Ross Hauser, MD

Difficulty swallowing can change a person’s entire day. Meals become stressful. Tablets seem harder to get down. Foods that once felt easy to eat are replaced by softer foods, and concern about choking can make eating with others uncomfortable. When swallowing problems occur alongside neck pain, headaches, or symptoms after an injury, patients may wonder whether the problems are connected.

At Caring Medical, our interest in this connection comes from patients who describe swallowing difficulties as one part of a broader symptom pattern. Cervicogenic dysphagia means swallowing difficulty associated with a cervical spine disorder. Possible contributors described in the literature include anterior bone spurs, spinal deformity, postoperative changes, and certain functional or mechanical disturbances. These are different processes and should not all be labeled cervical instability. (1)

In this article, we explain how swallowing works, what a neck-related contribution can mean, and why the particular cause matters. We also share a patient’s account of swallowing and other symptoms following a stretching movement, including the improvements and remaining difficulties he describes after treatment.

C2 Malrotation and swallowing difficulties

Ross Hauser, MD discusses C2 Malrotation and the symptoms associated with it, as well as why we like adjustments, curve correction, and Prolotherapy to help restore spinal integrity and resolve symptoms.

Video learning points:

The malrotation of the C2 vertebrae or the axis, is often what I call the Missing Link into what is causing a person’s symptoms.

• Rotated C2 can compress the vagus nerve which can cause digestive problems seen in some upper cervical instability patients.
• Rotated C2 can cause compression on the glossopharyngeal nerve which can cause dysfunction of the larynx muscles and cause swallowing difficulties.
• Rotated C2 can cause compression of the spinal accessory nerve causing cramping into the sternocleidomastoid muscle or the trapezius muscle and creating a situation of torticollis.
• Rotated C2 can cause compression and obstruct the right jugular vein causing increased brain pressure and problems of cognitive decline and mood disorders.
• Rotated C2 can compress the carotid sheath causing compression on jugular veins and carotid arteries causing intracranial hypertension.

Swallowing difficulty is different from a digestive complaint

The word “eating” can describe several separate experiences. A patient may struggle to chew, initiate a swallow, move food through the esophagus, tolerate a meal, or feel hungry. Those problems can overlap, but they do not mean the same thing.

Current recommendations distinguish oropharyngeal from esophageal dysphagia because the evaluation and potential causes differ. Symptoms help guide that distinction, but a patient’s description of where food sticks does not always identify the exact location of the problem. (2)

This distinction is especially important in our new patient interview. He describes difficulty swallowing and pressure associated with swallowing, but also says he could not digest food and had lost his appetite. His statements document his experience; they do not establish a diagnosis of gastroparesis, malabsorption, or vagus nerve injury.

How the mouth, throat, and esophagus work together

Swallowing requires coordinated movement and sensation. In the oral stage, the teeth and jaw help prepare food, and the tongue forms and moves the food bolus—a swallowable portion—toward the throat. In the pharyngeal stage, coordinated movements propel it through the throat while protecting the airway. The upper esophageal sphincter opens, and the esophagus carries it toward the stomach.

Airway protection involves several actions rather than one simple flap closing: the vocal folds close, the larynx elevates, and the epiglottis inverts as part of the swallowing sequence. Aspiration means material passes below the vocal folds into the airway. It can sometimes occur without coughing, called silent aspiration. (3)

Several cranial nerves contribute. The trigeminal nerve, cranial nerve V, supports chewing. The facial nerve, VII, contributes to lip and cheek control. The glossopharyngeal nerve, IX, supplies important throat sensation and the stylopharyngeus muscle. The vagus nerve, X, provides much of the motor supply to the pharynx and larynx. The hypoglossal nerve, XII, controls most tongue muscles. The hypoglossal nerve does not primarily control the pharyngeal constrictors. (3)

This anatomy helps explain why swallowing changes can accompany neurological disease, injury, or surgery. It also explains why observing a symptom is only the start of identifying its source.

When swallowing problems began after a stretching movement

A graduate music student describes a sudden change

Watch the patient interview: A patient discusses neck symptoms, swallowing difficulties, and his experience with Prolotherapy

In the interview, our patient describes working toward a doctorate in music composition while also teaching. He had experienced headaches before the event that markedly worsened his symptoms.

He recalls lying on his back and performing what he understood to be a nerve-flossing stretch. He lifted and strained his neck, then noticed a brief episode in which he could not hear. Tinnitus followed. Over the following days, he developed swallowing difficulty, pressure at the back of his head, and ongoing headaches.

He later experienced severe spasms in his neck and along his spine. Eating and sleeping became difficult. He recalls a systolic blood-pressure reading close to 200 and two emergency-room visits within three days. These are his retrospective reports, not measurements independently verified in this interview.

