Chiari Malformation Treatment without Surgery

Posted in Head Pain Disorders on Jan 18, 2022

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If you have been recently diagnosed with Chiari Malformation, you may be wondering what treatment options you have without surgery. It is the traditional belief that the only treatment for Chiari Malformation is surgery. Otherwise, your own treatment option to manage the symptoms is medication. However, new research proposes a few very interesting ideas to help people diagnosed with Chiari Malformation so that they can experience relief without surgery.

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The article published in 2022 examines the link between the vertebrae in the upper neck (the C1 and C2) and Type I Chiari malformations. In this article, the researchers note that approximately 1% of the adult population actually has a Type I Chiari Malformation. However, the vast majority of these are not actually symptomatic.

What this means is that the Chiari Malformation itself may not actually be the cause of your symptoms. It could be one of the effects! And if the underlying cause can be treated without surgery or drugs, even if the malformation itself does not completely go away, if it means that you are able to experience relief, that is ultimately what matters most!

Chiari Malformation - The Role of the Upper Neck

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What the researchers in this article proposed is a mechanism that a mechanical problem with the vertebrae in the upper neck, namely the atlas or C1 vertebra, can impart physical tension on the upper spinal cord.  (Note: it deserves mention that this hypothesis is not actually new. It has been proposed by several authors including upper cervical chiropractic researchers and other specialists who work in the field of head-neck disorders).

The researchers make particular note that is a large percentage of people who have a Chiari Malformation that it was a physical injury that triggered their symptoms. 

  • A trip of fall
  • A car accident or whiplash injury
  • head trauma or sports injuries

In many of these instances, the researchers also noted that it is not necessarily the severity of the injury that matters at all. It would therefore seem that there was already some type of preexisting condition that needed just that little extra push to get over the line for the Chiari Malformation to become symptomatic. One of the things that are most unique about the atlas vertebra is that it contains a unique series of ligaments known as myodural bridges that tether your spinal cord to the atlas vertebra and the surrounding muscles. The reason for these ligaments is twofold: 

  1. They facilitate the normal circulation of cerebrospinal fluid (CSF), which provides energy, oxygen, and other nutrients for your brain 
  2. They maintain the patency of your spinal canal when you move your head. Without these ligaments, you would crush your spinal cord every time you looked up or down.

The problem is believed to be that if there is a mechanical injury that affects the structure, alignment, and/or stability of the atlas vertebra, then these same ligaments exert mechanical tension on the brainstem, which sets up a negative cascade of events: 

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  • the muscles at the base of your skull tighten in order to protect against further damage
  • this tightening effectively locks the ligaments in place, which preserves the tension on the brainstem
  • this tension accumulates over time and ultimately leads to reduced compliance (or flexibility) of the brainstem
  • the reduced flexibility is believed to cause the brain to herniate into the spinal canal, but perhaps even more significantly
  • the reduced flexibility is believed to disrupt the normal flow of CSF, which is ultimately what produces the symptoms associated with the Chiari Malformation:           
  • headaches and migraines        
  •  dizziness and vertigo
  •  fibromyalgia and chronic fatigue 
  •  cranial neuralgias (e.g., trigeminal, glossopharyngeal,                  suboccipital neuralgia) 
  • vasovagal and associated central autonomic disorders

So yes, there are a lot of technical pieces to this story. However, this sequence of events is important. Without a proper appreciation for the cause of a Chiari Malformation, a specialist would otherwise be inclined to conclude that the problem (not the effect) is the herniation of the brain, which is why surgery is considered to be the only treatment for Chiari Malformation from a traditional perspective. Fortunately, when we have a proper appreciation of this sequence of events, it gives us the opportunity to example other treatment options for Chiari Malformation without surgery or drugs. 

And where it causes us to go is straight to the atlas vertebra.

Chiari Malformation and Atlanto-Axial Instability …?” I don’t quite agree.

