Chronic Pain Damages Your Brain

Chronic pain is front and center these days now that the opioid crisis – the wrong way to manage pain – has been exposed and opportunities to prevent and treat pain instead of medication (a key example: chiropractic) jump into the spotlight. The reason for this increased emphasis isn’t just because opioids have been proven often unnecessary and frequently dangerous, if not deadly, for treating pain – it’s also because pain, particularly chronic pain, can be just as dangerous / deadly if not addressed. In fact, recent research suggests chronic pain may be so damaging as to cause brain changes that lead to cognitive decline and dementia.

In a study involving more than 10,000 elderly adults, researchers reviewed more than a decade of surveys that tracked pain levels and cognitive abilities. While cognitive function (memory, attention, etc.) tends to decline with age, those declines occurred significantly more rapidly in people who reported ongoing moderate to severe pain compared to people with little to no pain. What’s more, the risk of suffering dementia (Alzheimer’s is the most common cause) was also slightly higher in people with chronic pain.

  This is a great example of how pain can impact areas of your body and life that aren’t directly tied in to the source of the pain. And that’s where chiropractic care can be so important, because chiropractors look for the cause of the pain and then work to resolve it, rather than just treating the symptom with a dangerous opioid or other medication. If you’re suffering from chronic pain, talk to your chiropractor; your body and mind will thank you for it.

brain - Copyright – Stock Photo / Register Mark

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Back Pain: Bad for Your Mental Health

If you’re not already utilizing chiropractic care to resolve your back pain and reduce the likelihood it will return – not to mention improving your overall health and wellness – that means one of two things: you haven’t suffered back pain (yet) or you’ve decided to temporarily suppress the pain with over-the-counter or prescription medications. The latter is, as mentioned, a temporary solution that doesn’t address the root causes of the pain, while the former is also likely temporary, since an estimated 80 percent of adults will suffer back pain at some point in their lifetime.

Back pain can be a problem for a variety of reasons beyond the pain, whether it’s limiting your daily function, forcing you to take time off work, or otherwise impacting your life. But there’s another reason suggested by recent research that should vault “getting rid of back pain” to the top of your priority list: Back pain could increase your risk of suffering mental health problems.

  The study used data from the World Health Organization’s World Health Survey 2002-2004 and involved more than 200,000 study subjects ages 18 and older from 43 countries. Data analysis revealed that compared to people without back pain, those with pain were more than twice as likely to suffer from one of five mental health conditions: anxiety, depression, psychosis, stress and sleep deprivation. Subjects with chronic back pain were particularly at risk for a depressive episode (more than three times more likely) or psychosis (2.6 times more likely) compared to pain-free subjects.

Think you’ve got your back pain handled? Nice try. Do something about the pain – and the potential mental health consequences – with regular visits to your doctor of chiropractic.

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Your Foot Bone’s Connected To Your Spine Bone

Spinal Stabilization: Your First Step Toward Lifelong Spinal Health

By Dr. Brian Jensen

Stabilizing your spine plays a vital role in your overall health. Your spinal cord contains the nervous system, the center for all your mental activity. Misalignments in your spine can prevent your nervous system from functioning normally, causing you pain and discomfort. It even can weaken your immune system, making it easier for you to get sick.

Athletic woman with illustrated bone structure. - Copyright – Stock Photo / Register MarkMany factors can contribute to misalignments in your spine. Poor posture, excess weight, injuries, heavy lifting, an unhealthy diet and improper sleeping positions are just a few causes. Something you might not know is that the majority of spinal problems start at your feet.

If you have pain in your neck, back, hips or knees – check your feet. Why? In the old song favorite, it’s because “Your foot bone’s connected to your leg bone, your leg bone’s connected to your hip bone,” and so on. By age 20, an estimated 80 percent of people develop some type of foot imbalance. By age 40, foot imbalances plague virtually everyone.

