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Spinal Instability

Everything You Need to Know

Is neck, mid-back, or low back pain interfering with your daily activities? Have you experienced any falls, accidents, or injuries to your spine that have not resolved the pain? There is a possibility that you suffer from spinal instability.  Read on to learn more about what spinal stability is, its causes, and how you can fix it.

What Is Instability Of The Spine Or Lumbar Instability?

Spinal instability is a condition that occurs when the spinal column is not able to maintain its normal alignment and function under normal loads. It can be caused by various factors such as trauma, degenerative changes, infections, tumors, or congenital abnormalities.

In a stable spine, the bones, discs, ligaments, and muscles work together to support and protect the spinal cord and nerve roots. However, in an unstable spine, the structures that support the spine may be damaged or weakened. This can lead to abnormal movement and excessive stress on the spinal cord and nerves. In most cases, bone and joint problems can be detected by imaging and easily diagnosed. Injuries to ligaments and muscles can be more subtle and require more investigation and knowledge from your medical provider.

Symptoms Of Instability Of The Spine

Spinal instability symptoms can vary depending on what structures are most affected by instability.

Pain or Discomfort in the Neck or Back

The affected area can hurt, particularly with movement or activity. In the neck, turning, rotating the head or looking upwards or downwards can cause discomfort. In the back, bending, twisting, or extending can cause back pain.  

Pain or Discomfort in the Arms or Legs

If the nerves get irritated, pain from the spine can radiate to the arms, hands, legs, and feet. 

Stiffness or Difficulty Moving the Spine or Turning Your Head

When the spine is unstable, the body limits neck or back movement to avoid more stress or pain. Thus, the muscles may tighten up and cause stiffness. 

Muscle Spasms

As the muscles try to protect the neck or back from too much movement, they can fatigue and spasm. Also, if the nerves are irritated from spinal instability, the muscle will “short circuit” and lead to spasms. 

Numbness and Tingling in the Arms or Legs

Nerve irritation from instability can cause numbness or tingling in the arms or legs where that nerve travels. 

Weakness in One or More Limbs

Nerve irritation from instability in the spine can lead to muscle weakness as the muscle cannot get a proper signal from the affected nerves. 

Changes in Bladder and Bowel Function

In severe cases where the spinal cord is injured (myelopathy or conus medullaris syndrome) or the lower spinal nerve roots are compressed (cauda equina syndrome), these problems can lead to losing control of bladder and or bowel function. This can be urine or bowel retention or uncontrolled accidents. 

Common Causes of Instability Of The Spine

Spinal instability has many causes. Some can be obtained from a specific injury, or gradual wear and tear over the years. Other genetic problems or acquired medical problems can be causes of instability as well.

Degenerative Disc Disease

Over time or due to multiple minor injuries, the intervertebral discs can lose fluid and/or bulge out, causing a loss of disc height. This loss of height in the disc can cause laxity in the ligaments at the level that support the spine. 

Spinal Trauma or Injury

Direct trauma such as a fall, motor vehicle accident, etc. can cause direct injury to a supporting spinal structure. A bone can be fractured, dislocated, or subluxated (moved out of its normal position). With trauma, ligaments, muscles, fascia (covering the muscles), or discs can be directly injured.


Osteoporosis is a condition where bone mass and density is decreased. This makes the bones of the spine more susceptible to fractures even with little trauma. Osteoporosis is most common in postmenopausal women but can affect men and younger women as well. 

Congenital Abnormalities

These abnormalities occur during fetal development and lead to defects in the spinal column. Some examples are Spina bifida, Chiari malformation, Klippel-feil syndrome, congenital spinal stenosis, etc.

Spinal Listhesis or Spondylolisthesis

spondylolisthesis is a spinal condition that occurs when one vertebra in the spine slips out of its normal position and moves forward or backward in relationship to the vertebral body below it. If it moves forward it is called anterolisthesis, if it moves backward it is called retrolisthesis. 


Cancers that originate in the spine can cause destruction of spinal tissue. Metastasis of tumors from another body organ can migrate to the spine causing destruction of spinal structures. 


Infection can occur from a procedure or surgery of the spine and sometimes blood infections can travel to the spine. Infection of a bone is called osteomyelitis and can cause destruction of the affected bone. Discitis is an infection of the intervertebral disks and epidural abscess is an infection in the space between the outer covering of the spinal cord. Tuberculosis and some fungal infections can sometimes migrate to the spine as well. 


