In recent months, we have had an influx of people contacting our office having done their own online research on the topic of potential craniocervical instability: i.e. ligament instability in the upper neck. Plus associated brain function changes with memory and mood that go with them. All this is causing a wide variety of symptoms that no one can explain:
Migraines
Headaches
Dizziness or Vertigo
Brain fog
Neck clicking or grinding
Plus associated brain function changes with memory and mood that go with them. One of the diagnostic methods that are proposed for craniocervical instability is what is known as a digital motion x-ray (DMX) study, which may reveal if the vertebrae in your upper neck are indeed moving too much. If so, a course of prolotherapy may be recommended, which is where a specialist injects a solution into the ligaments of the upper neck to help stabilise them.
We would like to mention a couple of things on the topic. First, we could like to give credit to Caring Medical in Florida, which has done such a fantastic job in getting the message out there. They are the ones who have put out so many videos and blog articles on the subject that people, who experience these types of issues may discover REAL HOPE. Second, we have personally had prolotherapy, and so we understand exactly what its value is in strengthening and stabilising ligaments. So yes, when one truly has a ligament stability problem, prolotherapy (or protein-rich plasma, aka PRP injections) may be just what the doctor ordered!
The one VERY IMPORTANT thing that we should add at this point is that simply because one may experience all of these symptoms - even if their neck is clicking - it does not necessarily mean that you require prolotherapy as a treatment option. In fact, you may not have craniocervical instability at all but instead may have a closely related condition that may be resolved without the need for an injection at all. And that problem may be a misalignment with your atlas vertebra.
How can an atlas misalignment mimic cervical instability?
An atlas (aka C1 vertebra located at the base of your skull) misalignment can mimic craniocervical instability because they both affect motion. First, let’s consider the concept of true craniocervical instability. This would be a case where you have suffered some type of physical injury that damaged the ligaments that normally support the stability of your upper neck. Not unlike a sprained ankle, craniocervical instability typically occurs with what is called a Grade II sprain: i.e., there is sufficient ligament damage to be detected properly on an ultrasound or MRI scan (if it is looked at the right way, which is frequently is not in the upper neck) and that may result in a 50% displacement of the normal articular relationships between two adjacent bones.
In other words, the ligament laxity causes the vertebra to shift 50% or more beyond its normal, neutral centre of gravity. And when those vertebrae are not stable, well, they can impart tension on the brainstem, which in turn may lead to a number of neurological and health issues. Now that we can picture that, let’s consider an alternative hypothesis: i.e., that you may not have a Grade II ligament sprain resulting in craniocervical instability, but instead a much smaller ligament injury (aka a Grade I sprain), which may only be a fraction of a millimetre small, but that causes a vertebrae to become entrapped or locked within its normal range of motion.
As a consequence of the vertebra locking and not actually moving properly, your body in its innate wisdom may produce compensatory changes at adjacent levels … especially in the space between your atlas and axis vertebrae that, if it ever becomes inflamed, is a major source of dizziness, TMJ issues, and headaches for people. So what happens is that those areas end up moving too much, not because they are actually unstable, but because they are compensating for an adjacent problem that is not moving enough. Because both types of conditions - i.e., craniocervical instability and an atlas misalignment - affect the exact same structures, they can produce the exact same types of symptoms. And in reality, they are actually opposite ends of the same spectrum: i.e., if you have true craniocervical instability, trying to INCREASE the motion in the upper neck is one of the worst things that you could do … but on the other hand, if you have an atlas misalignment, injecting a substance into the ligament to increase stability will NOT ACTUALLY SOLVE THE PROBLEM.
How do I know if it's craniocervical instability or an atlas misalignment?
So which is it? Is it craniocervical instability or is it an atlas misalignment Indeed, whomever you may consult - whether i.e., a musculoskeletal medicine practitioner who uses prolotherapy and what is known as an upper cervical specific chiropractor - we should be able to tell the difference? And while a DMX study is useful, there are other indicators that are also helpful including a coronal slice MRI (which allows you to see if there is ligament damage in the upper neck easier than from the normal sagittal or horizontal views) and also what is called digital articular x-rays (DAX).
DAX studies are a special method of imaging that can be performed using x-ray or cone beam CT (CBCT) technology, Unlike standard views which are taken from stock angles, DAX studies recognise that every human being has a unique architecture and orientation of the joints in their spine. As a result, in order to properly understand what is actually going on, we need to take a customised approach and measure a series of angles in order to know how to take the views and see what is going on. So whether we are dealing with craniocervical instability or an atlas misalignment, because we are typically looking for articular misalignments or motion abnormalities that are measured in millimetres, precision is the key.
At Atlas Health Australia, we are the leader in Blair upper cervical specific chiropractic serving Brisbane and southeast Queensland. Our practice works with people who experience both craniocervical instability and atlas misalignments by performing a series of assessments (including DAX studies) in order to determine what form of care you most likely require. If you may require prolotherapy, although we do not provide services, we have a number of professional contacts, who may be able to help. If instead, you require an atlas correction, that is where we may be able to help you directly.
References
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Rosa S, Baird JW. The craniocervical junction: observations regarding the relationship between misalignment, obstruction of cerebrospinal fluid flow, cerebellar tonsillar ectopia, and image-guided correction. Smith FW, Dworkin JS (eds): The Craniocervical Syndrome and MRI. Basel, Karger, 2015, pp 48-66 (DOI:10.1159/000365470).
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