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I originally wrote this article for Lifelines, the school paper at Life Chiropractic College West. The original audience was, therefore, my classmates – future chiropractors. I realize that many of you reading this blog are not chiropractors, but I still think the information is valuable for any individual to recognize the possibility of this condition in themselves or a friend. This information is not intended to diagnose or treat anyone, and you should always seek the attention of a licensed healthcare professional – preferably (if this clinical picture sounds relevant to you) a chiropractor who has experience with this condition. Further, I am happy to answer any questions by email at                        – Satya Sardonicus, DC

As chiropractors, our patients will often come in to the office with neck pain and a history of motor vehicle accident with associated whiplash – recent or past. In most cases, management of these individuals will be fairly simple. But there is an increasingly recognized condition that may occur following whiplash injury of which we should be aware. Cerebellar tonsilar ectopia, also known as a Type I Arnold Chiari malformation (when the ectopia is 5mm or more), is a herniation of the cerebellar tonsils through the foramen magnum. It can be congenital or acquired (commonly post-traumatic). The congenital form may be asymptomatic but become symptomatic following trauma – even minor trauma. Onset of symptoms usually occurs between age 25-454. Cerebellar tonsilar ectopia is found in about 5% of the population with no history of trauma, and almost 25% of people who’ve gotten whiplash1.

The white line drawn in signifies the foramen magnum - the inferior border of the skull; the cerebellar tonsil should sit several milimeters above this line.

I share this information with you all as I have recently been diagnosed with a 6 mm cerebellar tonsilar ectopia. I started having symptoms of muscle weakness and headache about 10 years ago, with increasing frequency and severity (as well as more symptoms) since then. It has been particularly difficult in the past several years, and several other diagnoses have been considered before we recognized the etiology of my clinical presentation. So I want to share with all of you a bit about the condition such that you might recognize and diagnose earlier your own patient who may have the same situation.

Symptoms of cerebellar tonsilar ectopia have to do with cerebellar and brainstem compression, compromise of cerebrospinal fluid flow and increased intracranial pressure. They include persistent headache, neck pain, paresthesia, muscle weakness, ataxia, downbeat nystagmus, short term memory loss, dizziness, breathing difficulty, cardiac irregularities, dysphagia, tinnitus and other inner ear conditions, progressive spasticity including fibrillations and fasciculations. The headache is similar to a tension headache, may be described as circumferential compression and/or suboccipital deep tension. I have also experienced stabbing headaches all around my head (most often periorbitally) which feel like a fork being twisted in my skull, with increasing frequency and severity over time. Photopsia (the presence of perceived flashes of light) may also be present and should not be confused with the prodrome of classic migraine headaches. Absence of the gag reflex is the most common physical indicator of lower cranial nerve involvement. Extreme fatigue may be present and related to sleep apnea associated with this condition4. Cerebellar tonsilar ectopia can present with a wide range of symptoms, and should be included in differential diagnosis with fibromyalgia, migraine headache, lyme disease, multiple sclerosis and other similar conditions.

Treatment published in the literature is largely neurosurgical, where the most common surgeries are 1) remove part of the back of the occiput and laminectomy of C1, C2 and maybe C3, or 2) cut of the part of the brain which is herniated. The purpose is to restore CSF flow and decompress the area, preventing the development of a syrinx in the spinal cord. Non-surgical treatment is largely pharmacological and prescribed to alleviate the neuropathic pain (allodynia and hyperalgesia); drugs may include anticonvulsants and opiates, and there is little evidence for their efficacy with this type of pain4. Fernandez et al report some improvement with cerebellar re-education therapies, speech therapy, physical therapies for musculoskeletal function, and even osteopathic craniosacral therapy. They report craniosacral therapy to improve CSF flow and lower intracranial pressure. Personally I have been getting craniosacral therapy almost daily, as well as very light force upper cervical adjustments (similar to adjustment of an infant). It has been about 4 weeks, and it helps some…in the beginning I felt better for an hour or so and now adjustments are holding about 24 hours. I have been advised to give it 6 months of intensive work to see maximal change. As someone who has never had so much as a Tylenol in her life, I am extremely hesitant to undergo neurosurgery. I urge you to work with anyone with this condition conservatively first, with baby adjustments and craniosacral therapy. And write up case studies! The literature is sparse on any treatment other than surgery for this condition, and as chiropractors we may be able to help. I certainly look forward to the coming months, where I hope to find resolution to this condition through chiropractic care.

I want to urge you all to keep this condition in mind when you have a complicated patient, particularly if they are not improving significantly under your care. I have been under chiropractic care since birth, and so I knew there was something affecting my health other than subluxation. If your patients do not respond as you expect, this may be something to consider.

Freeman et al point out that these chronic symptoms “may not be ascribable to psychosocial factors…but rather to organic neurological injury1.” With incidence rates of 25% in whiplash injury cases, we need to pay attention to the possibility of cerebellar tonsilar ectopia in our patients. Further, these symptoms can look like fibromyalgia, multiple sclerosis, lyme disease and other chronic illnesses. Upright MRI has been shown to be 2.5 times more sensitive for detecting cerebellar tonsilar ectopia, so refer your patients for upright MRI whenever you suspect this condition.