Scoliosis is a condition characterized by an abnormal curvature of the spine. There are several types, such as idiopathic, congenital, degenerative, neuromuscular, or functional scoliosis. No matter the cause, the abnormal curve puts excess stress on some areas of the spine and stretches or pulls ligaments and muscles on the opposite leading to instability. 

Treatment Options For Instability Of The Spine

The treatment options for spinal instability depend on the underlying cause and the severity of the instability.


Spinal Fusion Surgery

In more severe cases of spinal instability, surgery may be necessary to stabilize the spine and prevent further damage to the spinal cord and nerves. Examples that may need surgery are grade 2 spondylolisthesis, displaced fractures, tumors, infection, scoliosis affecting breathing, etc. Surgery may involve the use of hardware such as screws, rods, or plates to fuse the affected vertebra to provide stability. The decision to undergo surgery is serious and requires an in-depth discussion with your physician on risks and benefits. 

Non-Surgical Treatments

Home Remedies

Ice/heat/activity modification: Ice can be used to temporarily help with any swelling or temporary pain relief. Heat can relax the muscles or increase blood flow and may help temporarily with pain. Avoiding painful activities help manage pain and takes stress off the spine. 


NSAIDs, Tylenol, prescription meds. All medications just help the symptoms of pain due to instability but do not address the underlying issues. All medications have potential risks or side effects. 

Orthotics, Spinal Bracing, Taping

Bracing may be recommended for certain types of scoliosis or some fractures. For most spine problems bracing is not recommended as that can make the spinal muscles weaker leading to more instability. 

Physical Therapy

The goal of good physical therapy is to improve spinal posture, alignment, and strength to help take pressure off the spine and help to stabilize it through muscle activation and strengthening.  A good PT can also show you good exercises, stretches, etc. to do at home to help. Lastly many good PTs will have modalities that they can use to aid in those goals and help reduce pain. 

Dry Needling, Myofascial Release, Shockwave, Laser

These modalities often performed by different therapists or chiropractors can help aid in muscle relaxation, muscle strengthening, and reducing pain. 

Platelet-Rich Plasma (PRP) Injection

PRP is made by taking your own blood, centrifuging (spinning it) to separate the components, and concentrating the platelets. The concentrated platelets can then be injected into areas of tissue injury to initiate a healing response. Platelets have growth factors, cytokines, proteins, exosomes, etc. that mediate that healing response. PRP has supporting evidence that it can be used to treat ligament injuries in the spine, help heal disk tears, help irritated spinal nerves, and help arthritic spinal facets and SI joints(1-9). 

Risk Factors

Common risks for spinal instability are:

  • Trauma: Fall, MVA, sports injury, etc.
  • Prior spinal surgeries: Spine surgery itself such as microdiscectomy, laminectomy, decompression, etc can also cause damage as all surgeries involve cutting and damage to the spinal muscles, fascia, and possibly the disks, bones, and ligaments. 
  • Genetic Predisposition: some people have congenital abnormalities that can cause spinal instability such as those listed above. Some people genetically have a predisposition to spine instability such as those with hypermobility or Ehlers-Danlos Syndrome (EDS). In some genetic abnormalities, the body has a problem making collagen, which is important for stabilizing structures such as spinal ligaments and the disk annular fibers.  
  • Infections: Infections can sometimes migrate to the spine or a direct spinal infection from a procedure or surgery can cause spinal instability. 
  • Cancer: Cancer can originate in the spine or metastasize from other areas to the spine and cause damage. 
  • Age-Related Degeneration: as we get older, it is more likely that minor injuries can add up or disk dehydration and poor posture can affect the stability of the spine. 

Preventing Spinal Instability

As noted, spinal instability can be caused by a variety of factors. While some of these factors are beyond our control, there are several steps that individuals can take to help prevent spinal instability. Take the below steps to maintain good spinal health which helps to reduce the risk of spinal instability and other spinal conditions.

