Chiari Malformation: Supportive Neck Care in Redmond, WA
Honest information about Chiari malformation, and gentle, non-manipulative NUCCA care for neck symptoms, coordinated with your neurosurgeon.
Chiari malformation is a structural condition at the base of the skull, where part of the cerebellum (the lower back part of the brain) sits lower than normal and extends into the opening to the spinal canal. Many people find out they have it by accident on an MRI. Others live with headaches, neck pain and other symptoms.
We want to be upfront: NUCCA chiropractic does not treat Chiari malformation. Chiari is diagnosed and managed by a neurologist or neurosurgeon. Where NUCCA care may fit is with neck pain and muscle tension, using a gentle, non-manipulative approach and only in coordination with your neurosurgical care.
What Is Chiari Malformation?
Chiari malformations are graded by how much brain tissue extends below the skull opening (the foramen magnum). Type I is by far the most common in adults and is traditionally defined as the cerebellar tonsils sitting 5 mm or more below that opening. It may be present in up to 1% of people, and many never have symptoms.
01 · Chiari Type I
The most common form, often found incidentally. Can cause headaches and neurological symptoms in some people.
02 · Syringomyelia
A fluid-filled cavity in the spinal cord that develops in some people with Chiari. It needs neurosurgical monitoring.
03 · Chiari with Hypermobility
Chiari has been reported alongside Ehlers-Danlos syndrome, sometimes with craniocervical instability. See our EDS page.
Common Symptoms
- Headache at the back of the head, classically triggered or worsened by coughing, sneezing, laughing, straining or bending
- Neck pain and stiffness
- Dizziness or balance problems
- Numbness or tingling in the hands or arms
- Ringing in the ears or hearing changes
- Vision problems
- Difficulty swallowing or a hoarse voice
- Sleep apnea or breathing problems during sleep
Contact Your Neurosurgeon Promptly If You Notice:
- New or worsening weakness, numbness or clumsiness in your hands, arms or legs
- New difficulty swallowing, choking, or changes in your voice
- Worsening balance or coordination
- New breathing problems during sleep
- Loss of bladder or bowel control
Call 911 for a sudden, severe headache, fainting, or sudden weakness or numbness on one side of the body.
What Causes Chiari Malformation?
- A smaller-than-normal space at the back of the skull, present from development, which crowds the cerebellum downward
- Connective tissue disorders, such as Ehlers-Danlos syndrome, in some people
- Acquired causes, less commonly, such as changes in spinal fluid pressure
The headaches are thought to come from crowding at the skull base and disrupted flow of cerebrospinal fluid, which is why coughing and straining, which briefly raise pressure, can trigger them.
Why Gentle Care Matters at the Skull Base
Chiari involves the exact area where the skull meets the neck. That is why many people with Chiari are told to avoid neck manipulation, the quick twisting or thrusting movements used in many chiropractic adjustments. We agree: high-velocity neck manipulation is not appropriate for people with Chiari.
At the same time, many people with Chiari live with ongoing neck pain, muscle guarding and tension at the base of the skull. For those who have been evaluated and cleared by their neurosurgeon, NUCCA's light, non-manipulative approach may be an option to help with those neck symptoms.
Where NUCCA Care Fits, and Where It Doesn't
NUCCA (National Upper Cervical Chiropractic Association) care is a precise, low-force chiropractic approach focused on the alignment of the head and upper neck. Here is an honest look at its role:
NUCCA Care Does Not
- Treat, correct or reverse Chiari malformation
- Move the cerebellar tonsils or improve spinal fluid flow
- Treat syringomyelia
- Replace neurosurgical evaluation, imaging or decompression surgery
- Diagnose Chiari (that requires an MRI)
NUCCA Care May Help
- Ease neck pain and muscle tension at the skull base
- Ease neck-related headaches that differ from your Chiari headaches
- Offer a non-manipulative option when you've been told to avoid neck adjustments
- Support recovery after decompression surgery, only with your surgeon's clearance
No Twisting
Your neck is never rotated, flexed or pushed to end range.
No Cracking
No high-velocity thrust of any kind.
Precision Imaging
Upper cervical x-rays measure the exact direction and amount of misalignment.
Gentle Contact
Light, controlled hand pressure behind the ear while you lie on your side.
What to Expect
Free consultation: Every new patient starts with a free consultation with Dr. Schallmann to review your Chiari diagnosis, MRI reports, neurosurgical care and current symptoms. If you haven't been evaluated by a neurologist or neurosurgeon, we'll ask you to do that first. The examination and x-rays are not part of the consultation. They are separate services with their own fees, and we'll explain all costs before anything is done.
Coordination with your neurosurgeon: Before any care, we'll want to know what your neurosurgeon has recommended. If you've had decompression surgery, we'll need your surgeon's clearance first.
