New Discovery Brings New Hope For Neck Instability Patients

neck pain treatment nyc

The junction where your head attaches to your neck, called the cranial cervical junction (CCJ), is held together and kept stable by strong ligaments called the nuchal and supraspinous/interspinous (SS/IS) ligaments. The ligaments hold the head on, and hold the uppermost spinal vertebrae, C1, C2 and C3, together.

Over time, due to aging, trauma or disease, the ligaments can become lax or injured, causing instability in the CCJ. Consequently, joints may move around too much, leading to arthritis, and muscles, nerves and connective tissue may become overstretched, creating pain and neck instability.

A New Game-Changing Discovery

Until recently, it was thought that the ligaments and muscles of the neck were completely independent from the dura, the protective covering of the brain and spinal cord. The dura contains cerebral spinal fluid (CSF), which flows about the spinal cord and brain, helping to deliver nutrients, remove waste, provide shock absorption and maintain ideal brain temperature. The dura itself has a pain-sensitive nerve supply.

Recently, scientists discovered a new set of ligaments, collectively called the ventrodural ligament, or VDL, that attach directly to the dura. They also discovered that the rectus capitus posterior minor (RCPMin) muscle, located between C1 and the base of the skull, also attaches to the dura. These discoveries are huge, because they contradict the idea of the dura being independent of the muscles and ligaments of the neck, which has enormous repercussions for both practitioners and patients.

How VDL Discovery Affects Patient Care

  • Now that we know the dura is attached to other structures at the base of the skull, it becomes clear that misalignments or weakness of those structures can directly impact the dura. Motion in the joints can pull on the dura, impacting the flow of CSF and stimulating a pain response in the brain, leading to headaches.
  • Awareness of the VDL has repercussions for surgery, since invasive procedures in this area can directly affect the CSF and brain. Surgery can alter the shape of the dura, which in turn mediates the flow of CSF. While in some cases surgery may improve CCJ stability, it could also make things worse.
  • Treatment may require a different approach. Since we now understand the mechanical relationship between the dura and the muscles and ligaments of the upper spine, postural correction exercises, chiropractic care and other therapies may be able to improve CCJ stability without invasive surgery or injections.

Treatment for CCJ Instability in NYC

Procedures and treatments that affect the brain and spinal cord require specialized knowledge and expertise. The head and neck specialists at NYDNRehab understand the important ways in which weakness and instability in the neck can affect the brain and spinal cord. We offer the safest and most innovative treatment methods, with the goal of restoring healthy function and improving our patients’ quality of life.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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