Question
Hi-- I am a 45 year old healthy female with a forward head posture.  I think it started when I was a kid and read alot hunched over because of unrecognized near-sightedness.  I recently realized how unattractive it looked when I saw pictures of myself at a ballroom dance competition in profile and determined to stop sticking my neck out. I was actually able to pull my head up fairly well by pulling up at the crown of my head and moving my chin back, as well as pulling my shoulder blades back.  The muscles are a little sore but not bad.  However, I get this weird muscle contraction in my scalp causing me a tension headache, and I never used to get headaches.  If I push my hand against the scalp muscles at my occiput, the headache immediately vanishes.  I guess this is because I'm stretching the muscles?  Have you seen this before and if so, what might help?  Is this something a chiropracter would be able to help me with?  I really don't want to have my vertebrae popped or anything because that scares me.

Answer
Dear Pippa,

First you should print this out it is lengthy and complex in some areas.

Yes this is a very obvious chiropractic case and I treat patients like you every week.  This is a very common issue in our population and suboccipital headaches(base of the skull...what you have described)are some of the most common and easily remedied headaches.  To address these issues, the joints of the neck, the associated musculature as well as the neck structure needs to be addressed.  Here is some really good research on the topic:

Anatomy and Physiology of Headache.
Biomedicine and Pharmacotherapy:  1995, Vol. 49, No. 10, 435-445

Nikoli Bogduk

FROM ABSTRACT:
All headaches have a common anatomy and physiology.

All headaches are mediated by the trigeminocervical nucleus, and are initiated by noxious stimulation of the endings of the nerves that synapse on this nucleus, by irritation of the nerves themselves, or by disinhibition of the nucleus.

DR. BOGDUK ALSO NOTES:
The brainstem contains a region of grey matter called the trigeminocervical nucleus. This nucleus is causally continuous with the grey matter of the dorsal horn of the spinal cord. The trigeminocervical nucleus is 揹efined by its afferent fibers.?[Key Point]

The trigeminocervical nucleus receives afferents from the following sources:
         1) Trigeminal Nerve (Cranial Nerve V)
         2) Upper three cervical nerves
         3) Cranial Nerve VII (Facial Nerve)
         4) Cranial Nerve IX (Glossopharyngeal Nerve)
          5) Cranial Nerve X (Vagus Nerve)
All of these afferents terminate on common second-order neurons in the trigeminocervical nucleus.

Trigeminal Nerve afferents will descend to the level of C3 and perhaps as low as C4. The trigeminocervical nucleus is the sole nociceptive nucleus of the head, throat and upper neck. 揂ll nociceptive afferents from the trigeminal, facial, glossopharyngeal and vagus nerves and C1-C3 spinal nerves ramify in this single column of grey matter.?br>
Because the ophthalmic branch of the trigeminal nerve extends the farthest into the trigeminocervical nucleus, cervical afferent stimulation is most likely to refer pain to the frontal-orbital region of the head.

The stimulation of any neurons that activate the trigeminocervical nucleus can cause headache, which includes cranial nerves V, VII, IX, X, and C1-C3. 揂ny structure innervated by these nerves is capable of causing headache.?br>
揟he C1 and C2 spinal nerves are distinctive in that they do not emerge through intervertebral foramina.?br>
The C1 spinal nerve passes across the posterior arch of the atlas behind its superior articular process, descending in front of the C1 transverse process to descend as a part of the cervical plexus.

C1 spinal nerve does not supply the skin, but does supply sensory innervation to the suboccipital muscles. The sensory root of C1 can be found with the motor roots of the spinal accessory (cranial nerve XI) nerve.

The C2 spinal nerve crosses the posterior aspect of the C1-C2 facet joint; its dorsal root ganglion is opposite the midpoint of the C1-C2 facet joint.

The anterior primary rami of C1-C2-C3-C4 join and form the cervical plexus to innervate the prevertebral muscles: longus capitis, longus cervicis, rectus capitis anterior, rectus capitis lateralis, sternocleidomastoid and trapezius.

The anterior primary rami of C1-C2-C3 form the recurrent meningeal branches of the sinuvertebral nerves. These nerves innervate the anterior surface of the upper cervical dura mater, and then pass through the foramen magnum to innervate the dura mater between the pituitary gland to the anterior occiput (the clivus). They also innervate the medial portion of the C1-C2 joint capsule, the transverse and alar ligaments.

