Craniocervical Instability

AKA CCI, upper cervical instability, atlantoaxial instability, cervicocranial instability

Do you check off many of the following boxes? (read all)

• HEADACHES

• MIGRAINES

• BRAIN FOG    

• FATIGUE

• NECK PAIN

• SHOULDER PAIN

• UPPER BACK PAIN

• DISC BULGE/HERNIATION

• RINGING IN THE EARS

• BALANCE ISSUES

• UNEXPLAINED ANXIETY/DEPRESSION

• NUMBNESS AND TINGLING INTO ARMS/HANDS

• FACIAL PAIN/TRIGEMINAL NEURALGIA

• UPPER BACK PAIN

• UNPREDICTABLE FLARE UPS

• DIFFICULT CONCENTRATING

• HEAVY HEAD

While many of the symptoms above can be caused by an array of different things, craniocervical instability is a commonly overlooked, unknown, and misdiagnosed condition in all health fields. It is not talked about or studied in mainstream academia. If it is, conversations are only geared around the most serious of cases requiring surgery…..rest assure, surgery can be avoided with you!

Now I speak from personal experience. I will post my personal story on YOUTUBE and in video format attached to this blog eventually. Just know that I too had countless nights crying in bed as a grown man, riddled with anxiety wondering how I am going to survive, a dwindling  social life, less connections to family and loved ones, inability to participate in the simplest of activities like pickleball or even corn hole, difficulty attracting the right partner because dates are out of the question in the evenings when you’re in pain, your fuse being short and snapping on your kids or spouse when they aren’t even deserving it. I say this all not to invite sympathy but rather to ensure I can relate to you.

I am just curious, have you ever been so stressed and overwhelmed from poor health at work? You’re completely glazed over and don’t even have mental capacity to engage in a conversation with that colleague and student.

Or worse, you get home late from work, its 6:00PM and all your family wants to do is hang out. Yet, all you can think about is “don’t talk to me. I need to be alone.” You aren’t even emotionally available.

Well buckle up. Your are NOT crazy.  You just need the proper diagnosis.

Feel alone? No One Understands What You’re Going Through? Maybe Told “It’s In Your Head?”

RELAX. I knows this condition and many of the symptoms more than most……because I had CCI myself and almost all of these symptoms for 5 years. After trial and error and fighting to stay sane, I have found what not only works but also what DOES NOT WORK! So let’s save you some time.

WHAT IS CCI?

The name itself describes the mechanism. “Cranio” referring to head/skull. “Cervical” referring to the neck. “Instability” referring to unstable, or abnormally excessive movement of the bones. This junction between the head and first cervical vertebrae (C1 or ATLAS) is known as the craniocervical junction. Unfortunately , when this segment of the spine is unstable, it can cause an array of seemingly unrelated symptoms.

Ligaments hold bone to bone. There are a series of ligaments that connect the skull and Atlas vertebra. If these ligaments become loose, stretched, compromised in any fashion, the atlas is not supported well, moves outside its normal boundaries, and compromises many tissue like the brainstem, spinal cord dura matter, ligaments, nerves and muscles. It irritates these tissues ultimately hindering the function of the nervous system.

Compression, tension, and limited blood supply (hypoxia) (not anoxia) to nerves affect the conductivity (electrical signal strength) of nerves.

How could you get CCI?

Trauma

o   Car accidents, collision sports, and anything but not limited to whiplash that can lead to stretching and loosening of supporting ligaments.

Connection Tissue Disorders

o   Ehlers Danlos Syndrome is a genetic tissue disorder that compromises the strength and elasticity of important tissues like ligaments in the entire body. These patients are systemically hypermobile or “double jointed.”

Inflammatory Conditions

o   Rheumatoid  Arthritis RA, Lupus, and scleroderma are full body systemic inflammatory conditions that compromise tissues that should be supporting the spine. Chronic inflammation leads to degeneration of the spine, weakness in supporting ligaments, and constant pain. Many of these patients are put on anti-inflammatory medications and pain meds that only mask the symptoms while the fire of the condition itself continues to roar and destroy every tissue in its path.

