Mastering the 5kg Bowling Ball: What Your Neck Assessment is Actually Missing
Have you ever picked up a 5 kilogram bowling ball? It’s heavy, solid, and takes some serious effort to lift. Now, imagine balancing that exact bowling ball on a delicate stack of seven small bones, 24 hours a day.
That is precisely what your cervical spine does. Your head weighs about 5kg, and your neck has to perform a high-stakes structural balancing act to keep it upright while you stare at your phone, drive, or hit the gym. Fun fact: tilting your head forward just 45 degrees to read a text message effectively triples the weight your neck has to carry. No wonder you’re desperately rubbing your neck by the time the evening rolls around
Because holding up that bowling ball is a massive job , an assessment can never just look at where you point to your pain. If a physio only pokes your sore spots, they are completely missing the bigger picture. To find the root cause, an assessment must follow a roadmap split across a thorough Subjective (your story) and Objective (our tests) examination.
Let’s break down the assessment flow so you can stop patching up your symptoms and finally fix the system.
The Subjective Exam (Hunting for Clues)
Before any physical testing begins, your assessment starts with an in-depth interview. Your history directly guides our objective assessment because it tells us exactly where to focus and highlights the most likely diagnoses. We look at:
The Backstory
Did your pain start suddenly from a high-velocity impact like a sports tackle or whiplash, or has it built up slowly over months of aggressively slouching at your desk?
Symptom Behaviour
Does your neck feel like a dull, localised ache, or are you experiencing sharp, traveling pain, numbness, or tingling shooting down your arm?
The Triggers
Does your pain spike when you turn your head to check your blind spot, or does it throb as a constant tension headache at the end of a long day?
Red Flags
We screen for various non-negotiable red flags (like sudden drop attacks, double vision, or difficulty swallowing) because missing them can lead to serious complications. If moving your neck makes you feel like you’ve just stepped off a stormy boat cruise, we need to know before we touch you.
The Objective Exam (Testing the Machine)
1. THE NEUROLOGICAL CHECK (THE POWER LINES)
The very first thing we assess is your neurological system. The nerves that travel between your spine and body.
Sensory & Power Mapping
We test your reflexes, sensation along dermatomes , and check individual muscle power to see if a nerve root is compromised.
Neural Tension Tracking
We slide and stretch your arm through specific angles, called Upper Limb Neurodynamic Tests (ULNTs), to check if your nerves are free to slide or if they are getting snagged and irritated like headphones tangled in your pocket.
2. RANGE OF MOTION (THE MOVEMENT BLUEPRINT)
Next, we measure exactly how far you can move your head. No more guessing your flexibility or “eyeballing it.” At Lebatie Physiotherapy, we use Digital Goniometers to detect your heads angular displacement relative to gravity, showing us precisely where a joint is locked up or restricted.
3. ENDURANCE (THE BUILT-IN SHOCK ABSORBERS)
You have a set of deep, hidden stability muscles (Longus Colli and Longus Capitis) tucked right against your spine that act as your neck’s natural shock absorbers. Holding up a heavy head all day requires high endurance from these muscles.
We test this using various endurance tests, such as, the Craniocervical Flexion Test, which measures your ability to hold a tiny, gentle “chin-nod” against a small pressure balloon. If your deep endurance fails, your big, superficial shoulder muscles are forced to overwork to hold your head upright. This over-recruitment is a massive cause of chronic knots, shoulder tension, and tension headaches.
4. STRENGTH (THE ULTIMATE SHIELD)
Once we know your endurance, we measure your peak strength. Using a Handheld Dynamometer (HHD), we record the exact amount of force in kilograms your neck can generate when pushing forward, backward, and sideways. For contact sport athletes (like rugby players), elite neck strength acts as an absolute shield. Studies show that a stronger neck directly lowers concussion risks by absorbing and dissipating sudden, violent forces before they rattle your brain.
5. SPECIAL TESTS (TARGET DIAGNOSTICS & SAFETY)
Next, we apply targeted structural tests to find out exactly what is irritated and rule out deeper pathology:
The Compression Test (Spurling’s)
By gently tilting your head and adding localized, downward pressure, we check if your joint spacing is narrowing or compressing a nerve root.
Ligament tests
We use special tests to check your upper neck ligaments (like checking the transverse ligament that keeps your spine from pinching your spinal cord) and screen your vertebral arteries. This ensures your neck is safe to tolerate high-level physical activities, training, or manual treatments.
6. BALANCE & COORDINATION (THE BRAIN-EYE LOOP)
Finally, we check how your neck integrates with your global balance system. Your body uses three main systems to stay upright: Vision, your inner ear (Vestibular system), and Proprioception (the deep sensors in your neck joints).
If your neck is stiff or painful, it becomes like a smartphone trying to stream a movie on one bar of 3G data, the signal is a total mess. Your brain gets hit with a “sensory mismatch”. Your eyes and ears say you are steady, but your neck sends bad data to the motherboard. This is a hidden cause of unsteadiness, clumsiness, and blurred vision known as Cervicogenic Dizziness. We use balance tests and laser-target tracking headbands to see if your neck is sending distorted data to your brain.
Why True Neck Rehab Matters
If an assessment stops at “poke where it hurts,” your treatment will just be a temporary Band-Aid. True physiotherapy rehabilitation treats the entire machine through a targeted plan based on our findings.
Ready to recalibrate your system? Book your precision neck assessment with us today and start your road to moving pain-free.
References
AlDahas, A., Devecchi, V., Deane, J.A. & Falla, D. (2023) ‘Measurement properties of cervical joint position error in people with and without chronic neck pain’, PLoS ONE, 18(10), p. e0292798.
Araujo, G.G.C., et al. (2024) ‘Goniometry and fleximetry measurements to assess cervical
range of motion in individuals with chronic neck pain: a validity and reliability study’, BMC Musculoskeletal Disorders, 25, p. 651.
Grondin, F., Cook, C., Hall, T., et al. (2021) ‘Diagnostic accuracy of upper limb neurodynamic tests in the diagnosis of cervical radiculopathy’, Musculoskeletal Science and Practice, 55, p. 102427.
Luedtke, K., Starke, W., May, A., et al. (2020) ‘Concurrent validity and reliability of measuring range of motion during the cervical flexion rotation test with a novel digital goniometer’, BMC Musculoskeletal Disorders, 21(1), p. 535.
Selistre, L.F., Melo, C.S. & de Noronha, M. (2021) ‘Reliability and validity of clinical tests for measuring strength or endurance of cervical muscles: A systematic review and meta-analysis’, Archives of Physical Medicine and Rehabilitation, 102(6), pp. 1210–1227.
Treleaven, J. (2016) ‘Sensorimotor disturbances in neck pain: Implications for diagnosis and rehabilitation’, Manual Therapy, 25, pp. 1–12.
Vannebo, K.T., Iversen, V.M., Fimland, M.S. & Mork, P.J. (2018) ‘Test-retest reliability of a handheld dynamometer for measurement of isometric cervical muscle strength’, J Back Musculoskelet Rehabil, 31(3), pp. 557–565.
