Cervical Distraction Test

The Cervical Distraction Test is an orthopedic assessment that helps identify cervical radiculopathy. Specifically, nerve root compression or irritation in the neck that may cause arm pain, numbness, or tingling. It is considered the opposite of the Spurling’s Test (which compresses the cervical spine), as this test gently distracts or “opens” the vertebral segments.

How the Test is Performed

• Client position: Usually seated (can also be performed supine).

• The examiner stands behind or beside the client, placing hands under the chin and occiput (or on the mastoid processes and occiput).

• The examiner gently applies an upward, axial traction (longitudinal stretch) to the head and neck, lifting to unload the cervical spine and open the neural foramina.

• The maneuver is held for a few seconds (sometimes up to 30–60 seconds), and the client is asked about changes in their symptoms.

• A positive test: Reduction, relief, or cessation of the client’s familiar radicular or arm pain while the traction is applied.

• A negative test: No symptom change, or pain increases (which may indicate facet, muscular, or ligamentous pathology rather than nerve root compression).

Clinical Significance

• Relief of symptoms with distraction indicates that nerve root compression is present, and the reduction of pressure relieves neural irritation.

• If pain increases, other conditions such as facet joint irritation, sprain/strain, or cervical instability may be suspected.

• Test specificity is high (~90–97%), but sensitivity is moderate (~44%), making a positive result particularly meaningful.

Assessment

• Use for clients presenting with neck pain and radiating arm symptoms (tingling, numbness, weakness) that may be related to nerve root irritation.

• Carefully document the exact symptom changes with the test for treatment planning and possible interprofessional referral.

Treatment

• If positive:

  • Avoid deep, compressive, or forceful mobilization/manipulation of the cervical spine.

  • Focus on gentle soft tissue techniques for cervical paraspinals, shoulders, and upper thoracic region.

  • Educate clients about posture, ergonomics, and neural loading such as promoting neck positions that minimize nerve root compression.

• Cervical traction (when appropriately indicated) may provide relief and can be suggested as part of a home-based or clinical strategy.

Safety and Referral

• Refer to a physician or physiotherapist for imaging or specialist evaluation if symptoms are severe, progressive, include weakness, or fail to improve with conservative care.

• If pain is increased by the test, carefully reassess and avoid aggravating cervical techniques.