Cervical Instability · Craniocervical Ligament Laxity · Glastonbury, CT
When the ligaments that stabilize the upper neck become lax or injured, the head no longer sits securely on the spine. Dr. Paul Tortland, DO, FAOASM, CAQSM, RMSK evaluates cervical instability with motion-based imaging, confirms the diagnosis with targeted diagnostic injections, and treats lax ligaments directly with prolotherapy and custom-concentrated PRP.
Quick answer
Cervical instability means the ligaments holding the upper neck and skull together have become too lax to keep the head properly aligned over the spine. It is common in Ehlers-Danlos syndrome and other hypermobility disorders, and can also follow whiplash, concussion, or other head or neck trauma. Lax ligaments can irritate nearby nerves and the vagus nerve, and can crowd structures near the jaw and skull base, producing a wide symptom pattern: brain fog, dizziness, a rushing or pulsing sound in the ear, neck and shoulder pain, TMJ or jaw pain, migraines, light sensitivity, and a heavy, hard-to-hold-up head. Dr. Tortland confirms the diagnosis with digital motion X-ray (DMX) and diagnostic injections to the cervical facet ligaments, then treats lax ligaments directly with prolotherapy and custom-concentrated PRP, and treats entrapped or irritated nerves with hydrodissection.
Associated conditions
EDS, generalized hypermobility, nerve entrapment, vagus nerve compression, TMJ dysfunction, Eagle's syndrome
Diagnosis method
Digital motion X-ray (DMX) and diagnostic injections to the cervical facet ligaments
Interventional options
Diagnostic facet ligament injections, nerve hydrodissection
First visit
At least an hour, $500, ultrasound included
Physician
Paul Tortland, DO, FAOASM, CAQSM, RMSK
Who treats you
Dr. Tortland personally, every visit
Main treatments
Prolotherapy and custom-concentrated PRP to tighten and strengthen the lax ligaments
Insurance
Regenerative procedures not covered; HSA / FSA eligible
When to see a doctor
Consider an evaluation if you have unexplained brain fog, dizziness or vertigo, a rushing or pulsing sound in one or both ears, chronic neck or shoulder pain, TMJ or jaw pain, migraines, light sensitivity, or a head that feels heavy or hard to hold up, especially alongside joint hypermobility, a diagnosis of EDS, or a history of whiplash, concussion, or other head or neck trauma.
Seek emergency care right away, not an office visit, for sudden severe headache unlike any before, new weakness or numbness in an arm or leg, loss of coordination, difficulty swallowing or speaking, or neck pain after a significant fall or high-speed accident.
The challenge with cervical instability is that its symptoms overlap heavily with anxiety, vestibular disorders, and primary headache conditions, so it is frequently missed or misattributed. A standard cervical MRI or static X-ray usually looks normal because it captures the neck in one fixed position; instability by definition only shows itself with motion or stress on the ligaments, which is why the diagnostic approach matters as much as the treatment.
Related conditions
Cervical ligament laxity is frequently connected to, or mistaken for, the conditions below.
Diagnose · Confirm · Treat
01
An unrushed first visit maps your full symptom pattern, including brain fog, dizziness, ear rushing, neck and shoulder pain, TMJ or jaw pain, migraines, light sensitivity, and head heaviness, against your history of hypermobility, EDS, or prior head or neck trauma.
02
DMX captures the cervical spine in flexion, extension and rotation to reveal instability that a static MRI or X-ray, taken in one fixed position, cannot show.
03
A small volume of anesthetic placed at the suspected lax ligament confirms it as the true source of your symptoms before treatment begins, the same validate-before-treat approach used throughout this practice.
04
When lax ligaments are irritating or entrapping a nearby nerve, or contributing to vagus nerve compression, ultrasound-guided hydrodissection frees the nerve from surrounding tissue.
05
A dextrose solution is injected into the lax cervical ligaments to stimulate a localized healing and tightening response, the traditional first-line regenerative treatment for ligament laxity.
06
For ligaments that need a stronger biologic signal, PRP is custom-prepared on site to 12 to 15 times baseline platelet concentration and placed directly into the lax ligament under ultrasound guidance.
07
Follow-up at six to ten weeks compares your symptoms against baseline; most patients need a short series of injections spaced several weeks apart as the ligament tightens.
Candidacy
Comparison
Frequently asked
Sources
01
Mulvaney SW, Tortland PD, Shiple B, Curtis K. Regenerative medicine options for chronic musculoskeletal conditions: a review of the literature. Endurance and Sports Medicine. 2018.
02
Henderson FC Sr, Austin C, Benzel E, et al. Neurological and spinal manifestations of the Ehlers-Danlos syndromes. Am J Med Genet C Semin Med Genet. 2017;175(1):195-211.
03
Dagenais S, Yelland MJ, Del Mar C, Schoene ML. Prolotherapy injections for chronic low-back pain. Cochrane Database Syst Rev. 2007;(2):CD004059.
05
Maniquis-Smigel L, Reeves KD, et al. Short term analgesic effects of 5% dextrose epidural injections for chronic low back pain: a randomized controlled trial. Anesth Pain Med. 2016;7(1):e42550.
**Medical Disclaimer:** Information on this page is provided for educational purposes and does not constitute medical advice, diagnosis, or treatment, guarantee a particular outcome, or establish a physician-patient relationship. Treatment suitability and expected results vary by patient and depend on individual clinical circumstances and the available scientific evidence. The inclusion of a procedure, treatment, or therapy on this website does not mean that it is appropriate for every patient, effective for every condition, superior to other treatment options, or guaranteed to produce a particular result. Orthobiologic procedures discussed on this website are medical procedures performed under the practice of medicine. The FDA regulatory status of any particular product, device, or use may vary, and FDA approval or clearance should not be inferred unless specifically stated. Dr. Tortland reports no financial interest in the products or devices described on this page. Individual results vary, and treatment decisions require an appropriate clinical evaluation, including an in-person examination when indicated.
Candidacy is determined by exam, DMX and diagnostic injection, not over the phone. Bring your imaging and history of hypermobility or trauma, and get a clear diagnosis in one visit.