Efficacy of Suboccipital Release and Stabilization Exercise Training in Type 1 Chiari Malformation Patient Undergoing Surgical Treatment: A Case Report

Abstract

In Chiari malformation, some symptoms are known to recur after decompression surgery. To our knowledge, this is the first case for symptomatic outcome after suboccipital release and stabilization exercises the patient with type 1 Chiari malformation who has experienced surgery. The present study aims to investigate the efficacy of suboccipital release and stabilization exercise training in a patient with Type 1 Chiari Malformation undergoing surgical treatment. A 47- year-old female patient with Chiari malformation received suboccipital release and stabilization exercise training for 10 weeks. Her symptomatic parameters were evaluated, such as pain, grip and pinch strength, deep cervical flexor strength, balance and gait. After the treatment, there were improvements in pain perception, the score of performance index of deep cervical muscles, grip force, static balance and gait parameters. Suboccipital oscillation and stabilization exercises are thought to be safe and effective in patients with Chiari malformation undergoing decompression surgery

Neck pain and Headache Complicated by Persistent Syringomyelia After Foramen Magnum Decompression for Chiari I Malformation: Improvement with Multimodal Chiropractic Therapies

“…This case is similar to the 2 previously published cases describing conservative, rehabilitative, and manual therapies for patients with persistent symptoms after FMD [ 8 , 23 ]. In one case similar to ours, with persistent symptoms and syringomyelia after FMD, a physical therapist utilized a suboccipital manual release to alleviate neck pain, in conjunction with several spine stabilizing and strengthening exercises, which led to improvements in pain, gait, and balance [ 8 ]. In a similar case of headaches after FMD, but without syringomyelia, spinal manipulation was utilized with success; however, this treatment was modified to avoid any cervical rotation [ 23 ].…”

“…Clinicians considering a rehabilitative or manual therapy approach to patients with persistent symptoms and syringomyelia after FMD should do so with caution. In the present case and those previously published, providers took a measured, gentle approach to therapy, avoiding any excessive cervical rotation [ 8 , 23 ]. While there is limited research regarding the safety or harm of spinal manipulation in the presence of cervical syringomyelia (a cause of myelopathy), previous case reports have described exacerbation of degenerative cervical myelopathy with high velocity spinal manipulative therapy [ 38 , 39 ].…”

“…Finally, our literature search for similar cases describing the use of manual therapies for patients with persistent symptoms after FMD included PubMed, the Index to Chiropractic Literature, and Google Scholar. This search identified only a conference abstract and case report, which was not indexed in PubMed [ 8 , 23 ]. Accordingly, these references have limited detail and/or reliability.…”

“…There is a limited understanding of the optimal conservative treatment options for patients with neck pain or other symptoms and persistent syringomyelia after FMD [ 4 , 8 ]. One article described that pain medications and rest were commonly prescribed for these patients [ 9 ].…”

“…These have shown a variety of responses to care, including negative [ 10 – 13 ], equivocal [ 14 , 15 ], or positive outcomes [ 16 – 22 ]. As of July 4, 2022, we are aware of only 2 cases which reported the use of manual therapies for a patient following FMD, both yielding a positive outcome [ 8 , 23 ].…”