Be assured that dizziness and poor balance can be a symptom of Chiari regardless of what well-meaning physicians tell you. This does not mean that you have to argue with your health care professionals or dismiss what they have to say, but it is important to know that there are solutions available to you.
First off, it is important to rule out any other conditions that can affect your vestibular system and your balance. Often, folks with Chiari do not suffer from lack of testing but it is important to diagnose conditions that would necessitate other treatment. Blood work, scans, vestibular testing, plus others can all serve a function. When nothing has been found, and you are only left with skepticism that you are of sane mind and offered medications as a symptom manager (that typically do a poor job of addressing dizziness and balance issues associated with Chiari), you might want to give primitive reflex exercises a try. Some physical therapists have advanced training in this area and can help you out. Ask before committing to an assessment.
Primitive reflexes are patterns of movement that occur in everyone starting from a wee baby and start to disappear as the nervous system develops. Sucking reflexes and the grasp reflex are easy to see in newborns, but they soon disappear. As conscious movement matures, the frontal lobes suppress these primitive patterns of movements, and babies and toddlers go on to develop more complex patterns of movement.
Primitive reflexes are classified as soft neurological signs when they are present past their normal time frame. They are also called cortical release signs or frontal release signs. They are associated with learning disabilities, cognitive dysfunction, psychiatric conditions, and neurological conditions. Specific conditions include multiple sclerosis, dementia, concussion, brain injury, and stroke. Whenever the brain is challenged or physically stressed, these primitive reflexes can re-emerge and affect how the body moves and incorporates sensory stimuli. The very physical nature of Chiari places strain on the brain. Localized pressure on the cerebellum and compression of vestibular arteries that feed the brain are two that come to mind.
There are many different primitive reflexes which affect different body parts and different movements. They can be stimulated by touch, by body movement, or by vestibular movement in space. This vestibular movement in space stimuli is of interest for Chiari folk with dizziness or balance problems. We have all experienced or read about people who experience dizziness with turning their head, with looking up, with closing their eyes, and with rolling over. These movements all have the vestibular system moving in space as a common component. When primitive reflexes involving the vestibular system are present, they affect our perception of space, movement, and where we are. We stumble, lose our balance, or feel nauseous and dizzy.
The specific primitive reflexes that can affect dizziness and balance are:
- Tonic Labyrinthine Reflex (looking up or standing with eyes closed)
- Asymmetrical Tonic Neck Reflex (ATNR) (turning head)
- Symmetrical Tonic Neck Reflex (STNR) (tipping head to the side, forwards, or backwards)
- Moro or Startle Reflex (easily startles, nauseous with spinny rides)
- Landau (looking up or down)
Treating these primitive reflexes requires copying the particular reflex’s pattern of movement to repeat training of the nervous system. That frontal lobe needs to relearn how to perform normal movement and repress the primitive reflex. By repressing the primitive reflexes for the vestibular system, the brain will relearn how to properly manage sensory stimuli when the head is moved about in space.
Please contact member gabby jazzypants if you have any questions or would like a contact person for your own physical therapist that is willing to help you out. Success stories are also appreciated.
Warning: Before you begin …
All of the exercises * have a neck movement component. With Chiari, moving the neck can worsen symptoms of all sorts. We know this. I would suggest adding in neck movement at the end of each exercise sequence and just a little bit. If even this is too much and exacerbates symptoms, just imagining the movement and moving the eyes in the right direction will be enough. Same goes with other body parts. If you have a sore shoulder made worse by these exercises, do the movement that you can and imagine more.
Exercise patterns are held for 5 seconds and repeated 5 times. Do them twice a day.
Print these exercises off. Take your time, move slowly – no jerky movements – you do not need to go to end range positions to get the effect. Just try one for a couple days before adding in another exercise. It is tricky to follow exercises without a visual so be patient and try them!
1. Tonic Labyrinthine
Exercise must be done on your stomach, not in standing, so gravity is affecting the vestibular system properly. The exercise has two parts and should be done alternating – one then the other repeating the cycle 5 times.
Lay on your stomach
a) Posterior tilt (round your lower back)
Arms out to the side 90 degrees , bend elbows 90 (held-up position), Round your shoulders, thumbs to the floor as possible
Bend knee, press knees into ground (hip flexion)
*Bring nose to chest (neck flexion)*
Hold all movement components for 5 seconds then go to b)
b) Stick your bum out (anterior pelvic tilt)
Pull your shoulders back, arms out to the side, bend elbows
Bend knees, press knees into ground (hip flexion)
*Tip head back (neck extension)*
Hold all movement components for 5 seconds then repeat cycle 5 times.
2. Asymmetrical Tonic Neck Reflex (ATNR)
Lay on your back. Do five repetitions on one side then five going the other way.
a) Only Left knee bent. Right arm out to the side with palm up to ceiling
Rotate head to look at right hand. Do not side bend neck – ROTATE!
With left hand on right side of head, resist neck rotation for 5 seconds.
Repeat 5 times then switch sides.
b) Right knee bent. Left arm out to the side with palm to ceiling
Rotate head to look at left hand. Do not side bend neck – ROTATE!
With right hand on left side of head, resist neck rotation for 5 seconds.
3. Symmetrical Tonic Neck Reflex (STNR)
This exercise has three components. a) and b) are done alternating – one then the other until each are done 5 times. Then do exercise c) one way then the other for 5 repetitions. Persevere – it will make sense.
Start on all fours, hands under shoulders, knees under hips with a flat back and eyes looking to the floor.
a) Round back and *tuck nose* in (neck flexion). Hold 5 seconds. Go to b)
b) Arch back and *tip head back*. Hold 5 seconds then go back to a).
Repeat cycle 5 times
c) On all fours
Bend right hip and right shoulder together.
Think of making a “C” with your spine.
*Side bend your neck* to right shoulder.
No rotation – SIDE BEND – face stays parallel with the ground.
Hold 5 seconds.
Then go to the left to make a reverse “C” with your spine and
*side bending* to the left. Hold 5 seconds. Repeat cycle 5 times.
4 . Moro Reflex (Startle Reflex)
Two part exercise. Do one exercise then the other. Repeat cycle 5 times.
a) Lay on your back with legs straight. Shoulders out to the side at 90 degrees.
Elbows bent to 90. (held-up position)
Press heels into the ground. Press backs of hand into ground.
Arch back. *Tip head back*.
Hold 5 seconds then go into b)
b) Lay on your back with knees bent.
Palms together over your breast bone.
Press hands and knees together.
Round spine. *nose to chest* (neck flexion) Hold 5 seconds.
Repeat cycle 5 times
4. Landau Reflex
Lay on stomach with arms at 90 degrees and elbows bent to 90. (held-up position)
If you have difficulty getting into position, pillows under the chest can help.
Thumbs point to the ceiling.
Bend knees, lift thighs off ground, arch back
*tip head back* (neck extension)
Hold 5 seconds. Repeat 5 times.
With thanks to member gabby jazzypants for the sharing of this information and preparation of the article.