The sequence matters, but it does not prove what structure was injured. The transcript does not provide imaging findings, a swallowing-study result, or a vascular diagnosis. A stretching movement preceding symptoms does not, by itself, establish ligament tearing or explain every symptom that follows. Sudden hearing changes, severe head or neck pain, and major blood-pressure elevations also deserve consideration on their own medical significance.

The effect on eating, sleep, and studying

He describes being able to manage only about an hour of activity before needing to lie down. Lying down did not necessarily bring relief: spasms continued, and exhaustion did not translate into sleep.

His university and faculty were supportive, but continuing his studies and teaching while barely functioning was difficult. This part of the story helps explain the burden of swallowing problems beyond the swallow itself. Concern about food, poor sleep, pain, and reduced activity can affect academic work, employment, and travel.

He reports trying common pain medications and a period of physical therapy. He also describes earlier Prolotherapy with another provider, after which his appetite briefly improved. That short-lived change is part of his account, not proof of a digestive diagnosis or a specific treatment mechanism.

Improvement was gradual and incomplete

At the time of the interview, he reports seven neck Prolotherapy treatments at Caring Medical and approximately a year since the original event. He describes being able to eat and sleep again and function more normally. He had traveled to Korea to study traditional music and to Austria for a musical engagement.

He does not describe an instant or complete recovery. A long flight was still demanding, clicking and grinding remained, and he hoped to return to exercise. Rather than one symptom disappearing at a time, he felt several symptoms were gradually becoming less intense together.

For him, one of the most meaningful changes was feeling less concern after meals and less pressure in the back of his throat and head when swallowing. That is a functional improvement in his daily life. The interview does not establish resolution of aspiration risk or a measured change in swallowing physiology.

This is an individual patient experience. It cannot show how often another patient will improve, determine an appropriate number of treatments, or establish that Prolotherapy caused the reported changes.

When the cervical spine contributes to dysphagia

The cervical spine lies close to the pharynx and upper esophagus. That relationship creates several possible ways for neck pathology to affect swallowing: a structure can physically encroach on the swallowing pathway; alignment or restricted movement can alter mechanics; or nerve and muscle dysfunction can impair coordination.

However, an abnormal neck image does not automatically explain dysphagia. In a retrospective study of 100 people with dysphagia and matched healthy controls, spinal abnormalities were common. Among patients with abnormal spine findings, spinal disease was judged to be the primary cause of dysphagia in 16.9%. The study supports a cervical contribution in selected patients while illustrating how often abnormalities need additional interpretation. (4)

The practical question is not simply whether degeneration, straightening, or a bone spur exists. It is whether the finding plausibly interferes with swallowing in a way that fits the symptoms and functional assessment.

In this video, Ross Hauser, MD explains the functional dynamics and possible solutions to swallowing difficulties.

Eating and swallowing are complex behaviors involving volitional and reflexive activities of more than 30 nerves and muscles. To swallow something, the food has to pass from the mouth to the pharynx to the esophagus without going down the larynx into the lungs. If it goes down the larynx, it is called aspiration. Painful or difficulty swallowing is called dysphagia and can be caused by Atlantoaxial instability. Most of the major muscles that are related to swallowing once the food gets past the mouth are innervated by the cranial nerves that reside in the carotid sheath, just anterior to the upper cervical vertebrae.  The two nerves most involved in speech and swallowing are the glossopharyngeal (cranial nerve IX) and the vagus nerve (cranial nerve X).

Ligaments, upper cervical instability, and our clinical perspective

Ligaments support the cervical joints and restrain excessive movement. Our published review discusses capsular ligament laxity as a potential contributor to chronic neck pain and cervical instability. It is a review of anatomy, mechanisms, and treatment literature, rather than a controlled trial establishing Prolotherapy for dysphagia. (5)

In our clinical discussions, we also consider whether upper cervical dysstructure could influence nearby neural and vascular structures. C0 refers to the skull base; C1 is the atlas and C2 is the axis. Their movements and relationships matter to craniocervical function. Nonetheless, a rotated-looking C2 on one image, neck clicking, or relief with support is not sufficient to prove that a cranial nerve is compressed.

Our 2025 cervicovagopathy paper proposes mechanisms by which cervical instability and dysstructure might contribute to vagus nerve dysfunction. It is a hypothesis-and-theory article with clinical observations. It does not establish that unexplained swallowing difficulty usually results from vagus compression or that a neck intervention corrects swallowing physiology. (6)

Our related article on vagus nerve compression and the cervical spine explains that perspective in more detail. The proposed connection should sit alongside, rather than replace, consideration of established neurological and structural causes.

A useful case report with an important distinction

A case report described a young woman whose neck pain and swallowing difficulty decreased with isometric contraction of cervical muscles. Imaging showed anterior C5–C6 disc protrusion, an anterior longitudinal ligament lesion, and a small C6 osteophyte. Importantly, dynamic X-rays excluded anatomical instability. The authors proposed a combination of disc dysfunction, the osteophyte, and reduced functional stability. (7)

Muscle support and neck mechanics may influence symptoms, even when imaging does not show anatomical instability. Improvement when the neck is held still is a clue, not a stand-alone diagnosis of radiographic instability.

