The patient was a 25-year-old woman who was referred to a physical therapist for a chief complaint of pain at the base of the occiput and left upper quarter region, as well as bilateral hand paresthesias. The findings of the history and physical examination were discussed with the patient's physician, who then ordered magnetic resonance imaging of the cervical spine, which revealed protrusion of the cerebellar tonsils 1 cm below the foramen magnum, consistent with a type 1 Chiari malformation. J Orthop Sports Phys Ther 2012;42(5):483. doi:10.2519/jospt.2012.0409