Relationship between cranio-cervical flexion range of motion and pressure change during the cranio-cervical flexion test

Man Ther. 2003 May;8(2):92-6. doi: 10.1016/s1356-689x(03)00008-0.


The purpose of this study was to quantify the sagittal angular displacement of the head (cranio-cervical flexion) for the five incremental stages of the cranio-cervical flexion test (CCFT). Range of cranio-cervical flexion during the CCFT was measured using a digital imaging method in 20 healthy volunteer subjects. The intra-and inter-rater reliability of the digital imaging technique for the assessment of this movement were also examined. The results of this study demonstrated a linear relationship between the incremental pressure targets of the CCFT and the percentages of full range cranio-cervical flexion range of motion (ROM) measured in the supine lying position of the test using a digital imaging technique. A mean of 22.9% full range cranio-cervical flexion was used to reach the first pressure target of the CCFT followed by linear increments up to 76.6% for the last stage of the test. An increasing amount of cranio-cervical flexion ROM was used to achieve the five successive stages of the CCFT reflecting an increasing contractile demand on the deep cervical flexor muscles. Excellent inter-rater (ICC=0.994) and intra-rater reliability (ICC=0.988-0.998) were demonstrated for the angular measurements using this digital imaging technique.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Analysis of Variance
  • Cervical Vertebrae / physiology*
  • Confidence Intervals
  • Female
  • Head Movements / physiology*
  • Humans
  • Male
  • Manipulation, Spinal / methods*
  • Pliability
  • Range of Motion, Articular / physiology*
  • Reproducibility of Results
  • Rotation
  • Supine Position