Flat Back Syndrome – Diagnosis and Exercises

If you’re over the age of 35 and have spent years either sitting behind a desk, diving, labouring, or otherwise being very physically active, you might have a condition commonly called Flat Back Syndrome.

If you’re over the age of 35 and have spent years either sitting behind a desk, driving, laboring or otherwise being very physically active, you might have a condition commonly called Flatback Syndrome.

What is Flatback Syndrome?

Flatback Syndrome is really not a syndrome as such. I prefer to call it flatback posture or the correct medical term, alordosis.

Lumbar Lordosis is the normal inward curvature in the lower spine. “Alordosis” means “absence of lordosis” – the normal curvature isn’t present, and instead, the lower back is “flat.” The pelvis is usually tipped backward (posterior tilt), associated with or causing the normal spinal curve to flatten. This is Flatback Syndrome

alordosis

Copyright Posturo Global Ltd

Signs and Symptoms of Flatback Syndrome

  • flat lower back curve
  • forward head  
  • round shoulders
  • low back pain often described as ‘aching.’
  • groin pain
  • leg pain
  • spinal stiffness, especially on waking 

This list is only a guide. You may have many of the signs and symptoms listed, only a few or none of them. The list is to assist you in recognizing whether you have Flatback Syndrome.

What Causes Flatback Posture?

Incorrect Sitting

If you have spent years sitting incorrectly – sitting on your bottom muscles instead of sitting with your back aligned over your hips – you may have developed chronic muscular imbalances – short, tight abdominals, short, tight hamstrings, and weak hip flexors – pulling the pelvis into a tucked-under position (called posterior pelvis).

Slouch Back

Slouch Sitting – copyright Posturo Global Ltd

Disc Degeneration

Incorrect sitting and standing posture, poor nutrition, injuries, athleticism, and manual labor can lead to worn spinal discs and pain in a patient. The lower spinal discs should be wedged-shaped, which gives the lumbar region a healthy inward curve, known as lumbar lordosis.

Copyright Posturo Global Ltd

Interesting: When people say, ‘I’ve got lordosis in my lumbar spine,’ what they usually mean is that they have hyperlordosis or sway back. The hyper suggests an increase to the normal lumbar curve. We should ideally all have lordosis in our lumbar spine.

If the lumbar curve is exaggerated, it is a hyperlordosis; if it is flat, it’s an alordosis or without a lordosis. Saying you have ‘lumbar lordosis’ is actually saying you are normal. That always makes me laugh – in a kind-hearted doc sort of way.

When our spinal discs degenerate, they lose their natural wedge shape, causing a reduction in natural lordosis. This may result in flatback posture. It may also be common to see spinal curvature.

Herniated Disc

A herniated disc is just a severely degenerated disc, where the gelatinous, toothpaste-like material normally found contained inside the disc has leaked through the outer cartilage rings. This also causes loss of the natural wedge shape, which leads to a change in the normal lordotic curve.

Chronic Muscular Imbalance

Many of the muscles responsible for posture and body movement are found in “pairs.” One muscle (or group of muscles) moves a body part in one direction, while the paired muscle moves the same body part in the opposite direction. The two sides of such a pair are said to be “opposers” since the effort of one side opposes – works in the opposite direction to – the other side.

Both sides of a muscle pair’s efforts may also be exerted simultaneously (when sitting or standing relatively still) to provide the tension and support needed to hold a body part steady in a desired balanced position.

Further Resources: Balance Exercise for Beginners

When one of the muscles of a pair becomes stronger than its opposer, we say that the stronger one has become dominant. Dominant muscles tend to become short, tight, and over-aroused – or facilitated – neurologically. The weaker opposing muscle becomes long and under-aroused or passive.

Although these muscular imbalances are fairly predictable, individual differences do, of course, exist. Muscle imbalances commonly found in people with flatback posture include:

Dominant Short Muscles

  • Abdominals
  • Hip flexors

Passive Long Muscles

  • Hamstrings
  • Gluteals

Because posture and muscular imbalances affect the way we move, problems in one area lead to problems in other areas. Flatback posture often contributes to the development of round shoulders and forward head posture.

Other problems may result from the muscular imbalances found in flatback posture, including:

  • Sciatic leg pain (from inflamed, bulging discs)
  • Chronic lower back pain
  • Acute lower back muscle spasms (often one-sided)
  • Scoliosis
  • Degenerative disc disease
  • Deformity

 

It is not essential to know the exact cause of your flatback syndrome. Still, it suggests some daily posture exercise habit is needed to return mobility and optimal alignment to the spine. Spinal surgery correction or other surgical treatment is not ideal. However, surgery and physical therapy can help you, especially if you have a pinched nerve, neck pain, or other severe pain.

The patient’s objective is to ultimately restore good alignment by establishing healthy posture habits and daily routines. Good posture is a habit and one that you can learn to love. It also helps to avoid spine surgery or other intrusive treatments for the spine.

After Thought – Best Ergonomic Tip

Fully upright posture (90°) is hard on the discs in your low back, so avoid buying the “perfect ergonomic chair” that keeps you bolt-upright. Research has shown that reclining at a 135° angle is the least damaging to our lumbar discs when seated.

Before you jump and adjust your seat angle, recognize that such a position is impractical for working at a computer. You’d be so far back, you’d be straining to reach the keyboard, and you’d almost certainly increase your forward head position.

It seems that 110-120° is about perfect for reducing any forward head posture that could occur if you incline the seat back any further. Personally, I favor 120°, with lumbar back support.

In any event, do remember to keep your head back, nicely inline above your shoulders. Please don’t force it back; allow a gentle lengthening to lift your head back into alignment.

Review the chin tuck exercise for forward head posture if you are unsure.

