I just want to pick up the thread of cervical instability and its relationship with chronic pain again, as written about just the other day in the context of covid (having found numerous suggestions that covid can aggravate or even instigate cervical instability). In particular, I want to look at how this one, often unnoticed, structural issue might very well be lurking there right at the very core of fibromyalgia and a whole myriad of other chronic health issues.

Several weeks after I contracted covid, much increased cervical instability combined with intensely painful trapezius muscles is still my biggest problem so I have been encouraged to follow the thread of these issues (which are old foes of mine…most intensely severe around the time my health first “crashed” at the very beginning of my health journey). These systems are, again, so severe that the degree of pain and dysautonomia I am currently in is like reliving the worst of the past only, I would say, the cervical instability itself is the worst it has ever been in my case, so much so I am having to wear a neck support all the time.

Symptoms that result from cervical instability can all be cross-referenced to known symptoms of vagus nerve dysfunction, as per my previous post, and are extremely wide-ranging (because the vagus nerve isn’t know as the “wandering nerve” for nothing), affecting so many far dispersed parts of the body that they quickly start to sound a lot like the kind of symptom cacophonies that typcically get labeled fibromyalgia or one of the various other multi-symptom “mystery” health conditions I could reel off. In fact the last time I had a significant flare-up of cervical instability was just last April when I ended up in hospital with suspected heart issues (so, I am left asking, was that whole frightening episode really to do with my vagus nerve?) I am now back to routinely experiencing similar symptoms to back then, mostly at the end of the day when I am most tired (vagus nerve issues can often trigger palpitations, arrhythmias and so on) as well as pinched nerves, paresthesia, circulatory issues, gastrointestinal sluggishness including acid reflux, occipital neuralogia and a few other of the usual-suspect dysautonomic symptoms of old (as, again, itemised in the previous post). The link between vagus nerve issues and a whole array of dysautonomic symptoms is amply covered in this article summarised from an original post from one of my previously referred to sources Caring Medical and is a thorough surmise of the numerous catastrophic effects cervical instability can have on the autonomic system.

What I have now read in one particular article (from the same source) about cervical instability is so very compelling and interesting to me, relating it strongly to “fibromyalgia”, that I want to share a good portion of the article here as something of potential interest to my audience.

The article in question entitled “Fibromyalgia: A problem of over diagnosis of pyschiactric disorders? Under diagnosis of cervical spine injury?“quotes from a paper by Rush Medical University and Northwestern University Medical Center published a March 2023 in the Journal of clinical rheumatology which states “A straight neck without other radiographic abnormalities may be a major anatomical abnormality in fibromyalgia that has gone unnoticed.” It goes on to describe how the researchers found was “Most patients with fibromyalgia share an abnormality in common that is verifiable by a simple radiograph (Abnormal cervical spine curves). In 83.2% of the patients, the cervical spine was essentially straight (Cobb angle ≤10 degrees).” An image of this is captioned“As the cervical curve breaks down because of ligamentous cervical instability, the Cobb angle not only decreases (the spine is straightening and losing its natural curve) but as the lordotic curve becomes kyphotic, the atlas and dens of the axis protrude forward increasing the C6-atlas interval (and demonstrating Atlantoaxial instability and Atlas displacement.)” Findings of the study are that “In fibromyalgia patients, the loss of cervical curvature was approximately 6.5 times greater than in control subjects (50.3% vs. 7.8%). A straight neck without other radiographic abnormalities may be a major anatomical abnormality in fibromyalgia that has gone unnoticed. It may assist in the diagnosis, as well as suggest increased muscle tension/pressure as a possible etiology.”

What you really need to appreciate here is the sheer vulnerability of nerves in the cranial region given how they have to weave their way through a whole bundle of blood vessels and negotiate for space with the part of the spine that joins with the head and which frequently becomes entrained into bad habits that eventually turn into a permanent distortion of spinal shape. A whole lot of things can go wrong here, especially with a key nerve such a the vagus nerve (really two nerves) passing through on both the left and the right of the neck.

If cervical instability pre-existed fibromyalgia, though perhaps not even noticed until it became an overt problem, for instance due to a genetic predisposition towards hypermobility, then you can imagine how additional strain upon the vagus nerve around the same time that cervical instability was being further aggravated (say, by poor sitting posture at work, or due to increased neck tension caused by stress or because of exposure to a virus) led to the creation of a perfect storm that may have, finally, resulted in a fibromyalgia diagnosis. I can certainly envision how that might have been exactly what happened in my case!