Your feet are the foundation for your entire body; they allow you to stand, walk and run. Every day we expect our feet to take us where we want to go, support our weight and act as our body’s main shock absorbers. Your feet contain one-quarter of your body’s bones.  Each foot has 26 bones and 19 muscles. If that foundation is not solid and balanced, your entire body is affected.

Chiropractors have long known what some other health care professionals are just discovering: There is a cause-and-effect relationship between your foot and your spine. Movement at one joint affects movement at other joints, and every time your foot hits the ground to take a step, you’re passing that imbalance all the way up your skeletal structure. Over time, your body tries to compensate and this imbalance can cause pain in any number of places, such as your knees, hips, pelvis, low back and neck. Every time your feet hit the ground, a shock wave travels all the way through your body. If your feet are balanced, they can absorb much of that shock. But if they’re not in balance, the shock can cause your body additional strain, and eventually pain. Surprisingly, most of the time, your feet don’t hurt!

When you walk, your feet go through a three-phase process known as the gait cycle. Phase one is when your foot hits the ground (heel-strike); phase two is when your whole foot is on the ground (mid-stance); and phase three is when you start to take the next step (toe-off). Research has proven that during the gait cycle, there are small movements in your spine. If there is a problem with your gait cycle, it eventually will create problems in your spine.

Inadequate or unbalanced support from your feet puts abnormal stresses on your spine. Excessive shock, unequal leg lengths, or poor joint function in the feet or ankles all can affect your spine. The most common foot problem is pronation, or collapsed arches, which can seriously affect your body’s ability to absorb shock.

Flexible, custom-made orthotics are designed specifically for spinal stabilization. They help your foot maintain its normal position and control foot function. This only can be accomplished by supporting all three of the foot’s natural arches. A gradual weakening of the arches often occurs naturally after years of standing, walking and wearing shoes. The goal of stabilization is to control – not restrict – motion within your foot structure. Flexible, custom-made orthotics can enhance the structure and performance of your foot’s three functions, as described in the sidebar at right.

The most effective stabilization is based on two principal considerations: the amount of imbalance in your weight-bearing foot, and the degree of physical stress created by your occupation or lifestyle. Evaluating both of these factors allows your chiropractor to prescribe the stabilizing support level that will most effectively address your individual needs.

Pair of work boots standing at work site. - Copyright – Stock Photo / Register MarkIf you are experiencing a loss of spinal stabilization, your imbalances can easily be corrected using orthotics that are custom-made for each of your feet.A weight-bearing cast or digital scan provides the most accurate image of your foot for prescribing a stabilizing, custom-made orthotic. Your body’s movements and forces on your musculoskeletal system can only be observed in a standing position. If your body is evaluated in a non-weight-bearing position, vital information regarding your foot function is lost. A flexible orthotic, made from a weight-bearing cast or scan, allows your foot to be supported, not “crutched.” The resulting foot balance allows your body movements to function properly.

Your doctor can assist you in determining the extent of your imbalance (in your foot, pelvis and/or spine) and physical stress levels. If you are experiencing a loss of spinal stabilization, your imbalances can easily be corrected using orthotics that are custom-made for each of your feet. Sore or tight muscles; muscle or joint pain in the back, neck or extremities; poor foot function; and sore or tired feet are just some of the indications of loss of spinal stabilization. Ask your doctor to examine your feet if you are experiencing these or similar problems.

Your feet are foundational to the functioning of your entire musculoskeletal system. Spinal stabilization is the first step in spinal health. Your doctor can provide additional information specific to your needs.

1. Support. Over time, the effects of gravity upon a normal weight-bearing position will weaken the tissues and stress joints in your feet. Custom-made orthotics help reduce body-weight stress and strain by supporting proper joint position and reducing excessive motion.

2. Locomotion. When your foot hits the ground during the normal gait cycle, a series of responses occurs along your body’s kinetic chain. Excessive pronation due to structural or functional abnormalities is responsible for more chronic postural problems than any other foot disorder. Flexible orthotics can control both the degree and duration of pronation.