Inclining your seat 5° downward at the front and using armrests can further reduce lumbar disc pressure.

Happy sitting!

Mattress in a Box | Sleepovation Review Dr Paula Moore

I was skeptical when I first sat on my Sleepovation Mattress because it felt softer than the firm memory foam mattress I have slept on for years. My first night’s sleep, I slept for 10 hours straight and didn’t wake to use the bathroom once! That was miraculous for me.

I was on my way out to buy a new memory foam mattress for my bed – which I’ve had before and loved – when Brian from Sleepovation emailed me asking if I would endorse the Sleepovation mattress. He said it uses the latest sleep technology.

Having never even sat on a Sleepovation mattress, much less had one on my bed, I wasn’t prepared to offer an endorsement, but I was happy to give the mattress a try. A true endorsement will only ever come from me if I love and use a product regularly.

Brian was cool with that, and within the next 48 hours, my Sleepovation mattress arrived in a box.



I love several things about this mattress and a few things I’m not so keen on. Here is my review of the Sleepovation Mattress in a Box. I’m not that keen to endorse something that can be so subjective. Please have a read of my pros and cons, do a little research, and then decide for yourself.

Sleepovation Mattress |The good

  1. Support: Sleepovation claims to be the first ‘pocket system’ mattress – also known as ‘tiny mattress.’ In theory, the individual suspension system (made up of 700 tiny mattresses) supports the spinal column and each bone separately. It cradles the body’s curves while providing enough firmness for the back’s muscular and bony structures. This should give pain relief and pressure relief on the neck as there is motion transfer between the different air channels. This is potentially great for spinal alignment, depending on your sleeping position.

    I was skeptical when I first sat on my Sleepovation Mattress because it felt softer than the firm memory foam mattress I have slept on for years. On my first night’s sleep, I slept for 10 hours straight in comfort and didn’t wake to use the bathroom once! That was miraculous for me.

  2. Cleaner: The Sleepovation has removable, washable covers – two in fact! The one you see with the blue zipper in the image above and an elastic mattress cover fits over the top of the quilted cover. This is a definite benefit, as a quality mattress cover can run upwards of $100 and is advised to give you unmatched cleanliness.

    You can also vacuum between each of the 700 tiny mattresses to remove dust. That’s pretty unique!

  3. Cooler: The individual pocket system allows air to circulate right through the mattress channels. I don’t suffer from being too hot at night, so it will be interesting to hear from some of you on this potential benefit.
  4. Motion Isolation: Because each of the 700 tiny mattresses moves independently, you shouldn’t get much co-sleeping disturbance from your partner. So far, I have found that to be true.
  5. Greenguard Certification: Greenguard products are certified for low chemical emissions, so they are considered acceptable for sensitive individuals. I don’t have any allergies myself, so that will be for you to decide.

Sleepovation | Less good

  1. No Slats: Because there are 700 tiny mattresses, box spring or coil underneath isn’t ideal, and neither are slatting because the individual segments can slip through. So you need to use a platform bed or buy a thin sheet of plywood to place over the top of your slatted base.

  2. Not Organic: The material and foam for the Sleepovation mattress are not organic. Organic mattresses are part of the luxury mattress market, and you can expect to pay upwards of $3,000 for one; and by the way, memory foam mattresses are also not organic.

    Typical (non-luxury) mattresses contain chemicals that are probably not that healthy for anyone but particularly unsafe for babies and children. Most mattresses contain petroleum-based chemicals, toxic foams, synthetic fabrics, and fire retardant barriers or chemicals. These chemicals can off-gas and expose your family to dangerous toxins while they sleep.

    Organic mattresses are often made of cotton or wool and use no chemical treatments, but do your research before you buy!

  3. Price: I consider Sleepovation in the quality mattress market, typically between the $1,000 – $2,000 price point. Considering the average person sleeps for 8 hours each night, I did a little calculating:

    8 hrs x 30 days/mth x 12 mths/year = 2,880 hrs sleep/year

    If you start sleeping on a quality mattress like Sleepovation at the age of 30 and live to be 84, that is:

    54 years on a quality mattress. 54yrs x 2,880 hrs/year = 155,520 hrs sleeping on your quality mattress this lifetime.

    155,520 hrs / 24 hrs (per day) = 6,480 days of your adult life spent sleeping! That is 18 total years of sleep from age 30-84! Slightly depressing, isn’t it.

    A Sleepovation Mattress typically costs about $1,500:

    $1,500/6,480 days = approximately 23cents/sleep on your Sleepovation Mattress.

    I’m ok with that. You?

Where to get your Sleepovation Mattress

>> SleepOvation Mattress discount: Use coupon code POSTURE to save $50.

You can also buy a Sleepovation pillow made up of 77 tiny pillows and is recommended to give you a good night’s sleep.

 

Theory of Skull Horns Debunked

There seems to be a lot of media buzz this summer about horns growing on young people’s skulls, and I’d just like to say hogwash, balderdash and baloney! What a total crock. I’m unconvinced by the study findings, to say the least.

There seems to be much media buzz about horns growing on young people’s skulls, and I’d like to say hogwash, balderdash, and baloney! What a total crock. I’m unconvinced by the study findings, to say the least.

There is a huge issue I have with the neck x-rays that researchers analyzed in the study. As a result, it is impossible to conclude the correlation between cell phone use and skull morphology.

An enthesis is the attachment point of a tendon, ligament, fascia, or capsule to the bone. The function of the enthesis is to distribute force over a large area of bone.

A bone spur, also called an osteophyte, is an outgrowth of bone that can occur along the bone’s edges. They may also occur where muscles, ligaments, or tendons attach to the bone.

