Alar Ligament Test. To assess the integrity of the alar ligaments and thus upper cervical stability. Supine, hooklying. Place one hand on the occiput and use the other hand to palpate the spinous process of C2. Laterally flex or rotate the head to one side; you should feel the spinous process move to the opposite side. Repeat on the other side. Absence of the spinous process moving to the opposite side may indicate alar ligament injury. If you block the spinous process of C2 from moving, you may stress the ligament. You should encounter a firm end-feel in this case.
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