What other reports suggest

An earlier report described an older woman with neck stiffness, dysphagia, and cervical abnormalities whose symptoms improved after a course of chiropractic care. (8) A subsequent report described a woman with swallowing difficulty, reflux symptoms, osteophytes, cervical kyphosis, and scoliosis who improved during conservative treatment. (9)

A 2023 report described a man with eight months of difficulty swallowing and biomechanical abnormalities whose symptoms improved during a treatment course described by the authors as including physiotherapy and chiropractic techniques. (10)

These reports help identify possible clinical patterns, but single cases cannot determine which component of treatment was responsible or establish safety and effectiveness for other patients. They do not justify unsupervised manipulation or forceful stretching when instability or neurological symptoms are suspected.

Bone spurs and DISH can create a mechanical problem

Anterior cervical osteophytes are bony projections at the front of the cervical vertebrae. Depending on their size and location, they may interfere with the space needed for swallowing. They may occur with degeneration or diffuse idiopathic skeletal hyperostosis, known as DISH.

DISH involves ossification of spinal ligament and tendon attachment regions. In the cervical spine, bulky anterior bone formation can compress or displace the pharynx or esophagus and sometimes compromise the airway. A systematic review specifically examined these complications. DISH should not be described simply as proof that loose ligaments have turned into bone; its development is more complex. (11)

Stiffness may matter as well as bulk. A small retrospective study compared five people with advanced dysphagia undergoing bone removal with five people with mild symptoms. The authors suggested that restricted flexion associated with cervical ankylosis—marked stiffness or fusion—could contribute to swallowing difficulty in DISH. The study did not establish a universal sequence from ligament laxity to dysphagia. (12)

Some patients improve without bone-spur surgery

A 2024 case described an 85-year-old man with progressive swallowing difficulty despite a previous normal gastroscopy. Further assessment identified large cervical osteophytes. His symptoms improved with conservative measures, including swallowing therapy, dietary modifications, and medication. This was one case, but it shows why neither “all bone spurs require surgery” nor “a normal gastroscopy rules out a cervical cause” is a reliable assumption. (13)

Surgery can help when the obstruction is established

A 15-patient surgical series found improvement in swallowing scores after osteophyte removal, while also reporting complications in 27%. The authors highlighted the need to consider instability when removing osteophytes across three or more segments. That percentage comes from a small series and should not be presented as every patient’s surgical risk. (14)

A newer systematic review, published in a 2026 issue, reported significant initial improvement in 84% of cases and continued significant improvement at longer follow-up in 82%. The underlying reports were largely observational, with variations in selection and follow-up. These findings support potential benefit for appropriately selected patients; they do not establish that surgery is always needed or that it has low reward. (15)

Persistent swallowing problems after bone removal may reflect additional causes, residual functional impairment, recurrence, or postoperative changes. They do not automatically prove missed ligament instability.

Why swallowing difficulty can occur after cervical surgery

Swallowing difficulty is a recognized complication of anterior cervical surgery. Potential contributors include soft-tissue swelling, retraction-related injury, altered mechanics, nerve irritation, and implant-related effects. The frequency depends heavily on when swallowing is assessed and how dysphagia is defined.

A 2026 umbrella review included 32 systematic reviews. It reported very wide incidence estimates, with early postoperative dysphagia reaching 71% in some analyses and persistent symptoms at a year or more reported at 12–14% in selected analyses. Multilevel surgery, certain operative levels, and some implant or biological factors were recurrently associated with risk. Crucially, 31 of the 32 reviews were rated critically low confidence, limiting certainty. (16)

The older statement that “up to 79%” develop dysphagia should therefore not be read as a universal long-term rate. Timing, procedure, baseline swallowing function, and measurement method change the interpretation.

Posterior procedures do not eliminate the issue. In a 2024 comparison of 132 patients undergoing long-segment anterior or posterior cervical fusion, similar dysphagia rates were reported at three and twelve months. This supports attention to the broader effects of surgery and alignment, while differences between patient groups limit causal conclusions. (17)

Our article on anterior cervical discectomy and fusion outcomes discusses related postoperative concerns.

The burden of coping after surgery

A qualitative study interviewed 22 patients at several time points after anterior cervical surgery. Participants described swallowing symptoms and their efforts to adapt, sometimes without adequate professional guidance. This research captures a problem that complication statistics alone may miss: people can organize their entire eating routine around swallowing difficulty. (18)

Another patient account shared with us describes persistent dysphagia after surgery despite improvement in other symptoms. The useful lesson is that different symptoms can respond differently. A reported loss of cervical curvature alone does not establish the explanation for persistent swallowing impairment.

