How the Test is Performed

• Client position: Seated or supine, relaxed.

• The therapist passively moves the client’s head into extension and rotation (as if looking over the shoulder) and holds that position for about 30 seconds; sometimes, extension or rotation alone is tested, or the client is asked to hold their head in these positions.

• The therapist closely observes and asks if the client experiences dizziness, vertigo, visual disturbances, nystagmus (“seeing stars”), tinnitus, disorientation, or facial/limb sensory or motor changes.

• A positive test: The client develops neurological symptoms or vascular compromise in the test position. Testing should be stopped immediately, and the head returned to neutral.

Clinical Significance

• Positive Vertebral Artery Test indicates vertebrobasilar insufficiency (VBI), which occurs with compression or compromise of one or both vertebral arteries.

• Symptoms can be triggered by neck hyperextension, rotation, or a combination. This is true especially in older adults, those with atherosclerosis, or those at risk of stroke.

• Failure to recognize VBI can have grave consequences, as positional manipulation or sustained pressure in the upper cervical region could further reduce blood flow, risking cerebrovascular accident.

Assessment

• Always screen with the Vertebral Artery Test prior to performing cervical mobilization, traction, stretching, or prolonged positioning in extension/rotation.

• If positive:

  • Discontinue all cervical interventions and do not proceed with any technique that might compromise arterial flow.

  • Document which movement provoked symptoms, which symptoms occurred, and the time course.

Treatment

• Never perform aggressive stretching, mobilization, or strong manual therapy to the cervical region in clients with a positive VBI test.

• Focus instead on gentle, non-provocative techniques and safe positioning.

• Educate clients about the risks of sustained neck extension or home devices (e.g., massage guns, chairs) that can produce dangerous positions or forces.

• Advise to avoid yoga poses or activities that involve end-range cervical extension or rotation if at risk of VBI.

Safety and Referral

• Immediately refer any client with a positive VBI test, new neurological symptoms, or vertebral artery dissection suspicion for urgent medical evaluation.

• Collaborate with medical and physiotherapy teams for multidisciplinary management.