Craniocervical Instability (CCI) an Upper Cervical Problem

Craniocervical instability

What is CCI and how does it develop?

Craniocervical instability (CCI) is a pathological condition whereby there is an increased mobility at an area called the craniocervical junction. This is the region where the top bones of the neck (C1 and C2) meet the base of the skull. The instability is due to laxity, weakening, or rupture of the ligaments that help to stabilise these joints. As a result of this the brainstem and spinal cord can become stretched or compressed causing a multitude of different symptoms.

CCI normally develops as a result of physical trauma to the neck such as a car accident or severe blow to the neck or head. It is also related to inflammatory diseases such as rheumatoid arthritis, or congenital disorders like Down’s Syndrome. In recent years it has also been linked with connective tissue disorders such as Ehlers Danlos Syndrome (EDS). It has also been identified in patients with ME and Chronic Fatigue Syndrome (CFS).

Common symptoms include:
Unexplained headaches, or pressure felt at the back of the head
Neck pain, sometimes with reduced movement
Dizziness or lightheadedness
Pain around the ears
Ringing in the ears, fullness in the ears
Brainfog, difficulty focusing
Postural Orthostatic Tachycardia Syndrome (POTS)
Pain or clicking jaw (TMJ/TMD)


Assessing CCI

When assessing patients for CCI it is important to distinguish whether there is true stability of the joints or if it is a fixed misalignment of one of the upper cervical joints. Getting the appropriate imaging of the area is an important part of this process as well as a detailed physical examination of spinal mechanics and neurological function. As upper cervical chiropractors this is what we specialise in doing, as this area has been studied and researched by chiropractors since the 1920s.




Different imaging protocols can be used to identify the level of instability. Most commonly MRI, CT scans, or x-rays are used to assess the position of the bones and joints at the craniocervical region. At Top Chiropractic we use static Cone Beam CT (CBCT) scans taken in neutral to first assess any signs of misalignment. If we suspect there may be true instability and ligament damage from the findings of the imaging and physical examination we can then have further imaging taken to confirm this. These can be taken with the neck in different positions (rotation, flexion/extension, lateral flexion) to assess the degree of instability.

Chiropractic Care

In our practice we don’t often find a true instability but a fixed misalignment of one of the upper cervical joints that is presenting with similar symptoms as it affects the same structures as CCI. This is what we specialise in correcting. If you suspect or have been told you may have CCI it is important to get this correctly assessed. We would be happy to discuss your care with you

True CCI may require surgery in extreme cases, however conservative management is often encouraged first. Upper Cervical Chiropractic care is a non-surgical option and we have seen good success with patients presenting with CCI symptoms. If you or someone you know is struggling with CCI symptoms or a recent head trauma then book a complimentary consultation call with one of our upper cervical chiropractors today to discuss your case and find the appropriate options for investigation and management of your condition.

If you found this blog interesting then why not read our blog on post-concussion syndrome -


Symptoms and conditions of Craniocervical and Cervical Instability

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