  • Maintain good posture: Poor posture can put stress on the spine and lead to wear and tear over time. To maintain good posture, sit and stand with your back straight, shoulders relaxed, and feet flat on the ground. Have an ergonomic workstation if you do computer or desk work. 
  • Exercise regularly: Regular exercise can help keep the muscles and bones in the spine strong and healthy. This can include exercises that focus on core strength, such as yoga or Pilates, as well as weight-bearing exercises like walking.
  • Eat a healthy diet: A healthy diet can help you overall and spinal help in many ways. A die that is rich in calcium, magnesium, and vitamin D can help promote bone health and reduce the risk of spinal fractures. (link to Nutrition 2.0)
  • Avoid smoking and excessive alcohol consumption: Smoking and excessive alcohol consumption can weaken the bones and increase the risk of spinal fractures and other spinal conditions. Smoking can also reduce blood flow to the spine which increases the risk for degenerative disk disease. Smoking also, makes it more difficult to heal from spinal problems if they occur. 
  • Use proper body mechanics: When lifting heavy objects or engaging in other physical activities, use proper body mechanics to avoid putting unnecessary strain on the spine.

What Happens If Left Untreated?

If left untreated, spinal instability can lead to several complications and potentially serious consequences. These can include:

  • Chronic pain: Spinal instability can cause chronic pain, which can significantly affect an individual’s quality of life and ability to perform daily activities.
  • Nerve damage: Spinal instability can put pressure on the spinal cord and nerves, which can lead to numbness, tingling, weakness, and even paralysis in the most severe cases.
  • Loss of mobility: Severe spinal instability can cause loss of mobility and function, which can greatly impact an individual’s ability to perform daily activities and maintain independence.
  • Deformity: In some cases, untreated spinal instability can lead to spinal deformity, which can cause additional health complications and may require more extensive treatment.
  • Bowel or bladder dysfunction: Severe spinal instability can sometimes lead to dysfunction of the bowel or bladder. 

Early Detection Is Key. Get The Best Treatment For Instability Of The Spine

Seek prompt medical attention for neck or back pain or other symptoms of spinal problems. If you experience spine pain or other symptoms of a spinal condition, seek prompt medical attention from a board-certified musculoskeletal spine specialist who can help you prevent the condition from worsening and potentially causing spinal instability. Unless there is a severe traumatic injury or tumor, start with a non-surgical specialist.

At the Centeno Schultz clinic we are all board certified fellowship trained musculoskeletal specialists with specific expertise in regenerative medicine and is the source of much of the world’s research in this area. We have extensive experience treating spinal instability. Our focus is addressing the root causes of instability and offering non-surgical interventions mostly using platelet-rich plasma (PRP) and bone marrow concentrate containing stem cells (BMAC) to help heal damaged tissues reduce pain and restore function.

Doctors that Help With This Condition

Christopher J. Centeno, MD

Christopher J. Centeno, M.D. is an international expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate in orthopedics. He is board-certified in physical medicine and rehabilitation with a subspecialty of pain medicine through The American Board of Physical Medicine and Rehabilitation. Dr. Centeno is one of the few physicians in the world with extensive experience in the culture expansion of and clinical use of adult bone marrow concentrate to treat orthopedic injuries. His clinic incorporates a variety of revolutionary pain management techniques to bring its broad patient base relief and results. Dr. Centeno treats patients from all over the US who…

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John Schultz, MD

John R. Schultz M.D. is a national expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate for orthopedic injuries. He is board certified in Anesthesiology and Pain Medicine and underwent fellowship training in both. Dr. Schultz has extensive experience with same day as well as culture expanded bone marrow concentrate and sees patients at the CSC Broomfield, Colorado Clinic, as well the Regenexx Clinic in Grand Cayman. Dr. Schultz emphasis is on the evaluation and treatment of thoracic and cervical disc, facet, nerve, and ligament injuries including the non-surgical treatment of Craniocervical instability (CCI). Dr. Schultz trained at George Washington School of…

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John Pitts, M.D.

Dr. Pitts is originally from Chicago, IL but is a medical graduate of Vanderbilt School of Medicine in Nashville, TN. After Vanderbilt, he completed a residency in Physical Medicine and Rehabilitation (PM&R) at Emory University in Atlanta, GA. The focus of PM&R is the restoration of function and quality of life. In residency, he gained much experience in musculoskeletal medicine, rehabilitation, spine, and sports medicine along with some regenerative medicine. He also gained significant experience in fluoroscopically guided spinal procedures and peripheral injections. However, Dr. Pitts wanted to broaden his skills and treatment options beyond the current typical standards of care.

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Jason Markle, D.O.