One common bone spur is the calcaneal spur caused by the constant pull or traction on the heel from overpronation or fallen arches. Calcaneal bone spurs are frequently associated with plantar fasciitis, a painful inflammation of the band of tissue (plantar fascia) that runs along the bottom of the foot and connects the heel bone to the ball of the foot.

The method by which a bone spur develops follows the biomechanics of Wolff’s Law, which states that bone in a healthy person or animal will adapt to the loads under which it is placed. In other words, repetitive loading of bone will cause adaptive responses that enable the bone to cope better with these loads.

Skull Horns


From a biomechanical point of view, these skull horns, in theory, may be an adaptive mechanism we’ve developed to cope with the increased weight of the head when texting or using cell phones. I agree this is possible, but occipital osteophytes have been present on skulls long before the use of cell phones.

One of the best textbooks I’ve ever read (and I’ve read Volume 1 & 2 cover to cover, which amounts to about 2,000 pages) is Terry Yochum and Lindsay Rowe’s, Essentials of Skeletal Radiology. Before Dr. Yochum’s text, there had never been a chiropractic textbook published by a major publisher. The new edition is a mandatory text for all chiropractic students, and countless medical colleges require it in their curriculum.

On page 255 of the 2nd edition (Volume One), you will find the following, under the section, An Atlas Of Normal Skeletal Variants:

Prominent External Occipital Protuberance..There is a prominent external occipital protuberance, which is considered a variation of normal.

Looking more closely at the Journal of Anatomy study, I found that the x-ray images presented suggest another interesting finding. All of the x-ray images shown are of cervical spines with altered neck curves.

The study authors report their subjects as apparently healthy, asymptomatic, and mildly symptomatic young adults. I want to suggest that a misaligned altered cervical curvature is anything but healthy.

Cell Phones or Car Crashes?


Overt neck trauma (often resulting from a motor vehicle accident) resulting in alternate neck curvature is a serious health condition and far from apparently healthy.  Neck trauma (from an MVA) may cause vertebral compression fractures that cause the vertebral body to collapse into a wedge’s shape. This causes the spine section to tip forward, leading to a loss of the neck’s normal curvature.

MVA may also damage the ligaments along the back of the cervical spine leading to loss of the normal neck curve. If the kyphosis gets bad enough, it can narrow the spinal canal and pressure the spinal cord. Due to the relationship of the neck’s neurovascular structures, it isn’t hard to see that altered neck curves will cause nerve and vascular interference and manifest into pain and discomfort, fatigue, sleep disorders, organ dysfunction, depression, and eventually disease.

I do agree that a traction spur in the occiput bone of the skull is possible following Wolff’s Law of biomechanical adaption, but is this bony skull horn a normal variant, an adaptive process due to cell phone usage, or a result of past traumas (MVAs) that alter neck curves, change the mechanical loading in the head and ultimately cause adaptive changes to the bone? Clearly, further research is needed.

X-ray from the skull-horn study – the green line is normal.
 X-rays from skull horn study – Altered neck curves in red

In the images above, the flat or reversed neck curves are in red, and the normal or ideal neck curves in green. There is also evidence of moderate to severe degenerative disc disease (DDD) in these x-rays. Note that the disc degeneration is most severe where the curve flattens or reverses (red arrows).

The authors also reported that the prevalence of a skull horn (or prominent external occipital protuberance) was significantly higher in the male (67.4%) than in the female population (20.3%).

Even more interesting to me is that in this study, 7,720 people were killed in traffic accidents in 2001, 75% of which were men. This is largely due to differences in risk-taking behaviors between men and women, particularly younger men. This male/female prevalence is remarkably similar to the sex divide seen in the skull horn study. Hmmm.

The fact is that MVAs statistically damage the shape of your cervical lordosis (normal neck curve). Researchers from Chiropractic BioPhysics (Harrison DE, Katz E. Abnormal static sagittal cervical curvatures following motor vehicle collisions: Literature review, original data, and conservative management strategies. Proceedings of the International Whiplash Trauma Congress 2006; Portland, OR, June 2-3, pages 24-25) have identified:

That the average patient exposed to a MVC will lose 10 degrees of their cervical lordosis, develop a mid cervical kyphosis, and have increased forward head posture as a result of the MVC.

Cell Phone Warning


One conclusion from the horned skull study that I absolutely agree with is that our young adult population should take heed and act now to prevent poor posture‐related conditions in the future.

The more important question we should be asking – even though horns growing from our skulls is far more attention-grabbing – is: What is our sedentary mobile lifestyle doing to our children? Will, our children, be active and healthy well into their senior years, or will there be an influx and shortage of senior home placements for our 70-somethings.

Further Resources: Text Neck Pain Relief Stretches and Exercises – How to avoid neck pain, fix Text Neck and improve your forward head posture

If you or your children spend prolonged periods of time using mobile devices – cell phones, iPads, computers, or anything that encourages your head to travel forward and down, you are putting yourself at risk for future health problems. Here are three ways you can act now to encourage your children to develop healthy posture habits:

  1. Teach your children to move their eyes, not their heads when texting.

2. Complete the Text Neck Inventory with your child.

3. Teach your child (and do it with them) how to do a basic chin tuck.

Cervicogenic Headache Exercises

The cervicogenic headache is described as a unilateral or one-sided headache, generally starting in the neck and moving forwards. The headache generally dominates on one side. When the headache is severe however, it may also be felt on the opposite side, but to a lesser extent.

The 5-Step Cervicogenic Headache Protocol

I can’t remember when I had my first headache, but it was sometime in my early 20s. I’ve had a lifetime of headaches. My headaches have been the bane of my life but also my constant companion and gift.

Last Saturday, en route to a barn dance, I had a whopper of a headache. I’m not too fond of perimenopause for the resurgence of headaches in the last two years. However, if it were not for my headaches, I would never have found Dr Brian Sher (Toronto Chiropractor), who provided my first neck adjustment that vanished my headache on the spot and paved the way to Chiropractic college. For that, I am immensely grateful.

