March 3, 2025 • 24 mins
In this episode Dr. Ayla Wolf dives deep into cervical instability, a condition that often gets overlooked but can have significant effects on daily life. Understanding its symptoms, diagnostic challenges, and treatment options can empower listeners to seek the help they need.
• Explanation of cervical instability and its causes, highlighting four types of cervical instability
• Discussion of the wide range of symptoms associated with cervical instability, including neurological effects
• Overview of diagnostic testing processes, including advanced imaging techniques
• Examination of treatment options, including physical therapy, prolotherapy and platelet injections
• Emphasis on the importance of neck strengthening and postural awareness
• Call to action for listeners to learn more and take care of their neck health
Blog Post: Upper Cervical Instability After Head Trauma: https://www.lifeafterimpact.com/post/upper-cervical-instability-following-head-trauma
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Disclaimer:
This podcast is separate and unaffiliated from Sophia Bouwen's work and employment at the Health Partners Neuroscience Center.
Medical disclaimer: this video or podcast is for general informational purposes only, and does not constitute the practice of medicine or other professional healthcare services, including the giving of medical advice. No doctor patient relationship is formed. The use of this information and materials included is at the user's own risk. The content of this video or podcast is not intended to be a substitute for medical advice diagnosis or treatment. Consumers of this information should seek the advice of a medical professional for any and all health related issues.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Ayla Wolf (00:00):
A forward shifted C1 vertebrae can place strain on
the surrounding structures,leading to chronic symptoms.
And this fourth category isactually the one that I think is
going to be the cause of a lotmore incidence of ligament
laxity and upper cervicalinstability here in the future,
(00:22):
given the fact that, as asociety, so many people are
spending much of the day lookingdown and with a forward head
posture as they're staring atlaptops and tablets and phones.
Sophia Bouwens (00:37):
Welcome to the Life After Impact podcast, where
we do a deep dive into allthings concussion and brain
injury related.
We talk about all the differentsymptoms that can follow a
brain injury, different testingmethods, different types of
specialists out there anddifferent therapies available.
I'm Sophia Bowens, I'm herewith Dr Ayla Wolf and we will be
(01:00):
your guide to living your bestlife after impact be your guide
to living your best life afterimpact.
Ayla Wolf (01:13):
Welcome to Episode 8 of Life After Impact, the
concussion recovery podcast,where we break down complex
topics relevant to peoplesuffering from post-concussion
syndrome.
I'm Dr Ayla Wolf, and todaywe're diving deep into a
condition that often flies underthe radar but can have profound
effects on people's lives.
We are talking about cervicalinstability, and particularly
upper cervical instability,because trauma to the head and
(01:35):
neck can cause cervicalinstability.
This is a particularlyimportant topic for our
listeners.
If you've ever experiencedchronic neck pain, dizziness,
occipital headaches andotherwise unexplained
neurological symptoms, then thisepisode might be worth
listening to for you.
We'll explore what cervicalinstability is, why it happens,
(02:01):
what symptoms it causes, typesof specialized diagnostics that
exist and what treatment optionsare available, and then also
talk a little bit about why thiscondition is likely going to be
more common than it has been inthe past.
So let's get started.
So what is cervical instability?
Cervical instability occurswhen the ligaments in the neck
(02:25):
fail to properly support thecervical spine, leading to
excessive movement between thevertebrae.
This instability can put stresson the spinal cord, the nerves
and the blood vessels, causing apretty wide variety of
potential neurological as wellas musculoskeletal symptoms.
There was a really great studythat was published where they
(02:48):
discussed four basic or distinctpatterns of cervical
instability that they came upwith based off of the data on
8,000 digital motion x-rays andif you're not familiar with what
a digital motion x-ray is, wewill talk about that here in a
minute when we get intodiagnostics.
But I think that thiscategorization of these patterns
(03:11):
is extremely helpful.
The first category theydescribed is severe generalized
instability, and this is oftendue to some kind of underlying
hypermobility disorder, likeEhlers-Danlos syndrome, for
example, and it is much morecommon in females and can lead
to widespread joint instability,including the cervical spine.
(03:33):
So this is not a case of justan upper cervical instability.
This is where the jointinstability can affect any joint
, including the upper cervicalspine as well as the lower
cervical spine.
Then the second category isinstability around a fusion site
, and this can occur eitherabove or below a surgical fusion
(03:57):
or a degenerative fusion.
