JULLs TEST

Jull's cervico-cranial test

Julls Test assesses whether the correct ratio of neck flexor/ neck extensor strength is maintained after a whiplash injury. Normally this ratio should be:

Neck flexor / Neck extensor strength = 1.7 / 1.0

However, after a whiplash, this ratio drops to 1 /1. (Citation needed), as the deep neck flexors become weak.

Nerves ala Gray's anatomy

  • The Rectus capitis anterior and the Rectus capitis lateralis are supplied from the loop between C1 and C2;

  • the Longus capitis, by branches from the C1, C2 &C3;

  • the Longus colli, by branches from C2-C7 nerves.


More from Gray's.

How the test is done

  1. Lay your whiplash patient supine and drop the headpiece, supporting the head in the neutral position, with the chin slightly tucked (head flexed).

  2. Instruct the patient that you are going to remove your hands and you want to see if they can keep their head in exactly the same position for 10 seconds.

    Carefully observe the patient.

    The test is done in the neutral position. Repeat with the head 3 cm off the table, and in near full flexion.

    A positive Jull's

    Carefully observe the patient to see if s/he

    1. Raises the head (having to recruit the superficial flexors to maintain stability)

    2. Juts (or extends) the chin (head extension)

    3. The head begins to wobble or shake and the patient cannot maintain the position for the full ten seconds.

    Conclusion

    Julls Test concludes there is Deep Neck Flexor muscle weakness.



    Neck exercises

  3. Neanderthal man!

  4. Fix the eyes on a point on the wall directly in front of the eyes, and move the head forwards and backwards, slowly and rhythmically, careful to keep the chin on the same plane. Avoid flexion / extension - looking up and down. A slight chin tuck on extension is important.

    NOT TO BE DONE IN PUBLIC!


  5. Isometric neck exercise

  6. The head should not move at all in this exercise. Place the hands alternatively:

    • Against the forehead, push the head forwards against the resistance of your hands.

    • Repeat with hands behind the head. Attempt to extend the head and neck (without movement - against the pressure of the hands)

    • Place first the right, and then the left hand on the cheek. Attempt to rotate the head against resistance.

    • Cover the ear with your hand. Attempt to laterally flex the head (side-ways) without movement.





    Increased thoracic and cervical kyphosis

    Deep neck flexor weakness as illustrated by Julls Test is often associated with a thoracic kyphosis and compensatory cervical hyperlordosis. The scalenes become over-active to compensate for deep cervical flexor weakness.

    This is a complex postural syndrome, beyond the reference of this page.

    Relief may be obtained from this back stretch posture. Avoid extension of the neck as this may cause dizziness, either from a Vertebral artery syndrome or Benign Positional Postural Vertigo. Before using weights, if Julls test is positive, it would be advisable simply to support the head with the hands.


    Kolar's wall slide

    Brugger's Relief posture


    Those spending long hours typing at the computer should take a regular break in Brugger's relief posture. Done with deep breathing.


    USEFUL LINKS

  7. Go from Julls Test to CHIROPRACTIC RESEARCH
  8. Chiropractic Neck Pain treatment.
  9. Thoracic Outlet Syndrome
  10. Dizzy, a short story by Bernard Preston