• Cooperstein R
• Clark TA
• Whitney T

• Cervical Vertebrae
• Open Access Document
• Patient Positioning / standards
• Physical Examination / standards

Background: Cervical active ROM measurements in flexion/extension and lateral flexion appear to be universally obtained with the subject in the upright position, regardless of the measurement device being utilized. However, measurement of cervical active rotation has been measured in either the upright or supine positions, depending on the technological capabilities of the measuring device being utilized. Supine and upright measures of active cervical range of motion may not provide interchangeable results. The goal of this study was to compare such measurements using devices commonly used in clinical practice.

Methods: Active cervical rotation of 32 participants was measured in the upright and supine positions. A series of 3 upright measurements were obtained using a single magnetic compass-oriented goniometric device, and 3 supine measurements with a single gravity-dependent goniometer device. 

Results: Intra-examiner, intra-instrument reliability ranged from ICC (2,1)=0.876 to 0.912, rated “almost perfect.” The mean inter-examiner, inter-instrument reliability for left rotation was ICC (2,2) = 0.255 (“poor”); and for right rotation ICC (2,2) = 0.492 (“moderate”). Supine measurements were consistently greater than upright measurements, by an average of 24.40 in left rotation and 15.00 in right rotation. A paired samples-t test revealed a statistically significant difference between supine and upright measures.

Conclusions: Upright measurement of active cervical rotation does not provide information interchangeable with supine measures. Since the assessment of sagittal and frontal plane cervical movements is routinely done in the upright position, where functional disability is most likely to manifest, it stands to reason that transverse plane cervical movements (rotation) might best also be assessed in the upright position. This would most likely lead to a more accurate functional diagnosis. To ensure consistency of interpretation of active cervical rotation in research and clinical settings, it is important to consider the position in which active cervical rotation is measured. The position used may furthermore impact upon impairment ratings.

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