Axial compression test
14. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the event(s) complained about had a negative effect which the organisation has not put right. Having done so we cannot link the events complained about with the negative impact Mr U has claimed.
15. Mr U told us he attended a physiotherapy appointment because he was experiencing pain caused by a trapped nerve in the back of his neck. He said the clinician performed an axial compression test, applying immense pressure to the top of his head. Mr U said the clinician did not seek his consent to perform this test.
16. Mr U said the actions carried out by the clinician caused him immense pain and distress to the point where he blacked out for a few minutes. He said the clinician did not acknowledge the pain he had caused. He said the clinician told him to leave, without seeking any help for him.
17. Mr U complains of ongoing severe neck pain and headaches which he told us have impacted greatly on his quality of life. Mr U considers the issues he continues to experience are a direct result of the clinician’s actions at the appointment.
18. The organisation carried out an investigation into Mr U’s complaint. It explained the clinician carried out necessary clinical investigations as part of a complete review of Mr U’s condition. This was to determine a prognosis.
19. It acknowledged the clinician did not explain what investigations they were planning to undertake to assess Mr U’s condition, which included the axial compression test. The organisation said the clinician should have explained to Mr U that the axial compression test could lead to increased discomfort or intensifying pain.
20. NICE CKS says, ‘assessment of people with suspected cervical radiculopathy should include: excluding a red flag features that suggest a serious spinal pathology, asking about the symptoms, examining people for signs of cervical radiculopathy. A combination of tests should be used to help identify cervical radiculopathy, including: the spurling test’.
21. Cervical radiculopathy is a condition where a nerve root in the neck (cervical spine) is compressed or irritated causing pain, numbness, tinging or weakness in the neck, shoulder, arm or hand.
22. The Spurling test is a specific type of axial compression test focusing on the cervical spine. It involves downward pressure with the head rotated and extended, targeting nerve root compression in the neck.
23. We can see from records Mr U attended the clinical for a physiotherapy appointment in June 2024. We have considered the consultation information sheet completed at the assessment. This documents Mr U’ symptoms, his history, an absence of ‘red flag’ issues and the prognosis.
24. We asked our adviser whether the test and treatment the physiotherapist provided to Mr U was appropriate and in line with guidance given Mr U’s history and presentation at the appointment.
25. They said the assessment form does not indicate the type of compression test the clinician carried out. They said the Spurling’s test is a recommended test for a clinician to perform when a patient complains of pain radiating to the arm, and they suspect cervical radiculopathy. Our adviser commented on the quality and completeness of the assessment note. They said it is evident the clinician considered Mr U symptoms and any contraindications which would mean performing this test would be inappropriate.
26. Physiopedia explains the Spurling’s test. The test involves the clinician places a compressive force of approximately 7kg through the top of the head. The test is considered positive when it reproduces the patient’s symptoms. Although we accessed the Physiopedia in February 2026, we consider the information within it to be relevant to this case. We have accessed it to gain an understanding of the process of conducting a Spurling’s test.
27. In line with the Organisation’s response, our adviser said discomfort and worsening of the pain during the test is possible. This is because the test is intended to provoke symptoms so that a diagnosis can be made. They said this would be a temporary worsening of the pain.
28. They explained if a patient presented with ‘red flag’ issues such as fracture, infection, cancer or severe stenosis (age related narrowing of the spinal canal), then a compression test could cause harm.
29. They said it is evident the clinician clearly documented that they considered red flag symptoms before doing the test.
30. We can see Mr U had an MRI scan in July 2024 which showed he had moderate narrowing of the spinal canal. This tells us at the time of the compression test he did not have signs of severe stenosis. As stated above, this would have been a possible reason for the clinician not to perform the compression test.
31. A year later Mr U underwent a further MRI scan which indicated severe stenosis. Our adviser said the test the clinician performed at the appointment would not have caused this condition. This would have been a natural progression of the moderate narrowing of the spinal canal noted in July 2024.
32. Part of Mr U complaint is the clinician did not seek consent to perform this test.
33. The HCP ‘Physiotherapists Standards of Proficiency’ say therapists should:
2.7. understand the importance of and be able to obtain valid consent, which is voluntary and informed, has due regard to capacity, is proportionate to the circumstances and is appropriately documented … 4.1. recognise that they are personally responsible for, and must be able to justify their decisions and actions’.
34. We cannot see from the clinician’s note that he sought consent specifically to carry out the axial compression test. We cannot see documentation to indicate the clinician discussed any possible adverse effects with Mr U in terms of potential immediate or short-term worsening of the pain.
35. The HCP guidance indicates the importance of obtaining consent and documenting this.
36. Our adviser gave their view that the clinician should have explained the procedure and documented this alongside consent. However, they felt it could be argued Mr U demonstrated implied consent by attending the assessment appointment, answering questions and submitting to other testing before the clinician performed the Spurling test.
37. Our adviser emphasised the test the clinician performed was appropriate and is a routine test for a patient presenting with Mr U’s symptoms. They further emphasised the point that this test will not have caused the long-term symptoms Mr U complains about it.
38. We consider the clinician should have sought consent from Mr U and explained the test he was going to perform and any possible side effects. We cannot say Mr U would not have consented to the test, given the routine nature of the test, and that he would have been consenting to a test that should not cause long term harm.
39. We are sorry Mr U found the test caused him pain at the time it was carried out. We recognise he was in a vulnerable situation, and the clinician should have explained any physical intervention with him. We are unable to say the test the clinician performed will have caused the ongoing pain Mr U has told us about.
40. Mr U told us how upset and concerned he was when the clinician did not offer him help or seek additional support for him when it was evident he was in significant pain to the extent he blacked out for several minutes.
41. We cannot see anything on the assessment note to suggest Mr U was in significant pain after the clinician carried out the test. The assessment note specifically states, ‘no pain on compression of cervical’. There is no mention of the patient ‘blacking out’.
42. We understand the clinician has left the Organisation so we cannot obtain his view of the assessment.
43. We asked our adviser what the clinician should have done if Mr U lost consciousness momentarily and expressed significant pain.
44. Our adviser said if the events occurred as reported by Mr U, the clinician should have called for help, checked Mr U was breathing and placed him in the recovery position.
45. Our adviser reiterated their view that the axial compression test would not have caused this extreme reaction.
46. We do not dismiss Mr U’s account, and do not intend to suggest Mr U did not experience pain. From the evidence we have seen we are not able to say the clinician caused the level of pain Mr U has described at the appointment itself. Therefore, we cannot say the clinician should have sought additional support.
47. We also are not able to attribute Mr U’s prolonged pain issues with the test carried out by the clinician at the appointment. We will not be considering Mr U’s complaint further.
48. We hope Mr U accesses appropriate support and treatment to manage his pain, and his quality of life improves.