I'm going to make sure that she doesn't jut her
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head out forward, make sure you warn somebody before you put your hands on
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their face. When she's there go ahead and set up my goniometer,
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and melissa has 32 degrees of lateral flexion to the right, that's just shy of
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optimal. We do have a little problem here, where in this particular test the taller
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somebody is, the further this fulcrum gets from the point that we're watching,
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the more it's going to underestimate the value of this measurement. So keep that
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in mind, if somebody comes in between 30 and 35 but happens to be five foot ten,
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you might go ahead and leave lateral flexion alone. So I'm going to show you
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guys this one more time, we'll go to the other side, go ahead and side bend for me.
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Looks good right there, I'll go ahead and do it the other way this time, we'll go
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ahead and go movement arm or I'm sorry stability arm straight down, fulcrum
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right over spinous prominence, and then I'm going to line up with their external
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occipital protuberance, and again I got 32 degrees. Thank you Melissa.
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So she happens to have even range of motion on each side, and 32 is pretty
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close to 35, if she were my patient I would probably just leave this alone
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especially since Melissa is a little taller and we have that that little
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discrepancy in this test. But let's say she came in and she had 15 degrees and
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was complaining about neck pain, what would I do with this, well as I mentioned
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before cervical lateral flexion is one of these measurements, it's kind of nice
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that this is the the one measurement that actually works out, because it's
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usually the first thing somebody loses and the last thing they get back if they
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have neck dysfunction. So this becomes a really good measure to track the
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progress of our cervical dysfunction over time. Another great thing about this
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test is if you think about it, it actually implies every muscle in the
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cervical spine, or just about every muscle in the cervical spine. Anything
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that lies lateral to midline could potentially contribute to a restriction
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in lateral flexion, which might be part of the reason why this is the last range
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of motion people are likely to get back. You see a huge list of muscles here guys
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scalenes, levator scapulae, upper trap, SCM, splenii, semispinalis, suboccipital,
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transversal spinalis, you know those four right there are grouped portions of
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the erector spinae, and even your platysma can all affect this range of motion. It's
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going to take a little bit of time for you guys to understand which muscles are
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most likely to restrict range of motion, which had the biggest contribution to
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restriction. But it's also important to really know your functional anatomy,
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because what if it what if I release the scalenes, levator scapulae, upper trap, SCM,
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the big guys I get all of them out of the way, and I only get five degrees
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improvement which only takes them to 20 degrees of lateral flexion, and now I
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don't know what to do, well I need to know what some of these other structures
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are so that I can address them as well. For all we know it's the little
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transversal spinalis muscles between a couple segments in the cervical spine
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that are actually restricting lateral flexion.
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Facet joints, alright so let's go muscle, joint. We have those facet joints in the
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cervical spine. I can tell you I know a lot of personal trainers watch my videos
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the neck is not an easy thing for a personal trainer to to try to correct,
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because often we have joint dysfunction. Generally speaking to get somebody's
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neck back to optimal takes a fair amount of manual work, and knowing how to
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mobilize those facet joints in various directions is going to be important if
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you start having a lot of cervical dysfunction patients. You had inner
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transverse ligaments and the capsular ligaments, of course that's all going to
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be related to dysfunction of those facet joints. Fascia, there is a lot of fascial
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layers in the cervical spine, but even just the cervical fascia the superficial
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layers, and the cervical thoracic fascia which we might be able to get at with
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once again those pin and stretch, or instrument assisted soft tissue
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mobilizations. I know a lot of you guys have seen like the Graston technique on
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the neck, which tends to be very visually stunning because it'll leave a fair
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amount of petechiae the first time you do it, but it definitely can affect that
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range of motion. It's definitely something to kind of work through and
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I've definitely had good success myself with adding some of those fascial
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techniques to my cervical treatment plan. And of course nerves, as soon as we get
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to the neck guys we're not even talking about the long nerves and the arm
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anymore. We could have new nerve root involvement, if somebody goes into
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lateral flexion they can pinch down on a nerve root and if that nerve root
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happens to be inflamed, that is not going to feel good. And of course the brachial
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plexus of them, for example this is a little simplistic but if i were to
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laterally flex this way, pinch on this side might be nerve root, but this side
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I'm getting a pretty good stretch on my brachial plexus. Alright guys once again
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huge graph, necks are very challenging to work with, but I enjoy them very much
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because they are a puzzle. There is a huge amount of things that we could do,
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and I'm sure any of you guys out there working on a lot of neck patients know
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if you can relieve somebody of neck pain they think you are a saint, which is
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quite rewarding. I hope to hear about great outcomes, I hope you guys enjoy
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learning this particular technique and start learning from what it implies,
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look forward to hearing about great outcomes. Talk to you soon.
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