The supine examination affords the opportunity to examine the cervical spine in a maximally relaxed state. In the examination for lateral flexion restriction (dysfunction, fixation), begin your exam at the C-7/T-1 level.It will be easier to list the steps as follows:
- With the fleshy anterior aspect of your left index finger, take a contact on the lamina-TP region. Take out tissue slack, medial to lateral.
- With your right hand, cup the right side of the head and neck.
- With both hands working simultaneously and in unison, induce rotation of C-7 to the right.
- As C-7 is rotated to the right, simultaneously induce left lateral bending. Try to find the combination of rotation and left lateral bending that produces the greatest restriction to such combined force or pressure.
- Repeat steps 1-4 at each level the same way, up to and including the occiput.
- Feel each segment to determine which segment contains the greatest restriction, if any do. On the left side, you will notice the greatest restrictions at C-7/T-1, C-6/C-7, C-2/C-3, and C-1/C-2. I make this last statement as a general finding, as compared to the usual status of C-3 to C-5, and note that there always will be opportunities to find exceptions to this.
- Examine the right side of the cervical spine in the same fashion. You will notice fewer such restrictions on the right side, as a general rule. The right side typically will present with more mobility, with the exception of the occiput/C-1 and the C-2/C-3 levels. The occiput quite frequently presents with right lateral flexion and rotation restriction, as well as extension and forward glide restriction when tested from the right side. The C-2/C-3 level is often marginally restricted in lateral flexion and extension.
By all means, test this for yourself to determine the accuracy of these statements. One of the more excellent testing opportunities arises with patient headache complaints. In such cases, interesting mixed patterns exist at the O/C-1, C-1/C-2, and C-2/C-3 levels.
Joseph D. Kurnik, DC
Dr. Joseph Kurnik practices in Torrance, Calif. He is a former columnist and longtime contributor to DC; previous articles are available online at www.dynamicchiropractic.com.