Congenital Conditions

o   Down Syndrome or Dwarfism can lead to improper growth of bones, ligaments, and muscles leading to deformities that make it difficult to stabilize the spine

How Does CCI Manifest So Many Different Symptoms?

Dural Tension

-            The upper cervical (upper neck region) has very unique ligaments that attaches not only bone but also muscle directly and indirectly to the spinal cord dura matter (a protective outer layer of the spinal cord). All you need to know…..when bones and muscles move too much in the upper neck it will compress and create tension on the spinal cord and/or brainstem. Specific ligaments and connections will not be discussed in detail in this material to keep it simple for the lay person to understand.

-            The spinocerebellar tract is the most prone to irritation due to its position within the spinal cord. This tract or bundle of nerves runs through the entire spinal cord. Just as its name implies it travels from the spine to the cerebellum. The cerebellum is responsible for balance, postural muscle control, an even cognition and language processing.  It is responsible for sending signals back to the brain regarding sense of position (proprioception) and muscle tone. Therefore, poor signals up these bundle of spinocerebellar tracts can lead to bad messages relayed  back to the brain leading to compromised posture, increased muscular motor tone, balance issues, dizziness, ringing in the ears, and so much more.

Brainstem

-            During the presence of loose ligaments, excessive motion allows abnormal movement. This abnormal uncoupled movement is capable of transmitting pathological forces and traction into the spinal cord and/or brainstem.

-            There are a bundle of nerves that are highly responsible for  postural muscle tone within the brainstem (medullary reticulospinal tract and pontine reticulospinal tract). Unfortunately, traction of these nerves leads to dysregulated nervous system leading to poor postural motor control. This explains why an upper cervical adjustment typically leads to improvement in posture. You will see shoulders leveling out, ropey muscles along the entire spine loosen up, and elimination of abnormal head tilt.

Vagus Nerve (Cranial Nerve X)

-            Sits near the atlas (top bone in the neck). Therefore, excessive motion within the atlas can compress and irritate this nerve. The vagus nerve has numerous responsibilities within the autonomic nervous system. The autonomic nervous system affects blood pressure, heart rate, respiration, digestion, mental state, and so much more.

-            I could write an entire separate blog on the vagus nerve, its role, and the affects the spine can have on the vagus nerve.

Chronicity

o   Long term misalignment (subluxation) can lead to a loss of elasticity from the supporting ligaments. This loss and thickening can create forces onto the spinal cord dura. Chronic subluxations are UNLIKELY to cause CCI. However, it is important to note the importance of having an aligned spine.

o   A misalignment (subluxation) is very different than CCI. A subluxation is a bone that moving abnormal, stuck, or misaligned. Conversely, CCI allows the bone to move around too much.

Treatment

There are many approaches to managing CCI. Before you read further, keep in mind that every case is different and severity varies. You may need 1, 2, or even all recommendations. Some cases may be so severe that 100% resolution isn’t realistic. However, every treatment has its purpose and most of you would do anything for just a fraction of improvement. My goal with CCI…..I want you guys to tell me 75%+ improvement when re-evaluation is done.. By the way, I have tried all these and dozens of other treatments. These happened to work the best for me.

CHIROPRACTIC

Duh….of course I am going to start off with where I am biased….Chiropractic. Let’s be clear, though. While traditional Chiropractic with the twisting and popping is great, it is not ideal for CCI cases. One of the many things manual Chiropractic adjustments accomplish is to restore motion. As I explained earlier, patients with CCI already have too much motion within the craniocervical junction. Thus, unprecedented precision and gentleness is mandatory.

While I appreciate all forms of Chiropractic, especially Upper Cervical Technique, I recommend only 2 types of Upper Cervical Technique when managing CCI…..Orthospinology Technique and Atlas Orthogonal Technique. Why? Because these techniques are incredibly gentle, precise, successful, and don’t risk too much force into an already compromised spinal segment. These techniques use gentle instruments to create reproducibility and objectively guided adjustments. If you don’t have CCI, I am okay with all other forms of Chiropractic.

