You should always check with your doctor, since they are not wanting to be liable in case of something going wrong. But, at the same time, but I found this.
Recently, a number of people have started blogs focused on Chiari. From The Blogosphere will occasionally take a look at what's being said about Chiari in the blogs.
The following is reprinted, with permission from Dr. John Oro.
10/24/07
The risks of vigorous sporting activities following Chiari surgery are unknown. As reported by The Seattle Times and seattlepi.com, football player Brandon Johnson is one person defining the limits.
As a high school sophomore, Brandon developed crippling headaches and dizziness and was found to have a Chiari malformation. Approximately one year after surgical decompression he returned to football. "I wanted to take my chances. If they say I can't play, I want it to be proven that I can't play. If I got hurt, I would get hurt doing something I loved to do."
He worried about his decision. "I was real nervous. Thinking like if I get hit wrong, what will happen? Will I die? All that stuff crossed through my mind."
After sitting out one year during recovery, he returned to high school football and posted an impressive performance rushing for 3,155 yards and 54 touchdowns in his last two years. After a "heated recruiting battle", he agreed to play for the University of Washington Huskies.
Although Brandon seems to have made a full recovery and is back to the sport he loves, many features of his case are unknown. The extent of his malformation, the details of the decompression, and the degree of his neurological recovery are not specified in the report and thus decisions about returning to contact sports cannot be made from his experience.
CAUTION: The risks of returning to contact sports are unknown. Each person must discuss with his or her treating surgeon which activities are appropriate following decompression surgery.
Posted by John Oro', MD
11/7/07
This month, The Rockford Register Star reports that 16-year-old Doug Lillibridge has also resumed contact sports following surgery for CM-I.
Doug, a multisport athlete, plays soccer, basketball, and baseball. Ryan Webber, Doug's basketball coach, says:
"Everybody loves him. He's one of the most popular kids here, and he's always smiling. He's very talented. Whatever he wants to do, he can do it. His athleticism is what I marvel at. He's just a natural at whatever he does."
However, increasing headaches and dizziness began to take their toll. "The worst was just waking up every day. The mornings were terrible." Daytime was also difficult with Doug suffering "up to 30-plus headaches per day," lasting from seconds to hours.
An MRI revealed a Chiari Malformation I and a posterior fossa decompression was performed by Dr. Robin Bowman Chicago's Children's Memorial Hospital. One month following surgery Doug was allowed to slowly resume sports. His observations made during recovery clearly portray some of the symptoms experienced by many patients with Chiari malformation:
"Every time I'd go to sneeze or cough or anything, I'd wait for the headache to come back. Before the surgery, anything would affect it and make it worse. Laughing, sneezing, coughing. I basically had to have no emotions to have no headaches. But then I could do little things that I couldn't before. That was one of the first things I noticed."
Three months after surgery, Lillibridge was allowed to resume contact sports. As to his performance, fellow soccer player Dan Merrill notes: "he's doing an amazing job. He's exactly the same as he was for us last year. Probably even better."
CAUTION: The risks of returning to contact sports are unknown. Each person must discuss with his or her treating surgeon which activities are appropriate following decompression surgery.
Posted by John Oro', MD.
11/18/07
The two entries regarding Brandon and Doug, on returning to contact sports following Chiari surgery have generated significant interest. It is important to remember that most of the medical information about their conditions is not included in the available news articles. The neurological findings, the degree of crowding and brainstem deformity, the details of the surgical decompression, the follow-up results on the MRI scans, and the degree of neurological recovery are not included in the articles. Thus, do not make decisions from their experiences.
CAUTION: The risks of returning to contact sports are unknown. Each person must discuss with his or her treating surgeon which activities are appropriate following decompression surgery.
Posted by John Oro'
[Ed. Note: The opinions expressed above are solely those of the author. They do not represent the opinions of the editor, publisher, or this publication.]
July 22nd, 2010 -- While the growing use of MRIs has for the most part been extremely beneficial in terms of identifying Chiari, it has also caused a new type of problem when Chiari is found in people incidentally. In this context, incidental means that while a person is found to have cerebellar tonsils that are herniated out of the skull, they do not have symptoms that can be clearly tied to Chiari, or even any symptoms at all. Cases such as these can be very confusing for patients and their families as they ponder whether they will ever become symptomatic and require surgery.
There has not been a lot of research in this area, but one study did find that the vast majority of people found to have Chiari did not develop symptoms over a several year period. Of course, this does not mean that symptoms wouldn't develop in 20 years, or after a car accident. The fact is, it is not well understood why some people with Chiari malformations are symptomatic and some aren't. In fact, it is not even clear if people with herniations but no symptoms should be referred to as having Chiari.
For parents of children in this situation, the issue becomes even more complex when sports are involved. For example, hypothetically, what would you do if your son or daughter was playing soccer and bumped heads with another player hard enough that they were both taken out of the game as a precaution. As a further precaution, your pediatrician orders a CT or MRI to make sure there is no internal bleeding. The scan does not find any bleeding, but does show a Chiari malformation. Now you are faced with the dilemma of having to decide if it is safe for your child to continue to play soccer or other sports. Are they at risk of developing Chiari symptoms if their is another collision? While neurosurgeons can certainly provide opinions and evaluate how much room there is around the herniated tonsils, there are no evidence based guidelines to help families decide.
