Upper cervical and instability exists on a spectrum from mild forms causing discomfort but no hard neurological signs to more severe involving, with significant neurological compromise, with most patients having elements of both. Determination of UCI requires that two criteria be met:
1) Symptoms consistent with musculoskeletal and/or neurological UCI, and
2) Symptoms are altered by neck movement and/or position.
There are three components of mechanical irritability:
(1) The condition is severe,
(2) The condition is easily flared, and
(3) Prolonged time to ease after flare. Patients may flare hours after the aggravating activity, and multiple systemic symptoms can be exacerbated.
Motor control is particularly important for cervical stability, as instability is due to insufficient neuromuscular control and inappropriate recruitment patterns. Central nervous system
inhibition of stabilizer synergist recruitment often persists long after pain flare ups resolve contributing to innocuous and insidious recurrence. Treatment should take into consideration multiple factors including the complexity of the systemic symptoms and should be progressed slowly to patients' tolerance taking into consideration not only the musculoskeletal guidelines but the overall systemic and psychological complications that can potentially be a barrier to rehabilitation.
Cervical instability can be a devastating, life altering health consequence. Symptoms like headaches, even suboccipital and occipital ones, are a common complaint but headache treatments are sometimes offered without finding its true cause. Static x-ray and traditional MRI analyses often do not show upper cervical pathology. Radiologists who read the x-rays and MRIs most of the time emphasize the lower cervical vertebrae and discs in their readings, often not even commenting on the upper two cervical vertebrae.
Occipital and trigeminal neuralgia can also be a frequent complain on patients with upper cervical instability, and are both typically caused at the upper cervical instability, and it affects the neurons that participate in the central relay systems in the brain, that are involved with vision, proprioception (balance and 3-D perception), hormone levels, and even concentration, memory, emotions and happiness.
Cervical instability affects the functioning of not only the cervical nerves that innervate the muscles and skin of the arms and hands, but also the autonomic nerves that control blood pressure, heart rate, digestion, immune system function, breathing, and even energy levels Other symptoms related to upper cervical instability may include: neck pain, insomnia, dizziness, lightheadedness, neck pain with movement, preauricular (ear) region pain, ringing in the ear, and vertigo.
The sensation that the neck cannot support the weight of the head is a very common complain of many of my patients, and usually comes along with a slight or marked head tilt. Some patients may experience intracranial hypertension and pressure headaches, decreased blood flow in and out of the brain, brain fog, concentration difficulties, memory issues, emotional stress and even arterial and venous compression related symptoms. Dysautonomia symptoms are common due to brainstem compression, most commonly Postural Orthostatic Tachycardia Syndrome (POTS), and some cases may present with cervical angina, which is defined as a chest pain that resembles the pain (angina pectoris) of a heart attack but for which there is no clinical evidence of heart disease, and inability to maintain consistent body and skin temperature.
Digestive problems and facial issues are another cluster of symptoms seem on patients with craniocervical instability, including swallowing difficulties, chronic Hiccups, Temporomandibular Joint Dysfunction (TMD), burning mouth, facial pain, and even strange skin sensations.
Many patients will also experience excessive sweating, sweaty hands, and palms, itching skin, red ear episodes (unilateral or bilateral attacks of paroxysmal burning sensations and reddening of the external ear that can last a few seconds to several hours).
Vision problems like transient monocular blindness, and oscillopsia may be present, which may result from impaired eye stability. Ear fullness and hearing problems, Meniere’s Disease, chronic cerebrospinal venous insufficiency, tinnitus chronic fatigue syndrome, dizziness, balance problems, headaches, dissociation, anxiety depression, are also frequently reported.
Why is the RIGHT Physical Therapy Approach Important? Research has shown that both the cervical flexors and extensors lose strength and endurance in the presence of neck pain, and that co-activation of muscles cease especially with functional tasks. Fatty infiltration has been identified in the deep flexor and extensor muscles of people with chronic whiplash associated disorder. Patients with neck pain struggle to relax the superficial neck flexor muscles even after an activity has ceased. When a patient without neck pain rapidly lifts their arm the cervical muscles will activate, in patients with neck pain there is a significant deficit for both the superficial and deep neck flexors which can result in an increase strain on the cervical spine. Changes in function in the deep cervical muscles has an influence on function as it affects the support and control of the cervical spine and could lead to overload on specific segments.
Treatments that involve only the cervical spine or neck and shoulders exercises do not address all the issues caused by such a complex diagnosis.
At Actify we offer a proprietary holistic whole-body approach using a sling method that focuses on tonic stabilizers largely located near joints that play a crucial role in stability.
If you have FAILED traditional Physical Therapy and want to find out how we can HELP call us now!