A. Schäfer1, T. Schöttker-Königer1, T.M. Hall2, I. Mavroidis3, C. Roeben3, M. Schneider3, Y. Wild3, K. Lüdtke4
1University of Applied Science and Art (HAWK), Faculty of Social Work and Health, Hildesheim, Germany, 2Curtin University, School of Physiotherapy and Exercise Science, Perth, Australia, 3German Association of Manual Therapy (DVMT), Dresden, Germany, 4University of Luebeck, Human Medicine, Academic Physiotherapy, Pain and Exercise Research (PERL), Lübeck, Germany
Background: The flexion-rotation test (FRT) is widely used to detect movement dysfunction in the spinal segment C1/C2, especially in patients with cervicogenic headache. The current published literature indicates that range recorded during the FRT is not age dependent. This is questionable considering the well documented relationship between aging and degeneration in the cervical spine and loss of cervical movement in older people.
Purpose: The present study aims to examine the influence of age on FRT mobility and to provide normative values for different age groups. An additional aim is to examine the influence of age on the ratio between lower and upper cervical rotation mobility.
Methods: For this cross-sectional, observational study healthy subjects from 18-90 years were recruited. The upper cervical range of rotation during the FRT was measured using a digital goniometer. Personal data including age, weight, height and lifestyle factors were also assessed. A multiple linear regression model was used to predict total rotation mobility during the FRT.
Results: 230 (124 male) healthy, asymptomatic subjects, aged between 18 and 87 years were included. Regression analysis showed that 27.91% (p<0.0001) of the variance in FRT mobility can be explained by age alone, while 41.28% (p<0.0001) of the variance in FRT mobility can be explained by age and total cervical range of motion (ROM). Normative values for different age decades were calculated using regression analysis. No significant influence of age on the ratio between ROM of lower and upper cervical rotation was found. There was no relevant impact of personal (gender, height, and weight) and lifestyle (smartphone and PC use) factors on ROM during the FRT.
Conclusion(s): The results of this study show for the first time that the amount of upper cervical rotation during the FRT decreases with age. One other important finding is that approximately 60% of the total cervical rotation takes place at C1/2 regardless of age.
Implications: Results of the FRT have to be interpreted taking into account the individual age of the tested subject and the total mobility of the cervical spine in rotation. This helps to estimate the expected amount of upper cervical rotation in subjects at any age.
Funding, acknowledgements: n. a.
Keywords: cervical spine, atlanto-axial joint, flexion rotation test
Topic: Musculoskeletal: spine
Did this work require ethics approval? Yes
Institution: University of Applied Science and Art (Hildesheim, Germany)
Committee: Ethics committee of the University of Applied Science and Art
Ethics number: 43075
All authors, affiliations and abstracts have been published as submitted.