There’s a modern phenomenon that may add to the risks of cervical instability and that’s the one known as “text neck”, one I am sure we have all come across. The modern propensity to spend a lot of time using a hand-held device (I would include in that one of my own favourites, the Kindle which I find to be far easier on my painful wrists than holding a book open) has only put more strain on a weakness that some of us hypermobile types may have possessed even before the advent of these highly popular devices. Is it any coincidence that my health crashed around the same time I got my first ever smart phone, swiftly followed by an iPad, not to mention spending considerably more time on a laptop during the long evenings that invariably followed already long days performing a computer-based office job (which was completely unlike the much more ad-hoc, far less sedentary and often extremely low-tech work I was used to doing for all the years leading up to that point)? My whole way of life altered around 2004-09 as these kinds of tech took over and, along with my way of life, so did the way I spent most of my time and many of my most frequently sustained postures. I suspect most of us would be forced to confess that the number of hours we spend hunched over something gizmo-like has been on the steady increase over the past few years and this can be dire for our necks!

It was also around that same time, once I was forced to give up office work because of my health, that I took up painting as a daily activity. At times when I am busily occupied with my art practice, I spend a lot of time hunched over the kind of fine work that I now tend to prefer (so ironically) because the bigger paintings that I used to do became impossible due to my worsening health issues and an inability to stand wielding a long-handled brush.

So is cervical instability, made excessively rife by the advent of smartphones and such, really at the core of conditions such as fibromyalgia? The article referred to above continues by quoting the Kochi Medical School in Japan where researches found that “with the spread of smartphones and personal computers, the number of patients who experience pain in the head, neck, shoulders and back, and paresthesia in the upper extremities is increasing. Furthermore, it is widely known that in such patients, lateral images of the cervical spine taken by X-ray or MRI show that the cervical spine is deformed into a straight line, in contrast to the cervical spine in healthy subjects, which has a forward convex arch. . . . Additionally, this cervical spine deformity is often accompanied by cervical disc herniation and cervical spinal canal stenosis; thus, patients often complain of chronic pain in the shoulders, shoulder blades, and back, and discomfort and stiffness in the hands.” This was certainly me for a great many years of doing the rounds of all the treatment providers!

So yes, there has been some suggestion that this change of lifestyle factor may be a possible root cause of the diagnosis of fibromyalgia in such huge numbers in recent times (it was very rarely diagnosed or spoken about when I first self-diagnosed with it pre 2010). Given just how many of my own fibromyalgia symptoms seem to be back with a vengeance since covid messed with my pre-tendency towards cervical instability, especially since it was only last winter that I recall saying to my partner that I no longer felt like fibromyalgia was my primary issue for me any more, this would seem entirely consistent!

In response to discussion about the validity of the term “Text neck syndrome” the researchers continue: “. . . the main problem related to cervical spine deformity is that it is not widely recognized. As cervical spine deformity does not appear to have any major abnormalities initially, it is not of interest in the field of orthopaedic surgery because it is not indicated for surgery. Our search (of the medical literature) yielded no results when we searched for the term ‘straight neck’, which is commonly used to denote this cervical spine deformity in Japan. Moreover, there are very few papers on text neck, which signifies the same disease concept and symptoms. . . . In addition to not being widely recognized, patients with muscle pain and stiffness may be misdiagnosed with fibromyalgia…” They conclude: “We wished to raise awareness of the possibility that such patients may receive the wrong medical care and treatment for long periods of time.”

The attached article then goes on to give examples of the long term remission from fibromyalgia of a 44-year-old female following application of different spinal manipulation techniques, as published in the International medical case reports journal in November 2022. To be fair, I have undergone my own fair share of spinal manipulations over the years with limited success and one of the main problems has been the tendency for adjustments made by some highly skilled practitioners not to “take” for long enough to establish long term benefit (much to the frustrations of my various medical providers) and this seems to be typical of people that have underlying hypermobility issues, which can also be worsened by treatments that stretch out soft tissues that are already too lax, feeding into the problem (which is why it is so essential to find a hands-on therapist who truly understands about hypermobility and laxity).

