Chiari Malformation Syndrome and Upper Cervical Care

by Dr Grayson Blom

Many Chiari malformation treatments focus only on covering up your symptoms. Is it possible that the most commonly overlooked cause of the problem is an old injury to the upper cervical spinal column?

Chiari malformation syndrome occurs when a portion of the cerebellum and brainstem are pulled or twisted down into the opening at the base of the skull called the foramen magnum. There are several grades of Chiari malformation however the bottom line is to what degree does the cerebellum and/or brain stem get mashed through the foramen magnum into the upper cervical spinal column as this would determine the classification of Chiari malformation. The exception being type 4 Chiari malformation being a very rare genetic disorder. According to the national institute of neurological disorders many people have a Chiari Malformation but do not have any symptoms (ref 1). So the question then becomes what triggers the symptoms?

　
Why Is Chiari Malformation So Hard To Diagnose?

The most commonly missed clue is the fact that most MRI units that would be used to diagnose this condition are recumbent machines in that you must lay down, face up (supine) and when you lay down the cerebellum and/or brain stem will very likely slide back into the skull and the imaging radiologist will completely miss the problem.

It is also important to note that the symptoms of Chiari malformation are very similar to other common complaints people have, thus making it even harder to medically diagnose. The most common symptoms Chiari patients experience are neck pain, headache, vertigo (dizziness), balance problems, tinnitus, hearing loss, visual disturbance, nausea, insomnia, depression, numbness in arms or legs (ref 2,3). These are very common symptoms people seek Upper Cervical Chiropractic care for

　
How Do Chiari Symptoms Match Up With Brain Stem Cord Pressure?

When we look at the most common symptoms of Chiari malformation syndrome and how they match up to brain stem and upper cervical spinal structures it is apparent how they overlap. For example the symptoms of neck pain and headache are very common and most frequently occur due to spinal misalignment in the upper neck creating spinal compensations in the lower neck and the spinal column below to produce neck pain and back pain. In addition a spinal misalignment in the upper neck can also interfere with how blood and cerebrospinal fluid (CSF) circulate in and out of the head to produce headache symptoms or we could say superior brain congestion and inferior body compensation. Often the 8th cranial nerve is being mashed into the foramen magnum and the upper cervical spine. This finding is significant as the 8th cranial nerve is what controls hearing and balance. The apparent relationship of brainstem structures to upper cervical spinal structures is quite remarkable. Is it possible there is a relationship to upper cervical spinal injury and the development of Chiari malformation symptoms?

What about Nausea? This can occur with irritation to cranial nerves 9 and 10. The close proximity of these cranial nerves that match up for a cause and effect situation etc. Please also keep in mind the exact placement of these cranial nerve structures can vary as well. As a general rule things seen in an anatomy textbook only occur 30% of the time which means 70% of the time people will have some variation from what is considered textbook anatomy. The bottom line is that any portion of the nervous system that is under tension or compressed in any way will result in some form of dysfunction!

Can Subluxation Induce Chiari Malformation Symptoms?

So what is it that triggers Chiari malformation symptoms? If you read the description of the different classifications of Chiari malformation (ref 1) keeping in mind that connective tissue has been torn loose for these structures to move like this. Often the connective tissues of the Chiari patient have been torn loose allowing the brain stem and cerebellum to be pulled down into the foramen magnum and the upper cervical spinal column when the patient is upright in the field of gravity.

The most common cause of subluxation is a previous injury to the head or neck such as: a hard slip or a fall, a motor vehicle accident, a sport injury etc. A subluxation occurs when the connective tissues that hold the upper cervical spine together are torn loose allowing one of the upper two neck bones to misalign and lock out into a stressed position. The brain stem exits the floor of the skull in this area and ends near the top two neck bones. Could a Subluxation interfere with blood flow and cerebrospinal fluid (CSF) in and out of the head?(ref. 4,5,6,7,8) According to research it can in fact do so! Could a subluxation interfere with how the brain talks back and forth with the body?(ref. 9,10.) According to research it can in fact do so!

In virtually all cases the average time it takes for symptoms of a subluxation to start showing up is 10-15 years and in many cases even longer than that. In many cases damage to the spine can be dated to give us an approximation of when the subluxation began. It is amazing how often this matches up with a previous injury the patient sustained in the years prior, which is just now producing symptoms.

Upper Cervical Care For The Correction of Subluxation 

Upper Cervical Chiropractic care is a systematic approach to locate, and correct injuries to the upper neck. This is achieved by a procedure that is designed to:
 
1. determine the nature and extent of the spinal injury,
2. determine disruption to nervous system function using a form of thermography,
3. determine how long the spinal injury has been present and the prospects for correction.