3. Shock absorption. Heel-strike shock generates forces reaching five to seven times your body weight. Normal pronation relaxes the foot to absorb some heel-strike shock directly, and decreases the angle between the bones at your knee joint to help protect your spinal/pelvic structures from extreme shock. When you have excessive pronation, this protective mechanism breaks down, resulting in excess shock transmission to your spine. By controlling pronation, custom-made orthotics enhance your body’s natural shock absorbers.

Brian Jensen, DC, is a graduate of the University of Nebraska and Palmer College of Chiropractic. He specializes in structural biomechanics and has been in practice for 17 years.

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Maintain Strong Bones With Vegetable Protein

Elderly women who get too much protein from animal products like meat and cheese risk fractures and bone loss. Improving bone health can be as easy as using vegetables as a great source of protein. In a study published in the American Journal of Clinical Nutrition, women who received a higher ratio of their protein from meat or dairy products rather then vegetables, had three times the rate of bone loss.

Researchers gave more than 1,000 women a questionnaire, which covered 64 different kinds of foods. They then broke the results down to show how much of each group the women ate and looked at how much protein the women got from animal products and how much from vegetables. They were then categorized by intake level of animal protein.

Vegetables have some acid, but they also have a substance called base (a biocarbonate), which neutralizes acid. Our bodies don’t like too much acid, like the levels found in meat/dairy protein, so our kidneys help us adjust by excreting acid in urine. Because we get older, our kidneys become less and less capable of excreting the acid. As a result, bones, which are partly made up of base, step in to try to neutralize the acid. Over decades, this process causes the bone to dissolve, causing it to lose bone mass and calcium, which increases the risk of fractures.

The point is not to stop eating meat and cheese, but to eat more fruits and vegetables instead. Talk to your doctor of chiropractic about the basics of a healthy, balanced diet. For online information on nutrition, go to


Sellmeyer DE, Stone KL, Sebastian A, et al. A high ratio of dietary animal to vegetable protein increases the rate of bone loss and the risk of fracture in postmenopausal women. The American Journal of Clinical Nutrition 2001:73, pp. 118-122.

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Help Your Heart: East Whole Grain Foods

In today’s fast-paced world we order pizza on the cellphone, whisk through the fast-food drive-through for burgers and fries, and microwave just about anything we can get our hands on. But how many of us take the time to eat enough whole grain foods?

Whole grains are exactly that: foods that contain the entire kernel or grain  oatmeal, popcorn, brown rice, whole wheat pasta, rye bread, puffed rice cakes… the list goes on and on. Familiarizing yourself with this list is important, and making sure that you include whole grains in your daily diet is even more important.

Here’s why: A study in the American Journal of Clinical Nutrition followed more than 75,000 women for 10 years as part of the Nurses Health Study. During that time, the researchers administered food-frequency questionnaires at two-year intervals, and documented all cases of coronary heart disease (CHD) as they occurred.

Results showed that women who consumed higher amounts of whole grains had a decreased risk of developing CHD compared with women who consumed lower amounts. Interestingly enough, this reduced risk could not be explained by the contribution of any of the nutritional elements of whole grain foods (dietary fiber, vitamin E, vitamin B-6, etc.), suggesting that this protective effect may be attributed to whole grain intake in general, rather than any specific aspect of whole grains.


Liu S, Stampfer MJ, Hu FB, et al. Whole-grain consumption and risk of coronary artery disease: results from the Nurses’ Health Study. American Journal of Clinical Nutrition, 1999: Vol. 70, pp412-419.

For additional information on women’s health, go to

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In Need of a Few Adjustments?!

Parents of schoolchildren with behavioral problems can testify to the difficulties their children encounter: poor academic performance, low self-esteem and anger. Now, a new study suggests that schoolchildren who suffer from behavioral difficulties are also at an increased risk for developing lower back pain (LBP).

