What is Atlanto-axial Instability?

Posted in Chiropractic on Jul 23, 2021

Atlanto-axial instability is a potentially dangerous condition where the ligament between the atlas (C1`) and axis (C2) vertebrae at the top of your neck is partially torn. 

The consequence of atlanto-axial instability is that the bones of the neck can actually put pressure on the surrounding nerves including the vagus nerve (which control the function of your heart, lungs, and digestive system), the blood vessels that go to your head, and also the brainstem itself, which is the master control centre of the brain for all body functions.

Symptoms associated with atlanto-axial instability include the following:

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  • Seizures and blackouts
  • Dizziness and vertigo
  • Heart, lung, and digestive issues
  • Neck pain, headaches, and migraines

Many people with atlanto-axial instability also described a rubbing noise or “gristle” when they turn their head, which occurs because the atlas and axis are not moving properly. It is common for people with a genetic condition known as “Ehler’s Danos” which is where the ligaments are more flexible than they should be, or in people who have suffered severe head-neck injuries that have torn the ligament.

Atlanto-axial instability is a difficult issue to treat because of the location of the involved ligaments. Certain types of specialists who use Prolotherapy or even surgery may be able to assist. However, it is not without risk.

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Is it Atlanto-axial Instability or is your Atlas out of Alignment?

If you suspect that you may have atlanto-axial instability, one of the easiest tests to perform is a simple x-ray, which would demonstrate if there is a significant offset of the joint surfaces by approximately 50% (aka subluxation) or if there is other evidence of ligament injury that you can see on an x-ray or MRI. 

Frequently, views can also be taken with the neck in full flexion or extension, or with a digital motion x-ray (DMX) to see if there is excessive motion between the joints in the neck.

For many people who think that they may be experiencing atlanto-axial instability, all of their tests come back as “normal.” 

How can that be possible if you can hear and feel the neck crunching, and even experience some of the symptoms, but there be no sign of atlanto-axial instability.

The reason may be that the problem is not actually atlanto-axial instability at all, but there is actually a different problem that involves the alignment of your atlas itself.

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The Difference Atlanto-axial Instability and an Atlas Misalignment

There are three levels of ligament injury:

Grade III = Complete tears. In the upper neck, these are life threatening and require emergency surgery. These types of injuries are evident on normal diagnostic scans.

Grade II = Partial tears, approximately 50% of the ligament or severe stretching (e.g., Ehler’s Danos). These cause excessive mobility and can cause severe neurological problems. These types of injuries are also evident on normal diagnostic scans.

Then there are Grade I = Microtears, which may cause the normal position of the atlas or axis to shift or misalignment causing similar problems, but are NOT actually unstable at all, which is why they are NOT evident on normal diagnostic scans.

In order to identify micro-tears or small problems with the atlas alignment, these require specialised types of tests that look for evidence of articular misalignment only 1-3mm in size. 

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From a traditional medical perspective, these types of injuries are usually not considering “clinically significant” which is unfortunately why so many of them fall between the cracks.

However, it is our experience and opinion that when we consider the delicate and important nerves and vascular structures of the upper neck that a 1-3mm misalignment can still cause health problems. 

Furthermore, when there is an offset with the alignment of the atlas or axis, it can also cause that same cracking noise when you turn your head. So when people often go to Google to diagnose their symptoms, they encounter “atlanto-axial instability” and think that THAT is the reason for their symptoms. 

However, that is not always the case and misalignment of the atlas or axis can often cause the exact same symptoms.

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We emphasise that there is a BIG difference between atlanto-axial instability and an atlas misalignment.

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One requires medical attention. The other may respond well with a more conservative approach, which is where upper cervical specific care may be able to help.

Upper cervical specific care is a special division of chiropractic that does NOT use any twisting or cracking of the neck. Developed in the USA, the approach focuses on the alignment of the atlas and axis vertebra and how they can contribute to a myriad of neuromuscular conditions, including those that mimic atlanto-axial instability. 

What an upper cervical chiropractor does is perform a series of precise tests, including specialised diagnostic imaging to identify the exact location, direction and degree of any misalignment in your upper neck, and thus determent he most appropriate form of treatment that can correct the alignment and motion of your upper neck.

Upper cervical chiropractic does not use spinal manipulation (i.e., cracking), drugs or surgery), and is a precise approach to restoring the normal alignment in your neck so that your body and nerves are better able to do what they are designed to do: heal themselves.

Our practice, Atlas Health Australia, focuses on the Blair upper cervical specific technique. We are a leader in upper cervical specific care for Brisbane and work with clients from across Australia and internationally. Dr. Jeffrey Hannah is our principal advanced certified Blair upper cervical chiropractor. He is a recognised leader in the field of upper cervical care and is an international lecturer, speaker, and author. He has also studied various forms of upper cervical work including the NUCCA and Atlas Orthogonal methods.

If you would like more information about the difference between atlanto-axial instability and an atlas misalignment, or you would like to schedule a consultation with our practice to find out how we might be able to assist you, you can contact our office direct at 07 3188 9329, or send us an email through the Contact Us link on this page.

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We hope that you’ve enjoyed this article, and if there is any way we may be able to assist you, we will do our best.

Atlas Health Australia - “Hope, healing, and wellbeing from above-down, inside-out.”


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