So at times when there isdegenerative disc disease, you
can actually have a naturalfusion of vertebrae, and when
one part of the spine becomesvery rigid, what this can lead
to is excessive movement in theareas either above or below the
area that's fused.
Now I have my L3 and L4vertebrae fused due to a bad
(04:22):
snowboarding accident and evenmy neurosurgeon at the time said
after my surgery that it wasgoing to be very important for
me to do yoga for the rest of mylife, essentially to maintain
as much mobility throughout myentire spine as possible so that
I don't put excessive amountsof stress on the joints
immediately above and below thatfusion.
(04:43):
So I thought it was pretty coolwhen a neurosurgeon is telling
me to do yoga and it just pointsto this concept around the fact
that when one part of the spineis fused it is going to
completely change the dynamicsof the rest of the spine and
potentially put excessive stresson certain joints and certain
discs.
(05:04):
So what?
This is the second category.
The third category is severeupper cervical instability due
to trauma like a concussion or abrain injury.
So traumatic events such as caraccidents, whiplash injuries,
head trauma all of these canresult in ligament laxity, and
(05:24):
particularly in theatlantooccipital joint, which is
right where the skull meets thespine, and then the C1-C2 joint
.
So that is the third group.
The fourth group is a loss ofnormal cervical curvature and
anterior positioning of C1, thatfirst cervical vertebrae, the
(05:46):
natural curve of the neck iscrucial for stability.
The neck essentially acts likea spring wire that provides
cushioning to the head and thenormal curvature is essential
for that action.
A forward shifted C1 vertebraecan place strain on the
(06:07):
surrounding structures, leadingto chronic symptoms.
Strain on the surroundingstructures leading to chronic
symptoms and this fourthcategory is actually the one
that I think is going to be thecause of a lot more incidence of
ligament laxity and uppercervical instability here in the
future, given the fact that, asa society, so many people are
(06:29):
spending much of the day lookingdown and with a forward head
posture as they're staring atlaptops and tablets and phones,
especially all of these youngkids who have all of their
parents constantly yelling atthem to correct their posture.
So one of the reasons why Iwanted to do a podcast episode
(06:51):
specifically on cervicalinstability is for this very
reason that more and more peopleare losing their normal
cervical curvature and in somecases, when they have this
anterior shift of that firstcervical vertebrae, it can
actually put pressure on thecarotid sheath in the neck,
which is where we have our vagusnerve and our jugular vein, and
(07:14):
in doing so, this can actuallyaffect blood flow to the brain
and it can affect vagal nervefunction, which has all kinds of
consequences as a downstreameffect, and we'll get into a lot
of the possible neurologicalsymptoms that can arise from
cervical instability.
But this is something that isimportant to be aware of.
Just a few weeks ago I wasactually visiting one of my
(07:37):
local chiropractors and when Ibrought up the topic of a loss
of cervical curvature, hisresponse was that about 85% of
his patients have a loss ofcervical curvature and at this
point that was almost becomingso normal for him.
And I think that just goes toshow you just how common this
(08:00):
loss of cervical curvature hasbecome as a result of what we do
all day long as far as workingin front of computer screens and
, like I I said, on laptops andlooking at phones, and the fact
that we are always looking down.
And while this may be common,that doesn't necessarily mean
that it's normal or that it'sokay, and in some cases it can
(08:22):
really actually lead to a lot ofproblems.
So let's talk about thesymptoms of cervical instability
.
People with cervical instabilityoften report a wide range of
symptoms, many of which areneurological.
People can have chronicheadaches or a chronic sense of
head pressure and that is oftenlocated in the back of the head.
(08:44):
They definitely complain ofneck pain and at times it can be
quite debilitating.
Definitely complain of neckpain and at times it can be
quite debilitating.
People can actually have facialpain or a pulling sensation
within parts of their face oreven their mouth.
They can have tingling ornumbness in the face or the side
of the head or the scalp.
(09:04):
They often complain ofdizziness, lightheadedness or
possibly vertigo, and then theycan experience difficulty
swallowing or choking.
People can have changes invoice strength.
They can experience nausea, aswell as visual disturbances,
things like blurry vision,tunnel vision or even visual
(09:26):
auras, and that's usually inmuch more severe cases of
cervical instability andspecifically upper cervical
instability.
Other more severe symptoms caninclude even sleep apnea, which
can be caused by compression onbrainstem structures that affect
those nerves and nuclei thatregulate breathing.
(09:46):
And the instability can alsocause altered positioning of the
airway and dysfunction of themuscles involved in breathing,
leading to airway obstructionduring sleep.
