Physical therapy is considered when the patient is still young or when there is no radiographic evidence of significant instability, neurological symptoms or uncontrollable pain. The therapy consists of traction and three to six months in a Minerva jacket or a brace. In most patients leads this therapy to fusion of the atlanto-axial joint.
The goal of the physical therapy treatment for cervical instability is to enhance the function of the spinal stabilising subsystems and to decrease the stress on the involved spinal segments. Posture education will decrease the stress on the passive subsystem (which consists of capsules and spinal ligaments) by reducing the loads on the segments in end range and by returning the spine in a biomechanical efficient position. To enhance the active subsystem (muscles and tendons) strengthening exercises are required. In the cervical region, the multifidus (posterior) and the longus coli and capitus provide stability and therefore improve the quality and control of movement occurring within the neutral zone. Exercises should be focused on controlled motion and proprioception[13][14]. It is important to be aware of the fact that os odontoideum is an absolute contraindication to upper cervical manipulation