Anteroposterior x-rays with lateral bending:
- Lack of lateral flexion to one side
- Decreased vertebral rotation and tilt with aberrant movement patterns
- Misalignment of the spinous processes and pedicles
- Lateral translation or shift of vertebrae due to abnormal rotation
Assessment of upper cervical ligamentous instability is difficult and needs to be considered on an individual basis, taking into account the patient’s history, examination results, scans and any underlying medical conditions.
Neck questionnaires and outcome measures
These three questionnaires are specific and valid instruments to evaluate the neck pain and dysfunction: Neck Disability Index, Neck Bournemouth Questionnaire and Neck Pain and Disability Scale.
Treatment of Spinal Instability
Severe instability may need medical treatment. With a fracture, for example, surgical treatment may be required with stabilisation of the spine to allow the bones and ligaments to heal to prevent any further injury.
The difficulty is to understand when conservative treatment can be given, or surgical treatment for spinal instability is required. Lack of consensus about the current definitions of spine instability, and lack of understanding of spinal biomechanics and X-ray instability and the clinical presentation makes the diagnosis and treatment spine instability more of a challenge.
Old treatment methods for spinal instability like traction, casts, immobilisation and prolonged bed rest are replaced now with cervical fixation if required and early introduction of safe movement and mobilisation as early as possible, which has been shown to greatly assist with ligament healing. Conservative treatment is indicated when it does not damage neurological structures or cause nerve irritation, with the aim of improving movement and reducing muscle spasm & pain, thereby helping patients to resume active life as soon as possible.
Chiropractic manipulation for spinal instability
Spinal manipulation can be performed on the tight, locked, restricted or hypo-mobile vertebrae above or below the level of instability, which reduces the mechanical stresses at the level of clinical instability. Care must be taken to monitor the response to the manipulation to check if there has been any aggravation, excess rebound muscle spasm or neurological reaction. However, done with care, manipulation can make a huge improvement and stimulate healing.
A Chiropractic Study in 2016 for treatment of upper neck instability showed clear benefits; see more information below.
Postural and movement training
Reduces stress and pressure on the neck and upper back, helps reduce fatigue from long periods of sitting or working and teaches patients how to manage their condition, learning to vary activities, take breaks and avoid aggravating stresses and strains. The Alexander Technique is ideal for this learning as it focuses especially on the tension in the upper neck and base of the skull with upper cervical vertebrae and Suboccipital muscles.
Massage and Myofascial release techniques
Muscle releasing to the neck and base of the skull can be very tender whilst being performed, but can be varied and done more gently depending on the patient’s tolerance. The deep muscle releasing techniques are gentle and non-invasive so are highly unlikely to aggravate or worsen the instability and can be very beneficial and help greatly to release the muscle spasm, improve neck mobility and reduce the symptoms.
Muscle strengthening exercises for spinal instability
I personally do not like giving muscle strengthening exercises for the neck for various reasons. However there is a place for all different treatment approaches and sometimes these can be beneficial. They must be done carefully with caution and slow progressive increase. One of my main concerns, apart from lack of patient compliance, is that the exercises only worsen the condition and are difficult to perform. They may give pain and above all do not help improve the strength in the deeper core postural muscles, but only serve to over-stimulate the over-active external muscles that are already in pain or spasm. Care and caution must be used.
Neck stretching and range of movement exercises for spinal instability
Once again, I personally do not like giving movement exercises and muscle stretching exercises for the neck. However, as with strengthening exercises, no one treatment is right for everyone and sometimes these can be beneficial. They must also be done carefully with caution and slow progressive increase.
There is a huge danger that patients will get into bad habits of stretching repetitively, with the feeling that it helps, albeit very temporarily. I have lost count of how many clients attend with the constant habit of stretching the neck, shoulders or arms, which simply becomes a repetitive strain! I urge caution with this.
Neck Pain & Instability Helped by Chiropractic, According to 2016 Study
A study published on 30th October 2016 by International Journal of Clinical and Experimental Medicine (IJCEM) indicated Chiropractic can help patients with upper neck instability.
Instability of the atlantoaxial joint (C1-2) can be serious and lead to neurological problems (The hangman’s fracture is the most well-known extreme injury). 128 patients with pain and atlantoaxial instability shown on X-ray were divided into two groups of 64. Control Group 1 was treated with a form of traction. Group 2 was treated with chiropractic treatment for up to 1 month with a 1-year follow-up evaluation.
Conclusion of the study: the results suggest that chiropractic treatment for treatment of upper cervical instability was more effective than traction with a lower reoccurrence rate after 1-year.
- Cured: Main pain and tenderness were disappearing. X-rays showed normal C1-2 joint.
- Marked effective: The patient’s main pain was disappearing.
- Effective: The patient’s main pain was partially relieved.
- No Effect: The patient’s main pain remained, X-rays showed no change.