Reduced proprioceptive functions (the ability to sense your position in space and to coordinate movement) have also been associated with fibromyalgia patients as well as with issues of the cervical region, to the degree that these have been suggested as a worthy area for assessment when examining those who may have the condition. I can certainly vouch for the fact that my own proprioceptive abilities were one of the first things to take a “hit” when I first came down with whatever my initiating health issue was all those years ago (I was experiencing severe dizziness and coordination issues daily at work!) but no one from whom I sought medical advice seemed to have any suggestions as to what was causing them except that I should become completely tea-total and take antidepressants. Over the years, in line with increased soft tissue laxity occurring post menopause, these issues have further manifested as postural disorders such as POTs and racing heart beat, vision blurring or sweating on standing etc.

As alluded to above, when I mentioned how doctors assumed I was drinking too much or needed psychiatric treatment back in the day, it can be all too easy to assume that oddly behaving conditions such as fibromyalgia have their root in the mind and require an approach that is based strictly on the mind-body approach. Whilst not denying the value of some of these methods for tackling long term chronic conditions, there is a very real danger, here, of overlooking the more subtle kinds of physical anomaly that might be underlying a very real, structural issue impacting the nervous system. We can’t afford to be too black and white about this nor to throw the baby out with the bathwater!

These days, a lot of us seem to take back or neck pain for granted and one glance at people’s terrible postures in the supermarket queue (many of them fixated on their phones) will tell you that a massive number of them have poor spinal integrity; however, not everyone ends up dealing with a chronic health condition that is as broadranging in symptoms as it is utterly bewildering, not to mention prone to being misunderstood or treated as hypochondria by the medical profession. Not so long ago, I dived into the whole Tension Myositis Syndrome approach with gusto in an attempt at tackling my own conditions and, though I still see how much merit there is in the approach (which involves journalling out your deepest, darkest frustrations and emotions…hidden emotions which could be contributing to your quota of stress, resulting in neck tension and aggravated vagus nerve) I also can’t help but notice how heavily this approach leans into the argument that if you have a wide range of very different symptoms that seem to graze around the body, moving from pillar to post, popping up here and there, coming and going at different times etc then it must all be in your mind….a dangerously black and white viewpoint given that, should the perpetrator of all these wide-ranging problems be an unhappy vagus nerve (the “wandering nerve”) which has its fingers in almost every pie in the body, then it could all be to do with something much more “mechanical” as in one of the various things that might be contributing to vagal dysfunction.

In other words, the wide variance in symptom frequency and type could be to do with times when the cervical region is especially lax or under attack from some particular trigger (environmental exposure, virus, too much head-bent-over desk work, stress, tiredness etc) impacting the vagus nerve in slightly different ways each time, combined with the fact the vagus nerve itself, being so far-ranging, could set-off symptoms in one of a dozen different parts of the body in varying degrees and at different times, overlapping or individually; all in very bewildering patterns that are extremely hard to explain or diagnose but much more logical once you start to notice the pattern of vagal involvement. For instance, I have always had a time of day when a group of “symptoms of the moment” (these have varied throughout my many years with chronic health issues..typical examples are feeling nauseous or getting a headache) tend to come on more strongly and it generally corresponds with sundown, somewhat like the sundowning symptoms associated with Alzheimers. Well, at the moment its my newer covid-instigated symptoms such as breathlessness and coughing that seem to come on every day at a certain point in the evening, which feels a lot more like they are to do with the vagus nerve feeling over-tired, affecting performance of the diaphragm (as per my other post on this) rather than a bronchial issue per se.

We can’t afford to brush this vagal factor under the carpet without giving it proper consideration, especially if it might be to do with cranial instability, even if we aren’t overtly aware of having a weak spot in the neck (my much worsened, very obvious, cranial instability since covid has, in a way thankfully, forced me to examine my predisposition to this more deeply than ever before and I only wish I had looked into it much sooner). I came across the idea of cranial instability four or five years ago when I first dived into the lifelong hypermobility issues that became an overt problem for me post-menopause but I didn’t honestly linger in the topic for very long, apart from the phase when I was experiencing excruciating occipital headaches for 3 or 4 months (triggered by an unusually windy summer’s day when I went out without appropriate neck protection!) However, I am now focusing a great deal of attention on this area of research in the hope of garnering the kind of understanding that will helps me avoid too many further trigger events!