A nerve block case is not proof of one cause

A 2024 case report described post-ACDF painful swallowing and dysphagia treated with a glossopharyngeal nerve block. It raises the possibility that pain sensitivity can contribute to oral intolerance in some postoperative patients. It does not establish that a nerve block repairs a mechanical problem, excludes aspiration, or represents a routine treatment for dysphagia. (19)

Posture can change swallowing mechanics

The position of the jaw, head, neck, and hyoid bone influences the geometry and muscle activity of swallowing. Forward head posture involves changes across the upper and lower cervical regions, rather than the whole neck simply bending in one direction. The relevance to dysphagia depends on the individual’s physiology.

A study of 61 participants aged 12–26 with forward head posture and atypical swallowing compared orofacial myofunctional therapy alone with therapy combined with physiotherapy over 20 weeks. Both groups improved, while the combined group had better outcomes in the authors’ assessment. This was a particular young population with atypical swallowing, not proof that posture treatment corrects all adult dysphagia. (20)

A 2025 systematic review examined how head and neck positions affect swallowing movement and muscle activation. It supports the importance of position, including potential benefits of chin-down positioning in selected circumstances. It does not provide one posture that is safe or effective for everyone. (21)

Postural compensation and correction of a presumed spinal cause are different ideas. A position can temporarily change how a bolus travels without proving ligament instability. Likewise, symptom relief in a collar or with support is not a diagnostic test by itself. Chin-tuck maneuvers, neck strengthening, or nerve-flossing exercises should not be assumed appropriate solely because they appear in a video or general exercise program.

Jaw function and tongue movement matter before food reaches the throat

The temporomandibular joints and chewing muscles help prepare food. Pain, fatigue, limited opening, or impaired tongue coordination can make that oral stage difficult even when the main concern feels like a swallowing problem.

In a questionnaire study of 178 people with temporomandibular disorders, 99% reported at least one sign or symptom within a broad oral-stage difficulty category. This included painful chewing and chewing fatigue; only 33% reported swallowing difficulty specifically. The 99% figure must not be interpreted as 99% having confirmed pharyngeal dysphagia or aspiration. (22)

A study of 30 adults with temporomandibular disorders found associations between tongue mobility, pressure, oral motor control, and swallowing measures. These associations suggest that the tongue and jaw deserve consideration, but do not demonstrate that TMD-related swallowing complaints originate in cervical instability. (23)

Our discussion of TMJ pain and dysfunction provides additional context. A jaw problem, neck disorder, and swallowing impairment can coexist without one necessarily causing the others.

Why an endoscopy can be appropriate even when the neck hurts

Patients sometimes understandably ask why they were sent for gastrointestinal testing when they believe their symptoms began in the neck. An upper endoscopy examines the esophageal lining and structure and can help identify inflammation, narrowing, and other disorders. A routine neck scan does not exclude all esophageal disease.

A normal endoscopy also does not exclude every swallowing disorder. The 2025 clinical recommendations identify different roles for videofluoroscopic swallowing studies, fiberoptic endoscopic evaluation of swallowing, esophageal manometry, and other tests. These examine different aspects of function. Persistent symptoms after an unrevealing test should not be interpreted as proof either that nothing is wrong or that the neck is responsible. (2)

The location and timing of the problem matter. Coughing at the start of a swallow, food sticking after swallowing, and fullness long after a meal raise different questions. Anxiety about choking is understandable, but it should not substitute for investigating the underlying swallowing complaint.

Swallowing rehabilitation, nutrition, and hydration

Treatment research includes exercises for selected swallowing impairments, changes in food texture, compensatory strategies, and sometimes electrical stimulation. The purpose is to improve efficiency, safety, or nutritional intake according to the demonstrated impairment.

In a 2024 study of 64 older patients, a combined program involving modified diet, swallowing exercises, and electrostimulation was associated with improved swallowing-related quality of life. Because the intervention had several components, the findings do not identify the effect of any one component or establish that the same program applies to a young adult with a suspected cervical contribution. (24)

Maintaining hydration is also important. A review describes dehydration as a significant complication of dysphagia, with possible effects on cognition, constipation, and other illnesses. Fluid advice must take swallowing safety into account: simply telling someone who aspirates thin liquids to drink more water is not an adequate solution. Thickened fluids can be useful for selected impairments but are not a universal recommendation and may affect intake or acceptability. (25)

The same caution applies to a bland diet, avoiding caffeine, or reflux medication. These may address particular contributors, but they do not treat every cause of impaired swallowing. Nutritional support may remain necessary while the cause and safest intake are being addressed.

