How to – Rehab for Upper Cervical Instability

In this blog we argue that the onset of dystonic symptoms is associated with the bio-mechanical impairment of the lower cranial – upper cervical area, TMJ disks displacement and cranial derangement. 

One common complication of cronic upper cervical distorsions and subluxation of the first 2 cervical vertebrae is the development of laxity or injury of the ligaments that keep the cervical vertebrae of the neck aligned and functional. When upper cervical instability occurs, it is common to develop asymmetric abnormalities in the tone of muscles of the neck (both weaknes and spasms) that can lock and perpetrate de cervical derangement.

In this post we provide links to videos of simple guided exercises that can increase the strength in these muscles for improved stabilization. The videos and much of the information in this post derives from the article Atlas joint instability: Causes, consequences and solutions by Kjetil Larsen

Atlas and Axis Articulation, Muscles and the Transverse Ligament

The cervical spine is the top portion of the spine in the back of the neck. Some of the muscles that stabilize the neck are called: suboccipital, longus capitis, colli, multifidi, semispinalis cervicis and longissimus cervicis. The upper back and shoulder muscles, including the lower trapezius and the serratus anterior, are also important for spinal stabilization.


The atlas is the first and top cervical vertebrae (C1), holding the head (occiput) and thus forms the atlanto-occipital joint (A-O). The second cervical vertebrae, is the axis, or C2. The atlas (C1) pivots on the axis of the dens, making it a unique type of joint compared to the other vertebral joints. It’s called the atlantoaxial joint or A-A (C1-C2).

Thick ligaments hold these joints in place, but patients with atlas misalignment often have ligament laxity after e.g whiplash injuries and/or years of improper cervical posture and movement patterns. Laxity or injury of the Transverse Ligament will result in the dens not being aligned with the skull and the neck not being able to support the head. People suffering from Down Syndrome have a well studied and documented genetic laxity of the Transverse ligament.

Most of the time, despite some level of ligamentous laxity, great and lasting results can be achieved by re-establishing proper postural and cervical movement habits, as well as significantly strengthening the muscles that stabilize and syncronize the movements of the atlas joints.

Please find herebelow some simple guided exercises that can  increase the strength in these muscles for improved stabilization.

Exercise 1: Suboccipital Muscles

Exercise 2: Rectus Capitis Lateralis

Exercise 3: Scalenes

Exercise 4: Longus Colli

Exercise 5: Longus Capiti

Exercise 6: Sternocleidomastoid

Exercise 7: Upper and Middle Trapezious


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2 thoughts on “How to – Rehab for Upper Cervical Instability

  1. Marcel, please send me a password to view your post. Thanks, Andrea

    On Dec 3, 2017 4:00 PM, “Bio-Mechanical Dystonia” wrote:



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