Physical Therapy

Cervical Assessment: 10 Step Evaluation Protocol

How comprehensive is your cervical assessment when initially evaluating a patient with cervical spine problems? A combination of various testing allows for better diagnosis and therefore more appropriate treatments. Hands-On Seminars encourages a 10 step protocol for evaluating the cervical spine. These are:

  1. History and Interview
  2. Pain Assessment
  3. Postural Evaluation
  4. ROM Evaluation
  5. Manual Muscle Test Evaluation
  6. Orthopedic Special Testing
  7. Neurological Evaluation
  8. Myofascial Evaluation
  9. Physiological & Accessory Movements Evaluation
  10. Integration and Conclusion

History and Interview

This step requires active listening. One should ask and take note of both past and present medical history as well as any medications the patient may be taking. One must identify the biomechanics of the injury and the neck disability index may be used.

Pain Assessment

The Visual Analogue Scale (VAS) is recommended rather than a numeric scale. One can also use faces, body diagram and/or a modified version of the McGill Pain Questionnaire.

Postural Evaluation

The patient should be asked to stand in a relaxed position. The therapist should evaluate muscle contour, symmetry, body proportions, color, compensatory postures, conditions and creases in the skin.

Range of Motion Evaluation

Here, the therapist should evaluate the flexion of the cervical spine, rotation and side-bending to the right and left.

Manual Muscle Test Evaluation

Manual muscle test can be evaluated in various positions. The neck and thoracolumbar extension should be examined with the patient in prone position. The therapist should encourage the patient to elevate the head followed by the trunk. The therapist should also test the sternocleidomastoid and deep neck flexors.

Orthopedic Special Testing

The first thing the therapist should identify is whether the case is radicular or non-radicular. Does it involve the nerve roots and/or possibly the cauda equina? The therapist should perform a series of tests for local or radicular pain including the Jackson Compression Test, Spurling Compression Test, Distraction Test and the O’Donaghue’s Maneuver.

Neurological Evaluation

In this evaluation, the therapist will examine the upper extremity myotomes. The strength of C5-C8 will be tested as well as the T1. Additionally, the Deep Tendon Reflexes C5-C7 and can be numerically valued.

Myofascial Evaluation

Here, the therapist will test joint mobilization using all five grades of motion. The therapist should look for contraindications such as rheumatoid arthritis, osteoporosis, hemarthrosis, acute inflammation, and more.

Physiological & Accessory Movements Evaluation

The therapist will evaluate three types of movements: active and passive physiological movements (Osteokinematics) and passive accessory movements (Arthrokinematics). The purpose is to identify a comparable, a patient pain recognition sign, or any other joint sign (stiffness, spasm, etc.).