Headaches changed the trajectory of my life, for the better.

Here’s the problem that I see with headaches. Most people burdened by headaches can not think clearly enough to take the steps necessary to rid their lives of the misery of chronic pain.

I get it – that was me!

I couldn’t get through the day without a muzzy painful head. I didn’t really know why I was having daily headaches, I just wanted to be like everyone else, who smiled and laughed and went to work and generally just got on with life.

That wasn’t me. I was working for the Sport’s Clubs of Canada at the time. I remember being at my desk, rubbing my head in misery while trying to complete my sales calls. The pain wasn’t particularly dramatic – it just seemed to be there more days than not. It was a burden, a drain, a constant weighing down. Life didn’t feel as good with a headache.

One day, I discovered I didn’t have to live my life with the burden of a headache. That was the moment I had my first Chiropractic adjustment, and that moment changed my life.

Recently, I’m reminded of what it is to have chronic headaches, due to my current hormonal haze of perimenopause. A resurgence of headaches, has me eager to share my knowledge of headache, and how I survive and treat my own headaches successfully – for the most part. I am quite certain this can help you too.

Cervicogenic Headaches

The term “cervicogenic headache” was actually coined in 1983. Although there is long-standing notion that headaches can originate from structures in the neck and can be treated using manual approaches, it is only during the past two decades that the topic of cervicogenic headache has gained attention in mainstream medical literature.

Signs and Symptoms

The cervicogenic headache is described as a unilateral or one-sided headache, generally starting in the neck and moving forwards. The headache generally dominates on one side. When the headache is severe however, it may also be felt on the opposite side, but to a lesser extent.

There are also signs pertaining to the neck, such as reduced range of motion in the neck and mechanical stimulation applied on the affected neck area reproducing the headache symptoms. These strongly suggest cervical involvement in producing the headaches. Sometimes, same side shoulder/arm sensations and even pain have been reported.

People with a cervicogenic headache may report that the pain fluctuates, is continuous, lasts only a very short period of time, begins after long intervals, or starts up upon waking in the morning.

Prevalence

Studies support that cervicogenic headache is common. However, there is a great deal of variation in the perceived prevalence in the general population. For example, prevalence rates seem to range from 0.4% to 80%. It seems the disparity is due to contrasting diagnostic criteria being used in each study. The average affected age is 43,2, and the female/male distribution appears to have more agreement in the literature at 80% female, 20% male.

Resources: 1

Cause

There appear to be three main causes of cervicogenic headache discussed in the literature.

Convergence:

The basic premise of convergence is that when sensory nerves (first-order neuron) detect information about mechanical, thermal, and chemical states of the body and send signals back to the spinal cord, they converge on other nerves (second-order neurons) that carry signals from the spinal cord to the head. Pain signals from the periphery then get perceived as pain in the head and face, where the second-order neurons carry signals to the head (brain).1

Degeneration:

Disc degeneration, or degeneration in the neck’s facet joints, can cause inflammation and lead to irritation of sensory nerve endings for pain, called nociceptors.

Trauma:

In my clinical experience as a Chiropractor, trauma is frequently overlooked and a common cause of cervicogenic headache.  If you have a history of trauma – in particular, a past motor vehicle accident – and a history of chronic headaches, you need a cervical x-ray series to rule out structural changes to your natural neck curve (lordosis). These changes (flat curve – alordosis, or reversed neck curve – kyphosis), lead to degeneration and altered mechanics in the neck, which cause inflammation and irritation of the nerve endings responsible for pain.

The prevalence of joint pain (facet joints in the neck) after whiplash from a car accident has been reported as high as 54%.3

Neck Disability Index

Before you begin my cervicogenic headache protocol, I recommend you measure your starting point regarding self-reported disability. Howard Vernon developed a tool called the Neck Disability Index (NDI) in 1989. The NDI has become one of the standard evaluations for measuring disability due to neck pain and is used by both healthcare professionals and researchers. There are just 10 questions, and answers for each are scored from 0 to 5. The maximum possible score is 50.

You can see a copy of my own NDI report. Note my moderately high frequency of headaches (a recent resurgence since peri-menopause).

Bookmark the link to the Neck Disability Index and complete the evaluation before you begin my headache protocol and every month along the way, to objectively measure your progress in terms of disability.

Cervicogenic Headache Protocol

I’ve created an entire online course to help you treat your own cervicogenic headaches effectively; and I’ve also extracted a mini version for you here, which consists of 5 steps:

  1. Neck Disability Index: Complete the NDI before you progress through this protocol.
  2. Neck X-Rays: Have a cervical series of x-rays taken through your doctor or directly from your Chiropractor. Many Chiropractors have their own on-site digital facility, as I did. The standard series is Cervical AP (front to back) and Cervical Lateral (side view) and often APOM (an open mouth view to visualise the first two vertebrae C1 and C2). If in doubt as to why you need an neck x-ray to proceed, please refer back to the section Cause above and review the third cause, trauma.
  3. Range of Motion: Review the section above on signs and symptoms of cervicogenic headache. Reduced range of motion is almost always present in the neck of someone with cervicogenic headache. Whether or not the lost movement is the cause or the effect isn’t clear, but I stand by the need for increasing your cervical range of motion.
  4. Trigger Points: Myo-fascial trigger points, also known as muscle knots, are painful spots in the fascia (connective tissue) surrounding the muscle. Trigger points in the neck and shoulders are commonly associated with referred pain in the head. Refer back to signs and symptoms above. Recall that manual pressure applied to the affected neck area producing headache strongly suggests cervical involvement. So although self-applied trigger point therapy might initially bring on a headache (please use with caution); the idea is that regular administration, will lead to a reduced frequency and/or severity of cervicogenic headache.
  5. Stretch: After range of motion exercises and trigger point work, it is crucial you stretch your neck to elongate the muscles out to their full length. Although stretching as a treatment is going out of style, I still find it immensely beneficial and stretching often reduces or eliminates my headache on the spot!