There can even be cognitivesymptoms due to alterations in
blood flow to the brain and thenhearing changes.
Cervical instability can affectblood flow to the nerves.
(10:10):
The cochlear and vestibularnerves need the correct blood
flow to function and if you havecompression of the nerves or
compromised blood flow to thosenerves, then this can actually
lead to tinnitus, hearing lossor a sensation of fullness in
the ear.
So dysfunction of the uppercervical spine can actually
(10:30):
alter functions of theeustachian tube and that can
lead to that type of earpressure and then difficulty
with sound modulation.
So, as you can imagine, thesetypes of neurological symptoms
that cause changes in brainfunction and cognitive functions
hearing, breathing these areusually seen primarily in these
(10:52):
more severe cases of uppercervical instability.
As you can imagine, if peopleare suffering from so many
different neurological symptoms,those symptoms could easily be
misdiagnosed as many otherthings, whether that is
migraines or vestibulardisorders and even anxiety.
(11:14):
Sometimes people are, you know,their symptoms are kind of
swept under the rug or notconsidered serious, and so they
are just labeled as havinganxiety, and this can lead to a
lot of frustration and obviouslya delay in proper treatment
when there isn't a properdiagnosis.
So let's talk about diagnostictesting for cervical instability
(11:36):
.
Accurate diagnosis is crucialfor identifying cervical
instability and in determiningthe appropriate treatment.
Here's the problem.
However, healthcare as a wholeis not on the same page when it
comes to cervical instability,for some providers it is not
even on their radar.
For others, there may be abasic level of awareness of
(12:00):
severe cases of instability fromsevere trauma or a generalized
joint instability due tohypermobility disorders.
It is actually not very easy tofind experts in cervical
instability, and this is whythere's also confusion and
disagreement around the methodsin order to assess it.
(12:20):
So when this type ofdisagreement and lack of
standard protocols exists, thepeople who suffer the most are
the patients who are just tryingto get to the bottom of their
symptoms, to understand what isgoing on and what can be done
about it.
So let's talk about some of thetests that do exist and then
(12:41):
some of the treatment options Ihad mentioned earlier.
The digital motion x-ray, andthis is a dynamic imaging
technique that capturesreal-time movement of the
cervical spine to identifyinstability.
Unlike a typical x-ray, whichis just one image, a digital
motion x-ray, which is alsosometimes called a dynamic
(13:04):
motion x-ray, or DMX for short,is actually taking about 15
images per second, and so youcan really get a much better
sense.
When you're taking that manyimages in rapid succession and
with somebody moving their headinto different positions, you
can really capture the amount ofmovement that is happening of
(13:26):
those vertebrae, and so, unlikeany other device, these digital
motion x-rays are actually veryeffective at capturing excessive
amounts of movement of thecervical spine.
The problem is not very manypeople have them, and so they
are hard to find, or it's hardto locate a clinic that offers
it.
(13:47):
The next option, which might beeasier to find but still has
some problems associated with it, is what's called a standing
MRI.
Well, oftentimes, if you arelaying down for an MRI, you're
not going to capture cervicalinstability.
However, there are standingMRIs that are set up in order to
be able to do that.
The problem that I've seen withsome of my patients that have
(14:09):
had that is that the radiologyreport gets sent out and then,
when it comes back, the doctorsthat ordered the MRI don't
actually know how to interpretthem.
So a standing MRI can help toassess things like ligament
laxity, any kind of spinal cordcompression, and then there may
(14:30):
also be the need to do some typeof vertebral artery testing to
assess blood flow in thevertebral basilar system, to see
if there are any arteries thatare being compressed as a result
of these types of injuries.
Other clinics may offer flexionextension x-rays, which are
(14:51):
standard x-rays, but they'retaken with different neck
positions in an attempt to lookat this excessive motion
happening between the vertebrae.
Once cervical instability isdiagnosed, and specifically
upper cervical instability, in avery, very small percentage of
cases that are highly severethey may actually require
(15:14):
surgery, but in most instanceswhat is recommended is a
combination of physical therapyand neck strengthening in order
to help strengthen the deep neckmuscles that can compensate for
the ligament laxity, and thereare a lot of specialty devices
out there specifically for neckstrengthening, and so in this
(15:37):
case, it would also be importantto seek out a clinic whether
it's a physical therapy clinicor a specific chiropractic
clinic where they actuallyspecialize in cervical
instability and have the righttypes of equipment and neck
strengthening devices that areuseful for this type of
treatment.