Researchers examined 1,000 schoolchildren between the ages of 11-14 and found that those who experienced behavioral problems, as well as those that repeatedly complained of other symptoms, such as abdominal pain, headaches and sore throats, were at a substantially higher risk of developing LBP than those without those problems. In short, the study concluded that behavioral problems and other somatic complaints may eventually lead to the onset of LBP.

If you have a child who suffers from LBP, behavioral problems and/or other health concerns, talk to your chiropractor about treatment options. In addition to helping relieve LBP, a chiropractor can recommend wellness and lifestyle changes that promote physical, mental and emotional well-being.


For more information on back pain (and ways to avoid it!), visit


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Chiropractic: Good Even For “Minor” Pains

Chiropractic: Good Even for “Minor” Pains

About half of all children will suffer from low-back pain at some point, with nearly 15% experiencing frequent or ongoing pain. In North America, the primary providers of spinal manipulation are chiropractors. More studies are now being done to evaluate the role of chiropractic in treating back pain in minors.

In a study appearing in the Journal of Manipulative and Physiological Therapeutics, 15 randomly chosen Canadian chiropractors provided data on their pediatric patients between the ages of 4 to 18 and suffering from lower back pain. Information was gathered on treatment type and outcome of care, based on patient-rated pain scales. Characteristics of the children with back pain included:

  • The average age of sufferers was 13 years old.
  • Nearly 60 percent were male.
  • Half attributed pain onset to trauma (usually sports-related).
  • One in four reported pain of over three months duration.

The most common diagnosis was a “subluxation,” appearing in half of these children. Patients were almost universally treated with spinal adjustments, with few requiring other forms of therapy. After six weeks of treatment, major improvement (defined as “much improved” or “resolved”) was seen in nearly 90% of patients, based on one of the pain scales, and there were no reported complications in any of the patients.

In children, as in adults, chiropractic treatment is extremely effective for back pain, regardless of the cause or characteristics. Your doctor of chiropractic can provide more information about treating childhood back pain.


For more information about pediatric health, check out


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Relieving Back Pain During Pregnancy

Ah, the indescribable joys of pregnancy. The anticipation of new life, the intimate, developing bond between mother and child … and the back pain. More than 50% of women experience back pain during pregnancy, especially in the third trimester, and frequently the pain can be excruciating and debilitating.

A Swedish study involving 258 pregnant women investigated whether water gymnastics could reduce the intensity of back pain and the number of days taken for sick leave. Women were divided equally into two groups: an exercise group that participated in water gymnastics (one hour of relaxation exercises, performed in a swimming pool and accompanied by music) during the second half of their pregnancy; and a control group that did not participate in water gymnastics.

Although back pain intensity increased during the course of pregnancy for both groups, the exercise group reported less pain compared with the control group. The total number of reported days on sick leave was also lower in the exercise group (982 days taken) compared with controls (1,484 days taken).

Many of the joys and frustrations of parenthood will last much longer than nine months, so prepare yourself. But back pain is one frustration that doesn¹t have to last. If you’re expecting a child and are experiencing back pain, talk to your doctor of chiropractic about making your pregnancy as pain-free as possible.


For more information on women¹s health, go to

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Getting Hip To Chiropractic

An estimated 85 percent of people between the ages of 55 and 64 suffer from osteoarthritis – a debilitating condition that causes extreme joint pain and stiffness in the knees, hip, hands and spine. But osteoarthritis of the hip can be especially debilitating, since pain around the hip joint can radiate to the groin and thigh and impede walking and other movement.

In a recent small pilot study, researchers assessed the effectiveness of chiropractic manipulation in patients with hip osteoarthritis. Eight patients diagnosed with osteoarthritis or suffering from hip pain were assigned to a chiropractic group or a sham treatment group. Patients in the chiropractic group were assessed for limitation in hip range of motion and joint play restriction, and received chiropractic manipulation six times over a three-week period. Patients in the sham group did not receive any hands-on assessment, but were treated with a device modified to deliver a series of “thrusts” without any real force.

