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Assessment of the Atlanto-Axial Joint (AAJ)

This is an excerpt from Spinal Manipulations and Mobilization Techniques by John Gibbons.

When you passively rotate the cervical spine in a neutral position, how would you know you are focusing the assessment purely on the AAJ? In reality, you are ascertaining only passive range of motion for the whole of the cervical spine, because this is simply a general passive range of motion testing and not specific for the AAJ.

One technique I use works exceptionally well because I feel I can ascertain motion of the AAJ. From here, the therapist can treat the AAJ as well as any restriction that occurs.

With the patient supine, initially you gain a general view of the passive range available by gently rotating the head to the left and to the right, as this will identify any possible restriction within the cervical spine.

Next, you take the cervical spine into approximately 30°–40° of flexion. This motion will pretension the ligamentum nuchae, and tensioning this ligament will restrict the lower cervical spine from rotating, allowing the AAJ to rotate relatively freely.

When you rotate the cervical spine in flexion and feel a restriction, you can now potentially identify the issue as being located within the AAJ. For example, if you rotate the patient’s cervical spine to the right and you have full range of motion (figure 7.30a), and then rotate the patient’s cervical spine to the left side and you feel a restriction, I would consider the restricted side is on the right, therefore the dysfunction is located on the opposite side to the side you are rotating to (figure 7.30b).

More Excerpts From Spinal Manipulations and Mobilization Techniques

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