In the posterior cranial fossa, C1-C3 sinuvertebral nerves add components to cranial nerve X (vagus) and XII (hypoglossal). [Important]

The anterior primary rami from C1-C3 join the vertebral nerve, the plexus of nerves that travels with the vertebral artery, and supplies sensory branches to the fourth part of the vertebral artery.

The posterior primary rami of C1 innervate the 4 suboccipital muscles: inferior oblique, superior oblique, rectus capitis posterior major, rectus capitis posterior minor.

The motor component of the C2 posterior primary rami innervates the longissimus capitis and splenius.

The sensory component of the C2 posterior primary rami becomes the greater occipital nerve. It winds under the inferior oblique muscle, ascends and pierces the shared aponeurosis of the trapezius and sternocleidomastoid muscle to supply the posterior scalp.

The motor components of the C3 posterior primary rami also innervate the longissimus capitis and splenius muscles as well as the C2-C3 multifidus muscle.

The sensory component of the C3 posterior primary rami runs across the posterior aspect of the C2-C3 facet joint (which it innervates) and ascends as the third occipital nerve to supply the suboccipital region.

The posterior cranial fossa and its contents are innervated by cervical nerves.  Stretch on the dura mater can initiate mechanical pain. [Important]

揤ertebral artery disease, such as an aneurysm becomes an important differential diagnosis of what otherwise might seem to be neck pain with referred pain to the head.?br>
Arthritis of the upper cervical synovial joints (including C2-C3) can cause neck pain and headache.

Injury and damage to the alar ligaments can cause upper cervical pain and headache. The diagnosis is made with upper cervical rotational CT scanning, showing significant greater unilateral rotation. [Suncoast Healthcare orders FLAR study MRI sequencing of the upper cervical spine when alar or transverse ligament injury is suspected:  the techniques has good visualization of the damage]

**Posterior cervical muscle tears are not a cause of chronic headache.**

C2 neuralgia is a neurogenic headache that can be caused by 搒car tissue following trauma to the lateral atlanto-axial joint.?[Important]  [Fibrosis of the C1-C2 facet joint affecting the adjacent C2 root]