(15:57):
And then there are specifictypes of chiropractic care that
specialize in gentle adjustmentsto realign the upper cervical
spine and improve stability.
So not all chiropractic is thesame.
There are many, many differenttypes of chiropractic care out
there, different types ofadjusting techniques, and so
(16:18):
there are certain disciplineswithin the chiropractic
profession that really focus onthe upper cervical spine and are
trained to address cervicalinstability, and then the other
therapy that could be quitehelpful is prolotherapy, and
this can include either theinjection of a dextrose solution
or a person's own platelets,and this is called PRP, or
(16:42):
platelet rich plasma andprolotherapy.
The idea is that you areinjecting a solution into the
attachment sites for theseligaments, where they attach to
the bone, and this creates amild inflammatory response that
stimulates fibroblast activityto increase the tensile strength
(17:03):
of the ligaments and over timethis can improve the load
bearing capacity of thesecervical ligaments to make the
neck more stable.
In some cases, if prolotherapywith saline isn't cutting it,
the PRP is a little bit strongerand it's in effect, and how
that is done is that your ownblood is taken out of you, the
(17:26):
platelets are spun in acentrifuge and then those
platelets are injected back intothese specific sites.
So the PRP is a little bit moreexpensive than the prolotherapy
, but it is a little bitstronger in its effects.
We've mentioned in past episodesthe importance of neck
(17:46):
strengthening for people thathave had concussions, and I
think it's important when itcomes to the topic of just
generalized cervical instabilityor loss of cervical curvature,
(18:09):
of recovery, and the researchhas also suggested that it can
be preventative of futureconcussions, especially for
people in certain sports likesoccer, for example, and so I
think it's really important tobe able to find some kind of
provider whether that is aphysical therapist or a
chiropractor that has somespecialty in neck strengthening
and many of the exercises thatare out there can easily be done
at home, but it's importantthat you're doing them correctly
(18:32):
.
One of the reasons why I wantedto talk about cervical
instability is because so muchof the concussion research is
done kind of in a vacuum, so tospeak, where they're not talking
about pre existing conditions,and the reality is that I have
worked with many patients whohave had more than one
concussion.
(18:52):
I've had people that have beenin three or more car accidents,
and so they actually have hadthree concussions and three
different whiplash injuries thathave caused ligament laxity.
I've worked with people thathave Ehlers-Danlos syndrome or
people that have had lupus, forexample, which can affect the
joints and the connective tissue, that have then gone on to have
(19:15):
concussions and develop aworsening of ligament laxity and
cervical instability.
And so part of this podcast isreally emphasizing the fact that
concussions don't occur invacuums.
They occur in people that oftenhave pre existing issues that
they're dealing with, and soit's important to recognize how
some of these pre existingissues can actually set people
(19:38):
up for a situation where theymight develop a ligament laxity
or a cervical instability thatcan drive even symptoms that
mimic dysautonomia in terms ofchanges in, say, heart rate or
heart rhythm or heartpalpitations, the cognitive
symptoms, the changes in hearing, the headaches, migraines,
(20:01):
vertigo.
There's a lot of symptoms thatcan come on if somebody has
severe upper cervicalinstability, and the point of
this whole podcast is trying tohighlight all the different
things that need to be testedand looked at so that people
aren't spending years and yearssuffering without having the
(20:21):
right tests or the most accuratediagnosis.
In many cases, cervicalinstability is complex, but it
is treatable, and through acombination of things like
prolotherapy or plateletinjections, in conjunction with
neck strengthening programs andpostural restoration techniques,
people can get relief fromthese symptoms.
(20:45):
The most crucial thing is toseek out some type of specialist
who has a deep understanding ofthis condition and can offer
these types of specifictreatments In general, I think
it's also important for anybodywho spends a lot of time with
their head down and with aforward head posture as they are
(21:07):
looking at phones or laptops torecognize the long-term impacts
this can have on the cervicalspine in terms of a loss of
cervical curvature, and thatover time that can lead to
ligament laxity, which can causeproblems in the future.
So for anybody who is spendinga lot of time with their head
down and jutted forward, this isa good reminder to engage in
(21:34):
some kind of neck strengtheningprogram and to also work on
stretching the neck andadjusting their posture as much
as they can throughout the day.
For more information oncervical instability, you can
check out lifeafterimpactcom,and we have a recent blog post
that talks about cervicalinstability, along with a list
(21:55):
of the research papers that wereferenced in the making of this
episode.
