Taking the time to do an exam is important, but it is time spent. The exam serves as a way to physically validate your clinical impression following a history and clinical consultation. None of us wants to waste time doing "a bunch of tests," but a problem-focused exam is part of good case management. The cervical distraction test is a simple maneuver that can be combined with two related tests to provide a broad scope of information on the patient's status when we take the time to include it in our exam protocol.
Classically, the examiner stands behind the patient, cups the head in their hands and provides a gentle y-axis traction. I recall also being taught to cradle the head between the forearms to lift – but I find this awkward and the patient gets the impression that I am trying to do some kind of martial arts choke-hold. I don't like the forearm variation. Also note that some texts indicate to lift the skull by the mandible – again, I don't like this. This can aggravate or contribute to a TMJ condition. In my experience, it often creates other discomfort and compromises the exam.
In my exam flow, I will typically start with the cervical compression test – gentle pressure down the y-axis from the vertex. Also note that adding in the rotational component to cervical compression – the foraminal compression test – gives further insight into foraminal compromise. Immediately following compression, I cup the mastoids in my palms (avoiding pressure on the TMJ) and traction up. Several options should now be considered:
Evans' text also offers the clinical pearl that this test can be both diagnostic and indicative of proper therapy. Cervical distraction not only indicates the nature of the patient's complaint, but also provides a rationale for cervical traction as a part of a care plan. It should be further noted that when a patient requires more static force for relief, this indicates a more severe nerve compression syndrome, and possibly the need for surgical consult.
Some texts recommend holding traction for 30-60 seconds, but I have never had to wait this long. I typically find the patient experiences a response to the maneuver very quickly.
As always, good documentation is key. Doing an exam and not fully recording the findings does not serve you or the patient. Check-off exam forms do not work here. Make sure you clearly define what the positive finding is when performing this maneuver.
I like these tests because they are quick and simple; it should be easy to add these tests into your exam protocol if you're not already including them. Certainly there are other tests, signs and observations to be made in the individual case – the more information you have to confirm your findings, the more secure you will be in your diagnosis and treatment protocol.
These extra notes will help you to document the severity the patients' complaints. The extra documentation can also help make the difference if you must justify your diagnosis to an insurer or third party. Take the extra few seconds needed to add these tests into your exam routine – they will serve you well.
Resources
When sports chiropractors first appeared at the Olympic Games in the 1980s, it was alongside individual athletes who had experienced the benefits of chiropractic care in their training and recovery processes at home. Fast forward to Paris 2024, where chiropractic care was available in the polyclinic for all athletes, and the attitude has now evolved to recognize that “every athlete deserves access to sports chiropractic."
It is estimated that 61% of patients with CTS avoid taking surgical options due to postoperative complications and costly surgical procedures. Chiropractic care offers a comprehensive and effective treatment for carpal tunnel syndrome, addressing the condition from multiple angles. Recent studies also have unveiled a game-changing adjunct to chiropractic treatments for CTS: nerve flossing.
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
