Cervical Flexion-Rotation Test
- Fysiobasen
- Oct 4
- 2 min read
The Cervical Flexion-Rotation Test (CFRT) is a clinical test used to assess restricted mobility of the C1-C2 joint. This segment accounts for approximately 50% of the total cervical spine rotation¹.
Manual examination techniques have shown high sensitivity and specificity for detecting cervical joint dysfunction, particularly in patients with neck pain and headache². CFRT is simple to perform but requires precision to produce reliable results.
Test Procedure
The patient lies supine in a relaxed position.
The examiner fully flexes the cervical spine to isolate movement at the C1-C2 segment.
The head is then rotated to the left and right.
A positive test is indicated by pain, an early end to the movement, or a firm end-feel, suggesting restricted mobility at C1-C2⁶.
Normal range of motion in flexion: ~44° to each side.Patients with cervicogenic headache typically show an average 17° reduction in rotation compared to healthy controls³.
Scientific Evidence
Hall et al. reported that CFRT demonstrated 90% diagnostic accuracy, with a sensitivity of 88% and specificity of 92% in experienced clinicians (P < .001)¹.
Takasaki et al. found high intra- and inter-examiner reliability when CFRT results were compared to MRI measurements of C1-C2 rotation (ICC > 0.7)⁷.
CFRT is therefore simple, reliable, and validated for clinical use in assessing cervicogenic headache and C1-C2 mobility¹ ⁷.
Differential Diagnosis
CFRT can help differentiate cervicogenic headache (CGH) from other headache types:
Cervicogenic headache (CGH): Mean rotation ~25° → significantly reduced mobility.
Migraine: Mean rotation ~42° → minimal reduction in mobility.
Multiple headache forms (MHF): Mean rotation ~35°⁹.
In a large study, CFRT combined with palpation of upper cervical joints and assessment of cranio-cervical muscle control achieved 100% sensitivity and 94% specificity for diagnosing cervicogenic headache⁸.
This is clinically important, since physiotherapy has been shown to be effective for CGH, but not for migraine.
Conclusion
The Cervical Flexion-Rotation Test (CFRT) is a reliable clinical test for identifying restricted C1-C2 mobility, particularly in patients with cervicogenic headache. It demonstrates high diagnostic accuracy, is validated against MRI measurements, and can distinguish CGH from migraine.
CFRT should be used in combination with other clinical tests to improve diagnostic precision and guide targeted treatment strategies.
References:
Malange GA, Landes P, Nadler SF. Provocation tests in the cervical spine examination: historical basis and scientific analyses. Pain Physician. 2003;6:199-205
Hoppenfeld S, Thomas H, Hutton R. Physical Examination of the Spine & Extremities. New York: Prentice Hall, 1976. p126-127.
Cervical Distraction Test-Youtube
Wainner RS, Gill H. Diagnosis and nonoperative management of cervical radiculopathy. J Ortho Sports PT. 2000;30(12):728-744.
Wainner RS, Fritz JM, Irrgang JJ, Boninger ML, Delitto A, Allison S. Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine. 2003;28(1):52-62.
Rubinstein SM, Pool JJM, van Tulder MW, Riphagen II, de Vet HCW. A systemic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy. Eur Spine J.2007;16:307-319.