In upcoming episodes we will bediving into aspects of
dysautonomia and bringing youinterviews with different
specialists in the field ofconcussion recovery.
(22:15):
Medical disclaimer this video orpodcast is for general
informational purposes only anddoes not constitute the practice
of medicine or otherprofessional healthcare services
, including the giving ofmedical advice.
No doctor patient relationshipis formed.
The use of this information andmaterials included is at the
(22:36):
user's own risk.
The content of this video orpodcast is not intended to be a
substitute for medical advice,diagnosis or treatment, and
consumers of this informationshould seek the advice of a
medical professional for any andall health-related issues.
A link to our full medicaldisclaimer is available in the
notes.
A forward shifted C1 vertebrae can place strain on
the surrounding structures,leading to chronic symptoms.
And this fourth category isactually the one that I think is
going to be the cause of a lotmore incidence of ligament
laxity and upper cervicalinstability here in the future,
(00:22):
given the fact that, as asociety, so many people are
spending much of the day lookingdown and with a forward head
posture as they're staring atlaptops and tablets and phones.
Sophia Bouwens (00:37):
Welcome to the Life After Impact podcast, where
we do a deep dive into allthings concussion and brain
injury related.
We talk about all the differentsymptoms that can follow a
brain injury, different testingmethods, different types of
specialists out there anddifferent therapies available.
I'm Sophia Bowens, I'm herewith Dr Ayla Wolf and we will be
(01:00):
your guide to living your bestlife after impact be your guide
to living your best life afterimpact.
Ayla Wolf (01:13):
Welcome to Episode 8 of Life After Impact, the
concussion recovery podcast,where we break down complex
topics relevant to peoplesuffering from post-concussion
syndrome.
I'm Dr Ayla Wolf, and todaywe're diving deep into a
condition that often flies underthe radar but can have profound
effects on people's lives.
We are talking about cervicalinstability, and particularly
upper cervical instability,because trauma to the head and
(01:35):
neck can cause cervicalinstability.
This is a particularlyimportant topic for our
listeners.
If you've ever experiencedchronic neck pain, dizziness,
occipital headaches andotherwise unexplained
neurological symptoms, then thisepisode might be worth
listening to for you.
We'll explore what cervicalinstability is, why it happens,
(02:01):
what symptoms it causes, typesof specialized diagnostics that
exist and what treatment optionsare available, and then also
talk a little bit about why thiscondition is likely going to be
more common than it has been inthe past.
So let's get started.
So what is cervical instability?
Cervical instability occurswhen the ligaments in the neck
(02:25):
fail to properly support thecervical spine, leading to
excessive movement between thevertebrae.
This instability can put stresson the spinal cord, the nerves
and the blood vessels, causing apretty wide variety of
potential neurological as wellas musculoskeletal symptoms.
There was a really great studythat was published where they
(02:48):
discussed four basic or distinctpatterns of cervical
instability that they came upwith based off of the data on
8,000 digital motion x-rays andif you're not familiar with what
a digital motion x-ray is, wewill talk about that here in a
minute when we get intodiagnostics.
But I think that thiscategorization of these patterns
(03:11):
is extremely helpful.
The first category theydescribed is severe generalized
instability, and this is oftendue to some kind of underlying
hypermobility disorder, likeEhlers-Danlos syndrome, for
example, and it is much morecommon in females and can lead
to widespread joint instability,including the cervical spine.
(03:33):
So this is not a case of justan upper cervical instability.
This is where the jointinstability can affect any joint
, including the upper cervicalspine as well as the lower
cervical spine.
Then the second category isinstability around a fusion site
, and this can occur eitherabove or below a surgical fusion
(03:57):
or a degenerative fusion.
So at times when there isdegenerative disc disease, you
can actually have a naturalfusion of vertebrae, and when
one part of the spine becomesvery rigid, what this can lead
to is excessive movement in theareas either above or below the
area that's fused.
Now I have my L3 and L4vertebrae fused due to a bad
(04:22):
snowboarding accident and evenmy neurosurgeon at the time said
after my surgery that it wasgoing to be very important for
me to do yoga for the rest of mylife, essentially to maintain
as much mobility throughout myentire spine as possible so that
I don't put excessive amountsof stress on the joints
immediately above and below thatfusion.
(04:43):
So I thought it was pretty coolwhen a neurosurgeon is telling
me to do yoga and it just pointsto this concept around the fact
that when one part of the spineis fused it is going to
completely change the dynamicsof the rest of the spine and
potentially put excessive stresson certain joints and certain
discs.