Aging, chronic pain, and feeling dismissed

Age-related changes in strength and physiological reserve can affect swallowing, but new or worsening dysphagia should not simply be attributed to getting older. The presence of degenerative changes also does not prove that the spine is the primary cause. The swallowing-study research discussed above illustrates that distinction. (4)

People with fibromyalgia can also describe eating and swallowing problems alongside chronic pain, fatigue, and sleep disturbance. Interviews with eight adults with fibromyalgia and dysphagia documented a substantial psychosocial burden and experiences of feeling unsupported. This study describes lived experience; it does not establish a cervical cause or a treatment effect. (26)

Our new patient interview adds another perspective on that burden: repeatedly seeking explanations while struggling to sleep, eat, study, and work. Validating that experience does not require assuming that all symptoms have one structural origin.

Where Prolotherapy fits in this discussion

Our cervical literature discusses ligament laxity as a potential contributor to pain and instability. Dextrose Prolotherapy is intended to stimulate a local repair response. Evidence about chronic neck pain and ligament-related conditions should not be transferred automatically to swallowing outcomes. (5)

The new video documents one patient’s reported improvement after treatment. Brad has also described swallowing, breathing, and other symptoms after a fall, followed by improvement during treatment. These stories provide personal context, not controlled evidence or a schedule other patients should expect.

Neither a testimonial, an improved neck image, nor a reduction in pain establishes that swallowing is safe or that aspiration has resolved. Similarly, the cervical hypotheses discussed here do not establish neural therapy, scar injections, or cervical Prolotherapy as proven treatments for dysphagia.

The distinction we want patients to understand is that cervical disease can contribute to swallowing difficulty in selected circumstances, but the cause must be interpreted specifically. Bone-spur obstruction, postoperative impairment, altered muscle mechanics, cranial nerve disease, and appetite or digestive complaints are not interchangeable diagnoses.

This article provides general education and does not replace an individual medical assessment. Swallowing difficulty can cause aspiration, dehydration, and malnutrition. Patient experiences are individual reports and do not predict another person’s results.

References

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• he right and left masticatory muscles antagonistically act on the displacement of the cervical spine, i.e. the morphological and functional characteristics in patients with mandibular lateral displacement may play a compensatory role in posture control.”

What? The TMJ altered your posture by stressing your cervical spine. Isn’t posture a problem of swallowing difficulties? Isn’t posture a problem of everything?

Part 5: Swallowing difficulties: TMJ Involvement with cervical instability

In the Journal of Oral and Maxillofacial Surgery: The Official Journal of the American Association of Oral and Maxillofacial Surgeons, (24) doctors looked at oral stage dysphagia (swallowing difficulties that begin in the mouth) with potential effects on function and patient well-being.

To examine the effects of function in TMJ patients, the doctors looked at 178 TMJ/TMD temporomandibular joint dysfunction patients.

• Of the 178 TMD participants, 99% reported at least one symptom or sign of oral-stage dysphagia.
• Individuals presenting with
  • subluxation of the jaw (80%),
  • degenerative joint disorder (67%),
  • and myofascial pain disorder (40%) reported oral-stage dysphagia most frequently.

TMJ tongue’s involvement in swallowing difficulties

An April 2020 study in the Journal of Applied Oral Science (25) assessed tongue function and swallowing in individuals with temporomandibular disorders. They note: “This relationship between tongue function and swallowing is little addressed in individuals with temporomandibular dysfunction (TMD).” Results: Relationships were found between tongue function and swallowing for the following aspects: mobility (the ability of the tongue to move freely), pressure in protrusion (the force that the tongue moves forward during swallowing), swallowing of saliva, mean DDK (the ability to move from one tongue movement to another rapidly) rate in emissions “ta” and “ka” (this is measured by saying “ta” and “ka” as quickly as possible). Thus, the greater the change in tongue mobility (loss of mobility), the lower the tongue pressure in protrusion and swallowing of saliva, the lower the emissions per second, the longer the mean time between vocalizations, and the worse the swallowing of individuals with TMD.” In other words, tongue mobility presented swallowing difficulties in TMJ patients.

There is no doubt that TMJ patients suffer from swallowing difficulties, but do they have cervical instability as well, and is this making swallowing more challenging?

In many patients, we see primary problems related to neck pain and cervical instability see problems of TMJ. In many patients that we see with problems of TMJ, we see cervical neck pain. Surprisingly, despite the research suggesting the connection, many patients were not made aware that their jaw pain could be a problem originating in the neck.

In the medical journal Clinical Oral Investigations, (26) oral surgeons in Belgium made a connection.

They conducted a study looking for possible correlations between clinical signs of temporomandibular disorders (TMD) and cervical spine disorders.

• Thirty-one consecutive patients with symptoms of TMD and 30 controls underwent a standardized clinical examination of the masticatory system, evaluating the range of motion of the mandible, temporomandibular joint (TMJ) function, and pain of the TMJ and masticatory muscles.
• Afterward, subjects were referred for clinical examination of the cervical spine, evaluating segmental limitations, tender points upon palpation of the muscles, hyperalgesia, and hypermobility.
• The results indicated that segmental limitations (especially at the C0-C3 levels) and tender points (especially in the sternocleidomastoideus and trapezius muscles) are significantly more present in patients with TMJ than in the control subjects.

