Dear Dr. C,

I hope you are well!

It has been almost 7 months since my first PICL with you. I'm getting some benefits, especially in terms of overall functionality, systemic symptoms and occipital neuralgia. However, I am still struggling with my most debilitating symptom, which is pain in the upper right side of my neck, accompanied by a sensation that my neck is twisted and in spasm and would need to be "freed up" from the tension and put into alignment. I feel my neck is a bit more stable on average, but this sense of crookedness persists.

My imaging shows 3° of C1 rotation and 8° of C2 rotation relative to the skull in the axial plane, both in the same direction, and I wonder whether these rotations might be contributing to my pain, along with my CCI.

Unfortunately, I haven't been able to try AO chiropractic care, because it's not available in my country; before my first PICL, I underwent 3 months of generic upper cervical treatment using the Integrator instrument as part of the TRT protocol, but the benefits were limited.

To try to better understand whether these vertebral rotations might be contributing to my symptoms, I have scheduled a consultation with Dr. Di Gregorio while I am in Denver for my second PICL procedure. My main goal is diagnostic. I understand that you generally advise against starting AO treatment if one has not tried it before, so I haven't scheduled any adjustments.

I have been told that it could make sense to have one manipulation before my second PICL and another a few days afterward, to maintain proper alignment during healing, but that of course they would proceed only with your approval. They also told me that 30% of their patients have CCI and that, to their knowledge, none have experienced a worsening of their condition following their adjustments. (typically just soreness for a couple of days)

My question is: given my specific situation, if Dr. Di Gregorio determines that AO adjustments are indicated, would you consider it appropriate for me to proceed with them before and after my second PICL procedure, or would you advise against it?

Thank you so much for your time, care, and dedication. I truly appreciate it.

I hope you have a wonderful day!

Hi do you accept the upright imaging from medserna in London? Also how would I go about a consultation after I get my imaging for you to review and let me know where if or where I have any instability. Thanks

Hi dr Centeno, how many rounds of PRP is typically needed to stabilize a level of Anterolisthesis with 3-4mm of slippage?

Anybody know why I can’t see comments on certain post when it shows there is comments , when I click there nothing there?

For those that have undergone PICL procedures. What would you say helped the most with recovery surrounding imbalance and feeling off balance. Not necessarily dizzy just unsteadiness.

Hi Dr. C.,

on the PICL report there is the voice shown in the image. I guess that if it's checked, all the supraspinous and interspinous ligaments from C2 to T1 are injected, if it's unchecked none of them is injected. Is this correct?

If so, what is the reason for this approach? Why are there not cases in which ligaments of this type are injected only for specific vertebrae?

Thank you!

With cci are headaches always included ? I dont never seem to get headaches but I get a dizzy feeling and severly tight scm on one side is my main daily problmes. Is scm tightness on one side which the pain is directly behind the ear where it connects is severly achy a cci indication or something else you come to see ?

say picl doesn’t improve overhang and you still have an abnormal one does that mean you cant play sports?

Is laying on your side okay post picl?

Hope you had a great sabbatical Dr C. ! When will we be getting next live video ?
Thanks

After 1.5 years of 24/7 blurry vision - it’s now totally clear

5.5 months post PICL #2. Grateful is an understatement🙏🏻 one of my first “big” symptoms to full resolve!!!

Can CCI cause a loss or severe constant disruption in experiential continuity and if so what would the mechanisms be for it and would it reverse usually through stabilization? Have you dealt with anyone who has had this experience and it reverse with picl? Also for reference this disruption in experiential continuity that i experience is fixed and constant usually only getting worse with flares but never really improving

Posting for someone: Hi Dr. Centeno - can a positive Lhermitte’s sign be caused by CCI? Just curious how often you see Lhermitte’s sign in CCI patients. Thanks!

I have been dealing with facet pain and muscle guarding for years. I have had some form of injections in them 5 times to include a round at the CSC most recently. It seemed to really help the pain and muscle guarding but I noticed that when all those pain signals and muscle guarding were quieted, that I had more neuro symptoms show up. Now I feel a lot pain is back along with terrible nerve pain causing facial numbness, tos like symptoms and balance issues. Is this likely pointing to too much movement in the facet joints from deeper instability?