Post-residency, Dr. Markle was selected to the Interventional Orthopedic Fellowship program at the Centeno-Schultz Clinic. During his fellowship, he gained significant experience in the new field of Interventional Orthopedics and regenerative medicine, honing his skills in advanced injection techniques into the spine and joints treating patients with autologous, bone marrow concentrate and platelet solutions. Dr. Markle then accepted a full-time attending physician position at the Centeno-Schultz Clinic, where he both treats patients and trains Interventional Orthopedics fellows. Dr. Markle is an active member of the Interventional Orthopedic Foundation and serves as a course instructor, where he trains physicians from around the world.

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Brandon T. Money, D.O., M.S.

Dr. Money is an Indiana native who now proudly calls Colorado home. He attended medical school at Kansas City University and then returned to Indiana to complete a Physical Medicine and Rehabilitation residency program at Indiana University, where he was trained on non-surgical methods to improve health and function as well as rehabilitative care following trauma, stroke, spinal cord injury, brain injury, etc. Dr. Money has been following the ideology behind Centeno-Schultz Clinic and Regenexx since he was in medical school, as he believed there had to be a better way to care for patients than the status quo. The human body has incredible healing capabilities…

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More Resources

The Spine Owner’s Manual: How to Avoid Back Pain & Life-Altering Surgery

This e-book from Dr. Chris Centeno focuses on the spine and how it functions within the human musculoskeletal system and the body as a whole. Everything in our bodies works together like a well-tuned symphony to support our well-being, and a strong spine (including all of its component parts, such as spinal nerves, ligaments, muscles, etc.) is critical to complete health.

Using the Regenexx SANS approach, The Spine Owner’s Manual provides a series of tests and clearly defined exercises that you can do on your own to measure and monitor your own spinal health. These musculoskeletal tests will allow you to monitor where your own body might be struggling to maintain proper stability, articulation, symmetry, and neuromuscular function.

  • L5 S1 Or Lumbosacral Joint: What Is It And What Should You Be Wary Of?

    The L5 S1 joint, or the lumbosacral joint, is a critical joint. It lies between the lumbar segment of the spine and the auricular processes of the sacrum. The L5-S1 joint plays a vital role in transmitting the weight of the body via the sacrum and ilium downwards. The weight is distributed to the femur…

  • Degenerative Disc Disease Exercises

    Degenerative disc disease (DDD) is a physiological breakdown of the intervertebral discs in the spine. Clinical studies have shown that disc degeneration, or the narrowing of at least one intervertebral space, is prevalent in nearly 60% of the population above 40 years of age(1). DDD can occur in the cervical, thoracic, or lumbar spine. While…

  • 9 Safe and Effective Ways to Crack Your Lower Back

    “Cracking” the back is a safe and effective way to stretch the joints of the spine. This exercise also relieves pain and discomfort in the joints. You’ve probably done it just after waking up or at the end of a long day without really thinking about it. The Benefits Of Cracking Your Lower Back There…

  • Ligaments of the Spine: Understanding Their Importance

    It started as a dull ache and now has progressed.  It feels like a knife in the back of your neck and is preventing you from daily activities.  Medications, rest and conservative treatments have failed.  Your doctor noticed on x-ray that the bones are out of alignment.  He thinks you may have suffered a ligament…

  • Alternatives to Laminectomy

    If you have had an MRI of your spine, you are probably like most patients. You read the MRI report and then google every term on your MRI report from the Radiologist trying to figure out what it all means! Alternatives to Laminectomy should be an important part of that search. Today you’re in luck,…

  • A New Study For Patients With Ongoing Low Back Pain

    The multifidus muscle is an important stabilizer of the lumbar spine. Dr. Schultz discusses what the multifidus muscle is, its importance, what muscle atrophy is, the association between multifidus atrophy and low back pain, and a new, exciting study at the Centeno-Schultz Clinic using PRP injections.

  • How To Heal A Herniated Disc Naturally

    A herniated disc can stop you in your tracks. Dr. Schultz reviews what a disc herniation is, how it is diagnosed, whether it can heal on its own, current treatments, and a natural way to treat a herniated disc.

  • PRP for Herniated Disc, Bulging Disc, and Disc Protrusion

    Dr. Pitts discusses PRP for Herniated Disc, Disc Bulge, and Disc Protrusion Transcript Hello, everybody. This is Dr. John Pitts of the Centeno-Schultz Clinic, where we are the leaders and inventors of much of the field of interventional orthopedics, which is basically treating and diagnosing musculoskeletal, orthopedic-type problems using injections and regenerative agents rather than…

  • Non-Surgical Treatment Options for Adult Degenerative Scoliosis

    Scoliosis is a 3-dimensional spinal deformity that involves curvature of the spine. Our guest, Dr, Chris Gubbels, with advanced certification in Chiropractor Biophysics discusses non-surgical treatment options for scoliosis.


