The 5 Things You Need to Know About Chiari Malformation

Chiari Malformation

There is more to Chiari Malformation than just surgery and drugs. Here are 5 things you need to know that can help! Clear Chiropractic is an upper cervical specialist practice in Spokane, Washington that is a natural choice in healthcare without twisting, stretching or cracking.

A Chiari malformation occurs when a portion of the brainstem descends below the normal space inside your skull and into your spinal canal. Imagine a balloon with a piece of string attached. The balloon represents your brain, and the string is your spinal cord. If you tug on the string, the bottom part of the balloon squeezes downward into the spinal canal. When this happens, it causes crowding, like trying to fit your foot into a shoe that’s a half size too small. Although you could force it, the pressure would be quite unpleasant.

The same goes with a Chiari malformation, which can produce many common neurological symptoms:

People diagnosed with a Chiari malformation are often told that they have only two options: drugs or surgery. However, there is much more to the story than that. So, let’s explore a few things about Chiari malformation and what other options are available.


1. Not All Chiari Malformations Are the Same

According to research, approximately 2% of the population has a Chiari malformation. However, 68% of these people don’t actually have any symptoms at all.

In other words, a Chiari malformation by itself is not always the problem. This presents a huge issue for people who do experience symptoms but are told by their neurologist, “Your MRI is normal.”

Chiari malformation is medically diagnosed when the brainstem or cerebellum descends into the spinal canal by at least 5mm. However, since the advent of upright MRI, we know that even slight crowding in certain people can still produce symptoms. This is known as a Type Zero Chiari malformation.

2. Bone Structure and Ligament Elasticity Are Risk Factors

Chiari malformation is not a genetic condition. However, we do inherit similar bone structures from our parents. Certain cranial features can make some people more likely to experience Chiari malformation:

  1. A shallow skull base (shallow posterior cranial fossa): Some people have a very broad base at the back of their skull, while others have a very shallow base, almost like a “flat backside of the head.” This flattening means there is not as much space inside the skull for the cerebellum, so it doesn’t take as much physical tension on the neural tissues to cause the cerebellum to slide down into the spinal canal.
  2. A shallow cranial floor (platybasia): The shape inside the skull itself varies among individuals. A flatter internal base can lead to basilar invagination, where the C1 or C2 vertebrae at the top of the neck compress the medulla (brainstem), the vital life center of your brain.
  3. Connective tissue disorders (e.g., Ehlers-Danlos Syndrome): People have different strengths and flexibility among their ligaments. For those with more elastic ligaments (such as with Ehlers-Danlos Syndrome), this increased flexibility means that the ligaments that support the brainstem and upper neck don’t offer as much resistance to keep the brain inside the skull.

3. Whiplash is a Risk Factor

Head and neck injuries that damage the ligaments in the upper neck are a significant factor that can cause a mild Chiari malformation to become symptomatic.

Researchers examined a series of MRIs of people with suspected Chiari malformation: one group with no history of head/neck injury and one group with a history of whiplash. In both groups, they found approximately 5-6% of the population exhibited a Chiari malformation (at least 5mm) with a regular MRI. However, when they took an upright MRI, they found something astonishing: the group with no whiplash injury saw the incidence of Chiari malformation increase to 10%, and the group with a history of whiplash saw an incidence of Chiari malformation increase to 23%.

This research shows two things:

  • Even if a Chiari Malformation does not appear significant on a standard MRI, in an upright position, the incidence is at least twice as common.
  • A history of neck injury increases the incidence of Chiari malformation by nearly four times and is a major risk factor!

These findings may well explain why so many people with a Chiari malformation report feeling much better when they lie down compared to when they are sitting or standing upright.

4. Surgery is Not Always the First and Only Option

When a Chiari malformation is particularly pronounced or producing a syrinx (obstruction of cerebrospinal fluid), surgery may be required immediately. However, for many people, surgery may not be the only option.

As we’ve shown, stability of the joints in the upper part of your neck is a major factor in resolving issues associated with Chiari malformation. Even when surgery is required, treatments that focus on promoting strength and stability in your neck are a major piece of the puzzle.

Moreover, while there is a time for medications, because Chiari malformation is a physical/biomechanical condition, it requires a physical solution. Medications can manage symptoms, but they will not solve the problem by themselves.

5. There Are Non-Surgical Options to help with Chiari Malformation

While surgery has its place, there are other forms of healthcare that can assist so that you may not require surgery.

1. Craniocervical Care

The craniocervical junction, or upper neck, has a profound impact on brain health. The alignment, motion, and stability of the C1 and C2 vertebrae are crucial. A craniocervical specialist, a unique type of chiropractor, can identify misalignments and restore normal function without twisting, stretching, or neck cracking.

2. Craniosacral Therapy

Craniosacral therapy focuses on the flow of cerebrospinal fluid (CSF) around the brain and spinal cord. This gentle treatment can help manage symptoms naturally, promoting mental clarity and calmness. Note: In addition to craniosacral therapy, Network Spinal Analysis, Spinal Flow and NMRI techniques can also help.

3. Neuromuscular Dentistry (TMJ Therapy)

The temporomandibular joints (TMJ) impact the function of the C1-C2 joints in the spine. Neuromuscular dentists can address cranial problems and ensure proper TMJ function, which can alleviate related spinal dysfunctions, including Chiari malformation. Note: Myofunctional therapy and myofascial therapy can also help in this area.

4. Prolotherapy

Prolotherapy involves injections into the ligaments of the upper neck to promote healing and restore stability. This can be especially important for those who have had surgery for Chiari malformation, as it strengthens the ligaments of the upper neck.

Closing Thoughts

There is seldom a one-size-fits-all approach or “magic bullet” when it comes to Chiari malformation. It usually requires a team of specialists working collaboratively to achieve the best results. If you or a loved one have been dealing with health problems (even if your MRI says that “everything is normal”), schedule a consultation for a professional opinion.

The Blair Technique

The Blair technique is a specialized chiropractic approach focusing on the alignment, motion, and stability of the atlas vertebra. This gentle and precise method can help restore normal function at the junction between your head and neck, promoting overall health.

If you are looking for help with a chiropractor in Spokane, visit our home page more information. To schedule a new patient appointment with our Mead (north Spokane) or South Hill offices, complete a new patient request form here, or call us direct at 509-315-8166.