(05:04):
So what?
This is the second category.
The third category is severeupper cervical instability due
to trauma like a concussion or abrain injury.
So traumatic events such as caraccidents, whiplash injuries,
head trauma all of these canresult in ligament laxity, and
(05:24):
particularly in theatlantooccipital joint, which is
right where the skull meets thespine, and then the C1-C2 joint
.
So that is the third group.
The fourth group is a loss ofnormal cervical curvature and
anterior positioning of C1, thatfirst cervical vertebrae, the
(05:46):
natural curve of the neck iscrucial for stability.
The neck essentially acts likea spring wire that provides
cushioning to the head and thenormal curvature is essential
for that action.
A forward shifted C1 vertebraecan place strain on the
(06:07):
surrounding structures, leadingto chronic symptoms.
Strain on the surroundingstructures leading to chronic
symptoms and this fourthcategory is actually the one
that I think is going to be thecause of a lot more incidence of
ligament laxity and uppercervical instability here in the
future, given the fact that, asa society, so many people are
(06:29):
spending much of the day lookingdown and with a forward head
posture as they're staring atlaptops and tablets and phones,
especially all of these youngkids who have all of their
parents constantly yelling atthem to correct their posture.
So one of the reasons why Iwanted to do a podcast episode
(06:51):
specifically on cervicalinstability is for this very
reason that more and more peopleare losing their normal
cervical curvature and in somecases, when they have this
anterior shift of that firstcervical vertebrae, it can
actually put pressure on thecarotid sheath in the neck,
which is where we have our vagusnerve and our jugular vein, and
(07:14):
in doing so, this can actuallyaffect blood flow to the brain
and it can affect vagal nervefunction, which has all kinds of
consequences as a downstreameffect, and we'll get into a lot
of the possible neurologicalsymptoms that can arise from
cervical instability.
But this is something that isimportant to be aware of.
Just a few weeks ago I wasactually visiting one of my
(07:37):
local chiropractors and when Ibrought up the topic of a loss
of cervical curvature, hisresponse was that about 85% of
his patients have a loss ofcervical curvature and at this
point that was almost becomingso normal for him.
And I think that just goes toshow you just how common this
(08:00):
loss of cervical curvature hasbecome as a result of what we do
all day long as far as workingin front of computer screens and
, like I I said, on laptops andlooking at phones, and the fact
that we are always looking down.
And while this may be common,that doesn't necessarily mean
that it's normal or that it'sokay, and in some cases it can
(08:22):
really actually lead to a lot ofproblems.
So let's talk about thesymptoms of cervical instability
.
People with cervical instabilityoften report a wide range of
symptoms, many of which areneurological.
People can have chronicheadaches or a chronic sense of
head pressure and that is oftenlocated in the back of the head.
(08:44):
They definitely complain ofneck pain and at times it can be
quite debilitating.
Definitely complain of neckpain and at times it can be
quite debilitating.
People can actually have facialpain or a pulling sensation
within parts of their face oreven their mouth.
They can have tingling ornumbness in the face or the side
of the head or the scalp.
(09:04):
They often complain ofdizziness, lightheadedness or
possibly vertigo, and then theycan experience difficulty
swallowing or choking.
People can have changes invoice strength.
They can experience nausea, aswell as visual disturbances,
things like blurry vision,tunnel vision or even visual
(09:26):
auras, and that's usually inmuch more severe cases of
cervical instability andspecifically upper cervical
instability.
Other more severe symptoms caninclude even sleep apnea, which
can be caused by compression onbrainstem structures that affect
those nerves and nuclei thatregulate breathing.
(09:46):
And the instability can alsocause altered positioning of the
airway and dysfunction of themuscles involved in breathing,
leading to airway obstructionduring sleep.
There can even be cognitivesymptoms due to alterations in
blood flow to the brain and thenhearing changes.
Cervical instability can affectblood flow to the nerves.
(10:10):
The cochlear and vestibularnerves need the correct blood
flow to function and if you havecompression of the nerves or
compromised blood flow to thosenerves, then this can actually
lead to tinnitus, hearing lossor a sensation of fullness in
the ear.
So dysfunction of the uppercervical spine can actually
(10:30):
alter functions of theeustachian tube and that can
lead to that type of earpressure and then difficulty
with sound modulation.
So, as you can imagine, thesetypes of neurological symptoms
that cause changes in brainfunction and cognitive functions
hearing, breathing these areusually seen primarily in these
(10:52):
more severe cases of uppercervical instability.
