Abstract
Dear sir Jull et al. report on a new physical examination test—a test of craniocervical flexion—which may be useful in identifying a musculoskeletal source for headache; that is, a cervicogenic headache (1). As the authors point out, further study is required to evaluate this test, yet their limited observations thus far are interesting and may be of relevance to those treating whiplash patients.
Headache in whiplash patients, particularly chronic headache, is probably multifactorial, and certainly there is an increasing body of literature defining the contributions of these multiple factors (2). Within the context of the motor vehicle accident or other injury victim, who may withdraw from normal activities and particularly work, and who may ‘slouch’ as a maladaptive way of reducing symptoms initially, one must consider that the development of a head-forward posture eventually becomes a contributor to chronic neck pain and headache long after the injury has resolved. It would thus be interesting to know the observations of the head posture in the subjects of Jull et al.
It may be that such postural abnormalities may ultimately be leading to muscle dysfunction that produces symptoms and produces the abnormal findings of the craniocervical flexion test. In such cases the solution is obvious, as specific interventions such as use of a lumbar roll when seated, chin retraction exercises, and back extension exercises can correct postural disorder (2, 3).
Future studies like that of Jull et al. should thus include a statement of the posture of the subjects and the relationship between any postural abnormalities and the likelihood of a positive craniocervical flexion test. One could then also examine what happens to this test finding when specific posture correction methods are employed.