Three articles on PainSci cite Swinkels 1996: 1. The Complete Guide to Neck Pain & Cricks 2. What Happened To My Barber? 3. Does Spinal Manipulation Work?
PainSci notes on Swinkels 1996:
This 1996 paper found that “there is no correlation between the measure of hypermobility and the presence of clinical symptoms. Also, the validity of the upper-cervical stability tests is questionable.”
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
OBJECTIVES: The purpose of this review is to examine the internal validity of the standardized clinical stability tests for the upper cervical spine in relation to symptomatology. Whether radiology can confirm the clinical diagnosis is also examined. The importance of radiology in this situation, the pathogenesis and the prevalence of atlanto-axial hypermobility and the clinical symptomatology are discussed.
DATA SOURCES: A literature search from January 1984 to March 1995. We consulted the CD-ROM Medline with the keywords "atlanto-axial instability," "atlanto-axial dislocation," "hypermobility," "cervical spine" and "atlanto-axial joint." Ninety-six Dutch, French, German, and English publications were selected. The Documentation Centre of the Institute for Research and Postgraduate Education Physiotherapy (SWSF) was consulted with the keywords: atlanto-axial joint, upper cervical spine, segmental examination, interobserver-reliability, intraobserver-reliability, interobserver variation, intraobserver variation, manual therapy, examination, diagnostics. Finally, recent developments and views published during this study were added.
RESULTS: There seems to be no correlation between the amount of hypermobility or subluxation and the presence of clinical signs or neurological signs. The clinical signs can vary from relatively diffuse complaints, no symptoms and signs to serious ones. Radiology does not seem to be a reliable diagnostic mechanism in relation to upper-cervical instability. Conventional X-rays fail to give adequate information about atlanto-axial stability. CT-scan and MRI can visualize much more because of the direct sagittal projection but neither is an absolute standard. Furthermore, in relation to upper-cervical hypermobility, the validity of radiology is under debate.
CONCLUSION: There is no correlation between the measure of hypermobility and the presence of clinical symptoms. Also, the validity of the upper-cervical stability tests is questionable. In diagnostics, every radiological examination measures anatomical and morphological variables, not functional variables. Despite this, CT and MRI should be preferred in diagnostics over conventional functional radiology.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Association of Lumbar MRI Findings with Current and Future Back Pain in a Population-based Cohort Study. Kasch 2022 Spine (Phila Pa 1976).
- A double-blinded randomised controlled study of the value of sequential intravenous and oral magnesium therapy in patients with chronic low back pain with a neuropathic component. Yousef 2013 Anaesthesia.
- Is Neck Posture Subgroup in Late Adolescence a Risk Factor for Persistent Neck Pain in Young Adults? A Prospective Study. Richards 2021 Phys Ther.
- Sudden amnesia resulting in pain relief: the relationship between memory and pain. Choi 2007 Pain.
- Photobiomodulation therapy is not better than placebo in patients with chronic nonspecific low back pain: a randomised placebo-controlled trial. Guimarães 2021 Pain.