Purpose of Valsalva Test for cervical/lumbar Spine: To determine if there are neurologic symptoms related to radiculopathy (pain, muscle weakness, numbness and/or tingling that spreads distally in the limbs) when the patient inhales, holds the breath and bears down (strains) as if trying to have a bowel movement (1).
Patient position: Standing or sitting upright with back unsupported.
Examiner position: Standing beside the patient.
Procedure: The Valsalva manoeuvre involves the following steps: the patient takes in a deep breath, holds the breath and strains as if trying to have a bowel movement, i.e.., exhales 2 to 3 seconds over a closed glottis with a gradually increasing force.
The aim of this manoeuvre is to increase the intra-spinal/discal/thecal pressure and/or increase the compression on the spinal nerves while increasing the intra-thoracic/abdominal pressure. So, make sure the air is trapped in the chest while straining after the deep inhalation, ie., close the glottis and pinch the nose, if required, while straining.
Note: The Valsalva manoeuvre may result in dizziness or syncope if the blood flow to the brain and heart is temporarily blocked due to increased intra-thoracic pressure (2).
Outcome: The test is positive if the neurologic symptoms appeared while straining.
References:
- Johnson RH, Smith AC, Spalding JM. Blood pressure response to standing and to Valsalva’s manoeuvre: independence of the two mechanisms in neurological diseases including cervical cord lesions. Clinical science. 1969 Feb;36(1):77.
- Pstras L, Thomaseth K, Waniewski J, Balzani I, Bellavere F. The Valsalva manoeuvre: physiology and clinical examples. Acta physiologica. 2016 Jun 1;217(2):103-19.