Active Movement Screening: Cervical Spine Range, Quality, and Symptom Response

Purpose of Cervical Active Movement Screening (AROM)

Cervical AROM screening is a quick, repeatable way to observe how the neck moves, how symptoms respond to movement, and whether the pattern looks more like a local mechanical issue (joint/muscle) or a possible nerve-related presentation. You are not trying to “diagnose” a specific tissue on day one; you are collecting consistent movement findings that help you decide what to test next and what needs caution.

In this chapter, you will use the same method each time: standard setup, standard sequence, and standard recording. Consistency is what makes your findings meaningful.

1) Setup: Position, Cues, and Avoiding Compensation

Patient position (seated)

• Seat the person upright on a stable chair, feet flat, hips and knees roughly 90°.
• Hands resting on thighs to reduce shoulder hiking and trunk bracing.
• Ask them to keep the chest facing forward unless you specifically ask for a combined movement later.

Head and chin position

• Start from a neutral head position: eyes level, jaw relaxed.
• Use a gentle cue: “Imagine your head is floating up; keep your chin level.”
• Avoid starting in a chin poke (upper cervical extension) because it can falsely limit flexion and bias symptoms.

What you watch for (compensations)

• Trunk rotation/side shift: the torso turns instead of the neck.
• Shoulder elevation: upper trapezius substitution during side-bending.
• Jaw jutting/clenching: can accompany protective guarding.
• Early movement in the upper cervical region: “hinging” at C0–C2 during extension/rotation.

Standard instruction script

Use the same wording to reduce variability: “Move your neck as far as you comfortably can. Stop if you feel pain, tingling, dizziness, or anything concerning. Tell me what you feel and where you feel it.”

2) Standard Sequence: Flexion, Extension, Rotation, Side-Bending, Then Combined/Functional

Run the same order each time so you can compare sessions. If symptoms are easily provoked, you can stop early and move to symptom modification checks.

A. Flexion

How: “Bring your chin toward your chest.”

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• Watch for smooth curve through the neck rather than a sudden “drop” at one segment.
• Note if the person flexes through the upper thoracic spine instead of the neck.

Common symptom responses: local posterior stretch, midline neck discomfort, or reproduction of headache/arm symptoms in some cases.

B. Extension

How: “Look up toward the ceiling.”

• Watch for upper cervical hinging (chin lifts sharply with minimal lower cervical extension).
• Watch for trunk extension as compensation.

Common symptom responses: facet-type local pain, dizziness/visual symptoms (stop rule), or arm symptoms if foraminal narrowing is provocative.

C. Rotation (right and left)

How: “Turn your head to look over your shoulder.”

• Keep shoulders facing forward; lightly stabilize the shoulder if needed (without forcing).
• Compare sides for range and symptom response.

Functional reference: typical full rotation is roughly “chin near the shoulder line,” but record what you see rather than chasing a number.

D. Side-bending (right and left)

How: “Bring your ear toward your shoulder—don’t lift the shoulder.”

• Watch for shoulder hiking and trunk side-bending.
• Note whether the head translates (shifts) rather than side-bends.

Symptom note: side-bending can provoke local muscle stretch pain or nerve-related symptoms depending on direction and context.

E. Combined/functional movements (choose 1–3 based on symptoms)

Combined movements help you see whether symptoms are position-dependent and whether certain postures reproduce the person’s complaint.

• Extension + rotation (each side): “Look up and turn.” Often provocative for facet/foraminal sensitivity.
• Flexion + rotation: “Tuck down and turn.” Can be useful when headache or upper cervical sensitivity is suspected.
• Return-from-position test: Ask whether symptoms ease immediately when returning to neutral (mechanical clues).
• Functional task simulation: “Show me how you check your blind spot” or “how you look down at your phone,” observing habitual movement strategy.

3) What to Record: A Simple, Beginner-Friendly Template

Record the same categories for every movement. This turns a “look-and-see” screen into usable clinical data.

AROM recording checklist

Centralization vs peripheralization (simple definitions)

• Centralization: symptoms retreat toward the neck/spine (e.g., hand tingling reduces and becomes only neck discomfort). Often a favorable mechanical sign.
• Peripheralization: symptoms spread further away from the neck (e.g., neck ache becomes forearm/hand tingling). Treat as a caution signal and consider neuro screening.

4) Quick Differentiation Cues: Muscular Strain Patterns vs Radicular-Type Symptoms

These cues are not a diagnosis, but they help you decide whether you should stay in a mechanical screen or shift toward a neurological screen.

More consistent with local muscular/joint mechanical pain

• Location: neck/upper shoulder region, often one side.
• Quality: ache, tightness, pulling, localized sharp pain at end-range.
• Behavior: predictable with certain movements; often eases quickly when returning to neutral.
• Movement quality: guarded but usually no true distal neurological symptoms.
• Palpation correlation (if done later): tender muscles reproduce familiar pain without distal tingling.

