{"id":177559,"date":"2026-08-13T12:02:18","date_gmt":"2026-08-13T12:02:18","guid":{"rendered":"https:\/\/pabau.com\/?p=177559"},"modified":"2026-08-13T13:32:51","modified_gmt":"2026-08-13T13:32:51","slug":"smooth-pursuit-neck-torsion-test","status":"publish","type":"post","link":"https:\/\/pabau.com\/es\/blog\/smooth-pursuit-neck-torsion-test\/","title":{"rendered":"Smooth pursuit neck torsion test: Complete clinical guide"},"content":{"rendered":"
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Key takeaways<\/h3>\n <\/div>\n
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The smooth pursuit neck torsion test (SPNT) compares eye tracking in a neutral position against tracking while the trunk is rotated 45 degrees.<\/p>\n <\/div>\n

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Tracking that falls apart in torsion points to the neck as a source of dizziness rather than the inner ear.<\/p>\n <\/div>\n

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No validated cutoff for the neutral-to-torsion difference exists yet, so published thresholds vary by study and by equipment.<\/p>\n <\/div>\n

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Tjell and Rosenhall described the test in 1998, and later work supports its use after whiplash injury.<\/p>\n <\/div>\n

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A positive result should push treatment toward cervical manual therapy, proprioceptive retraining, and gaze stability work.<\/p>\n <\/div>\n <\/div>\n <\/div>\n \n\n\n

Your patient still feels unsteady eight weeks after a rear-end collision. Their neck is stiff, the Dix-Hallpike is negative, and the vestibular screen explains none of it. The smooth pursuit neck torsion test<\/strong> was built for that moment.<\/p>\n\n\n\n

The test compares how smoothly the eyes track a moving target in two positions. First the head sits neutral. Then the trunk rotates underneath a head that stays still. If tracking gets worse in torsion, the neck is a likely source of the dizziness.<\/p>\n\n\n\n

Tjell and Rosenhall described the method in 1998. It has since spread through vestibular assessment protocols in physical therapy practices<\/a> and chiropractic offices. The appeal is simple. It is quick, cheap, and needs nothing beyond a target to follow.<\/p>\n\n\n\n

The SPNT separates neck-driven dizziness from vestibular dizziness<\/h2>\n\n\n\n

The smooth pursuit neck torsion test is a clinical oculomotor assessment with one job. It shows whether the cervical spine is contributing to a patient’s dizziness.<\/p>\n\n\n\n

Standard smooth pursuit testing looks at the eye movement system on its own. The SPNT adds neck torsion as a variable you control. Rotate the trunk under a still head and cervical proprioceptive input changes, while the vestibular system stays exactly where it was.<\/p>\n\n\n\n

That gives you a clean contrast. If the inner ear drives the dizziness, tracking holds steady wherever the trunk sits. If the neck drives it, tracking degrades or turns asymmetric as soon as torsion appears.<\/p>\n\n\n\n

The difference decides the treatment plan. A positive SPNT points toward cervical management. A negative result in a patient who is still dizzy sends you back toward peripheral vestibular or central causes.<\/p>\n\n\n\n

Why an injured neck can blur eye tracking<\/h2>\n\n\n\n

The upper cervical spine is dense with mechanoreceptors. Joint capsules, ligaments, and deep muscle spindles at C1 to C3 feed position information into the vestibular nuclei, the cerebellum, and the oculomotor pathways. The cervico-ocular reflex (COR) is one of the routes that signal takes to the eyes.<\/p>\n\n\n\n

Normally you never notice any of it. Cervical input blends with vestibular and visual signals, and gaze stays stable while the body moves. After a whiplash injury, that input becomes distorted or lopsided.<\/p>\n\n\n\n

The mismatch between the three systems is what the patient reports as dizziness, and it also shows up in the smoothness of their tracking. Torsion is how the test provokes it. Rotating the trunk 45 degrees stretches one side of the neck and shortens the other, which changes the signal arriving from the injured segments.<\/p>\n\n\n\n

When the SPNT is worth running, and when it isn’t<\/h2>\n\n\n\n

Run the SPNT when cervical involvement is plausible, not on every dizzy patient who walks in. Five presentations put it firmly on the list:<\/p>\n\n\n\n