Where does all this leave those of us who may suspect this is an underlying cause of our own long-term issues with chronic conditions such as fibromyalgia? The approach suggested by the author of the article attached, being their clinic’s specialism, is a method called prolotherapy which involves receiving injections to the neck to attempt to strengthen tissue where there is currently laxity. This is a method that is both costly and hard to come by in the UK, though I now have it on my radar, but one thing that is pretty interesting to me is that the method involves stimulating localised inflammation where the injections occur in order to encourage healing. Furthermore, some other reading I have been doing about how NSAIDS interfere with the healing process by reducing inflammation right at the crucial moment when the body really needs to generate some inflammation in order to heal the damaged tissue in question has got me thinking about all the years of “natural” anti-inflammatories I have tended to shovel down my own throat daily in an effort to get well from fibromyalgia (having taken fistfuls of NSAIDS when I first became symptomatic, about the same time I began to experience horrible dysautonomic effects, I gave up using then well over 16 years ago due to such adverse side-affects); could it be that this well-meaning approach to pain relief has been, in my case, misguided, even potentially making my laxity worse at times when I was already desperately compromised? I have even found a study (another and another) suggesting the anti-inflammatories interfere with collagen, which is surely a concern for anyone with hypermobility. For instance, over the last few weeks of increased pain symptoms, I have been taking a high dose of boswellia daily but now wonder if I need to cease taking these at all and just let nature take its course during the post-covid healing process; maybe I have been undermining my body’s own natural defences by turning to anti-inflammatories to deal with my neck and back pain…certainly food for thought!

By a similar token, I have read that appropriate daily movement is utterly critical (rather than increased sedentary behaviours as often recommended) when worsened laxity occurs in order to ensure that sufficient blood flows to the injured tissue to effect a healing. Thankfully, I have been trussing myself up in with all manor of body supports and then still going out for my daily walks as best I can these last couple of weeks, in spite of the significantly increased pain, and I do think this is serving me far better than giving into the pain by increasing the time spent lying down or being sedentary at home. The long-popular approach of RICE (rest and ice) has recently been criticised for reducing blood supply to the target area and even damaging crucial nerves if overused, as can often be the case when chronic pain is present. As someone prone to worsening neuropathy, I now wonder how much extra damage I may have caused with so many years of overusing freeze gels and the like behind me, all of which, whilst offering temporary pain relief, may have been impacting the flow of blood to very areas that most needed extra support with the natural healing process!

The most obvious implication of all this, I would say, is that if cervical instability is underlying the fibromyalgia or whatever chronic condition you have then you are left wide open to constantly reinjuring yourself; so, is this why so many people just don’t seem able to recover from chronic conditions however hard they try to follow all the latest healing protocols and adopt the best possible mindsets? If cervical instability is going on behind the scenes then this is whole thing is no mere “loop in the brain” (phrase used by brain retraining approaches to chronic illness) nor emotional trauma response creating problems as a distraction but a very real, if you like, “mechanical” issue trip-wiring your recovery. It will also, potentially, worsen with age, especially as a post-menopausal woman with reduced collagen or post-virally given some viruses such as covid seem to utilise the vagus nerve to transport themselves around your system, causing damage and then longstanding havoc even after the event.

As before, my best suggestions are to consider anything designed to strengthen or support your cervical region or any other lax regions such as torso, including the use of external supports (as mentioned, I am now wearing a neck strap, which is just the right side of supportive without being too unnaturally restrictive, for most of the daytime hours and certainly when I go out). Additionally, anything known to help recondition the vagus nerve is worth a go, on which subject there are numerous articles out there (typical suggestions include gargling, singing, laughing, meditation, deep breathing, listening to uplifting music, dancing, increased sodium, certain foods and supplements especially those containing choline eg. eggs, omegas and B vitamins, exposure to sunlight and reducing exposure to stress, chemicals, EMFs and, of course, viruses).

The biggest piece is that knowing is power so, for me, understanding that my chronically vulnerable cervical region could be sat there at the very crux of just so many of my longstanding health problems means that I will be keeping a much closer eye on it from now on. No more days mindlessly bent over a device or slopping onto the sofa in some highly inappropriate position because I’m “too tired to move” and a great deal more care taken to protect the neck region, even on the mildest of summer days (I have long observed that even the merest draught, even in warm weather, can trigger off some of my worst symptoms and am a big fan of wearing a summer, as well as winter, scarf)…these are just a few of the things I intend to build into my life from hereon-in.

Disclaimer: This blog, it’s content and any material linked to it are presented for autobiographical, general interest and anecdotal purposes only. They are not a substitute for medical advice, diagnosis, treatment, or prescribing. Opinions are my own based on personal experience. Please seek medical advice from a professional if you are experiencing any symptoms that concern you.