KEY POINTS FROM SUNCOAST HEALTHCARE PROFESSIONALS
1) All headaches have a common anatomy and physiology.
2) All headaches are mediated by the trigeminocervical nucleus, and are initiated by noxious stimulation of the endings of the nerves that synapse on this nucleus, by irritation of the nerves themselves, or by disinhibition of the nucleus.
3) The brainstem and upper cervical spinal cord contains a region of grey matter called the trigeminocervical nucleus.
4) The trigeminocervical nucleus is 揹efined by its afferent fibers.?[Key:  Chiropractic adjustments stimulates mechanoreceptive afferent fibers]
5) The trigeminocervical nucleus receives afferents from the following sources:
         A) Trigeminal Nerve (Cranial Nerve V)
         B) Upper three cervical nerves
         C) Cranial Nerve VII (Facial Nerve)
         D) Cranial Nerve IX (Glossopharyngeal Nerve)
         E) Cranial Nerve X (Vagus Nerve)
**All these afferents terminate on common second-order neurons in the trigeminocervical nucleus.
6) Trigeminal nerve afferents will descend to the level of C3 and perhaps as low as C4.
7) The trigeminocervical nucleus is the sole nociceptive nucleus of the head, throat and upper neck. 揂ll nociceptive afferents from the trigeminal, facial, glossopharyngeal and vagus nerves and C1-C3 spinal nerves ramify in this single column of grey matter.?br> 8) Pain in the forehead can arise as a result of stimulation by cervical afferents of second-order neurons in the trigeminocervical nucleus that happen also to receive forehead afferents.
9) Pain in the occiput (primarily innervated by C2) may arise from trigeminal nerve stimulation.
10) Because the ophthalmic branch of the trigeminal nerve extends the farthest into the trigeminocervical nucleus, cervical afferent stimulation is most likely to refer pain to the frontal-orbital region of the head.
11) The stimulation of any neurons that activate the trigeminocervical nucleus can cause headache, which included cranial nerves V, VII, IX, X, and C1-C3. 揂ny structure innervated by these nerves is capable of causing headache.?[Key Point卆ddresses the joints of the neck]
12) Structures innervated by C1-C3:
         A) Dura mater of the posterior cranial fossa
         B) Inferior surface of the tentorium cerebelli
         C) Anterior and posterior upper cervical and cervical-occiput muscles
         D) OCCIPUT-C1, C1-C2, and C2-C3 joints
         E) C2-C3 intervertebral disc
         F) Skin of the occiput
         G) Vertebral and Carotid arteries
         H) Alar and transverse ligament
         I) Trapezius and Sternocleidomastoid muscle
13) 揟he C1 and C2 spinal nerves are distinctive in that they do not emerge through intervertebral foramina.?br> 14) C1 spinal nerve does not supply the skin, but does supply sensory innervation to the suboccipital muscles.
15) The C2 spinal nerve crosses the posterior aspect of the C1-C2 facet joint and innervates it.
16) The anterior primary rami of C1-C2-C3-C4 join and form the cervical plexus to innervate the prevertebral muscles: longus capitis, longus cervicis, rectus capitis anterior, rectus capitis lateralis, sternocleidomastoid and trapezius.
17) The anterior primary rami of C1-C2-C3 form the recurrent meningeal branches of the sinuvertebral nerves. These nerves innervate the anterior surface of the upper cervical dura mater, and then pass through the foramen magnum to innervate the dura matter between the pituitary gland to the anterior occiput (the clivus). They also innervate the medial portion of the C1-C2 joint capsule, the transverse and alar ligaments.
18) In the posterior cranial fossa, C1-C3 sinuvertebral nerves add components to cranial nerve X (vagus) and XII (hypoglossal). [WOW!  Anatomical proof there is a direct connection with chiropractic adjustments and improvements with abdominal organ system!]
19) The anterior primary rami from C1-C3 join the vertebral nerve, the plexus of nerves that travels with the vertebral artery, and supplies sensory branches to the fourth part of the vertebral artery.
20) The posterior primary rami of C1 innervate the 4 suboccipital muscles: inferior oblique, superior oblique, rectus capitis posterior major, rectus capitis posterior minor.
21) The motor component of the C2 posterior primary rami innervates the longissimus capitis and splenius.
22) The sensory component of the C2 posterior primary rami becomes the greater occipital nerve. It winds under the inferior oblique muscle, ascends and pierces the shared aponeurosis of the trapezius and sternocleidomastoid muscle to supply the posterior scalp.
23) The motor components of the C3 posterior primary rami also innervate the longissimus capitis and splenius muscles as well as the C2-C3 multifidus muscle.
24) The sensory component of the C3 posterior primary rami runs across the posterior aspect of the C2-C3 facet joint (which it innervates) and ascends as the third occipital nerve to supply the suboccipital region.
25) Nociception pain can be initiated by the accumulation of inflammatory chemicals.
26) Nociception pain can be caused by mechanical stimulation following a 揹istortion of a network of collagen?such as ligament or dura mater. [Important: this supports the mechanics of subluxation]
27) Central pain involves no tissue damage but results from dysfunction of the descending pain inhibitory pathways. [Important: the journal Pain in November 1996 suggests that spinal adjusting relieves pain because it activates the descending pain inhibitory system.]
28) Stretch on the dura mater can initiate mechanical pain. [Important: there exists a connective tissue bridge between C1-C2 that attaches to the inferior oblique muscle and attaches to the dura mater. Biomechanical problems in this region can stretch the dura mater, initiating mechanical pain.]
29) The posterior cranial fossa and its contents are innervated by cervical nerves.
30) 揤ertebral artery disease, such as an aneurysm becomes an important differential diagnosis of what otherwise might seem to be neck pain with referred pain to the head.?br> 31) Arthritis of the upper cervical synovial joints (including C2-C3) can cause neck pain and headache.
32) Injury and damage to the alar ligaments can cause upper cervical pain and headache.
33) Posterior cervical muscle tears are not a cause of chronic headache.
34) C2 neuralgia is a neurogenic headache that can be caused by 搒car tissue following trauma to the lateral atlanto-axial joint.?[Important:  Fibrosis of the C1-C2 facet joint affecting the adjacent C2 root]

Now, your concern over neck adjustments is a common fear, especially in light of all the incorrect information out there on the safety of neck adjustments.  For over 50 years the American Medical Association circulated propaganda to the public stating that chiropractic was unscientific and dangerous.  They specifically founded a quackery group for the sole purpose to eliminate chiropractic as a profession.  This is well documented, and they were sued and found guilty in federal court in the 70's and 80's for these false statements (The Wilk case).Unfortunately much of this still exists, and often MD's will warn you to stay away from chiropractic physicians and neck adjustments even though they have no understanding of the profession or of what a spinal adjustment actually is or does.

