Lower Cervical Rotation

Can’t turn your head? Find out why

So the neck, thorax, shoulders, and more are all related, but is there a convenient way to illustrate the interconnectedness of these areas?

I think there is one test that can provide TONS of insight here.

That test?

Lower cervical rotation

The ability to rotate the lower part of the neck can demonstrate how well you can move the uppermost parts of the thorax and can help differentiate if you need to drive interventions either below or above the neck. 

Want to know all about the importance of this often-overlooked test?

Check out Movement Debrief Episode 142 to learn more!

Watch the video below for your viewing pleasure.

Or listen to my sultry voice on the podcast version:

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Zac Cupples iTunes

Show notes

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Cervical rotation assessment and treatment

Question: “Hey Zac, What do you look for when you assess neck rotation and needs for lower cervical rotation?”

Answer: Cervical rotation is an excellent measure that bridges that gap between craniocervical and thorax limitations.

We will be separating measuring this area into upper and lower cervical contributions.

The bulk of cervical rotation happens at C1-C2, which accounts for about 45 degrees of motion in each direction.

The remaining 45 or so degrees happens in the rest of the cervical spine. You’ll also get some thoracic spine movement down to T5-ish with cervical rotation.

An easy way to measure upper cervical rotation is the classic flexion-rotation test. Here, you’ll flex the neck until the chin is touching the chest, then rotate the head, shooting for 45 degrees each way.

But how in the heck do you measure the remaining cervical rotation contributions?

I’m glad you asked!!!

There is a test called lower cervical rotation, where you essentially grab the neck and rotate it as a unit.

The way you perform the test is by approximating your index fingers up against C7. Grasp the neck and rotate it as a unit, as you can see in the video below:

There isn’t really a “normal” degree on this test. You have to go by feel. Usually, the test is restricted if you feel an abrupt halt or block as you into the rotation.

If you can’t test someone manually, you can simply look at seated cervical rotation, then have the client actively perform the flexion-rotation test, and note the difference.

So we have two areas to target: lower cervical rotation vs upper cervical rotation

Lower cervical rotation

If there is a limitation in cervical rotation in one direction, that means you’ll have reductions in:

  • ipsilateral posterior expansion
  • Contralateral anterior expansion

This limitation will occur all the way down to T5. Meaning that this test can be another test to determine if one needs upper thorax (T2-4) expansion. This test is especially useful if your supreme clientele has REALLY FLEXIBLE shoulders. Can’t trust ’em!

If you see a restriction here and you’ve already stacked, then you want to drive activities that isolate rotation here. Movements such as cross-connects, where the thorax rotates one direction and the head rotates the opposite direction, can be a useful way of targeting this region:

You can also combine head rotation with humeral rotation, like with an armbar screwdriver:

Upper cervical rotation

If you have cleared up everything else, yet you notice there is still a restriction in upper cervical rotation, you’ll likely need to either drive upper cervical mobility or target the cranial sensory systems.

Most people are either biased towards a forward head posture or a military posture. For the former, you’ll need to drive slight OA flexion. You can accomplish this position easily with a drunken turtle:

If you need OA extension, simply cueing undouble chin during any move can be enough. Looking ahead in a chair and wall squat can do the trick:

You can also utilize manual therapy in this area to attain desired outcomes.

Let’s suppose that you’ve tried this to no avail, you may have to consider affecting different sensory systems. This “fix” could either involves a dental (or myofunctional) to improve palatal tongue posture, working with a neuro-optometrist, or potentially impacting other sensory systems.

When should I refer to an optometrist?

Question: “How do you know if vision is a factor in limited cervical movement?”

Answer: There aren’t really hard and fast rules when it comes to determining when you need to make the optometric referral. It’s usually a cluster of exhausting conservative options and history indicating visual disturbance.

I cannot stress this enough: make the vision referral AFTER exhausting all conservative options. Meaning, you’ve stacked, and taught other basic movement skills.

If I bold and italicize at the same time, you know I mean bidness!

The reason why I say this is because many times you can refer someone who doesn’t necessarily need this discipline or doesn’t have the fundamental movement skills needed to build upon visual training. Do the basics first.

Now if you’ve gone after conservative measures and things just aren’t bopping, you might consider a referral to a neuro optometrist if you see some of the following medical history indicators:

  • High prescription (4.0+/- or more)
  • strabismus
  • Lazy eye
  • concussion history
  • cataracts
  • monovision
  • Abrupt changes in prescription
  • difficulty focusing, brain fog, have to consistently re-read, poor penmanship
  • LASIK/PRK surgery, especially if botched
  • blind in one eye

There are likely others that I’ll be able to contribute as I work on this referral source and knowledge base more.

There isn’t really a specific test that would point you towards seeing an optometrist, but one thing that I’ve seen is severely limited straight leg raise that doesn’t improve with interventions.

If you need to make an optometry referral, again, try to find a neuro optometrist. Working on visual skills other than sight is critical for influencing movement options.

Sum up

  • Lower cervical rotation involves addressing upper thorax rotation to improve mobility
  • Upper cervical rotation involves address OA movement or sensory systems to improve mobility
  • Vision therapy is pursued when all other options are exhausted and medical history poses signs that would warrant a consult.
Image by Barbora Hnyková from Pixabay


  1. Hey Zac, great job and happy birthday. I understand what you’re saying with the compressive and expansive forces with right thoracic rotation. Compressive posterior left because vertebra rotates left, so that would mean expansive left anterior, compressive right anterior and expansive right posterior. Is this describing superficial compression and expansion since right rotation includes left side bend which IR left ribs which would equate to different expansion/compression forces than listed above?

    1. Hey Mark,

      Thank you for the kind words!

      So I’m looking at pure rotation and not considering sidebend into this equation. We cannot say that sidebend always occurs with rotation, despite what Fryette’s laws say. Interestingly enough, the coupled motions in the thorax are quite variable. Some places will show same, some show opposing. It shows we don’t know enough. I would peep this article to learn more – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4534848/

      I think a lot of the coupling depends on the sagittal position, and the book spinal engine has some interesting theories on this as well.

      So much we don’t know, which is exciting!

      Hope you are having wonderful holidays!


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