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Cervical Instability

Cervical instability also called cervical instability of the cervical spine (CICS), is a health condition in which ligaments of the upper cervical spine (as opposed to the low back pain in sacroiliac joint pain) become loose and might lead to nerve damage along with an array of adverse indications.

What Causes Cervical Instability?

There are assortments of possible risk factors and causes of cervical instability. The most prevalent ones are as follows. :

  • Trauma: Any traumatic event, such as a road traffic accident, blow, or a similar impactful experience, may injure the cervical spine, disturb the ligaments, leading to cervical instability chronically.
  • Micro injuries: Repeated overuse leads to micro-injuries in the ligaments and surrounding structures of the cervical spine, leading to cervical instability and chronic neck pain.
  • Genetic disorder: People with certain syndromes such as Down Syndrome, and Ehlers-Danlos, frequently experience cervical instability as a symptom.
  • Rheumatoid arthritis (RA): Arthritic conditions such as RA can also cause cervical instability due to progressive deterioration in the joints and neck vertebrae.

Symptoms Of Cervical Instability

Cervical instability symptoms often mimic other musculoskeletal, orthopaedic, and neurologic disorders. However, certain primary signs and symptoms show that the condition you are having is actually CICS. These include:

  • Dizziness
  • Recurring headache
  • Stiff or tight neck
  • Pain and tenderness in the upper neck towards the skull base
  • Struggle to hold up your head for a prolonged period
  • Heaviness in the head
  • Pain aggravating to the shoulder
  • Balance issues
  • Shakiness in the head and neck

A lady with cervical instability holding her neck

How Do You Test Cervical Instability?

Following methods are used for testing cervical instability:

  1. Upright magnetic resonance imaging (MRI)
  2. CT scan (computerized tomography)
  3. Digital x-ray

While MRIs are frequently performed as the most common diagnostic tests for CICS, it has been reported in a 2012 study that MRIs show limited diagnostic value in individuals who have had the disorder due to whiplash.

How Do You Fix Cervical Neck Instability?

Which CICS treatment is the best is not established. However, the following five treatment options are considered by evidence to be the most effective.

1. Chiropractic

A common treatment for the symptoms of cervical instability such as poor posture, headache, and spinal misalignment is chiropractic care. This treatment utilized for the upper cervical region can potentially help the condition.

Another 2020 study reported that chiropractic manipulative therapy of the spine is an effective therapy for the correction of cervical instability together with other disorders. Spinal manipulation is reported to be safe and efficacious when done by an experienced chiropractor. 

2. Surgery

Not all cases of cervical instability may need surgery. You won’t require surgery if your cervical instability is not out of control. Mostly, surgery is needed in severe cases to tackle the symptoms of progressive conditions.

In most surgical therapies, the objective is the correction of craniocervical junction dysfunction at the conjunction between the skull and the upper spine.

Surgical treatments include:

  1. Cervical fusion spine surgery
  2. Screw-rod constructs
  3. Halifax clamp
  4. Posterior sublaminar wiring
  5. Transarticular screws

However, as the surgical procedures are invasive and more expensive, doctors generally begin with more conservative treatments at first before resorting to invasive surgery.

3. Physical Therapy

Another effective method for CICS is physical therapy. Doctors generally suggest physical therapy along with chiropractic care for best results. It involves:

  • Posture education
  • Strengthening exercises
  • Soft tissue mobilization
  • Joint mobilization
  • Spinal manipulation
  • Proprioception exercises

Your doctor might advise wearing a cervical collar or a brace as per the severity of your condition.

4. Strengthening Exercises

Strengthening exercises that can be used for the treatment or prevention of cervical instability include:

  1. Chin tucks – support your posture and neck joints and are the most frequently used strengthening exercises used for the improvement of cervical instability.
  2. Isometric exercises – give strength to the neck area with its active range of motion.
  3. Rotating the neck – leads to a slow and periodic strengthening of the muscles and joints surrounding the upper cervical spine.
  4. Yes and no neck motions  aids in stretching the joints and muscles of the neck. Slow nodding is done in a yes motion. The head is shaken in no motion.
  5. Practising good posture – decreases pressure from the spine. Every day good posture should be practised for as long as possible. Every passing day you should be able to practice good posture for a longer duration.

You should stop any exercise or motion that causes pain. If you feel pain, it is a sign that you should rest and not thrust further. Consult your physician for advice before starting these exercises.

5. Prolotherapy      

Prolotherapy is a comparatively novel treatment option for cervical instability patients.

It is a regenerative technique with injections that aim to enhance the natural healing process of your body for strengthening and repairing damaged ligaments and joints. It is generally aimed at acute and chronic musculoskeletal damages that cause chronic neck pain associated with primary joint instability and loose ligaments.

According to a 2007 study, prolotherapy constantly improved neck pain in impact patients.

Several patients opt for a combination of chiropractic care, physical therapy and prolotherapy.

How to Prevent Cervical Instability?

Generally, cervical instability occurs in people with connective tissue disorders. People who are at an increased risk, for example, Ehlers-Danlos syndrome, need to avert cervical instability.

For the prevention of cervical instability, you need to visit your chiropractor, practice strengthening exercises, mindfully sit in a good posture every day, and evade circumstances that can potentially cause whiplash or spinal trauma.

All patients should practice these tips for improved general health, especially those with connective tissue diseases or defects in the spine or neck.

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