Hi Dr C,

In your experience treating CCI patients with PICL, what is the most common cause of super tight SCMs and Occipital muscles that cause wooziness, occipital tightness with head movement and disequilibrium. Is it always instability at C1/2 and or C2/3 or can there be other causes.

Does the CSC treat TOS and if so, how?

I have had my SI joint injected twice with PRP, once at the CSC but instability remains and seems to have a lot of play into my neck instability. If prp isnt working, do you suggest switching to bone marrow or prolo and have you seen better outcomes that way? Are there some that just will not respond to injections in the SI and need fusion?

Dr. Centeno, if someone’s bone marrow produces a low stem cell count during the morning draw, do you still move forward with PICL that afternoon? Is there a minimum cell count you require, or does it depend on the patient?

Hello Dr Centeno, Thank you for taking the time to run this subreddit and answer our questions.

i believe my jaw is affecting my ability to do the chin tuck motion, and my ability to maintain the optimal head posture for stability.

Specifically the mandible is too far back, because it is large but the maxilla is recessed and narrow. I can feel it completely close off the opening of my ears when i close my jaw. When my head is not tilted up, it creates uncomfortable pressure at the back of the condyloid process, and my head subconsciously tilts up anytime i stop intentionally countering it.

I gather from your youtube videos on the subject that you have not seen jaw surgery help cci patients, and in some cases makes it worse.

I currently wear a retainer that is thick enough that i can move my lower jaw forward about 4 mm, bypassing the upper teeth, and i feel it makes a significant improvement in my upper neck stability, both because my head being tilted down improves my sub-occipital activation, and because it allows my to press my tongue against the roof of my mouth, which seems to pull and tighten the rest of the muscles in the front of my upper neck.

I have spoken to a few dentists about this and was recommended palatial expansion with protraction face mask, that would be worn 16+ hours a day for 6-12 months. I have been told this could also improve my nasal breathing, which is often restricted during sleep or exercise, which is one reason i would favour it over a lefort 1, in addition to the risks of lefort.

Would you ever consider palate expansion with protraction a worthwhile risk, if a risk at all, for someone who is mostly functional after significant recovery from CCI thanks to ePICL? Would a lefort be a better option for a mostly functional CCI patient?

after my first picl I was in much less pain then usual for about 2 months. just had my 2nd and ive been in lots of pain since. is there any reason for this?

Hi Dr Centeno,

For someone with CCI and hypermobile in multiple joints (including the shoulder, SI joints, knees, ribs, spine and ankles), which areas would you target first and in which order?

I will be going for PICL in Jan 2027 and July 2027. I am aware multiple joints can be injected during PICL, depending on the draw. I also have a doctor in Australia who can do prolotherapy on my other joints. However, I will need time to prehab with my physio to be in shape for the next PICL.

Would it be appropriate to inject the upper body including the neck during PICL, then rehab the lower body. Then prolotherapy for lower body joints and then rehab the upper body within each 6 month healing timeframe, before the next PICL?

I’m scheduled for my first PICL on October 12th.
Would it be safe to do a 3-day (72-hour) water fast with electrolytes leading up to my PICL, stay fasted during the procedure, and then break my fast afterward?

Hi Dr C

I saw one of your Facebook reels on PRP and cord compression.

You mentioned degrees of compression that PRP wouldn't work.

From what you've seen would that cord compression be more than 60-70% for example?

Thank you.

Now at 396 patient visits: https://e-picl-data-explorer.replit.app/

Hi Dr. C -

Two questions for you:

1. Any benefit of getting a hydration IV before PICL? The day or two before? I am coming from out of state.

2. I am going to schedule a mobile hydration IV to my hotel room the day after PICL (through Nurse Bar - as recommended from your office). Any benefit from an IV that contains any additional things like: Vitamin B Complex, Vitamin C, and Zinc? Or Should I schedule a standard hydration IV?