Part 6: Treating Cervical Spine Instability is treating swallowing difficulties

In this video, DMX imaging displays Prolotherapy results in before and after treatment images. This patient’s treatment had problems of a pinched nerve in the cervical spine resolved. Prolotherapy is discussed below. Prolotherapy is a regenerative medicine injection treatment that utilizes dextrose, a simple sugar as a proliferant to rebuild soft tissue structures.

This video demonstrates the alleviation of cervical disc herniation and the patient’s related symptoms.

• In this video, we are using a Digital Motion X-ray (DMX) to illustrate a complete resolution of a pinched nerve in the neck and the accompanying symptoms of cervical radiculopathy.
• A before digital motion x-ray at 0:11
• At 0:18 the DMX reveals completely closed neural foramina and a partially closed neural foramina
• At 0:34 DMX three months later after this patient had received two Prolotherapy treatments
• At 0:46 the previously completely closed neural foramina are now opening more, releasing pressure on the nerve
• At 1:00 another DMX two months later and after this patient received four Prolotherapy treatments
• At 1:14 the previously completely closed neural foramina are now opening normally during motion

Swallowing difficulties can be a degenerative disorder of weakened cervical neck ligaments

Now let’s explore a March 2019 study in the medical journal Spine. (27) This research comes from the Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan. the goal of this study was to investigate whether cervical (neck) alignment is related to dysphagia in patients with cervical diffuse idiopathic skeletal hyperostosis.

This is what the researchers found puzzling:

• Diffuse idiopathic skeletal hyperostosis involves a wide range of ligamentous ossifications (calcifying of the ligament), which can cause dysphagia. However, even patients with a high degree of ossification can have only mild dysphagia. Dysphagia results from esophageal compression due to ossification; however, the exact cause of dysphagia is unknown.

So they looked at 5 patients with advanced dysphagia due to anterior cervical hyperostosis (bone spurs) who underwent bone removal, and five patients with mild symptoms who were only monitored.

• The Eating Assessment Tool-10 (EAT-10) (most of you are aware this is a swallowing evaluation measurement) indicated a high degree of dysphagia in the people who had surgery for bone removal compared with the non-surgical group.
• In the surgery group, the EAT-10 score significantly decreased postoperatively and improvement in dysphagia was observed.
• The conclusion was: “Restriction of flexion due to cervical spine ankylosis may be one of the reasons for dysphagia in patients with DISH.”

What is this research telling us?

• Swallowing difficulties can be a degenerative disorder of weakened cervical neck ligaments
• Weakened cervical neck ligaments cause neck instability
• Neck instability causes abnormal motion in the cervical vertebrae
• Abnormal motion causes bone spurs
• Bone spurs cause swallowing difficulties.

Conservative care treatments and other symptoms and conditions

We will see many patients who were told about surgeries, such as those spoken above, and offered surgical consultation for his/her problem with swallowing if there is a concern the problem is due to a diverticulum or outpouching of the throat. However, the surgical recommendation is often compromised by the difficulty in diagnosis and concurrent diagnoses.

Conservative treatments may be offered to see if the surgery is warranted or, better yet, avoided.

Recommendations to relieve the symptoms may include:

• a bland diet,
• hydration,
• eliminating caffeine or alcohol from the diet,
• modifying the consistency of foods to make them easier to swallow,
• elevating the head while sleeping, or
• therapy to strengthen the swallowing muscles, particularly when the swallowing difficulty seems to be the result of a neurological disorder.
• In certain situations, drugs that slow the production of stomach acid, muscle relaxants, or antacids may be prescribed.

Exercises to strengthen the swallowing muscles, electrostimulation of the swallowing muscles, and a modified diet

A June 2024 study in the journal Medicina (28) looked at oropharyngeal dysphagia (patients cannot form a bolus of food to move it from the mouth to the esophagus.) Many patients with oropharyngeal dysphagia are at risk of depression while quality of life deteriorates.

In this study: “Patients with oropharyngeal dysphagia received complex treatment: exercises to strengthen the swallowing muscles, electrostimulation of the swallowing muscles, and a modified diet.” The quality of life of 64 patients was assessed. The results show that the quality of life improved after the complex treatment of oropharyngeal dysphagia.

• The average age of patients was 77.8 years, and 56.3% of patients were women.
• At baseline, mild oropharyngeal dysphagia was found in 18.8% of patients; moderate in 51.6%; and severe in 29.7%.
• Aspiration risk was low in 28.1% of patients; medium in 39.1%; and high in 32.8%.
• The severity of oropharyngeal dysphagia and aspiration risk significantly decreased after treatment.

