Cervical Spine ART/MET

Question 1

Spurling’s Maneuver- with compression

Answer 1

1) physician behind or to side of patient
2) extend neck
3) sidebend towards testing side
4) rotates toward testing side
5) if needed consider adding compression

Question 2

C-Spine: Bilateral Forearm Fulcrum Forward Bending

Answer 2

1) arms crossed under patient’s head and hands placed palm down on patient’s shoulders
2) gently flex patient’s neck, giving a longitudinal stretch of paravertebral muscles
3) repeat 30-90 seconds or until desired effect achieved
4) reassess

Question 3

Cervical MET/ART Regional Restrictor

Answer 3

1) patient supine and physician at head of table
2) physician gently flexes patient’s neck to beginning of restrictive barrier
3) physician instructs patient to extend (bend backward) while physician applies equal counterforce
4) hold 3-5 seconds, instruct patient to stop and relax
5) new RB, repeat 3-5 times
Can use same treatment for rotation and sidebending

Question 4

C2-C7 motion

Answer 4

rotation and sidebending in same direction due to uncinate processes

Type 2 like

Question 5

Cervical Segment Exam Rotational Testing

Answer 5

Rotation Left: induced by anterior pressure on posterior aspect of right lateral mass
Rotation Right: induced by anterior pressure on posterior aspect of right lateral mass

Question 6

Cervical Segment Exam Translation/Sidebending Testing

Answer 6

Sidebent Left: likes to translate from left to right

Sidebent Right: likes to translate from right to left

Question 7

Typical Cervical MET C3-7 Flexed

Answer 7

1) patient supine with physician seated at head of the table
2) physician cradles patient’s occiput within their hands and slightly extends neck
3) press laterally on left articular pillar with 2nd MTP inducing sidebending towards and up to regional restriction
4) rotate occiput towards and up to restriction until vertebra moves at the level (now engaged in all 3 planes)
5) for 3-5 seconds, patient gently sidebends or rotates their head away from barrier
6) patient relaxes; new RB; repeat; reassess

Question 8

Typical Cervical MET C3-7 Extension

Answer 8

1) patient supine with physician seated at head of the table
2) physician cradles patient’s occiput within their hands and slightly flex neck
3) press laterally on left articular pillar with 2nd MTP inducing sidebending towards and up to regional restriction
4) rotate occiput towards and up to restriction until vertebra moves at the level (now engaged in all 3 planes)
5) for 3-5 seconds, patient gently sidebends or rotates their head away from barrier
6) patient relaxes; new RB; repeat; reassess

Question 9

ART Extension

Answer 9

1) treatment circles in a posterior direction (anterior to posterior circle through the node)
2) emphasize the downward and lateral pressure while moving towards the sidebending restriction to promote correction

Question 10

ART Flexion

Answer 10

1) treatment circles in anterior direction (posterior to anterior circle direction through the node)
2) emphasize the extension and side bending arc towards the side bending restriction to promote correction- upward and lateral

Question 11

AA Joint Motion (C1-C2)

Answer 11

primary motion is rotation
atlas rotates about the den
almost NO sidebending or flexion/extension

Question 12

AA diagnosis

Answer 12

Dx: rotation only

• grasp head with fingertips
• gently, but full flex the C spine (this locks C2-C7, isolating rotation to the atlas)
• without loosing flexion, rotate head bilaterally, assessing range of motion and freedom
• barrier will be subtle
• greater rotation to the right implies restriction of left rotation

Question 13

AA MET/ART

Answer 13

1) patient supine, physician sits at head of table
2) physician gently fully flexes the patient’s neck
3) physician rotates patient’s head towards the side of reduced motion, until the edge of the RB is reached
4) have patient rotate head back to midline, while physician applies counterforce for 3-5 seconds
5) after relax, engage new RB
6) repeat if needed (once is usually sufficient)

Question 14

OA (C1) movement

Answer 14

Major motions: flexion/extension
Minor motions: side bending, rotation
Type 1 like

Question 15

OA diagnosis sidebending/translation

Answer 15

-grasp head with both hands, tips of fingers 2 and 3 over occipital articulation
-translate OA joint to right and left with head in neutral, noting any restriction of side bending
(restriction of translation to right = SB right, rotated left)
-repeat translation in flexion and extension
Example if translational end feel becomes more symmetric in extension: OA E SrRl

Question 16

OA diagnosis rotation testing

Answer 16

• grasp head with both hands, with the neck in neutral position, place tips of fingers on occipital ridge
• with the right hand, lift anterior on the right ridge to rotate the OA joint to the left and note any restriction of left rotation (preferred rotation to left = rotated L; sidebent R)
• with the left hand, life anterior on the left ridge to rotate the OA joint to the right and note any restriction of right rotation (preferred rotation to right = rotated right; sidebent left)
• repeat in flexion and extension

Question 17

OA MET

Answer 17

1) patient supine, physician at head of table
2) place one hand under the patient’s occiput, and pads of the finger contact the gap between the occiput and atlas
3) opposite hand cups the patient’s chin
4) physician gently flexes and side bends patients occiput to RB
5) patient gently lifts the chin up or pulls the chin down or tilts the head up or down (hold occiput and sides of head bilaterally if focusing on rotation or sidebending)
- can use alternative activation direction side bending (tip your ear toward your shoulder) in the direction of the diagnosis, away from the restriction
6) after tissue relaxation, engage new barrier
7) repeat if needed
8) reassess