Cervical Spine Dysfunctions

◆Occipitoatlantal (OA, C0–C1)

• •Motion: primarily FLEXION/EXTENSION (yes nod)
• •Side-bending and rotation are COUPLED OPPOSITE (Type-I-like)
• •Diagnosis: place on supine patient, side-bend test through OA only
• •Example: OA F SR RL (flexed, side-bent R, rotated L)

◆Atlantoaxial (AA, C1–C2)

• •Motion: ~50% of cervical ROTATION happens at AA (no nod)
• •Side-bending and flexion/extension are NEGLIGIBLE
• •Diagnosis: maximally flex cervical spine (locks out C2–C7), assess rotation L vs R at AA
• •Example: AA rotated L (only)

◆Typical cervicals (C2–C7)

• •Side-bending and rotation coupled to the SAME side (regardless of flexion/extension)
• •Articular pillars assessed for rotation; transverse processes for side-bending
• •Most common: lower cervical (C5-C6) dysfunctions from prolonged neck flexion (screen time)

◆Treatment options

• •Muscle energy (most common): patient pushes against operator's resistance, then operator moves into new barrier
• •HVLA: 'crack' technique; only after thorough screening (no rheumatoid arthritis, Down syndrome, vertebrobasilar insufficiency)
• •Counterstrain: indirect — find tender point, position into 'point of ease' for 90 seconds
• •MFR: direct or indirect myofascial release

◆Cervical contraindications

• •Avoid HVLA: vertebrobasilar insufficiency (test with extension + rotation), Down syndrome (atlantoaxial instability), Rheumatoid arthritis (transverse ligament weakness), unstable fracture, malignancy, infection, anticoagulated

Cervical motion by segment