Cervical Neck Instability
Ross Hauser, MD discusses the problems of Cervical Neck Instability and treatment options including Prolotherapy, Stem Cell Therapy, and Platelet Rich Plasma Therapy
Instability of the Neck
The cervical (neck) area is a very important and sensitive area of the body, as it protects the brain stem, provides rotational flexibility, and allows for other body functions to work properly. Damage to the C0, C1, or C2 vertebrae can cause many more problems than just pain in the neck. Their close proximity to the brain stem can lead to blocked neural signals and cause systematic problems throughout the body. The pain that shoots down your arm may stem from a problem that comes from damage to the C1 and C2 vertebrae.
Upper cervical instability is a more severe issue than many people realize. Cervical instability can be difficult to diagnose for the average practitioner. This is largely due to the low reliability and validity of radiographic studies including functional (motion) radiographs and many clinical examination measures that are still under debate and are rather questionable. Unfortunately, there is often no correlation between the hypermobility or subluxation of the joint, clinical signs or symptoms, or neurological signs or symptoms. Sometimes there are no symptoms at all which further broadens the already very wide spectrum of possible diagnoses for cervical instability. However, this is not the case for those of us who are skilled in recognizing cervical joint instability.
Diagnosis and Symptoms of Cervical Neck Pain and Instability of the Neck
Destabilization of the upper cervical area can lead to severe life-threatening neurological sequelae that include but are not limited to vertigo, post-whiplash concussion, tinnitus, drop attacks, dizziness, occipital neuralgia, and headaches. (migraine headaches).
Physical therapists typically use the following to diagnose cervical instability:
- Intolerance to prolonged static postures
- Fatigue and inability to hold head up
- Better with external support, including hands or collar
- Frequent need for self-manipulation
- Feeling of instability, shaking, or lack of control
- Frequent episodes of acute attacks
- Sharp pain, possibly with sudden movements.
Traditional treatment of Instability of the Neck
Traditional treatment of cervical instability includes temporarily treating the area using electrical stimulation, physical therapy, chiropractic adjustments, and even surgical fusion (if immediately necessary or severe of a case). All of these treatments will require a fair amount of visits and possibly the use of other treatments long term in order to keep the results they may give. A permanent solution to cervical instability, however, is comprehensive Hackett-Hemwall Prolotherapy.
Prolotherapy: A Non-Surgical Alternative to Instability of the Neck
Prolotherapy treatments are a series of injections that attack the true problem of joint instability, lax ligaments. Treating cervical instability is no different than treating any other body part. Our Prolotherapists are experts in treating this condition that is often completely life-altering and disabling, which traditional medicine often leaves the patients to long term pain medications and an unending trail of unsuccessful treatments.
Whenever the ligaments of a joint become loose, the joints themselves become unstable. Prolotherapy injections induce a mild version of the body’s natural immune response, also known as inflammation, which brings immune repair cells, growth factors, and cytokines to the scene in order to aid the body in healing itself. By strengthening the weak supporting structures, we can stabilize these structures, thus eliminating the excessive mobility and halting the myriad of often weird symptoms that can incapacitate many patients. They CAN get their lives back using Prolotherapy to treat cervical instability!
Danielle R. Steilen, MMS, PA-C
Imagine neck pain for 35 years; it gives new meaning to a pain in the neck. For Barb, it started with a skiing accident. She developed C1 joint laxity and consequently it periodically went out and caused dizziness, inability to concentrate, and all sorts of autonomic nervous system symptoms that many patients with C1 instability are told are literally “all in their heads!”
In her quest to end her pain, Barb started chiropractic NUCCA treatments, but after four months of treatments she found her pain returned before she reached her car in the chiropractor’s parking lot. Scratch NUCCA treatments. The chiropractor sent her to a neuromuscular dentist who prescribed an orthotic splint to wear to bed to correctly align her jaw. After one month Barb developed muscular spasms in her jaws and was diagnosed with TMJ. She never had TMJ prior to the orthotic. Scratch the orthotic.
Prolotherapy for C1 instability
Fast forward to her discovery of Prolotherapy. Seven Prolotherapy treatments and Barb felt 50% better. After nine treatments she felt 65% better. At treatment #11 Barb declared her C1 pain to be 80% gone. One or two more treatments and Barb will graduate pain free. We’re glad she found the solution to her chronic pain…but not as glad as Barb. Because of the severity of Barb’s neck injury, she required more than the usual three to six visits that most of our patients receive. But Barb, ever tenacious, was willing to put in the time to achieve complete healing.
Remember, Prolotherapy works by injecting a small amount of solution into the area that is weakened or damaged. This injection treatment signals the body to send reparative cells to the treated area and cause the area to grow stronger, thus enabling the body to heal itself, with just a little jump start! Treating the C1 area is not done by all Prolotherapy doctors, as it is a very difficult area to reach with a needle. The Prolotherapy doctor needs to have advanced skills to even attempt these injections.
Prolotherapy on a patient’s cervical area:
This video is going to demonstrate comprehensive Hackett-Hemwall Prolotherapy of the neck. Here you see me, Dr. Ross Hauser, marking out some landmarks relating to the neck. The midline mark is made so I know where the spinus processes are. We want to stay lateral to the midline, because the midline is where the spinal cord is. I am doing the superior and inferior nuchal ridge. This particular patient has extensivearthritis in their neck, severe neck pain, and clicking and grinding in the neck.
This is a very comprehensive procedure. Again, we are doing the superior and inferior nuchal ridge on the occiput, which is where a lot of muscles attach. A lot of people are very sensitive at these locations. Now I am doing the midline on the occiput. Typically, I would do this if someone was having significantheadaches, which this person is having. If a person has neck pain before or during the headache, that indicates that Prolotherapy will help resolve their headaches. This includes migraine headaches as well astension headaches. I am being very thorough on the occipital ridge, making sure that the whole occiput is treated.
Now we are going to do the lateral masses, so we are going to do the lateral transverse processes of C2 to C7. I am going down, doing each vertebra. Each vertebra is going to get four different injections. They are going to get injections on the right, left, on the facet joints, as well as the lateral masses or transverse processes. You can see that I am somewhat following the line that I drew from the mastoid process down to the spinous process of C7. Here I am doing the facet joints. The facet joints are located one finger breadth from the midline. This is another reason I drew the midline: so I can easily tell where the facet joints are. Prolotherapy of the neck is a very effective treatment for chronic neck pain, headaches, as well as neck instability.
There are lots of people who go to a chiropractor and need a lot of chiropractic care, but the vertebrae sublux or get out of alignment a day or two after the patient goes to the chiropractor. This means that they have joint instability. The best treatment for joint instability of the neck and anywhere else in the body I believe is Prolotherapy. By stimulating ligament repair, Prolotherapy can stabilize those joints. Thus, the muscles spasms stop, and the pain that the person is suffering from stops.
As you can see, this person is not sedated, and they are tolerating the procedure very well. If someone was having a lot of problems with the procedure, we could give them sedation; either oral pain medications or IV sedation. However, most people just “grin and bear it,” because even a thorough treatment like this is only going to take a few minutes. As you can see, it is done very safely, in the office. If you have had neck pain for five or ten years, then this is a simple price to pay to get rid of pain for the rest of your life, even though the procedure is a little bit painful. This person did extremely well, and tolerated the procedure very well.