It probably works about the same way that stretching out a calf cramp works: you win the tug-of-war with the spasming muscle. Paul Ingraham

If you enroll in my How to Get Rid of Headache and Migraine, I know it will help you. In the course you find out everything I know about headaches and learn the actual exercises and techniques I’ve used so successfully to treat my own chronic headache pain for over two decades. These exercises have the potential to alleviate even the most chronic of headaches. Not only do I cover my top seven self-treatment techniques, but I also teach you how to rule out worrying red flags, give you several ergonomic best practices and share with you the top three researched methods for outsourcing headache treatment.

If you don’t enroll, the Cervicogenic Headache Protocol above will be an excellent place to begin.

Resources:

  1. https://pdfs.semanticscholar.org/6b12/e55353802b0802526da5c55ec153cd95a657.pdf%20art
  2. https://clinicalgate.com/cervicogenic-headache/
  3. https://pdfs.semanticscholar.org/fa07/dac287ce63485bbf4c1b5c7fad5da3d2e458.pdf

Infinite Moon Everpillow Review

Simplicity is the word that comes to mind. Infinite Moon has kept things simple with the Everpillow. There is a regular shaped pillow (The Original) for back sleepers and a curved pillow (The Curve) for side sleepers.

The Everpillow by Infinite Moon is yet another option of comfortable pillows available online. In my never-ending search for the perfect night’s sleep, one of my posture pupils brought this pillow to my attention.

Sleeping is a competitive market. There are ergonomic pillows, organic pillows, memory foam pillows, thin pillows, fat pillows, extra firm, extra soft, down-filled, goose-filled, and even pillows filled with cooling gel. With so much choice in the sleeping marketplace, it’s getting harder to be different. Infinite Moon doesn’t just make different pillows. They make a difference too.

Everpillow is more than just a comfortable pillow. When you purchase an Everpillow, you become part of a pretty cool story. More on that later…

Overview of the EverPillow


Simplicity is the word that comes to mind. Infinite Moon has kept things simple with the Everpillow. There is a regular shaped pillow (The Original) for back sleepers and a curved pillow (The Curve) for side sleepers. Notice there isn’t one for stomach sleeping, because as any good posture doctor will tell you, you should avoid stomach sleeping!

You have three options for the pillow fill you get. 100% natural latex, Kapok silk from the Java Cotton Tree – which is meant to be particularly good at resisting moisture and mites – or a combination of the two, allowing you to customize what kind of pillow you get. Nice!


Infinite Moon is a Movement


Infinite Moon’s business model is part of a movement called Emergent.

Emergent is a movement of people and businesses dedicated to transforming business and society. Over the last 15 years, our shared mission and 20/20/60 model has transformed local communities through more than 2 million dollars of charitable giveback.

The idea is that 20% goes to charity, 20% is re-invested, and 60% is profit for the company. I already loved this company before my pillow even arrived as one with a high level of ideals.

Infinite Moon Philosophy


If you like to choose the companies you buy from based on their philanthropic endeavors or impact on the world, then this might sway your pillow-buying decision. Infinite Moon has paired with a Denver-based company that helps transition people at risk back into the workforce. This includes people with addictions formerly incarcerated or homeless.


Everpillow is Natural


These days I’m a little cautious when I read 100% natural. Even the label no sugar added sadly, does not mean free from sugar. It just means they haven’t added any more sugar to the original recipe ingredients. Everpillow fill comes in 100% natural latex or Kapok silk. There are synthetic latex varieties, but natural latex comes from rubber trees. Kapuk silk comes from the Java Cotton Tree of Central and South America. I love the idea of sleeping on silk!

Kapok Tree silk

While I really like the EverPillow, there are 2 small things I would change or add. I’d like to see each pillow come with a slipcover. Although the pillow I ordered has a lovely organic cotton cover that feels like heaven, it is still the only barrier from drooling mouth to pillow fill. I usually buy my own slipcovers for all of my pillows, but I think it would be a really nice added feature to include one in the purchase.

The second thing I’d change is the shape of the curved pillow. I ordered The Original without the cut-out for the shoulder. I am a side sleeper, but I wouldn’t say I like the idea of a semi-rigid seam, but I didn’t test this model, to be fair. I’m not too fond of the aesthetics of funny-shaped pillows. I like symmetry – hence my affinity for good postural alignment. I like to make up my beds with nice sheets and pillowcases. A c-shaped pillow looks darn funny. Plus, I find The Original is nicely pliable. It easily forms into my shoulder—no need for a curve.

My Infinite Moon EverPillow Recommendation


I was pleasantly surprised with the EverPillow. I normally get contacted by companies who want me to test their ergonomic products. This was one of the first companies I actually contacted. I wasn’t sure what to expect, and in fact, the pillow stayed boxed for several weeks before I even opened it. Unboxing the pillow and customizing the fill levels to make my sleeping posture and alignment as close to ideal as possible was a very intuitive and enjoyable experience.

Everpillow is a quality product that is accurately priced. I like that they’ve made a real effort to be different and give back financially and directly to their local community. Oh, and I’m in love with Kapok silk; from the very moment, my hand dove deep into my silky pillow fill… heavenly!

Shop Infinite Moon

5 Easy Ways to Boost Body Confidence

The way we talk, sit, and stand carries a lot of meaning. Our unconscious gestures and body posture convey thoughts and feelings even more than the words that we speak. When confronted with conflicting signals (e.g. we speak confidently but our shoulders round and we slouch), others may rely on our non-verbal cues.