As you can imagine, if peopleare suffering from so many
different neurological symptoms,those symptoms could easily be
misdiagnosed as many otherthings, whether that is
migraines or vestibulardisorders and even anxiety.
(11:14):
Sometimes people are, you know,their symptoms are kind of
swept under the rug or notconsidered serious, and so they
are just labeled as havinganxiety, and this can lead to a
lot of frustration and obviouslya delay in proper treatment
when there isn't a properdiagnosis.
So let's talk about diagnostictesting for cervical instability
(11:36):
.
Accurate diagnosis is crucialfor identifying cervical
instability and in determiningthe appropriate treatment.
Here's the problem.
However, healthcare as a wholeis not on the same page when it
comes to cervical instability,for some providers it is not
even on their radar.
For others, there may be abasic level of awareness of
(12:00):
severe cases of instability fromsevere trauma or a generalized
joint instability due tohypermobility disorders.
It is actually not very easy tofind experts in cervical
instability, and this is whythere's also confusion and
disagreement around the methodsin order to assess it.
(12:20):
So when this type ofdisagreement and lack of
standard protocols exists, thepeople who suffer the most are
the patients who are just tryingto get to the bottom of their
symptoms, to understand what isgoing on and what can be done
about it.
So let's talk about some of thetests that do exist and then
(12:41):
some of the treatment options Ihad mentioned earlier.
The digital motion x-ray, andthis is a dynamic imaging
technique that capturesreal-time movement of the
cervical spine to identifyinstability.
Unlike a typical x-ray, whichis just one image, a digital
motion x-ray, which is alsosometimes called a dynamic
(13:04):
motion x-ray, or DMX for short,is actually taking about 15
images per second, and so youcan really get a much better
sense.
When you're taking that manyimages in rapid succession and
with somebody moving their headinto different positions, you
can really capture the amount ofmovement that is happening of
(13:26):
those vertebrae, and so, unlikeany other device, these digital
motion x-rays are actually veryeffective at capturing excessive
amounts of movement of thecervical spine.
The problem is not very manypeople have them, and so they
are hard to find, or it's hardto locate a clinic that offers
it.
(13:47):
The next option, which might beeasier to find but still has
some problems associated with it, is what's called a standing
MRI.
Well, oftentimes, if you arelaying down for an MRI, you're
not going to capture cervicalinstability.
However, there are standingMRIs that are set up in order to
be able to do that.
The problem that I've seen withsome of my patients that have
(14:09):
had that is that the radiologyreport gets sent out and then,
when it comes back, the doctorsthat ordered the MRI don't
actually know how to interpretthem.
So a standing MRI can help toassess things like ligament
laxity, any kind of spinal cordcompression, and then there may
(14:30):
also be the need to do some typeof vertebral artery testing to
assess blood flow in thevertebral basilar system, to see
if there are any arteries thatare being compressed as a result
of these types of injuries.
Other clinics may offer flexionextension x-rays, which are
(14:51):
standard x-rays, but they'retaken with different neck
positions in an attempt to lookat this excessive motion
happening between the vertebrae.
Once cervical instability isdiagnosed, and specifically
upper cervical instability, in avery, very small percentage of
cases that are highly severethey may actually require
(15:14):
surgery, but in most instanceswhat is recommended is a
combination of physical therapyand neck strengthening in order
to help strengthen the deep neckmuscles that can compensate for
the ligament laxity, and thereare a lot of specialty devices
out there specifically for neckstrengthening, and so in this
(15:37):
case, it would also be importantto seek out a clinic whether
it's a physical therapy clinicor a specific chiropractic
clinic where they actuallyspecialize in cervical
instability and have the righttypes of equipment and neck
strengthening devices that areuseful for this type of
treatment.
(15:57):
And then there are specifictypes of chiropractic care that
specialize in gentle adjustmentsto realign the upper cervical
spine and improve stability.
So not all chiropractic is thesame.
There are many, many differenttypes of chiropractic care out
there, different types ofadjusting techniques, and so
(16:18):
there are certain disciplineswithin the chiropractic
profession that really focus onthe upper cervical spine and are
trained to address cervicalinstability, and then the other
therapy that could be quitehelpful is prolotherapy, and
this can include either theinjection of a dextrose solution
or a person's own platelets,and this is called PRP, or
(16:42):
platelet rich plasma andprolotherapy.
