What causes Craniocervical Instability?

There are several causes of Craniocervical Instability. The most common causes for CCI are congenital Connective Tissue Disorders, neck trauma and systemic disorders. If you’d like to know more about these causes, please scroll down to read.

Connective Tissue Disorders

The hereditary connective Tissue (ligaments, tendons) known as “Ehlers Danlos Syndrome” (EDS) is common in patients with CCI. Many with this disorder believe they are just “very flexible” in which other people call them “double-jointed”. This unfortunately is not a gift but rather patients with EDS have a genetic faulty collagen production, which means ligaments are weaker and overstretch and/or dislocate their joints.

EDS in itself does not mean one automatically has CCI or a problematic life. In fact, many skilled in gymnastics and those in ballet for example have EDS, but because their muscles are well trained, their body relies on their strong muscles greatly and thus they don’t suffer as others do. However, the most common factor in CCI patients is EDS, especially ones who suffered a trauma (accident, deep massage at the skull, or chiropractic manipulation). Craniocervical Instability is caused by weakness or damage to the ligaments that support the head.

For the majority of EDS patients it can be an extremely challenging path with a lot of pain and disability.

CCI can also occur in patients with Hypermobile Spectrum Disorder. In these patients EDS is not very clear, but they tend to have some (local) congenital ligament laxity, which makes it hard to diagnose EDS.

Since EDS is more comprehensive than simply loose ligaments, other grades of this disorder can affect not only musculoskeletal, but also cardiovascular as well as neurological.  

The video to the right is one of our favorite videos that explains how to test if you have EDS by the “Beighton Score” by Izzy Komblau who has EDS. Another video is from the professionals at Physiotutors.

For more professional understanding of EDS please visit their website



The second common cause for Craniocervical Instability is neck trauma. When someone experiences a whiplash during a car accident, ligaments in the cervical spine can overstretch and can get torn or ruptured in severe cases. Also, manual chiropractic manipulations of the cervical spine can lead to damage of cervical ligaments. This leads to chronic instability of the cervical spine. We do not suggest here that all chiropractors are dangerous, but caution is needed in the types of manipulation done, and thus we do not suggest having the neck thrusted into adjustment.

Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a systemic inflammatory disease that induces not only destructive arthritis in the systemic joint but also distinct spine lesions. Surgical interventions are often required as these musculoskeletal disabilities progress. In the cervical spine, RA-related spine lesions can cause occipital neuralgia and myelopathy, which are major issues that interfere with activities of daily living. Surgical interventions are mandatory to relieve neck pain, to improve physical function, and to decrease the risk of mortality, when patients do not improve with conservative treatments.  

RA-derived systemic inflammation leads to spinal pathology through bony erosion and ligamentous laxity.

> For references, please visit our references page