In fact, this topic - and whether there should be restrictions on children after decompression surgery - generated a spirited debate at the last Conquer Chiari Research Conference. Some pediatric surgeons stated that after surgery they do not place any restrictions on their patients, while others insisted that contact sports should be avoided. Interestingly, in the 2010 NFL draft, a player was selected who had had Chiari surgery as a teenager.
A case report published in the May issue of the Clinical Journal of Sports Medicine (Harrell, Barootes) highlights the difficulties that primary care physicians and sports medicine physicians have in deciding whether an athlete found to have Chiari incidentally should be allowed to return to play. Specifically, they report the case of a 19 year old male who was participating in spring football training at a university. The athlete began to experience frontal headaches that he rated as a 10 out of 10 on a pain scale. The headaches were also accompanied by light sensitivity and nausea. He had no history of any medical problems. The physicians ordered an MRI to rule out a tumor or hemorrhage and found a 8mm Chiari malformation with wedge shaped tonsils. However, they also found sinusitis.
They held the student out of practice, treated the sinusitis, and referred him to a neurosurgeon for evaluation. The neurosurgeon could not find any neurological problems or symptoms that related to the Chiari. Once the sinusitis was treated, the patient's headaches went away and he asked to return to football. The neurosurgeon cleared him to play because there was no indication of any blockage to the normal CSF flow. The athlete returned to practice without incident or further problems.
Based on their experience and a review of the literature, the authors highlight these points for primary care physicians to consider when confronted with the issue of a child found to have Chiari participating in contact sports:
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Do not allow participation in contact sports if Chiari 1 is confirmed and any of the following
presence of syringomyelia
obliteration of the subarachnoid space
evidence of indentation of the medulla (anterior)
symptoms that can be related to the Chiari malformation
Neurosurgeon should be consulted before allowing return to sports
Brain and entire spinal cord MRI should be performed
If patient is cleared to play by a neurosurgeon, primary care physician should monitor for any clinical signs related to Chiari
The authors stress that these should not be considered guidelines as there is no research to back them up, but rather items for the treating physician to consider.
-- Rick Labuda
Young Chiari Athletes:
The Possibility of Injuries during Participation
June 2014 - Participating in athletics can be difficult for some individuals diagnosed with Chiari. Others, however, still may be able to return to sports of their choice whenever they please. Those involved in the Chiari community have a hard time calculating the risks associated with collision sports such as football, soccer, basketball, lacrosse, martial arts, and hockey. It is even harder to think about these possibilities when children are the athletes involved.
In Harvard Medical School’s study of Chiari malformations and sports participation, Dr. William P. Meehan III and his colleagues discuss the chances of fatal injuries occurring on the field. The doctors participating in this study agreed that all Chiari cases are different and many depend on the child’s ability or inability to be active as well as the clinician’s assessment of the patient’s health and well-being.
Dr. Meehan III and his associates also address the likelihood of Chiari slowing or completely stopping cerebrospinal fluid flow. Furthermore, they inform readers about the possibility of sudden death after a minor trauma or rapid head movements. Some specialists say that asymptomatic Chiarians cannot return to contact sports while those with symptomatic Chiari have additional restrictions when it comes to athletics. However, there are others who do not believe that non-severe, asymptomatic Chiari malformations should keep competitors from contact or collision sports.
Many doctors have diverse opinions on patient care and fitness, but whatever the circumstance, these decisions are usually made on a case-by-case basis. There are not many studies which connect Chiari to fatal collision sport injuries; therefore, it is difficult to estimate specific athletic risks. In the interest of attaining authentic answers, Harvard Medical School decided to contact 300 athletic Chiari patients between the ages of eleven and nineteen.
Although Dr. Meehan III and his team did not receive all of the questionnaires, 147 (53%) responded and completed the survey as requested. Eighty-six of the respondents were female while sixty-one were male and the average age of both groups was fifteen. Seventy-two patients underwent decompression surgery, seventy-three had not, and two decided not to answer. Out of the 147 individuals, the top three collision sports played were football, basketball, and lacrosse.
There was not a significant difference between athletes who had decompression surgery and those who had decided against it. This important information allowed researchers to collect participation data before decompression occurred and by respondents who decided against surgery. Thirty-three patients reported that they suffered a concussion while participating in sports while twenty-one experienced an injury resulting in a loss of consciousness. The medical records of the 106 individuals who did not respond to the study were then inspected for any sporting injury resulting in death, paralysis, or coma; no such trauma was found.
In the population that was studied, Dr. Meehan III and his colleagues found that the risk of catastrophic or fatal outcomes in young Chiari patients was 0. However, there were limitations to this investigation. First, since this study included only 147 participants, it does not accurately portray the probability of tragic injuries during athletics. A larger number of individuals would be needed to measure rare sports-related traumas. Second, most of the data was collected retrospectively which means individuals could recall outcomes inaccurately. Third, there was no way to accurately estimate the collision risks of young athletes with a Chiari malformation. Finally, individuals with Chiari have different anatomies which can alter the possibility of catastrophic injury.
