Way back in the mid-90s, a local audiologist referred me a patient with dizziness. He had noticed me treating several patients with traumatic neck injuries and was curious. That began a many year association where I as a young physician learned from this older and wiser provider. He basically taught me about how the upper neck could cause dizziness, headaches, and other symptoms. This also began my fascination with upper neck injuries.
As the 90s ended, I had begun treating these patients with either upper neck facet joint injections of steroids or prolotherapy into ligaments. In addition, we used trigger point dry needling (IMS) of the upper neck muscles. We had some success with this approach and then as the early 2000s progressed, we added radiofrequency ablation of the C2-C3 joints. Again, more successes. However, there was always a core group of these patients that we couldn’t help or that we could only help minimally. Around 2005, our clinic became the first on planet earth to use bone marrow stem cells to treat many common orthopedic problems. Around the same time, a local chiropractic physician and I began working on diagnosing upper neck instability using DMX. Shortly thereafter, we abandoned steroid injections due to the research beginning to show that these potent anti-inflammatories were harming tissues. We also noted radiofrequency ablation causing the same tissue damage. At that point, by approximately 2010, we had switched to using platelet-rich plasma or stem cell injections.
One of the things that happened along the way was that as I began getting referred upper neck injury patients I had to re-educate myself. For example, this meant that I and my colleagues began to acquire extensive experience in injecting the upper neck joints. This was right at the time that most physicians had stopped injecting these areas.
Despite all of these advances, we still had a significant chunk of upper neck instability (craniocervical instability or CCI) patients we couldn’t help. Around 2014/15 I began to work on a new procedure to attempt to directly inject the internal craniocervical ligaments. This was a daunting task and I considered many approaches, but ultimately settled on the idea that the easiest and safest way to perform this procedure was through the posterior oropharynx (back of the throat). Hence, the PICL procedure was born and for several years after that was continuously updated and improved. In addition, we finally began observing that this patient population was improving. We heard stories of life-changing results in patients that we had unsuccessfully treated for many years. Eventually, this caused us to pull together these cases for publication and then we also begin a randomized controlled trial.
Today, as inventors of the PICL procedure, we have learned much about upper cervical anatomy and how to inject this area that was not previously known. We also have amassed the world’s largest experience base in direct, non-surgical treatment of the CCJ.