*Author’s note: I have been doing dramatically better since getting the treatment – it’s a new protocol that I and a colleague have been developing (Sam Zoranovich has background in both chiropractic and craniosacral therapy); this is a combination of craniosacral and light force upper cervical adjustments, as well as some therapy for gently releasing adhesions between the spinal cord and it’s protective layer to allow for unencumbered movement of the cord. In the beginning I needed treatment almost daily, but after a month I was down to every other day and after two months, every three days. It has now been 4 months and my headaches are significantly reduced in frequency and intensity, muscle weakness has improved so much that I have taken up running again (which I was unable to do for several months before I was diagnosed and began this treatment 4 months ago), and all of my symptoms in general have improved or disappeared completely. I am much less dizzy, my vision is better, my temperature regulation is much better, I get motion sickness much less often, I have more energy, and it goes on… I am so glad to finally have figured out what was going on and to now be getting better! It is a blessing to see the potential to be completely free of the countless symptoms – seeing the light at the end of the tunnel is a miracle in and of itself. I feel healthier than I have in years! This protocol has literally changed my life.

1 Freeman et al. A case-control study of cerebellar tonsilar ectopia (Chiari) and head/neck trauma (whiplash). Brain Injury July 2010; 24(7-8): 988-994.
2 Reiser MF. Magnetic Resonance Tomography. Springer-Verlag, Berlin Heidelberg. 2008. p 212.
3 Sperling NM et al. Otologic manifestations of Chiari-I malformation. Otology Neurotol 2001; 22:678-681.
4 Fernandez et al. Malformations of the craniocervical junction (chiari type I and syringomyelia: classification, diagnosis and treatment). BMC Musculoskel Dis 17 Dec 2009; 10(Suppl 1): S1.



Have you even thought or spoken those words? Have you ever heard anyone use this as a reason why they would not want to have a chiropractic evaluation? If so, then I would have to say that you are not alone. I have heard this sentiment numerous times. When I hear these words spoken, I have to ask myself, “What is it that they don’t ‘believe’ in?”

Do you ‘believe’ in chiropractic? Well let’s find out. Do you ‘believe’ that your brain’s responsibility is to control and coordinate all of your bodily functions? If you do, then you are in agreement with every physiology text book that has been published. Do you ‘believe’ that your brain sends out information, in the way of brain waves or messages, over the nerve system to control and coordinate every physiological function you perform? Again, if you do then you are in agreement with every medical text book ever written on the subject. Do you ‘believe’ that a disruption of the information flow over the nerve system causes a state of imbalance and threatens your health? If so, you are in agreement with anyone who has ever studied the Central Nervous System. Do you ‘believe’ that removing any obstruction to nerve flow would improve your health and your brain’s ability to control and coordinate all of your bodily functions? If you do then you agree with all the published research on the topic.

So then, what is it that you do not ‘believe’ about chiropractic? See when you really understand the concept behind how chiropractic works, then you realize that you do ‘believe’ in chiropractic. So then why do so many people use the “I don’t believe in chiropractic” excuse? Good question. I can only surmise that people don’t understand what chiropractors do so they just default to the “I don’t believe” stance. In the end, this is quite sad because they do believe in what chiropractors do, they just don’t realize it. This means they may never experience the benefits that chiropractic has to offer because of a misunderstanding. All too many people will continue to use drugs and resort to surgery when that may not even be necessary. It doesn’t have to be that way!

You owe it to yourself to have a chiropractic evaluation and find out whether you are a chiropractic candidate or not. It’s not hard to do, just pick up the phone and call the office. We’ll sit down with you and hear out your concerns. We’ll walk you through the entire process and then we will discuss the results of your tests so that you can understand them. At that point if you are a chiropractic patient you can make an informed decision about whether you receive chiropractic care or not. You owe it to yourself. Your health is too important not to check out chiropractic. Don’t delay one more minute, make an appointment today.

“Please understand my friend that where you find yourself tomorrow is a function of the positive decisions and actions you take today.”

Akin Awolaja, Educator of a Wise Living

To live consciously means to seek to be aware of everything that bears on our actions, purposes, values and goals, and to behave in accordance with that which we see and know. Living consciously means taking responsibility for the awareness appropriate to the action in which we are engaged.

What is good health? The vibrant living state of an organism wherein all systems are able to function through the full range of their potential, 100% upon demand. It’s common knowledge that good health requires quality nutrition, adequate sleep and regular exercise. What else do we need? Fresh air, pure water, good hygiene, sunshine, mental and emotional balance… In ancient Greece, health was said to come from balance and harmony between healing power within and technique from without. Personally, I seek technique from without from my chiropractor, dentist, massage therapist and family support systems to support the natural healing capacity within me.

How do you cultivate good health?

We are born with an innate intelligence which, through the nervous system, directs the intricately beautiful growth and organization of every being. The brain coordinates all functions of life, sending and receiving information through the spinal cord and nerves exiting the spine between each segment.

Children who develop with healthy spines grow up smarter, healthier, more coordinated, stronger, calmer and happier than children who suffer from neurological interference due to spinal misalignment.

Healthy foundation.
It’s much more important to prevent diseases than wait until an illness occurs. Through regular adjustments, counseling on proper dietexercise and posture, chiropractic can help you raise a child whose body is structurally & functionally sound. Your child will also learn good habits at an early age which can be very beneficial throughout life.

Your child should get a chiropractic exam during that all-important first year of life when spinal trauma can occur during birth and from tumbles while learning to sit up or walk. Improper lifting and carrying of your child can also contribute to spinal stress. Your child’s spine grows almost 50% in length during that first year. It’s this kind of tremendous growth and developmental changes which make a complete chiropractic examination so important in the early stages of your child’s life.

Chiropractic is one of the safest forms of health care.
A baby’s spine is very supple during the first few months of life and only a light pressure is applied to make spinal adjustments. Chiropractic care is a natural, drug-free approach to promote health and wellness for your family while avoiding harmful side effects associated with more conventional approaches.

What makes more sense to you: waiting for disease to happen, or being more proactive?

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