There is one very important part of these researchers thesis where I do not agree, and I believe that this point needs a bit of clarification. When the researchers talked about mechanical problems involving the atlas vertebra, they use the terms “atlanto-occipital instability” and “atlanto-axial instability,” which refer to the ligaments between the C1 and the skull above and the C2 vertebra below.  The problem that I have is with the word instability.

Now, from a technical perspective, they are correct. Instability technically means any injury, however slight to the ligaments that normally hold the bones together and facilitate movement. Where they do not clarify is that there are three levels of actual injury:

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  • Grade III injuries, which are complete tears of a ligament. Yes, these are mega unstable!
  • Grade II injuries, which are partial tears. These are also unstable.

However, there are also Grade I injuries, which are micro-tears. These types of injuries typically do not show up on MRI scans because they are so small, but nevertheless can still cause the vast array of symptoms associated with a Chiari Malformation. However, these types of injuries are not actually unstable. On the contrary, Grade I injuries involving the atlas ARE stable, but persistently abnormal, which is why they may be able to cause the same types of problems as if they are unstable.

Maybe it is just me, but I have a similar pet peeve around the word “scoliosis.” Many people are diagnosed with scoliosis when they have nothing more than a postural tilt. It is not simply my opinion, but true scoliosis should not be diagnosed unless it is at least a 20-degree curve. The reason is the perceived problem of scoliosis can have many negative psychological impacts on body image and health.

The same goes with calling Grade I atlas misalignment injuries “unstable.” They ARE stable. Your head is not going to fall off your shoulders. You aren’t at risk of quadriplegia. They can be repaired safely. And if they are linked with Chiari Malformations, they can be treated without surgery.

Chiari Malformation Treatment without Surgery - Brisbane Upper Cervical Chiropractor

Here is where a unique approach to healthcare may be able to help you known as the Blair Technique.

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The Blair Technique is one of several methods known as upper cervical specific chiropractic. Unlike general chiropractic that involves rotatory cervical manipulation, twisting, or cracking, the Blair Technique does not use any spinal manipulation at all. Instead, it uses a precise and specific impulse (very light, approximately the amount of pressure you would use to click a pen) in order to restore the normal motion through the upper neck.

The Blair Technique is similar in many ways to the NUCCA and Atlas Orthogonal techniques that include detailed diagnostic imaging in order to identify the exact position, degree of misalignment, and thus degree of correction that is needed to restore the normal alignment of your atlas vertebra. Where the Blair Technique differs is that we take additional measurements into account that customise the procedure for your own bone structure. Every human being is different on the outside, and also the inside. Unless we take these individual differences into account, we are not always able to understand what is actually going on. 

(Note: this is one reason why we find that many people with Chiari Malformations, who have already had CT or MRI scans still can’t figure out what’s going on. It is because the angles that those images were taken don’t take your 3D structure into full account).

Again to be clear, we aren’t talking about making the Chiari Malformation go away per se. We are talking about correcting the mechanical issues with the alignment and movement of the atlas vertebra. When we do this, we find that many people with Chiari Malformation are able to experience relief even if the size of the herniation does not change. Remember: there are many people walking around with a Chiari Malformation in Brisbane who have no idea because they don’t experience any symptoms. So it isn’t the malformation by itself that is always the problem.

If we can correct the alignment and movement of the atlas, we may be able to help reduce the mechanical tension on the suboccipital muscles and ligaments. In turn, this may help to reduce the tension on the brainstem. And in turn, this may help to restore normal CSF circulation, which may actually be responsible for your symptoms.

We hope that this article has been informative and valuable. If you are looking for options for Chiari Malformation treatment without surgery would like more information on how the Blair Technique may be able to help you, please contact our office in North Lakes at 07 3188 9329 or click the Contact Us link at the top of this page.

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Atlas Health is the premier Upper Cervical healthcare centre in Brisbane, Australia. We have 15 years of experience in helping people with health conditions including Chiari Malformation. It is our privilege to assist you.

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