What do people see when you walk into a room? Hopefully, they see a confident, successful, happy individual. But if we’re not careful, what we communicate through our body posture, may not be the image we wish to convey.

Our body movements, gestures, alignment (posture), eye contact, skin flushing, breathing, and even perspiration all add to the words that we speak. When I was younger, I blushed easily, and it intensified when people commented on my flushed cheeks. I still blush as an adult, but now I can laugh it off without feeling horribly embarrassed.

The way we talk, sit, and stand carries a lot of meaning. Our unconscious gestures and body posture convey thoughts and feelings even more than the words that we speak. When confronted with conflicting signals (e.g., we speak confidently but our shoulders round and we slouch), others may rely on our non-verbal cues.

Check for inconsistencies. Our gestures should be consistent with what we are saying. For example, if a person speaks as if she is confident but fidgets with her hands when she communicates, she conveys conflicting signals. Unfortunately, the overarching message will usually default to our body language.

Be observant but don’t overanalyze every single gesture. Avoiding eye contact, for example, does not have to mean that a person is lying, insincere or nervous. It is possible someone may look away to recall better or narrate things when not looking directly at you. Trust what your instincts are saying about someone’s non-verbal communication. If you sense that a person is nervous or insincere, you are probably right.

Communication is the foundation of any successful relationship, whether it is personal or professional. If you want to communicate body confidence, power, and authority, practice these 5 communication cues:

1. Maintain assertive body posture.

The key to coming off poised and confident is in the way we hold ourselves. Forward head posture, neck hump, round shoulders and slouching, look less attractive to an observer than an upright, symmetrically aligned body. To stand confidently, stand with your feet approximately four to six inches apart. Distribute your weight equally on both legs, avoid swaying, stand long and tall and face the person/s you are speaking to.

Further Resources: Forward Head Posture – Cause and Cure

When was the last time you met a confident person who slouches? Exactly! When we sit or stand with expansive power postures, we boost our testosterone levels, and testosterone is associated with success and the winner effect.

2. Watch your hands

Placing your hands on your hips is a posture many people use, but this can give off an air of arrogance or impatience, just as crossing your arms can. If you tend to play with your hair, touch your lips, or jiggle coins in your pocket when you’re with a group of people, remember that our body gestures communicate more than the words we say.

3. Don’t cross your legs

Not only is crossing your legs bad for your circulation because it increases the pressure on your veins, but it also makes you take up less space and can look less confident. Don’t spread your legs to China – I recently suggested that a friend of mine sit beside me on the Go Train – and equally, don’t wrap yourself up into a corkscrew either. Imagine what this is doing to your pelvic posture. Yikes!

4. Pay attention to your face

Do you know what your face looks like when you are looking at, listening to, or talking to other people? Some people’s standard facial expressions can be stern, grumpy, angry, and sometimes nice and smiley. I love those people who look like they are smiling, even when they are not.

Mike Budenholzer, coach of the Milwaukee Bucks

This was Mike Budenholzer’s expression through the entire game against the Toronto Raptors this week. Fair enough, the Buck’s did lose (go Raptors!), but even when the Bucks were well ahead, this was his typical appearance. Hilarious! Kind of.

If you have a rather severe standard facial expression, people may avoid you, think you are mad at them, or get defensive around you. These are not good outcomes if you want to connect with people.

What can you do? Please pay attention to the comments your friends and colleagues make when you’re listening to them. Do people often think you’re upset because of your furrowed brow? Do strangers tell you to smile or cheer up? If this is the case, practice smiling in front of your bathroom mirror. And by the way, practicing this will probably make you smile for real. Apparently, it also helps – when listening to others – to keep your lips slightly parted, so you are less likely to interrupt. Try it!

5. Make eye contact

Confident, assertive people can hold a gaze. Too much eye contact may feel intrusive, rude, and dominant. We need to strike a balance. You know that feeling when you are at a business event and speaking to someone who is scanning the room for someone better? It doesn’t feel very good. Don’t be that person! Learn to listen with your eyes. People instinctively like people who listen to them.

The way we hold ourselves is often a reflection of how we feel about ourselves, so being more self-aware and maintaining good body posture (it helps when we practice daily posturecise) improves our confidence. Not only do we look more attractive with upright, symmetrical posture, but studies on posture are beginning to show us that our brains are actually more capable of positivity when the body is in an upright stance.

Leg Length Difference: Clinical Significance | Posture Doctor

My right leg is 9mm shorter than my left. This is called leg length inequality; also known as leg length deficiency, leg length insufficiency, or short leg. This was diagnosed reliably from x-ray, whilst I attended Chiropractic University over two decades ago.

X-Ray is the only reliable means for measuring leg lengh inequality. As a result of my short leg, I have an associated lumbar scoliosis and a history of disc degeneration in this region of my spine. Ugh!

Personally, and clinically – after years treating patients with leg length inequality, having regular manual adjustments and wearing a heel lift – I believe my chronic back pain was largely associated and caused by my leg length asymmetry. The medical research however, may contradict my self-diagnosis.

Leg lengh inequality


Prior to the 1970s, the data on leg-length inequality (LLI) was found to be unreliable in terms of accuracy of leg length measurement from x-ray.

A review by Gary Knutson – published in 2005 in Chiropractic and Osteopathy, used LLI data from 1970-2005. All the studies reviewed were selected because they used accurate radiological methods to determine anatomic LLI. Those that failed to used accurate radiological methods were excluded from his review.

Leg-length inequality (LLI) is a topic that has been examined extensively in the research. Several questions have remained largely unanswered regarding leg-length inequality and include: how common is LLI, what is the average amount of LLI, what are the effects of LLI? The purpose of Knutson’s review was to highlight current research to answer these questions.

