Issue link: https://www.massageandbodyworkdigital.com/i/1524992
80 m a s s a g e & b o d y wo r k s e p te m b e r/o c to b e r 2 0 24 Chiari Malformation "My Brain Is Too Big for My Head" By Ruth Werner Critical Thinking | Pathology Perspectives In March 2022, episode 208 of the "I Have a Client Who . . ." Pathology Conversations with Ruth Werner podcast included a client who had repeatedly been denied massage because they had a diagnosed Chiari malformation—the massage therapists at their clinic had been too nervous to work with them. The contributor was perplexed, wanting to know why this might be so, and if any real risk was present. Since then, I've had the opportunity to chat with several people with Chiari malformation and learned some fascinating things that are relevant for massage therapists. ANATOMY REVIEW To understand the importance of Chiari malformation, we must do some anatomy review to refresh our knowledge of the functions and locations of a few key structures. The cerebellum, or "little brain," has several functions. It regulates coordination between prime mover muscles and their antagonists, helps maintain balance, controls eye movement, and sets muscle tone and posture. The brain stem, which has several parts, carries out important autonomic functions. It helps control respiratory rate, blood pressure, swallowing, and sleep. The brain stem and cerebellum, along with the rest of the central nervous system, rely on the free f low of cerebrospinal f luid (CSF). When the cerebellum and brain stem are impaired, or if CSF can't move freely, some or all these vital functions may be limited or lost. The foramen magnum, or "big hole," in the occiput is the passageway from the spinal cord into the skull. For most people, that big hole is the right size and in the right place. The cerebellum and the brain stem are tucked inside the back of the skull. The occiput doesn't slip off the atlas; the supporting ligaments around C1 keep everything in position, and the myodural bridge connects the suboccipital triangle muscles to the dura mater in such a way as to allow both stability and freedom of movement for the head. But what happens if all those structures are not in exactly the right relationship with each other? What happens if some parts of the cerebellum are pushed down into the spinal canal and the f low of CSF is blocked? The repercussions of such a structural anomaly range from being trivial to severe and extreme. This is Chiari malformation, and it affects about one in every 1,000 live births in the US, which amounts to about 3,700 new cases every year. 1 Research suggests about 2.5 million people in the US have been diagnosed with the most common type of Chiari malformation, and many more may have it without knowing. Chiari malformation can have a profound impact on the quality of a person's life. Does massage therapy have a role to play for people with this condition? After we gather some information, we will put this question through a critical thinking process to figure out what might be possible. KEY POINT • Chiari malformation involves a herniation of part of the brain into the spinal cord, which may involve severe and chronic headaches, hydrocephalus, weakness, dizziness, and much more.