PHYSICAL THERAPY

Physical therapy is another great way to help manage CCI. I personally felt this helped me immensely. Because ligaments are loose in CCI, muscle stability and strengthening can help stabilize the muscles surrounding the upper neck via muscles connecting the upper neck to the upper back, shoulders, middle of the back and more.

If needed, I provide physical therapy for my patients in conjunction with Chiropractic adjustments. Now, I have seen dozens of physical therapists where I got minimal results. You must remember, CCI is not well understood in any profession. It was not until 5 years into my injury that I found the perfect physical therapist. So naturally, I implemented the same techniques to my clinic.

Massage

Therapeutic massage is great, especially for many other common musculoskeletal issues. I personally see a massage therapist. It is going to help release some of those overworked muscles that are trying to stabilize the neck due to the laxity of the ligaments. Frankly, it will keep you sane while dealing with chronic pain for years.

With that said, one must remember these muscles are tight due to ligaments being loose and leading to excessive bony movement causing nerve compression and pain. Thus, massage alone is great only for temporary relief for CCI, but now these relaxed muscles can potentially create more laxity and instability. Ideally, massage therapy  needs to be followed up with physical therapy in hypermobility cases.

Orthobiologics/Regenerative Medicine

Orthobiologics is the modern era of tissue regeneration. It has many types of natural substances that are injected into the sight of injury to further increase recovery. Its is essentially 100% all natural. You may have heard buzz words like stem cells, plasma rich protein PRP, prolotherapy, and more. And no…..I am not talking about corticosteroid injections. They definitely have their place, but steroid injections have a completely different mechanism of action. Side note…..corticoseroid injections can actually make CCI patients even worse. Recent research has shown that corticosteroid injections weaken the multifidi muscles (muscles that are highly responsible for stability). And if you have learned anything in this blog, I sure hope you caught on that that is completely counter intuitive.

I will not go more in detail on regenerative medicine. Instead, listen to the attached video interview I did live with one of the top pioneers in regenerative medicine, Dr. John Pits with the Centeno Schultz Clinic. He’s also my doctor who I am forever grateful.

If you are interested in this, make sure to reach out to the Centeno Schultz Clinic (Click for link to website)

What worked for me

Upper Cervical Chiropractic is critical for CCI. Yeah yea yeah…..of course I am going to say that being a Chiropractor. However, I am also going to say it over and over again given the results it provided both myself and my patients. Now, if you are looking for an upper cervical Chiropractor specifically for CCI, I would highly recommend Atlas Orthogonal Technique (Click for directory of Dr.'s near you) or Orthospinology Technique (Click for directory of Dr.'s near you). All upper cervical techniques are great. However, I believe many of the other upper cervical techniques may apply too much force for CCI. Normally, I would tell you to see any upper cervical Chiropractor. However, in the cases of severe CCI, one must use minimal force for the adjustment just like the two technique I just mentioned

I saw all sorts of physical therapists around the country and I only found one that finally helped in my hometown fortunately. You must find a physical therapist who really analyses how you move and prescribes you custom exercise routines. A common buzzword is a “functional movement PT.”

Aside from corticosteroid injections I have done all the above orthobiologic injections. I have had 8 stem cell, PRP, and prolotherapy procedures and it has completely changed my life and kept me in practice after considering closing my practice due to the unbearable levels of pain due to my CCI.

Closing

This is a serious life altering injury. Full transparency, I still deal with symptoms and issues. However, it is relatively manageable now. I also tend to beat my body up more than most at my job adjusting 100s of patients a week.

Healing from CCI typically is always going to need a multifaceted approach. It is complex and requires attention from many fronts.

Here is my closing advice…..PLEASE don’t give up. I know this sounds cliché, but its true. I went through this shit for 6 years….6 long years. If you can hear the urgency in my voice, it’s because I have it. I am trying to save you time. I never gave up. As a motivator, think most about why you need to be healthy and at your best. For me, it was that I want to be the best father to my future children. I knew that being a present father would be impossible if I didn’t win my health back. So find your why and find your reason to be healthy. Then you’ll find your path to optimal health and a flourishing life!