Visualization Technology

Motion Testing: Sidebending and Rotation from the Forward Bent Position -- If something interferes with the capacity of either facet to open normally, restriction of forward bending will occur. For example, if a left facet does not open normally, but the right does open normally, left sidebending will be possible but right sidebending will be restricted in the forward bent position. In the cervical spine during flexion/extension, sidebending and rotation are coupled movements in the same direction. Therefore, rotation will also be affected by facet joint dysfunction. If the left facet does not open normally, we would expect to encounter abnormal resistance with right to left translation in the forward bent position. The segment is said to be restricted in flexion, rotation right, and sidebending right. The positional diagnosis is ERSleft, and the motion restriction is FRSright.

Example -- While monitoring a typical cervical segment at the articular pillars, you flex the cervical segment by rotating the patients head forward and forward bending the neck down to the level of the segment that is to be tested. You notice that the finger you have placed upon the right articular pillar moves slightly superior and anterior, but the finger monitoring the left articular pillar does not move (or if it does move, it moves less than the right side). You also notice that you encounter abnormal resistance when you translate the segment from right to left. When you extend the patients cervical spine, you note that both fingers monitoring the articular pillars move symmetrically, slightly posterior and inferior, and that you encounter normal translational resistance in both directions. We know that in extension the facets are supposed to close, and that in flexion the facets are supposed to open.

In extension, both facets are fully closed. The vertebra faces directly forward because there is no rotational component associated with the backward bending.

However, in flexion, the right articular pillar moves anterior and superior to the left articular pillar, indicating that the left facet has not fully opened.

Because the left facet has not opened properly, we see left rotation (with left sidebending) of the vertebra, with the left facet functioning as a pivot point.

We conclude that the segment is restricted in flexion, rotation right, sidebending right . The positional diagnosis is ERSleft, and the motion restriction is (FRSright). Click here to visualize this type of dysfunction from a -- side view -- back view -- top view) .