While the sham group reported some positive benefits, the study showed that at least six chiropractic treatments over a three-week period could benefit patients suffering from hip osteoarthritis. Researchers noted, however, that additional research on such treatment for the condition is still warranted.

This study adds to the growing body of evidence that affirms the benefits of chiropractic in treating more than just back and neck pain. If you suffer from osteoarthritis or any other debilitating condition, pain relief may be as close as your doctor of chiropractic.

For more information on senior health, visit


Brantingham JW, Williams AM, Parkin-Smith GF, et al. A controlled, prospective pilot study of the possible effects of chiropractic manipulation in the treatment of osteo-arthritis of the hip. European Journal of Chiropractic 2003;51(3):149-166.

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Should You Change Your Running Form?

According to many running experts, making a few small changes in running form can improve speed and efficiency, and reduce injury rates. Alberto Salazar is famous for changing everything from the tilt of a runner’s pelvis to the position of their thumbs.1

From a biomechanical perspective, it makes sense that nearly every runner has some slight imperfection in form that can detract from optimal performance. Think of the auto industry putting cars in wind tunnels and blowing streams of smoke over the cars’ exteriors to identify design problems that could result in reduced gas mileage. As related to running, identifying and correcting slight biomechanical glitches should theoretically improve efficiency and increase speed.

Two Popular Running Techniques

Although there are dozens of running clinics, the most popular techniques for teaching running form are ChiRunning2 and the Pose Method.3 The ideal running form Chi and Pose recommend is very similar. Both techniques strongly discourage making initial ground contact with your heel. Chi runners are taught to strike the ground with the midfoot; while Pose runners are taught to make contact a little farther forward on the ball of the foot.

Another key concept in Chi and Pose running is that you must strike the ground with your lead foot directly beneath your pelvis. Chi and Pose advocates state that because this contact point shortens your stride, when you want to run faster, you must increase your step frequency (i.e., cadence). Overstriding is to be avoided at all costs. Both Chi and Pose say the ideal running cadence is approximately 180 steps per minute.

runners - Copyright – Stock Photo / Register MarkWith more than 50 percent of runners injured each year, the notion that a recreational runner could reduce the risk of injury while becoming faster and more efficient is definitely appealing. The question is, do claims of improved efficiency and reduced injury rates have merit?

In the past few years, several studies have evaluated Pose and Chi running. In 2004, the prestigious journal Medicine and Science in Sports and Exercise published a paper in which 20 heel-toe runners were instructed to run using the Pose technique.4 Biomechanical analysis revealed that compared to conventional heel-toe running, Pose running resulted in shorter stride lengths and smaller vertical oscillations of the pelvis. Just as Romanov suggested, Pose runners reduced the magnitude of the initial impact force and also reduced stress on the knee. The only downside was the Pose runners had increased stress at the ankle.

The results of this study are similar to a more recent study comparing impact forces and movement differences between conventional heel-strike runners and Chi runners.5 As with the Pose study, the Chi runners had significant reductions in initial impact force and knee stress, but had to absorb more force with the ankle.

Regardless of the added stress on the ankle, these two studies seem to confirm that Chi and Pose running do what they say: reduce initial impact force and stress on the knee.

However, a problem with both of these studies is that the reduced impact forces and lessened knee strain associated with Chi and Pose running most likely had nothing to do with the changes in running form and everything to do with the fact that the Chi and Pose runners ran with shorter stride lengths. If the heel-strike runners would have shortened their strides the same amount as the Chi and Pose runners, they more than likely would have had the same reduction in impact forces, even if they were running with the worst running form possible.

Impact Forces & Ground Contact

The reason stride length is so important is because impact forces are stride-length dependent: The shorter you make your stride, the lower the initial impact force will be. In fact, researchers from the University of Wisconsin6 have shown that regardless of running form, runners who decrease their stride length while increasing their cadence can maintain the same running speed while reducing impact forces by as much as 20 percent. Rather than spending years trying to master a specific running form, impact forces can be dramatically reduced with a few simple changes in stride length and cadence.

