1. Muscle endurance of short neck flexors
This test was first described by Grimmer, and several modifications have been described since then.
Test position: The patient in supine position. The modified test position is crook lying.
Subjects are instructed to "tuck in their chins" (craniocervical flexion) and then to raise their heads. The time between assuming the test position until the chin begins to thrust is measured in seconds with a stopwatch.
Modification of the original test by Grimmer: In these modifications, the starting position for the test is different (crook lying) and the examiners monitor the chin tuck and occipital position.
2. Manual muscle testing
Test position: Test is performed without head support, prone for extensors and supine for flexors. Manual resistance is applied and strength is graded.
Grade 1= enable to maintain position against gravity. ……..
Grade 5= maintaining position against full manual resistance.
3. Craniocervical flexion test
Patient position: patient in a supine position.
Upper cervical flexion is measured with an inflatable pressure biofeedback unit placed behind the neck, with the patient in a supine position.
The subject slowly performs an upper cervical flexion without flexion of the mid and lower cervical spine. The test can be scored in two ways. Activation score is the maximum pressure achieved and held for 10 seconds.
A performance index is calculated by multiplying pressure increases from baseline (20 mm Hg) by the number of successfully completed 10-second holds.
Isometric cervical muscle strength measurements can be measured with dynamometric instruments that use integrated strain gauges or a load cell and microprocessor. Results are presented in Newton.
These instruments can measure neck flexion and rotation, using three different kinds of instruments, a Penny and Giles hand-held myometer, a portable dynamometer and a modified Sphygmomanometer dynamometer.
5. Functional lifting tests
There are two different performance tests, the PILE test and the timed weighted overhead test.
In the PILE test, subjects are instructed to lift weights in a plastic box from waist to shoulder (0.76–1.37 m). After four lifting movements, the weight is increased.
Timed weighted overhead test:
In the timed weighted overhead test, subjects are asked to raise their arms above their heads. They are then instructed to thread a rope with their hands through links of a chain with 5-pound cuff weights attached to each wrist.