An April 2024 paper (29) presented the case of a 78-year-old patient with sarcopenic dysphagia (swallowing-related muscle degeneration) that improved swallowing function after strength training of swallowing-related muscles using neuromuscular electrical stimulation. This 78-year-old man had an intraductal papillary mucinous tumor of the pancreatic duct. After admission for treatment, the patient developed aspiration pneumonia and was placed on strict bed rest without oral intake, which resulted in progressive malnutrition. After 86 days of treatment, the doctors concluded: “As a component of swallowing rehabilitation, neuromuscular electrical stimulation may offer therapeutic benefits for patients with sarcopenic dysphagia.”

Hydration

A July 2024 study (30)  from Spanish researchers discussed the importance of hydration in people with dysphagia and its consequences. They write: “Dysphagia increases the risk of malnutrition and dehydration in the patient. However, dehydration, although one of the most common complications of dysphagia and associated with significant risks, including hospitalization and mortality, has been little studied in terms of its relationship and associated risk factors.”

In this review of previously published research, the authors continued: “Dehydration is a frequent and serious complication in patients with dysphagia, which can lead to problems such as urinary tract infections, constipation, confusion, and worsening of chronic diseases. Therefore, it is crucial to carefully evaluate and monitor the fluid intake of these patients, and strategies to improve hydration include the use of thickened liquids, stimulating appetite, and adapting the texture and presentation of foods . . . adequate assessment and management of hydration, is essential to prevent serious complications.”

However, the truth is, a person suffering from this often painful and debilitating condition may be seen by numerous specialists and yet find no resolution for the symptoms and, thus, no understanding as to why the condition exists at all.

In our office, we perform a physical examination and use our ultrasound and Digital Motion X-ray machine, described in the video above to get at the cause of the problem rather than simply seek to treat the symptoms. This helps us determine, if, as often, we are looking at a dysfunction of the autonomic nervous system, a problem of posture, a problem of degenerative aging, or a problem possibly of TMJ-related challenges.

Swallowing difficulties as well as a host of other symptoms including neck, eye, and facial pain, cervical vertigo, dizziness, and ringing in the ears, is very treatable using Prolotherapy to the neck ligaments.

Prolotherapy is, in our opinion, the safest and most effective non-surgical treatment for repairing ligament damage. It stimulates the body to repair damaged and weakened areas by inducing a mild inflammatory reaction. Since the body heals from inflammation, Prolotherapy stimulates healing.

As mentioned earlier, swallowing difficulty may also be due to an autonomic nervous system dysfunction. While the actual cause of this dysfunction may be elusive, Neural Therapy to the head and neck area has been known to help with swallowing difficulties. Neural therapy involves the injections of anesthetics to help the nerves reset themselves. For example, if the patient had previously had surgery in the mouth or neck area, the scars would be injected as they can act as “interference fields” to the autonomic nervous system.

Brain fog, breathing and swallowing difficulty, dizziness, tinnitus

Brad’s story will resonate with many of you. He will describe the same symptoms and combination of symptoms that many of our patients suffer with when they first see us.

Brad’s story is unique, it may not be typical of the patients we see. Brad with treated with Prolotherapy injections and neck curve correction techniques. Not everyone will achieve these results as the results of treatment will vary.

We specifically want to highlight his case because he has some unusual strange sensations in his ear and breathing difficulties because of his problem with his contracting diaphragm.

Patient symptom list:

• Ringing in the ears and a sensation in his ears of hot wax. He also reported it was as if spiders were crawling in his ears.
• Severe dizziness. The patient describes that he would be in a car and then out of nowhere he would get dizzy and it would feel like the car was flipping end over end.
• Brain fog
• Contracting diaphragm
  • Patient’s description at 1:32: “I would just be sitting or standing there, doesn’t matter which, and all of a sudden I couldn’t breathe. Finally, I would take a big gasp of air, and finally, I would be able to breathe.
• Swallowing difficulties: The saliva in his mouth would build up and it was as if he was drowning. This would cause panic attacks.
• The patient also reported when he turned his head to the right, he would lose control of all his muscles and would “drop.”

The patient had these symptoms for 3 – 4 months. It started with a fall of a ladder. Symptoms did not develop for months

• The patient fell off a ladder from a height of 12 feet. He hit a sink and his head snapped backed
• His symptoms started to develop four months after the fall

Because of the nature of his injury and ligament damage in his cervical spine, the patient underwent eight prolotherapy treatment sessions. Here is his description:

• After the eight sessions, the patient reports “almost everything is gone.” A slight ringing in the ears remains but is diminishing.
• The patient did not realize how bad his brain fog was. On his first visit, he had difficulty filling out paperwork. On his last visit he realized filling out the paperwork was “super easy.” It was then he realized the extent of his brain fog.
• The diaphragm problems went away after the 4th or 5th visit along with the swallowing difficulties.

The problems of people with fibromyalgia and dysphagia

A February 2024 study from Trinity College Dublin published in the journal Health Expectations (31) looked at eight patients with fibromyalgia to try to learn more about the lived experiences of dysphagia among people with fibromyalgia. A topic, barely covered in the medical research.