Let me alleviate those fears...all chiropractic physicians are specifically trained to take pressure of the neck while adjusting it rather than creating pressure...neck adjustments are safer than the use of advil or tylenol, and there are multiple research papers published in medical journals (not chiropractic journals) that have proven this without a doubt.  When the neck is being adjusted, it takes pressure off the disk and facet joints of the neck and the pop is from a simple release of gas pressure form the joint capsule...just like you can "pop" your finger knuckles.  This is no different that opening a soda can, or a champagne bottle...the faster the gas releases, the louder the noise.  This allows for proper motion of the joint, improved muscle tone and function, reduced pain, and proper neurological transfer of signals from the tissue to the brain and the brain to the tissue. Now, I prefer to adjust the spine with my hands, and most of my patients prefer that as well, but some still hold a fear, so I use an instrument to adjust their neck called the Arthrostim.  No popping occurs and joint mobilization can be obtained easily.  Most chiropractors have the ability to utilize instruments in their practice, or have drop pieces to adjust the spine which will not result in popping noises...so there are many options.  Anyway, here is one of the latest published studies on safety:

Safety of Chiropractic Manipulation of the Cervical Spine
A Prospective National Survey
Spine:  Volume 32(21), October 2007, pp 2375-2378
Thiel, Haymo W. DC, PhD; Bolton, Jennifer E. PhD; Docherty, Sharon PhD; Portlock, Jane C. PhD

FROM ABSTRACT

Study Design: Prospective national survey.

Objective: To estimate the risk of serious and relatively minor adverse events following chiropractic manipulation of the cervical spine by a sample of U.K. chiropractors.

Summary of Background Data: The risk of a serious adverse event following chiropractic manipulation of the cervical spine is largely unknown. Estimates range from 1 in 200,000 to 1 in several million cervical spine manipulations.

Methods: Treatment outcomes obtained from 19,722 patients. Manipulation was defined as the application of a high-velocity/low-amplitude or mechanically assisted thrust to the cervical spine. Serious adverse events, defined as referred to hospital and/or severe onset/worsening of symptoms immediately after treatment and/or resulted in persistent or significant disability/incapacity, and minor adverse events reported by patients as a worsening of presenting symptoms or onset of new symptoms, were recorded immediately, and up to 7 days, after treatment.

Results:  Data were obtained from 28,807 treatment consultations and 50,276 cervical spine manipulations. There were no reports of serious adverse events. This translates to an estimated risk of a serious adverse event of, at worse ? per 10,000 treatment consultations immediately after cervical spine manipulation, ? per 10,000 treatment consultations up to 7 days after treatment and ? per 100,000 cervical spine manipulations.

Minor side effects with a possible neurologic involvement were more common. The highest risk immediately after treatment was fainting/dizziness/light-headedness in, at worse ?6 per 1000 treatment consultations. Up to 7 days after treatment, these risks were headache in, at worse ? per 100, numbness/tingling in upper limbs in, at worse ?5 per 1000 and fainting/dizziness/light-headedness in, at worse ?3 per 1000 treatment consultations.

Conclusion:  Although minor side effects following cervical spine manipulation were relatively common, the risk of a serious adverse event, immediately or up to 7 days after treatment, was low to very low.

THESE AUTHORS ALSO NOTE:
It is generally assumed that serious complications following spinal manipulative therapy of the cervical spine, including neurologic deficit and stroke, are relatively uncommon.

Estimates of serious complications following spinal manipulative therapy of the cervical spine 搗ary between 1 serious adverse event in 200,000 manipulative neck treatments to 1 in several million.?br>
揜elatively minor side effects of cervical spinal manipulation, such as neck pain, stiffness and soreness, headache, and tiredness are common in clinical practice.?br>
This study is the first, large-scale prospective study designed to record serious and minor adverse events following chiropractic manipulation of the neck.  This study involved 377 chiropractors, 19,722 patients and 50,276 cervical manipulations.