It is important to also note that subluxation is not the only way Chiari malformation symptoms can develop, please consider a space occupying mass such as cancer in the form of a tumor et. al. With that said the most commonly overlooked source of these problems is in fact due to a subluxation. The bottom line is that a subluxation is a neuro-vascular-degenerative disorder that interferes with the nervous systems ability to communicate back and forth with the body and therefore produces some sort of dysfunction. What type of problem develops from a subluxation depends on a several different factors such as:
 
1. the nature and extent of the spinal injury,
2. how long has the injury been present?,
3. most importantly the patients unique anatomy in the upper cervical spinal area.

As an example it is known that there are over 83 different variations of how the blood flows in and out of the head. It is common knowledge that whatever structures in the body don't get enough blood, will not function properly. It is also common knowledge that a small amount of pressure or irritation to the brain stem or spinal cord can cause neurological dysfunction. 

(Editor's note: Remember the objective of upper cervical care is to correct head neck misalignment that is interfering with proper brain to body communication. When this is corrected the body functions at a higher level and can often correct other problems more efficiently on its own. Please do not confuse upper cervical care as a treatment for any condition, disease or symptom.)

Protecting Your Upper Cervical Correction

By Dr. Michael Polsinelli

Of all the bones in the spine, the first one (the atlas) is the most vulnerable because it doesn’t have the bony locks that the others have, and it has to support a large amount of weight (the head). Because this misalignment can irritate the spinal cord, it can be devastating to our health. Using a light touch or gentle pressure, Upper Cervical Doctors are able to free the atlas bone toward the proper position. This will strengthen many postural muscles, balance the hips and legs, and allow people to function and feel much better.

Once we have had a misalignment of the atlas, it is possible for the atlas to misalign again. In addition to another injury, physical stress is another reason that we can go out of alignment.

Physical stress can be things like improper lifting or sitting. Sleeping on our stomach can cause significant stress to the upperneck. Heavy backpacks stress the spines of our children and teenagers.

Having our head in an extended position for any length of time can stress the upper neck. This includes painting ceilings, getting our hair washed at a salon, and getting our teeth worked on at the dentist. For painting, use ladders and extension poles. Wash your hair before going to the salon, or bend forward for the hair washing (at the minimum, use lots of towels under your neck and don’t extend a lot). Finally, talk to your dentist before major teeth work and set up signals so that you can take very short breaks (even as small as 4 seconds can reduce the stress).

Sleeping in awkward positions can cause our atlas to shift out of alignment. Don’t fall asleep on the couch or in a chair. The jerking of trying to stay awake in a seated position can also cause the atlas to misalign. Finally don’t sleep in a moving vehicle (especially if driving). The vibration of the vehicle can cause the atlas to go out of alignment since our muscles are so relaxed. Sudden movements can also be problematic. The worst is flying. There is not enough room to get comfortable, and the turbulence can knock the atlas out of position.

With everything, allow comfort to be your guide, make sure you are comfortable while sleeping, sitting and lifting. If not, change position or take a break. When the ligaments can’t do their job properly, the muscles will take over. We’ll notice tightness in our necks. If this occurs, take a break, lay down, nap if you can. If you are driving, park the car and put the chair back and rest for 5 minutes. This will allow our ligaments to get the break that they need, and allow us to hold our alignments. By listening to our bodies we can take better care of ourselves and allow the healing process to occur.

Once again, the initial misalignment is often caused by an injury, even if a subtle one at the time. Once we have had an injury we are vulnerable to going out of alignment again. By listening to our bodies and being smart, we can reduce the physical stress on ourselves. Finally, the longer we hold our alignment the less likely we are to lose the alignment, especially from day to day activities.

Upper Cervical Care and Foot Pain

Aberrant Upper Cervical Arthrokinematics can cause Foot Pain

Male, Age 29, Case of Achilles Tendonitis, Uneven Running Gait

This 29‑year‑old runner had run during high school and college, but had to stop in recent years due to chronic achilles tendonitis. He had tried many forms of treatment but was unable to alleviate the pain unless he stopped running altogether. He also described himself an having an "uneven gait" when he ran. He claimed that he felt like he struck harder on one leg compared to the other side.

During his initial examination, a spinal injury was discovered, with the primary site located at his upper neck. The neck injury was causing his spine and pelvis to shift into a stressed, weakened posture, that was putting greater pressure on one leg compared to the other. After having his neck injury corrected, all Achilles pain healed and remained absent so that he was able to once again resume running 60 miles per week.

(Remember the old song, “…your foot bone’s connected to your shin bone and your shin bone’s connected to…” Eventually you start to see that the whole body is connected. An area as profound neurologically for balance mechanisms as the upper cervical spine makes it very clear how a problem here could be a factor in someone’s foot problems.)