Another common misconception regarding running form is that it is always better to make initial ground contact with the mid- or forefoot. According to many running authorities, striking the ground with your heel should be avoided at all costs. Contrary to popular belief, studies involving thousands of athletes show there is no difference in injury rates between runners making initial contact with the heel and those striking with a more forward contact.7 Furthermore, the vast majority of recreational runners are more efficient when striking the ground heel-first.

In a recent study evaluating efficiency while running at different speeds, researchers from Spain showed that compared to mid- and forefoot strikers, slower recreational runners are almost 10 percent more efficient when striking the ground with their heels.8 The benefits associated with heel striking continue until runners reach the 6:25 minute-per-mile pace, after which heel and midfoot contact points are equally efficient. The reduced efficiency associated with mid- and forefoot contact points while running at slow speeds explains why Pose runners, despite having reduced impact forces, are considerably less efficient than conventional heel-strike runners.9

Studies comparing impact forces associated with different contact points consistently show that the same force is absorbed by your body whether you strike with your heel or forefoot – the force is just absorbed by different joints. Runners who strike the ground with the forefoot absorb more force with their arches and calves, while runners making initial contact with the heel absorb more force with their knees.

Force absorption at different locations explains the higher prevalence of Achilles and plantar fascia injuries in mid- and forefoot strikers, and the higher prevalence of knee pain in heel strikers. This is the biomechanical version of, “Nobody rides for free.” If you’re a fast runner who has a tendency for knee pain, you might want to consider gradually transitioning to run with a more forward contact. Conversely, runners plagued by chronic Achilles injuries should run with a heel-first strike pattern in order to reduce the potential for reinjury.

An alternate option for a runner with knee pain is that rather than striking the ground along the midfoot, you should lean slightly forward at the hips during stance phase. Researchers from the University of Southern California10 suggest a slight forward lean while running transfers forces that would normally be absorbed by the knee into the upper hamstrings and hip, with no added force being absorbed by the foot or ankle. The authors point out that because distance runners rarely hurt their upper hamstrings, rather than increasing the risk of an Achilles injury by transitioning to a midfoot contact point, a better approach would be to incorporate a slight forward lean at the hips.

Keep in mind that while making subtle changes in running form can reduce the potential for injury, the majority of research suggests making even a slight change in the way you run will reduce overall efficiency. Remember, although runners trained in the Pose style of running have significant reductions in impact forces traveling through the knee, they become significantly less efficient.9 According to exercise physiologist Tim Anderson,11 runners are able to critically evaluate the metabolic cost of every step while running to develop a unique running style most efficient for them.

Even though changing running form almost always results in reduced efficiency, there are certain movement patterns present in runners that greatly increase the risk of injury and should therefore be modified. Excessive inward rotation of the hip during stance phase is especially problematic because it often results in chronic retropatellar pain.

What We’ve Learned

In summary, the research on running form consistently shows that if your goal is to become fast and efficient, be cautious about making significant changes in form because you intuitively pick the running style that works best for them. The most effective way for advanced runners to improve form and efficiency is to perform high-intensity plyometric drills designed to increase tendon resiliency. Improvements in running form will naturally follow.

Conversely, if your goal is to avoid injury, the easiest way to do this is to reduce impact forces by shortening the overall stride length while increasing cadence. Because the best predictor of future injury is prior injury, your running style should accommodate prior injuries; e.g., runners with a tendency for knee pain should consider making initial ground contact on their midfoot, while runners with a history of Achilles injuries should strike the ground heel first. The bottom line is that excluding a few obvious examples, such as excessive inward rotation of the knee and/or excessive frontal plane motion at the pelvis, the runner is almost always the best judge at choosing the running form that is right for them.


Thomas Michaud, DC, is the author of Injury-Free Running: An Illustrated Guide for Preventing and Treating Running Injuries, the content of which forms the basis for this and subsequent articles. He is a 1982 graduate of Western States and practices in Newton, Mass., where he has treated thousands of recreational and elite runners.

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