Comparison of range of motion during the cervical flexion rotation versus the side-bending rotation test in individuals with and without hyperlaxity

Objective: The flexion rotation test (FRT) is used to determine C1-2 involvement in individuals with neck pain and headaches. Some individuals present with generalized joint hyperlaxity (GJH) which could influence the results of this test, which relies on a soft tissue locking mechanism. The purpose of this study was to examine the side-bend rotation test (SBRT), which utilizes osseous locking, compared to the FRT. Methods: Thirty-eight healthy individuals (25 female, 26.03 years) were assessed for GJH via the Beighton Hypermobility Index (BHI). A blinded examiner performed the FRT and SBRT bilaterally, measuring ROM using a digital goniometer device. Results: Statistically significant differences in ROM were present for the FRT based on negative (0-3) and positive (4-9) BHI score: (Right 46.4±3.6, 49.6±4.8, p=.031), (Left 45.5±3.5, 49.0±5.2, p=.023); no differences were observed for the SBRT (Right 37.6±4.3, 38.9±3.4), (Left 37.7±4.2, 37.6±3.4).  When further stratifying the groups, a one-way ANOVA and post-hoc testing revealed significant differences of FRT range of motion between the BHI 7-9 group(52.4 ± 4.4 -53.9 ± 3.4) compared to BHI 0-3 (45.4 ± 3.6-46.2 ± 3.5) and 4-6 groups (46.0 ± 3.7-46.4 ± 2.2), p < .001; there were no significant differences between the 0-3 and 4-6 groups. There were no between group differences for the SBRT, BHI 0-3 (37.5 ± 4.4-37.7 ± 4.3), BHI 7-9 (39.9 ± 3.7-39.2 ± 3.5). Discussion: Individuals with GJH demonstrated significant differences in ROM for the FRT, but not the SBRT. The SBRT may be a useful alternative to the FRT for individuals with hyperlaxity. However, further research needs to be conducted to assess the diagnostic ability of this test in individuals with cervical pathology.