Fatal traumas are real and measurable, but risk is favorably low even in the case of collision sports. Many athletes and clinicians agree that the benefits of participating in sports outweigh possible risks. Expert opinion as well as various case reports suggest that young athletes with Chiari may be more prone to catastrophic injury, but reasons behind why this may be the case are unknown.
As with most health related situations, risk should be considered depending on the individual’s abilities or disabilities. If an athlete wants to return-to-play, then they should discuss the decision with their doctor to see if it is a possibility. Most clinicians know that every Chiari patient is not the same and will decide what can and cannot be done on a case-by-case basis.
Author’s Note: We asked our followers on Facebook to answer a few questions regarding children and young adults being involved in sports. Many parents responded as well as a few individuals who were involved in athletics during high school. The majority of adolescents, aged 3-19, were decompressed with minimal pain and/or returning symptoms. However, the number of individuals involved in contact sports was almost tied with those told not to pursue high impact-associated sports. As the study declares, it mostly depends on how much or how little a person can tolerate as well as the doctor’s discretion.
I also spoke to Dr. David Frim, the Professor of Surgery, Neurology, and Pediatrics at the University of Chicago, for a few minutes regarding young adults with Chiari that participate in contact sports. He informed me that there is not published data which states that Chiarians have a greater risk of injury during physical activity. However, he expressed that “everyone is a little bit afraid to clear someone to go back to a sport.” If a patient expresses that he or she wants to continue playing, Dr. Frim warns the patient and his or her family that all collision sports are considered dangerous with a high rate of injury, but returning to athletics usually depends on the condition of the individual. The ultimate decision to return to high-risk recreational activities depends on the patient’s parents as well as the school board.
Dr. Frim also shared his insight on the benefits of sports verses the potential risk of contact sports. In his opinion, it more or less depends on the sport. There are tremendous benefits in participating in athletics through elementary, middle school, high school, and college. Studies prove that those who exercise receive exceptional grades as well.
To add to Dr. Frim’s understanding of young Chiarians and sports, here are a few responses from parents of student athletes:
“I have two boys that have [Chiari] and both have had decompression surgery. I was very nervous in the beginning about contact sports. I wouldn’t let my 10 year old play for years. I have finally grasped the idea that I can’t keep him in a bubble… I’m sure in several years I will allow my 3 year old to play sports as well. Their doctors have gave us the okay to play sports but to proceed with caution.” –Kristal Eimer
“I think that my daughter being active in sports helps her cope with Chiari. It allows her to be part of the same things as other kids. This gives her the self-esteem she needs because she is different and tolerates things differently. As a parent, I need to know her limits and be able to help her learn what they are and how to deal with the things that happen to her body. Chiari can manifest in many ways and each case is different.” –Karen Purdy
“Before finding the Chiari 1 malformation, I remember feeling so happy that my son found his ‘thing’—hockey. I was so sad for all the things they said he couldn’t do, but loved to do. I explained the level of play to his neurosurgeon and she said it was okay for now, but when they start body checking, he has to quit. She warned of injuries that could leave him paralyzed which scared me to death. Then I wondered: what if we can find a way to protect our Chiari kids so they could play? I found helmets & neck braces for him to wear under his hockey gear. I still hold my breath every time he falls, but I want him to be both happy and safe.” –Becky Balliard
“My 19 year old son has played soccer for 15 years. He has never had a problem before or after surgery, nor was he given special treatment. Our only rule was that he could not practice head shots. Truth be told though, during a game he would not hold back and would often head the ball. He never experienced negative symptoms while playing. Now, as a young adult, he does experience pain in the back of his neck if he runs fast for long distances. We have no regrets letting him play; however, wrestling and football were out of the question.” –Carey Johnson
“My daughter is 17, diagnosed [with Chiari] at 16, and had decompression surgery a year ago next week. Our neurosurgeon is knowledgeable about Chiari and after surgery and the last MRI, which showed great improvement in regard to syringo, he said, ‘Go have a good life.’ My daughter wasn’t in contact sports, although volleyball moves require diving for balls and hitting the floor. Now, she has to find a ‘new norm’ and rest when headaches or arm pain occur; other than that, she’s good to go!” –Laurie Bremer
“My daughter was diagnosed at age 5 with Chiari and Epilepsy. She had decompression surgery at age 7 and is doing very well now. She is a competitive cheerleader and we have had no sports-related problems. She does have unique concerns due to the Epilepsy which makes us very cautious. I thank God every day for her successful surgery as she was losing motor skills at an alarming rate.” –Tabbi McCallister
A HUGE THANK YOU TO EVERYONE WHO TOOK THE TIME TO POST OR E-MAIL, WE GREATLY APPRECIATE IT!
Ed. Note: The opinions expressed above are solely those of the author. They do not represent the opinions of the editor, publisher, or this publication. Ms. Eubanks is not a medical doctor and does not give medical advice. Anyone with a medical concern is strongly encouraged to seek professional medical care.
Mine all say it is good as long as I’m careful. Many of us don’t move enough because of our chronic pain. Keep going!