Clinicians' perceptions of minor cervical instability

Appropriate musculoskeletal physiotherapy management of spinal conditions requires recognition of clinical patterns in order to make a provisional diagnosis. This study aimed to assist the recognition of minor cervical instability (MCI) by surveying clinicians experienced in the management of neck conditions. A total of 153 Australian physiotherapists with postgraduate qualifications in manipulative physiotherapy and experience in the management of neck conditions completed a questionnaire that required them to indicate the importance of 15 clinical findings in the diagnosis of MCI. The responses were examined descriptively then subjected to factor analysis to identify possible groupings of findings. Clinical findings considered by greater than 50% of respondents to be either very important or vitally important in the diagnosis of MCI were: a history of major trauma; reports of the neck catching or locking or giving way; poor muscular control; signs of hypermobility on X-ray; excessively free end-feel on passive motion testing and unpredictability of symptoms. The factor analysis resulted in four distinct factors, each clinically interpretable. Therapists treating patients with neck conditions should at least consider the possibility of MCI when presented with any of the six findings reported above or with any of the groupings of findings identified by the factor analysis.