The idea is that you areinjecting a solution into the
attachment sites for theseligaments, where they attach to
the bone, and this creates amild inflammatory response that
stimulates fibroblast activityto increase the tensile strength
(17:03):
of the ligaments and over timethis can improve the load
bearing capacity of thesecervical ligaments to make the
neck more stable.
In some cases, if prolotherapywith saline isn't cutting it,
the PRP is a little bit strongerand it's in effect, and how
that is done is that your ownblood is taken out of you, the
(17:26):
platelets are spun in acentrifuge and then those
platelets are injected back intothese specific sites.
So the PRP is a little bit moreexpensive than the prolotherapy
, but it is a little bitstronger in its effects.
We've mentioned in past episodesthe importance of neck
(17:46):
strengthening for people thathave had concussions, and I
think it's important when itcomes to the topic of just
generalized cervical instabilityor loss of cervical curvature,
(18:09):
of recovery, and the researchhas also suggested that it can
be preventative of futureconcussions, especially for
people in certain sports likesoccer, for example, and so I
think it's really important tobe able to find some kind of
provider whether that is aphysical therapist or a
chiropractor that has somespecialty in neck strengthening
and many of the exercises thatare out there can easily be done
at home, but it's importantthat you're doing them correctly
(18:32):
.
One of the reasons why I wantedto talk about cervical
instability is because so muchof the concussion research is
done kind of in a vacuum, so tospeak, where they're not talking
about pre existing conditions,and the reality is that I have
worked with many patients whohave had more than one
concussion.
(18:52):
I've had people that have beenin three or more car accidents,
and so they actually have hadthree concussions and three
different whiplash injuries thathave caused ligament laxity.
I've worked with people thathave Ehlers-Danlos syndrome or
people that have had lupus, forexample, which can affect the
joints and the connective tissue, that have then gone on to have
(19:15):
concussions and develop aworsening of ligament laxity and
cervical instability.
And so part of this podcast isreally emphasizing the fact that
concussions don't occur invacuums.
They occur in people that oftenhave pre existing issues that
they're dealing with, and soit's important to recognize how
some of these pre existingissues can actually set people
(19:38):
up for a situation where theymight develop a ligament laxity
or a cervical instability thatcan drive even symptoms that
mimic dysautonomia in terms ofchanges in, say, heart rate or
heart rhythm or heartpalpitations, the cognitive
symptoms, the changes in hearing, the headaches, migraines,
(20:01):
vertigo.
There's a lot of symptoms thatcan come on if somebody has
severe upper cervicalinstability, and the point of
this whole podcast is trying tohighlight all the different
things that need to be testedand looked at so that people
aren't spending years and yearssuffering without having the
(20:21):
right tests or the most accuratediagnosis.
In many cases, cervicalinstability is complex, but it
is treatable, and through acombination of things like
prolotherapy or plateletinjections, in conjunction with
neck strengthening programs andpostural restoration techniques,
people can get relief fromthese symptoms.
(20:45):
The most crucial thing is toseek out some type of specialist
who has a deep understanding ofthis condition and can offer
these types of specifictreatments In general, I think
it's also important for anybodywho spends a lot of time with
their head down and with aforward head posture as they are
(21:07):
looking at phones or laptops torecognize the long-term impacts
this can have on the cervicalspine in terms of a loss of
cervical curvature, and thatover time that can lead to
ligament laxity, which can causeproblems in the future.
So for anybody who is spendinga lot of time with their head
down and jutted forward, this isa good reminder to engage in
(21:34):
some kind of neck strengtheningprogram and to also work on
stretching the neck andadjusting their posture as much
as they can throughout the day.
For more information oncervical instability, you can
check out lifeafterimpactcom,and we have a recent blog post
that talks about cervicalinstability, along with a list
(21:55):
of the research papers that wereferenced in the making of this
episode.
In upcoming episodes we will bediving into aspects of
dysautonomia and bringing youinterviews with different
specialists in the field ofconcussion recovery.
(22:15):
Medical disclaimer this video orpodcast is for general
informational purposes only anddoes not constitute the practice
of medicine or otherprofessional healthcare services
, including the giving ofmedical advice.
No doctor patient relationshipis formed.
The use of this information andmaterials included is at the
(22:36):
user's own risk.
The content of this video orpodcast is not intended to be a
substitute for medical advice,diagnosis or treatment, and
consumers of this informationshould seek the advice of a
medical professional for any andall health-related issues.
A link to our full medicaldisclaimer is available in the
notes.
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