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. 

Inflammatory Conditions

Rheumatoid arthritis (RA) is a systemic inflammatory disease that primarily affects the synovial joints. The inflammation targets the synovial membrane, leading to overproduction of synovial fluid, joint swelling, and progressive destruction of cartilage and bone. While RA commonly involves the small joints of the hands and feet, it can also affect the spine, particularly the cervical spine, leading to distinct spinal lesions. Chronic inflammation weakens ligaments, erodes bone, and damages joint capsules, which can result in joint laxity and instability, especially at the atlantoaxial joint (C1-C2). This instability increases the risk of spinal cord compression and neurological deficits. As the disease progresses, these musculoskeletal impairments may necessitate surgical interventions. In the cervical spine, RA-related lesions can cause occipital neuralgia and myelopathy, which significantly interfere with daily activities. When patients do not respond to conservative treatments, surgery becomes essential to relieve neck pain, restore physical function, stabilize the spine, and reduce the risk of mortality.

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