How to Diagnose Craniocervical Instability (CCI)

Have persistent headaches, dizziness, or neck pain become a normal part of your day-to-day life? The underlying cause of these symptoms could be craniocervical instability (CCI). It’s easy to misdiagnose or overlook this condition, but understanding how it impacts your quality of life and what you can do to manage it is especially important for those living with CCI. 

Let’s take a moment to explore what CCI is, the common symptoms to look for, how the condition is diagnosed, and how physical therapy and working with a specialist can make a difference in the way you live your life. Let’s go!

What is Craniocervical Instability (CCI)?

Craniocervical Instability is a condition where there’s too much movement between your skull and upper neck (cervical spine), specifically between the cranium (your skull), the C1 vertebra (also called “atlas”) and the C2 vertebra (also called “axis”). 

The structures in this area, known as the craniocervical junction, are supposed to be held in place by ligaments that allow minimal movement, but sometimes these ligaments become too lax or suffer damage, resulting in instability. 

The craniocervical junction is part of the anatomy that protects your brain stem and upper spinal cord, which control important neurological functions that you don’t need to think about in your daily life, like breathing and regulating your heart rate.

Common Symptoms of Craniocervical Instability 

Those with CCI have ligaments that have become weakened, stretched, or even ruptured. This can be because of an injury or trauma to the area, such as a car accident, or an underlying connective tissue condition like Ehlers-Danlos Syndrome (EDS). 

Compromised ligaments in your craniocervical junction can no longer align your skull and upper cervical spine properly, resulting in excessive movement and loss of stability in the area that can cause a wide variety of challenges. 

CCI can be tricky to diagnose because the symptoms can be varied and tend to mimic other conditions. Here are some common symptoms of craniocervical instability: 

• Heavy Headaches and Pressure Headaches

A heavy headache can be constant or near constant and feels as though your head is too heavy to support. Pressure headaches are a result of reduced cerebrospinal fluid flow, and usually feel worse when you cough, sneeze, or laugh, or during other straining movements. 

• Autonomic Dysfunctions

Brainstem compression can reduce how well your autonomic nervous system functions. Symptoms can include, but aren’t limited to: rapid heart rate, heat intolerance, fainting, chronic fatigue, extreme thirst, and others. 

• Neck Pain

Excessive movement, alignment changes, and weak ligaments contribute to stress and pain in the neck that can range from mild to severe.

• Balance Problems

Dizziness, vertigo, impaired coordination, blurred vision, and muscle weakness are all symptoms of craniocervical instability that can contribute to balance problems.

• Brain Fog

Craniocervical instability can cause cognitive difficulties, such as confusion, forgetfulness, difficulty focusing, slowed thinking, and inability to concentrate.

Unfortunately, chronic complex conditions and craniocervical instability often go hand in hand. Conditions like dysautonomia and Mast Cell Activation Syndrome can worsen the symptoms of CCI, often due to inflammation caused by these conditions. 

While it isn’t the case for everyone, understanding the relationship between chronic complex illness and CCI can help you and your doctor decide on the best treatment plan for you.

Craniocervical Instability Diagnosis 

Because CCI is a complex condition with symptoms that can be attributed to other conditions, it can be tricky to diagnose. Your healthcare provider will look at your medical history, provide a physical examination, and use imaging tests to determine if you may have craniocervical instability. 

Here’s a more detailed look at the CCI diagnosis process: 

• History

Your healthcare provider will learn about your medical history, taking into account any injuries or underlying health concerns. Connective tissue disorders like Ehlers-Danlos Syndrome (EDS) can cause weakened ligaments, making those with conditions like EDS more susceptible to craniocervical instability. 

• Examination

A physical exam allows your healthcare provider to check for signs of instability and other related symptoms you may be experiencing. 

• Imaging

Imaging tests are the most accurate way to diagnose CCI. Upright MRI and Digital Motion X-ray (DMX) are especially useful because they can show instability in multiple positions. These images help your doctor to determine the degree of instability. 

• Injections

Diagnostic injections can be a valuable tool to confirm a CCI diagnosis. They are injected into precise locations in specific nerves, joints, and ligaments to see if stabilizing an area can help relieve symptoms temporarily. 

Diagnosing CCI might be a complicated process, but understanding what’s going on with your body can be the difference between receiving effective treatments, and playing guessing games with your health. 

Craniocervical Instability and Ehlers-Danlos Syndrome

Those with Ehlers-Danlos Syndrome have inherently weaker connective tissue and because of this are more prone to CCI. The diagnostic process isn’t much different, but dynamic imaging techniques such as DMX and upright MRI are even more important in these cases. Patients with EDS must also meet specific diagnosis criteria.

Here are some of the measurement techniques used to diagnose CCI in those with EDS: 

• Clivo-Axial Angle

• Harris Measurement

• Grabb-Mapstone-Oakes Measurement

• Angular Displacement of C1 to C2

While these terms are very technical and might not make a lot of sense, your care team will be able to explain them to you in a way that makes sense and helps you understand your condition better.

Using these measurement techniques also allows your healthcare provider to rule out other conditions and get to the root of your condition, so you can get the treatment you need more easily.

Physical Therapy for Craniocervical Instability 

Physical therapy isn’t just for recovering from sports injuries or surgery; it’s a valuable tool to manage and even improve chronic health conditions like CCI. With the help of a specialist, you can feel better and live your life with more confidence.

Here’s how physical therapy can be incredibly beneficial for managing CCI: 

• Strengthening Supporting Muscles

Physical therapy exercises help strengthen your neck muscles, giving more stability and support to your craniocervical junction. Strengthening exercise can also help resolve muscle imbalances that are making your CCI symptoms worse.

• Better Alignment

By improving your posture and spinal alignment with exercise and ergonomics education, you can reduce the strain on your craniocervical junction and alleviate some of the symptoms you’re experiencing with CCI.

• Improved Flexibility and Mobility

Physical therapists use a variety of techniques to improve your mobility, which helps relieve tension and strain on your neck while improving symptoms of CCI.

When you work with a physical therapist for your CCI, you’ll have the support and guidance you need to start feeling better, see meaningful progress, and effectively manage your condition. 

Why Working With A Specialist Matters

Living with CCI can add plenty of challenges to your life, but receiving proper health care shouldn’t be one of them. Working with a specialist at ActifyPT means you’ll get treatment from an expert who has the training to accurately diagnose and effectively manage craniocervical instability. 

General practitioners may not have the knowledge or specialized equipment required to provide the care you need. What’s more, a specialist can create a personalized treatment plan that takes into account your individual needs, so you’re set up for success from day one. Working with someone who knows the ins and outs of your condition can truly make a world of difference. 

Craniocervical instability is a condition that requires careful attention when diagnosing and treating, but with proper management, it’s possible to live a lifestyle that you love. If you think you might have CCI, don’t wait to reach out. Our CCI experts at ActifyPT are ready to help you take the first steps towards relief!

Key Takeaways

• Craniocervical instability is when excessive movement between your skull and upper cervical spine occurs, usually because of ligaments that are too lax or damaged. 

• CCI has a broad range of symptoms, but typically chronic headaches, neck pain, cognitive troubles, and autonomic dysfunction are hallmark symptoms of CCI. 

• Diagnosing CCI involves looking at your medical history, a physical examination, and imaging techniques like MRI and DMX. 

• Those with EDS are more prone to CCI because of inherently weaker connective tissue.

• Working with a physical therapy specialist can significantly improve how you live with CCI. Personalized care, expert knowledge, and advanced treatment options can give you the relief you need.