揟o estimate risk in cases where no occurrence of an adverse event occurs, Hanley's rule of three was used.? [See 揷omments?section for explanation and discussion]

RESULTS
揘o significant adverse event was reported by the chiropractors using the definition criteria.? The most common of complaint reported by patients was fainting/dizziness/light-headedness, which occurred in only 1.5% of cases.  During the following 7 days, discomfort in the area of the manipulation (neck pain) occurred in 7.3%, symptoms of shoulder/arm pain occurred in 4.8%, and reduced movement in the neck and upper limb occurred in 3.9%, headache occurred in 3.9%, numbness/tingling in upper limbs occurred in 1.3%, and fainting/dizziness/light-headedness occurred in 1.1% of cases.

DISCUSSION
揝afety of treatment interventions is best established with prospective surveys, and this study is unique in that it is the only prospective survey on such a large scale specifically estimating serious adverse events following cervical spine manipulation.?[Hanley's rule of three]

揟he risk rates described in this study compare favorably to those linked to drugs routinely prescribed for musculoskeletal conditions in general practice.?揟he risks reported here are also lower than those reported for acupuncture, which were described as a very safe intervention in the hands of a competent practitioner.?br>
揂lthough minor side effects were found to be relatively common, the risk of a serious adverse event, immediately and up to 7 days after treatment, was estimated to be low to very low in these consultations.?

揙n this basis, this survey provides evidence that cervical spine manipulation is a relatively safe procedure when administered by registered U.K. chiropractors.?br>
KEY POINT FROM AUTHORS:
揃ased on treatment outcomes obtained from 19,722 patients, the risk of a serious adverse event following cervical spine manipulation was estimated to be low to very low; risks of minor side effects, on the other hand, were relatively common.?br>
KEY POINTS FROM SUNCOAST HEALTHCARE PROFESSIONALS
1) This study is the first, large-scale prospective study designed to record serious and minor adverse events following chiropractic manipulation of the neck. The study involved 377 chiropractors, 19,722 patients and 50,276 cervical manipulations. 揟here were no reports of serious adverse events.?
2) 揘o significant adverse event was reported by the chiropractors using the definition criteria.?br> 3) 揟he risk of a serious adverse event, immediately or up to 7 days after treatment, was low to very low.?[The incidence in this study was zero]
4) Prior estimates of serious complications following spinal manipulative therapy of the cervical spine 搗ary between 1 serious adverse event in 200,000 manipulative neck treatments to 1 in several million.?br> 5)  揜elatively minor side effects of cervical spinal manipulation, such as neck pain, stiffness and soreness, headache, and tiredness are common in clinical practice.? This therefore adds a compounding variable to the symptom reporting as a measure of adverse event after treatment.
6) The most common immediate complaint reported by patients was fainting/dizziness/light-headedness, which occurred in 1.5% of cases.
7) During the following 7 days, discomfort in the area of the manipulation (neck pain) occurred in 7.3%, symptoms of shoulder/arm pain occurred in 4.8%, and reduced movement in the neck and upper limb occurred in 3.9%, headache occurred in 3.9%, numbness/tingling in upper limbs occurred in 1.3%, and fainting/dizziness/light-headedness occurred in 1.1% of cases.
8) 揟he risk rates described in this study compare favorably to those linked to drugs routinely prescribed for musculoskeletal conditions in general practice.? 揟he risks reported here are also lower than those reported for acupuncture, which were described as a very safe intervention in the hands of a competent practitioner.?br> 9) 揂lthough minor side effects were found to be relatively common, the risk of a serious adverse event, immediately and up to 7 days after treatment, was estimated to be low to very low in these consultations.?
10) 揙n this basis, this survey provides evidence that cervical spine manipulation is a relatively safe procedure when administered by registered U.K. chiropractors.?br>
COMMENTS & DISCUSSION FROM SUNCOAST HEALTHCARE PROFESSIONALS
Although there were absolutely no serious events associated in this study involving 50,276 cervical spine adjustments, the authors applied something called 揌anley抯 rule of three?to estimate risk of serious adverse outcome in a study where no risk was found.  Why would you need to estimate risk if no risk was found?  A larger sample size would have been a more appropriate way to gauge risk.

揟o estimate risk in cases where no occurrence of an adverse event occurs, Hanley's rule of three was used. This states that if none of n patients show the event, then it can be assumed with 95% confidence that the chance of this event is, at worst, 3 in n (i.e., 3/n). It is generally accepted that treatment associated events occurring at a rate of 1 in 10,000 to 100,000 can be categorized as very low risk. Therefore, a sample size of 50,000 cervical spine manipulative interventions was sought to give a frequency of 1 serious adverse event in approximately 17,000 interventions.?