Prevalence of leg-length inequality


Several studies using precise radiographic method data, were combined giving a subject size of 573, with a LLI range of 0–20 mm. The mean or average LLI was 5.21 mm. What’s interesting is that most Chiropractors who treat LLI, start using heel lifts at 5mm. It seems, the science backs this up.


It seems a much higher percentage of the population has LLI closer to 5 mm.

Four of the studies reviewed by Knutson measured subjects by gender and no difference between male and female was found, suggesting that gender plays little role in the amount of LLI.


The data also demonstrates no preference for left or right leg, which fascinates me. Many musculoskeletal diagnoses have a one-sided inclincation. Thoracic scoliosis to the right makes up 85-90% of all adolescent scoliosis; stroke more frequently affects the left-side of the brain and 90% of the world’s population is right-handed!

Seven of the Knutson’s studies identified subjects that had LLI as being symptomatic (subjects = 347) or asymptomatic (subjects = 165). Symptoms included knee and hip problems and low back pain (mostly within the last 12 months).

What I find amazing, is that there is no statistical difference between these two groups; suggesting that the average LLI is not correlated to symptomatic problems, like low back pain.


Note: There will always be individual exceptions. Just because research fails to show a correlation between leg length inequality and back pain, does not mean a relationship doesn’t exist.


Effects of LLI


The most common effect of anatomic LLI is rotation (twist) of the pelvis – often referred to as pelvic torsion. Knutson explains that in the standing position, the weight of the body in the pelvis (on the short leg side) induces a downward force towards the feet. With asymmetry of the leg-lengths, the pelvis, being pushed down on the femoral head (hip), must then rotate or torsion.

So if you have a left short leg, it is likely that your pelvis drops down to the left and twists right, or away from the short leg side. This is how we measure it on x-ray:

Here you can see a very clear LLI on the left side. The result is a downward force toward the left femoral head of the hip, with a right torsion or twist through the pelvis. This would mean that your pubic bone (green dot) would be visualised to the right of your gluteal fold (white dotted line) on x-ray.

The amount of pelvic torsion from this left LLI is measured by the distance between pubic symphysis joint and gluteal fold; illustrated by the green arrow.

Further Resources: Scoliosis Exercises You Can Do From Home

With larger amounts of leg-length inequality (greater than 22mm), subjects in this study developed flexion of the knee on the long leg side. This is the body’s clever way of attempting to level up the pelvis.

Other effects of LLI and pelvic torsion demonstrated in the research literature, include postural scoliosis, wedging of the 5th lumbar vertebra and bone traction spurs (osteoarthritis).



Clinical significance


Knutson’s research attempted to quantify what ranges of LLI are clinically significant, that is, associated with back pain, injury, muscle strength asymmetry or other physiologic changes.

Chronic low back pain and LLI

Chronic low back pain affects about 21% of the population. One would expect this percentage to be higher if LLI caused low back pain, given that 50% of the population has LLI of 5.2 mm or more.

As you can see, the correlation between LLI and chronic low back pain really becomes demonstrable when LLI is above 15 mm.

In this study Dr Oro Friberg notes that relatively small amounts of LLI may only be clinically significant relative to certain conditions such as prolonged standing or gait, such as with daily work, marathon runners, military training and sporting activities.

In this study Gofton and Trueman found a strong association between LLI and osteoarthritis (OA) on the side of the anatomically longer leg. I often explain it to my students in this way: The longer leg hip joint gets impacted with increased load, as forces are pushing upwar; much as forces are pushing downward (with gravity) on the short leg side.

In their study, few subjects were aware of any difference in leg length. The authors acknowledge that many with LLI fail to develop this condition, suggesting that other factors may also be important.

LLI conclusion


In summary, childhood-onset leg-length inequality appears to have little clinical significance up to 20 mm. Past the ~ 20 mm point, structural changes may cause compensatory muscular contractions.

The purpose of Knutson’s paper was to review the research regarding leg-length inequality; prevalence, mean magnitude or size, effects and clinical significance.

The prevalence of leg length inequality seems almost universal and was found to be ninety per cent of the population. The average magnitude of LLI was small and found to be 5.2 mm. Based on the research reviewed, small childhood-onset LLI under 20mm (under normal situations) does not seem to be clinically significant.

It seems the body is well able to compensate for minor LLI of up to 2cm. However, as a Posture Doctor who has spent years treating 100’s of people with LLI (including myself), I feel much more research is needed to convince me.

Until such a time, I will continue to help those of you with LLI and your associated postural distortions; to bring your pelvis back towards a neutral orientation, and to decrease active muscular compensations, through use of heel lifts, effective exercise programs and manual treatment.

Important Test For Brain Health – One Leg Balance | Posture Doctor

An important test for brain health is the ability to balance on one leg. Researchers found that the inability to balance on one leg for longer than 20 seconds was associated with vascular disease in the brain, specifically small areas of tissue death (mini strokes) without symptoms.

I made a new friend recently. She, like me, is 50 (something) and a bit of a tomboy, in that she has been active and sporty all her life. Then just over a year ago, she had a car accident and four days later when trying to answer a question at work, nothing came out of her mouth. She just couldn’t find the words. Moments later, she said to her colleague: I think I’ve hurt my brain.

There is a lot of current online buzz about brain health. Listening to CBC Radio this morning they were talking about particulate matter – from city pollution – and the cognitive impact.

Then I happened upon this study that found that an important test for brain health is the ability to balance on one leg. Yasuharu Tabara, Ph.D., and lead study author and associate professor at the Center for Genomic Medicine says that:

Individuals showing poor balance on one leg should receive increased attention, as this may indicate an increased risk for brain disease and cognitive decline.

