Craniocervical Instability and Hypermobility

By Jennifer Richards, LMT 2026

Understanding the relationship between connective tissue and the upper cervical spine

The upper cervical spine is responsible for supporting the head and protecting the brainstem. In individuals with hypermobility or **Ehlers-Danlos Syndrome (EDS), connective tissue differences can sometimes affect the ligaments that stabilize this region.

One condition that may occur in some hypermobile individuals is craniocervical instability (CCI).

Craniocervical instability refers to excessive movement between the skull and the upper cervical vertebrae. This instability can occur when ligaments responsible for stabilizing the upper neck become lax or weakened.

It is important to note that CCI is not present in everyone with hypermobility, but awareness of the condition can help individuals recognize symptoms and seek appropriate evaluation.

The Role of Ligaments in the Upper Cervical Spine

The head rests on two specialized vertebrae:

• Atlas (C1)

• Axis (C2)

These vertebrae allow the head to nod and rotate. They are stabilized by several ligaments that help control movement and protect the brainstem.

In connective tissue disorders, ligaments may be more elastic. When these ligaments do not provide sufficient stability, the skull and upper cervical spine may move more than intended.

This excessive motion can sometimes irritate surrounding structures such as nerves, the spinal cord, or blood vessels.

Symptoms Sometimes Associated with CCI

Symptoms can vary widely depending on the individual and the degree of instability.

Possible symptoms reported by some patients include:

neck pain or pressure at the base of the skull headaches that worsen when upright dizziness or balance issues visual disturbances brain fog or cognitive fatigue sensitivity to head movement

Because many of these symptoms overlap with other conditions, proper medical evaluation is important.

Why Hypermobility May Increase Risk

Connective tissue provides stability throughout the body, including in the ligaments of the cervical spine.

In individuals with hypermobility:

ligaments may stretch more easily joint stability may be reduced muscles may compensate by tightening

This muscle guarding can sometimes cause chronic neck tension.

For this reason, the neck can be an area of particular sensitivity in hypermobile clients.

Massage Therapy Considerations

Massage therapists working with hypermobile clients should be aware that the upper cervical spine may be more vulnerable in some individuals.

Massage therapists do not diagnose craniocervical instability, but awareness of potential instability can help guide safe bodywork.

Avoid Excessive Neck Movement

Aggressive neck stretching or strong rotational techniques may not be appropriate for hypermobile individuals.

Gentle Cervical Techniques

If working near the neck, gentle techniques that support muscular relaxation without forcing range of motion are generally safer.

Avoid Cervical Traction

Manual traction or pulling on the neck may increase instability in some individuals with ligament laxity.

Support the Head

Proper head support during massage is important to prevent strain on the upper cervical structures.

Encourage Medical Evaluation

If a client reports symptoms such as severe dizziness, neurological changes, or worsening symptoms with neck movement, referral to a healthcare provider may be appropriate.

Why Awareness Matters

Craniocervical instability is one example of how connective tissue disorders can affect areas of the body that are not immediately obvious.

Understanding these connections can help individuals with hypermobility make informed decisions about movement, exercise, and bodywork.

Education also helps practitioners modify techniques to ensure treatments remain safe and supportive.

Helpful Resources

For more information about hypermobility and cervical spine involvement, visit The Ehlers-Danlos Society:

Neurological and spinal manifestations of EDS

https://www.ehlers-danlos.com/neurological-and-spinal-manifestations-of-the-ehlers-danlos-syndromes/

This resource discusses neurological and spinal complications that may occur in connective tissue disorders.

Educational Disclaimer

Hypermobility and Ehlers-Danlos Syndrome exist on a spectrum. Every individual experiences connective tissue disorders differently, and not everyone will experience the symptoms or challenges discussed in this article.

The information shared here is intended for educational and awareness purposes only. It is not intended to diagnose, treat, or replace medical advice from a qualified healthcare professional.

Massage therapists do not diagnose medical conditions. If you are experiencing neurological symptoms, persistent neck pain, or concerns related to cervical spine stability, please consult an appropriate healthcare provider.

— Jennifer Richards, LMT