  1. Williams C, Jerome M, Fausel C, et al. (October 08, 2021) Regenerative Injection Treatments Utilizing Platelet Products and Prolotherapy for Cervical Spine Pain: A Functional Spinal Unit Approach. Cureus 13(10): e18608. doi:10.7759/cureus.18608
  2. Centeno CJ, Elliott J, Elkins WL, Freeman M. Fluoroscopically guided cervical prolotherapy for instability with blinded pre and post radiographic reading. Pain Physician. 2005 Jan;8(1):67-72. PMID: 16850045.
  3. Ashley Smith, Ben Andruski, George Deng, Robert Burnham, Cervical facet joint platelet-rich plasma in people with chronic whiplash-associated disorders: A prospective case series of short-term outcomes, Interventional Pain Medicine, Volume 1, Issue 2, 2022, 100078, ISSN 2772-5944. Cervical facet joint platelet-rich plasma in people with chronic whiplash-associated disorders: A prospective case series of short-term outcomes – ScienceDirect
  4. Lam KHS, Hung CY, Wu TJ. Ultrasound-Guided Cervical Intradiscal Injection with Platelet-Rich Plasma with Fluoroscopic Validation for the Treatment of Cervical Discogenic Pain: A Case Presentation and Technical Illustration. J Pain Res. 2020;13:2125-2129. Published 2020 Aug 20. doi:10.2147/JPR.S264033. Ultrasound-Guided Cervical Intradiscal Injection with Platelet-Rich Plasma with Fluoroscopic Validation for the Treatment of Cervical Discogenic Pain: A Case Presentation and Technical Illustration – PMC (
  5. Centeno C, Markle J, Dodson E, Stemper I, Hyzy M, Williams C, Freeman M. The use of lumbar epidural injection of platelet lysate for treatment of radicular pain. J Exp Orthop. 2017 Nov 25;4(1):38. doi: 10.1186/s40634-017-0113-5. PMID: 29177632; PMCID: PMC5701904. The use of lumbar epidural injection of platelet lysate for treatment of radicular pain – PubMed (
  6. Monfett M, Harrison J, Boachie-Adjei K, Lutz G. Intradiscal platelet-rich plasma (PRP) injections for discogenic low back pain: an update. Int Orthop. 2016 Jun;40(6):1321-8. doi: 10.1007/s00264-016-3178-3. Epub 2016 Apr 12. PMID: 27073034. Intradiscal platelet-rich plasma (PRP) injections for discogenic low back pain: an update – PubMed (
  7. Tuakli-Wosornu YA, Terry A, Boachie-Adjei K, Harrison JR, Gribbin CK, LaSalle EE, Nguyen JT, Solomon JL, Lutz GE. Lumbar Intradiskal Platelet-Rich Plasma (PRP) Injections: A Prospective, Double-Blind, Randomized Controlled Study. PM R. 2016 Jan;8(1):1-10; quiz 10. doi: 10.1016/j.pmrj.2015.08.010. Epub 2015 Aug 24. PMID: 26314234. Lumbar Intradiskal Platelet-Rich Plasma (PRP) Injections: A Prospective, Double-Blind, Randomized Controlled Study – PubMed (
  8. Prysak MH, Lutz CG, Zukofsky TA, Katz JM, Everts PA, Lutz GE. Optimizing the safety of intradiscal platelet-rich plasma: an in vitro study with Cutibacterium acnes. Regen Med. 2019 Oct;14(10):955-967. doi: 10.2217/rme-2019-0098. Epub 2019 Oct 7. PMID: 31587600. Optimizing the safety of intradiscal platelet-rich plasma: an in vitro study with Cutibacterium acnes – PubMed (
  9. Cheng J, Santiago KA, Nguyen JT, Solomon JL, Lutz GE. Treatment of symptomatic degenerative intervertebral discs with autologous platelet-rich plasma: follow-up at 5-9 years. Regen Med. 2019 Sep;14(9):831-840. doi: 10.2217/rme-2019-0040. Epub 2019 Aug 29. PMID: 31464577; PMCID: PMC6770415. Treatment of symptomatic degenerative intervertebral discs with autologous platelet-rich plasma: follow-up at 5-9 years – PubMed (

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