More consistent with radicular-type (nerve-related) symptoms

• Location: symptoms into arm/hand (especially below elbow), or clear dermatomal-like distribution.
• Quality: tingling, numbness, burning, electric/shooting pain.
• Behavior: may worsen with extension/rotation/side-bending toward the symptomatic side; may improve with unloading or retraction (varies).
• Key sign: peripheralization with cervical movements is a reason to escalate to a neuro screen.

Beginner rule: If the symptom description includes numbness/tingling/weakness, or symptoms travel below the shoulder, treat it as “neuro until proven otherwise” and screen accordingly.

5) Symptom Modification Checks (Quick, Low-Tech)

When a movement reproduces the person’s symptoms, you can do brief modification checks to see if symptoms change. These are not treatments; they are “response tests” that guide next steps.

A. Repeated movements (gentle, symptom-guided)

When: symptoms are mechanical and not severe; no stop-rule signs.

How: Choose the movement direction that is most relevant (often the one that reproduces symptoms or the opposite if clearly aggravating). Perform 5–10 gentle repetitions, staying within tolerable range.

• Example: If rotation left is limited and painful, try 5 gentle repetitions into left rotation and reassess range and pain.
• What you want to see: improved range, reduced pain, or centralization.
• What concerns you: increasing pain intensity, new distal symptoms, or peripheralization.

B. Posture correction (stacking and chin position)

How: Ask the person to “grow tall,” gently bring the head back over the shoulders (a light cervical retraction), and relax the shoulders. Then retest the provocative movement.

• If symptoms reduce or range improves, it suggests a position-sensitive mechanical component.
• If symptoms worsen or distal symptoms appear, stop and consider neuro screening.

C. Unloading (supporting the arms or head)

Goal: reduce load on cervical and shoulder girdle structures.

• Arm support: have the person rest forearms on armrests or pillows; retest symptoms.
• Head support: gentle manual support under the occiput (no traction force) while they relax for 10–20 seconds; then retest.

Interpretation: symptom reduction with unloading can suggest sensitivity to compressive load or sustained postures, and it can help you choose calmer testing next.

6) Stop Rules During Cervical AROM Screening

Stop the movement screen immediately and move to appropriate medical referral or urgent evaluation pathways (based on your setting) if any of the following occur.

• Dizziness, faintness, or nausea that is new or clearly provoked by neck movement.
• Visual changes (blurred vision, double vision, “blackout,” visual field changes).
• Severe headache escalation during testing, especially if sudden or unlike their usual headache.
• Neurological worsening: new or increasing numbness/tingling, new weakness, loss of coordination, new gait disturbance, or symptoms rapidly spreading into the limb.
• Loss of speech clarity, facial droop, or other acute neurological signs (treat as emergency signs).

Practical tip: If you are unsure whether a symptom is significant, err on the side of stopping and documenting exactly what happened and when.

Short Case Examples (How to Apply the Method)

Case 1: Mechanical neck pain with limited rotation

Presentation: 34-year-old with right-sided neck ache after sleeping awkwardly. No arm symptoms.

AROM findings (sequence):

• Flexion: mild tightness posterior neck, full range.
• Extension: mild discomfort right lower neck at end-range.
• Rotation: right = mild limit with end-range ache; left = moderate limit with “blocky” feel and guarding.
• Side-bending: left reproduces right neck stretch discomfort; no distal symptoms.

What you record: “Rotation L: moderate limit, end-range ache R neck, guarded; improves slightly after 5 reps.”

Modification check: 5–10 gentle repeated left rotations; retest. If range improves and pain decreases, this supports a mechanical, movement-responsive pattern.

Case 2: Cervicogenic headache features

Presentation: 42-year-old with unilateral headache starting at upper neck and spreading to temple; worse with sustained desk work; no nausea/visual aura reported.

AROM findings:

• Flexion: may feel “pull” at upper neck; headache may reduce slightly in flexion for some people.
• Extension: reproduces familiar headache at upper neck/occiput early to mid-range.
• Rotation: one side clearly limited and reproduces headache (often the symptomatic side).
• Combined: extension + rotation increases headache quickly.

What you record: “Extension: headache reproduced mid-range, R suboccipital to temple; returns toward baseline within 2 minutes after neutral.”

Modification check: Posture correction (gentle retraction + tall sitting) then retest extension/rotation. If headache intensity decreases, note the position sensitivity and consider further upper cervical assessment in later testing.

Case 3: Arm symptoms requiring a neuro screen

Presentation: 50-year-old with neck pain and tingling into thumb and index finger, worse after driving; reports occasional grip weakness.

AROM findings:

• Extension: increases tingling into forearm/hand at end-range.
• Rotation toward symptomatic side: increases distal symptoms (peripheralization).
• Side-bending: toward symptomatic side increases tingling; away may reduce it (varies).

What you record: “Extension: peripheralization to thumb/index at end-range; tingling persists 5 minutes after.”

Next step cue: Because symptoms travel into the hand and peripheralize with cervical movement, stop further provocative combined testing and proceed to a focused neurological screen (myotomes, dermatomes, reflexes, and neural provocation tests as appropriate in your scope).