• All eight participants reported the negative psychosocial impact of their dysphagia. Participants reported managing their dysphagia by themselves
• Participants discussed feeling unsupported in healthcare interactions due to clinicians not understanding the occurrence, nature, or impact of eating, drinking, and swallowing difficulties.
• Participants also reported that they did not have access to evidence-based management strategies that adequately addressed their fibromyalgia-related swallowing problems. The researchers suggested: “Perhaps as a consequence of the negative experiences with health professionals . . . many participants here reported self‐managing their dysphagia.

The same researchers also published in the medical journal Dysphagia (32)  that “People with fibromyalgia can experience both autonomic and somatic disturbances, cognitive and mental health symptoms, and hypersensitivity to external stimuli. Fibromyalgia often co-occurs with a range of well-researched comorbidities (e.g., temporomandibular disorders, migraine, and irritable bowel syndrome). However, emerging research suggests that individuals with fibromyalgia also often experience eating, drinking, and swallowing problems (e.g., odynophagia, glossodynia, etc.). However, there is very little known about these issues, their psychosocial impact, or the best means of managing them clinically.” In this review study, researchers found that dysphagia and GERD are prevalent in fibromyalgia patients (51.9% and 25.9%, respectively), among other issues. From reviewing existing literature, eating and swallowing problems appear to be common among adults with fibromyalgia.

Research on cervical instability and Prolotherapy

Caring Medical has published dozens of papers on Prolotherapy injections as a treatment for difficult-to-treat musculoskeletal disorders. We are going to refer to two of these studies as they relate to cervical instability and a myriad of related symptoms including the problems of swallowing difficulties or cervicogenic dysphagia.

In our own research, our Caring Medical research team published a comprehensive review of the problems related to weakened damaged cervical neck ligaments. (33)

This is what we wrote: “To date, there is no consensus on the diagnosis of cervical spine instability or on traditional treatments that relieve chronic neck instability issues like those mentioned above. In such cases, patients often seek out alternative treatments for pain and symptom relief. Prolotherapy is one such treatment that is intended for acute and chronic musculoskeletal injuries, including those causing chronic neck pain related to underlying joint instability and ligament laxity. While these symptom classifications should be obvious signs of a patient in distress, the cause of the problems is not so obvious. Further and unfortunately, there is often no correlation between the hypermobility or subluxation of the vertebrae, clinical signs or symptoms, or neurological signs (such as swallowing difficulties) or symptoms. Sometimes there are no symptoms at all which further broadens the already very wide spectrum of possible diagnoses for cervical instability.”

What we demonstrated in this study is that the cervical neck ligaments are the main stabilizing structures of the cervical facet joints in the cervical spine and have been implicated as a major source of chronic neck pain and in the case of cervicogenic dysphagia-type symptoms, cervical instability.

Summary and contact us. Can we help you? How do I know if I’m a good candidate?

At the Hauser Neck Center in Fort Myers, Florida a common complaint that I hear almost every day from new patients that come in is that they have a choking sensation and they have episodes of panic because it’s difficult to breathe.

A patient told me after they suffered a car accident “I would feel like I was choking and I couldn’t breathe I always felt that there was secretions in my throat and that we were going down into my lungs. I couldn’t breathe, it felt like my airways were getting blocked.”

We see many patients suffering from many symptoms. One of the symptoms is the choking sensation. We find that many of these people have cervical instability and this can lead to the following problems of:

• slurred speech
• personality changes
• insomnia
• always feeling fatigued
• lightheadedness
• light sensitivity
• ear pain
• ear pressure
• various kinds of headaches
• head pressure
• anxiety
• autonomic storms
• cognitive decline

The question then can be asked, “Is my choking sensation something related to my neck? Possibly if you are someone with a clicking, popping, grinding in your neck. For someone who has neck pain, or someone who has been on the computer for years, the answer can be yes.

In the image taken from the video, if you are constantly looking down, there is a change in the neck curve. When the curve changes, the vagus nerve gets stretched. When the vagus nerve is stretched it goes into dysfunction. This may cause you to NOT swallow properly, or the food goes into your lungs, not down to your stomach. The epiglottis, which is the flap that prevents food from going into the lungs, is innervated by the vagus nerve. If the vagus nerve is damaged or dysfunctional, the epiglottis will be dysfunctional. In addition, the swallowing muscles can be impacted leading to choking or difficulty breathing.

We hope you found this article informative and that it helped answer many of the questions you may have surrounding Cervical disc disease and difficulty swallowing. Just like you, we want to make sure you are a good fit for our clinic prior to accepting your case. While our mission is to help as many people with chronic pain as we can, sadly, we cannot accept all cases. We have a multi-step process so our team can really get to know you and your case to ensure that it sounds like you are a good fit for the unique testing and treatments that we offer here.

Please visit our contact page!

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