Based upon this Hanley抯 rule of three, these authors computed the following information:
1)  揟his translates to an estimated risk of a serious adverse event of, at worse ? per 10,000 treatment consultations immediately after cervical spine manipulation, ? per 10,000 treatment consultations up to 7 days after treatment and ? per 100,000 cervical spine manipulations.

2) The highest risk immediately after treatment was fainting/dizziness/light-headedness in, at worse ?6 per 1000 treatment consultations.

3) Up to 7 days after treatment, these risks were headache in, at worse ? per 100, numbness/tingling in upper limbs in, at worse ?5 per 1000 and fainting/dizziness/light-headedness in, at worse ?3 per 1000 treatment consultations.?br>
Utilization of the Hanley rule of three seems very bizarre. Because the 3 will never change in the equation, yet the number of adjustments could change. Using this study of 50,000 adjustments, the risk is 50,000/3 = 16,666, meaning one serious adverse event per 16,666 adjustments, not the one serious event in 10,000 reported.

**If only 10,000 adjustments were given with no serious adverse events, the risk would be 10,000/3 = 3,333, meaning one serious adverse event per 3,333 adjustments.  **If only 100 adjustments were given with no serious adverse events, the risk would be 100/3 = 33, meaning one serious adverse event per 33 adjustments.  **Conversely, if a larger sample size had been utilized the ratio is even more favorable:  If  100,000 adjustments were given with no serious adverse events, the risk would be 100,000/3 = 33,333

We are certainly glad this study had at least 50,000 adjustments.  However, the rationale and utilization of the arbitrary Hanley's rule of three statistics should not be considered an accurate measure of risk.

Important Consideration:  Again using Hanley抯 rule of three, the number of serious adverse events per 50,000 adjustments was 1 / 16,666; yet the authors interpreted it as 1 / 10,000 adjustments. Therefore, they did not correctly report their own statistical data in the results section, and overstated their calculated estimated risk.

Now...Forward head posture can be the result of trauma (intense and fast stress on the neck) or long term cumulative stress such as poor posture like you described.  Again this is a common problem in our society from car crashes, football and other sports, and our flexion dominated society (cell phones, PDA's, computers, TV viewing, poop posture, etc...) Here is what some experts say about forward head posture and altered spinal structure:

揊or every inch of forward head posture, it can increase the weight of the head on the spine by an additional 10 pounds.?Kapandji, Physiology of Joints, Vol 3.

揕oss of the cervical curve stretches the spinal cord 5-7 cm and causes Disease.? Dr. Alf Breig, Neurosurgeon (Nobel Prize Recipient)

揊orward head posture leads to long term muscle strain, disc herniations, arthritis and pinched nerves.? The Mayo Clinic, Nov. 3rd, 2000

?0% of the stimulation and nutrition to the brain is generated by the movement of the spine?Dr. Roger Sperry, (Nobel Prize Recipient for Brain Research)

Additionally, Dr. Sperry demonstrated that 90% of the energy output of the brain is used in relating the physical body to gravity.  Only 10% has to do with thinking, metabolism, and healing, so when you have forward head posture your brain will rob energy from your thinking, metabolism, and immune function to deal with abnormal gravity/posture relationships and processing.

"To live a long, active, energetic life, few things matter more than good posture"  Rene Calliet, MD (The Rejuvenation Strategy)

"Posture effects and moderates every physiologic function from breathing to hormonal production.  Spinal pain, headache, mood, blood pressure, pulse, and lung capacity are among the most easily influenced by posture"  American Journal of Pain Management, 1994;4: p36-39.

Bottom line here is that, you can fix this problem with specific exercise, spinal adjustments, traction protocols, and ergonomic considerations.  I do this everyday at my office and get great results with my patients.  The technique I use in practice is called CBP (Chiropractic Biophysics / Clinical Biomechanics of Posture).  This is the most highly researched and published technique in chiropractic and you can research (over 100 published research papers) it at www.idealspince.com.  They have a listing of certified doctors on the website as well.

I hope this helps your understanding Pippa.  I know much of this is complex in terminology regarding the research, But I want you to get a deeper understanding and see that I base my opinions not only on my previous chiropractic education and clinical experience, but also on complex medical research as well.  As a patient, I would hope that all of your doctors, regardless of discipline, would educate you to the best of their ability and this should always include the proof of opinion.  Good Luck...you should try chiropractic!

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net