chiari malformation

[smithy]

Hi Rip,

I was curious if yourself or anyone else who would care to chime in - has had any experience with training people with chiari malformation? can the stress of barbell training aggravate the condition or maybe even help it out?

Also has anyone reading this had the surgery?

My partner has just been diagnosed with it from a mri scan she had. She deals with headaches and trap/neck pains most days but would like to get back to barbell training and is concerned it could make things worse.

Any input is appreciated!

Cheers.

[Mark Rippetoe]

No input, sorry. Looks potentially very serious, so I sit down and shut up.

[khopkinsIM]

I have been diagnosed with Arnold Chiari Malformation syndrome. I'm 45 and have been training with barbells for thirty years. No problems whatsoever. Coincidentally, my mother also has it. She's 70 and has pretty severe balance issues. I'm convinced that regular training will keep me from a similar fate.

[Jonathon Sullivan]

No experience; no literature. khopkins' experience is the best we have to go on.

[Tim Garvey]

Smithy, you didn't mention the type of Chiari, but since Chiari I is the type I see the most, I will comment on that.

My training is as a nurse practitioner, and I have seen quite a few pediatric patients with Chiari I malformations. Sometimes they are identified as part of a workup for headaches with specific symptoms and sometimes they are identified incidentally when MRI imaging is done for another reason. I cannot provide specific information for what will or will not make this condition worse for a person I have not evaluated, so she will need to rely on her local neurologist or neurosurgeon for specific recommendations.

Some percentage of the population would meet the diagnostic criteria for Chiari I based on MRI, but will never have any problems, because they anatomically have enough room for the spinal cord and cerebellar tonsils at the foramen magnum. Others suffer a variety of symptoms which can include kinking of the cord, compression of the cord, hydrocephalus, and syrinx. Sometimes symptoms are severe enough that surgeons will recommend decompression surgery, which does not always relieve the symptoms.

Here is a good description of the classic presentation of Chiari I related headaches from conquerchiari.org "The classic Chiari headache is generally considered to be intense pain in the occipital region (the back of the head) that is triggered by straining (Valsalva manuever), coughing, or physical activity, and usually does not last very long."

If your partner is already experiencing some degree of neck pain, and posterior skull headaches, and these symptoms are the result of her Chiari causing some degree of nerve compression, then heavy lifting under valsalva could very well make her symptoms worse. If she has a syrinx as well, that could potentially be further exacerbated.

I cannot think of any mechanism whereby somebody with a symptomatic Chiari I, would improve their symptoms by doing more valsalva. However, someone with adequate space for CSF flow may live their whole life without any symptoms.

If your partner's Chiari malformation is secondary to spina bifida, or a connective tissue disorder, then there may be a number of other concerns. She really needs to speak to her personal physician about her particular diagnosis.

[Will Morris]

I searched high and low and found nothing. We have active duty military personnel with chiari malformations. That might indicate khopkins's experience isn't as crazy as it may seem at first.

[tbennett]

I was diagnosed with a Chiari I about two years ago. Might possibly be related to life-long headaches, I suppose, but have *never* noticed a connection between lifting and headaches. In fact, very anecdotally speaking, I seem to have fewer headaches when I'm on a good run of workouts. Also, it's gotten better as I've aged - had spinal meningitis at age 5, and the headaches after that were bad for years, 1-2 prostrating ones a month, with copious vomiting. By college time, it was down to 3-4 bad ones a year, and currently it's 1-2 prostrating a year, plus maybe 1 mild one a month. As such, surgery or anything else for the CM isn't exactly a rush (7mm of herniation on the right, for Sully and anyone who cared for the anatomy details).

At age 43, I've done linear progress about 4x now (gotten derailed each time by weird stuff like pneumonia, broken tailbone, new baby that was critically ill for a while, etc), but got up to 355x3x5 for my squats at the end of the best run, FWIW. Hope to beat that in the next year...