Visits 1 and 2 (1 hour each): If you move forward, your first visit includes an examination and precision upper cervical x-rays. Your second visit reviews the findings and, if appropriate, includes your first gentle NUCCA correction.
Ongoing monitoring: We track your neck symptoms at every visit and will stop care and refer you back to your neurosurgeon if any new neurological symptoms appear.
The Providers Who Lead Chiari Care
- Neurosurgeon to evaluate your Chiari, monitor for syringomyelia and decide whether surgery is needed. Posterior fossa decompression is the main surgical treatment for symptomatic Chiari.
- Neurologist for headache management and neurological monitoring
- Physical therapist experienced with Chiari for gentle strengthening and posture work
- Sleep specialist if you have breathing problems during sleep
- Geneticist or EDS specialist if hypermobility is suspected
- Pain management specialist when headaches or neck pain are persistent
We're glad to coordinate with your other providers and share findings with your permission.
When NUCCA May Not Be the Right Fit
- You haven't been evaluated by a neurologist or neurosurgeon for your Chiari
- Your neurosurgeon has advised against any neck treatment
- You have a growing syrinx or progressive neurological symptoms
- You have recently had decompression surgery and haven't been cleared by your surgeon
- You have signs of significant craniocervical instability that haven't been evaluated
- You have any of the warning signs above
What the Research Shows
There are no clinical trials on NUCCA or any chiropractic care for Chiari malformation. The sources below explain how Chiari is defined, how it overlaps with hypermobility, and how symptomatic and incidental cases are managed.
National Institute of Neurological Disorders and Stroke
Chiari Malformations.
National Institutes of Health.
The federal government's patient overview of Chiari malformations, symptoms, related conditions and treatment.
Assessment of Patients with a Chiari Malformation Type I (2022)
Brain and Spine, 2:100850.
A review of clinical and imaging assessment. Notes that Chiari type I may be present in up to 1% of the general population, and describes the classic headache triggered by straining and coughing.
Henderson FC Sr, et al. (2017)
Neurological and spinal manifestations of the Ehlers-Danlos syndromes.
American Journal of Medical Genetics Part C, 175(1):195–211.
Reports Chiari malformation as a condition seen alongside EDS, sometimes complicated by craniocervical instability.
Natural History and Conservative Treatment Options in Chiari Malformation Type I in Adults (2020)
Cureus, 12(12):e12050.
Reviews the natural history of Chiari type I and conservative management for people with no or mild symptoms.
Research findings describe groups of patients, not guaranteed individual outcomes. Your evaluation will determine whether NUCCA care is appropriate for you.
Frequently Asked Questions
Is chiropractic safe if I have Chiari malformation?
High-velocity neck manipulation, the quick twisting or thrusting kind, is not appropriate for people with Chiari. NUCCA care is non-manipulative: no twisting, no thrust and only light hand pressure. Even so, we only provide care after you've been evaluated by a neurologist or neurosurgeon, and with their input.
Can NUCCA fix my Chiari?
No. Chiari is a structural condition at the skull base. NUCCA care cannot move brain tissue, change the skull or improve spinal fluid flow. Its role is limited to helping with neck pain and tension.
Can I have NUCCA care after decompression surgery?
Only with your surgeon's clearance. Healing after decompression takes time, and your surgeon is the right person to decide when, and whether, gentle neck care is appropriate.
How do I tell a Chiari headache from a neck headache?
Chiari headaches are classically at the back of the head and triggered by coughing, sneezing or straining. Neck-related headaches are more often linked to neck posture, stiffness and muscle tension. Many people have both, and your neurologist can help sort them out.
Can NUCCA x-rays show Chiari?
No. Chiari is diagnosed with an MRI. NUCCA x-rays measure the alignment of the upper neck bones to plan your corrections.
Is Chiari related to EDS?
Chiari has been reported alongside Ehlers-Danlos syndrome, sometimes together with craniocervical instability. If you have both, your neurosurgeon should evaluate the stability of your upper neck. See our Hypermobility / EDS and CCI pages.
Is the first consultation really free?
Yes. Every new patient starts with a free consultation. The examination and x-rays are not part of it. They are separate services with their own fees, and we'll explain all costs before anything is done.
Related Conditions
- Craniocervical Instability (CCI)
- Hypermobility / EDS
- Headaches
- Occipital Neuralgia
- Neck Pain
- Numbness and Tingling
- Vertigo / Dizziness
- Gentle Chiropractic
Gentle Neck Care, Coordinated with Your Neurosurgeon
If you live with Chiari and ongoing neck pain, and your neurosurgeon is open to gentle care, a free consultation can help you decide whether NUCCA is a good fit.
Dr. Justin Schallmann, DC, is NUCCA Part 2 Certified and one of about 300 doctors trained in NUCCA worldwide.