The study consisted of 841 women and 546 men, with average age of 67. To measure one-leg standing time, participants stood with their eyes open and raised one leg. They  performed the leg raise twice and the better of the two times was used in the study analysis. Small blood vessel disease of the brain was evaluated using magnetic resonance imaging.

The researchers found that the inability to balance on one leg for longer than 20 seconds was associated with vascular disease in the brain, specifically small areas of tissue death (mini strokes) without symptoms. They noted that:

  • 34.5 % of those with more than two lesions (infarctions) had trouble balancing.
  • 16 % of those with one lesion had trouble balancing.
  • 30 % of those with more than two micro bleeds had trouble balancing.
  • 15.3 % of those with one micro bleed had trouble balancing.

“One-leg standing time is a simple measure of postural instability and might be a consequence of the presence of brain abnormalities,” said Tabara.

Although this study is not saying that poor balance causes brain disease and/or cognitive decline, the inability to balance for at least 20 seconds, may suggest brain abnormalities. So poor balance suggests poor brain health, but can improving balance improve our brain health as we age? Now that’s a great research question!

Personally, I like to err on the side of caution with my own health. I’m not comfortable with pill popping and I’m definitely not waiting for signs of aging (other than my quickly greying hair and ever-creasing skin argh). I’ve incorporated balance exercises into my daily posture routine.

Get the balance right


Balance shouldn’t be a concern just for the elderly who are more prone to falls (and the serious complications those falls can cause). Balance training is important for anyone who wants to age well, avoid falls, improve athletic ability, coordination, stamina and overall fitness and health.

If you haven’t thought much about maintaining, or improving your balance, now is a good time to start.

In order to have good balance, we rely on the information given to our brain from three main body systems: our ears, the nerve endings in our muscles, and our eyes (vision).

As children, we develop balance climbing trees (where I spent many hours climbing up, up, up to collect long forgotten bird nests), riding our bikes, walking and running on uneven surfaces and playing sport and games. As adults, we seldom think about balance and rarely practice it.

When was the last time you climbed a jungle gym with your kids, walked along the slim surface of a forest log or tried to balance on one leg whilst brushing your teeth with the opposite hand (I love this one)?

The eyes have it


Your sense of vision is a big part of good balance. Vision works hand in hand with the inner ear to maintain balance. If you move your eyes or take vision out of the equation altogether, it’s harder to balance. You might be surprised how challenging it is to simply stand with your eyes closed. We play around a lot with removing vision during some of the more advanced balance exercises in our posture school.

Better balance means better coordination, POSTURE, core strength, agility and athletic skill. You even burn calories using balance training!

Balance training is good for people of every age, so don’t be afraid to start incorporating balance exercises into your daily workouts. Everyone can benefit from balance training and even better if our ability to balance keeps our brains young, sharp and disease-free!

Try walking off-piste


5 Powerful Strategies to Get You Unstuck | Posture Doctor

Change stimulates our brain. You can start small by changing one daily routine, brushing your teeth with the opposite hand, or doing ten shoulder rolls in the shower each morning. It really doesn’t need to be monumental – it just has to be different.

So this is a little embarrassing to admit … Saturday night I went speed dating! Eek, there I said it.

Actually, it was pretty fun. I’m an up-for-adventure kind of gal, so why not right?!

When you read to the end of this post, you will see why DOING SOMETHING DIFFERENT – and why there are some things we should just NEVER SAY on a date – relates to your posture and health.

I arrived at 5.20pm and actually found a parking spot in Toronto. Luck was on my side!



My speed dating event included a free cocktail, so as you can imagine, I immediately went to the bar for a little Dutch courage – a glass of bubby helped.

I had twelve dates – each lasted five minutes. I had prepared some stock questions in case of awkward silences:

  • What did you do this morning?
  • What was a favorite childhood past-time?
  • Canoe trip, Vegas or Mexico? Bet you can guess my answer.

I didn’t rely on my fixed questions; most of the conversations seemed to flow easily.

MOSTLY!

For any of you planning to try speed dating, definitely do NOT say this:

So tell me everything about you. (We only had 5 minutes)

Or this:

I don’t like being touched – eek, I was trying hard not to giggle at this point.

If you’ve ever speed dated, you know that at the end, if you put a tick in the YES box and they also tick YES, then you’ve got a match. I had one of those! But hey, some things are a little too private to share (wink).

Here it is – this is why DOING SOMETHING DIFFERENT might help get you unstuck. I’ve been single for a few years now. I’ve dated online, had friends intro me, and waited for the magical moment that perfect person walks into my life. Ah ya, hasn’t happened. So I did something different!

Where are you stuck?


Maybe you want to quit your job, move to a small town (I did this – highly recommend it), learn a new skill, or improve your posture?

I’m cheating because of course I know that you want to correct your posture, or you wouldn’t be reading this.

What have you tried?


Maybe you’ve enrolled in one of my courses? Bought my Posturecise DVD, tried a Pilates class, personal trainer, new mattress, sit-up-straight app or wearable??

What does DOING SOMETHING DIFFERENT look like for you?

Here are five things you can do, right now to empower yourself to move closer to the life you deserve:

1 Change Your Physiology


This one I borrowed from life transformation guru Tony Robbins. Tony suggests that feeling stuck and making progress are not interdependent. You can only be in one state at any given moment.

… the feeling of progress, stops when we feel stuck – and miserable – because ultimately, progress is the key to happiness.

He goes on to suggest that bad physiology reinforces negative feelings. As Tony says, “Motion creates emotion.” Changing your physiology means adjusting your body to alter your mindset. This can be something as simple as changing your posture so you are standing long and tall, doing something funny with your body like wiggling your bottom for 20 seconds, or something more intense like going for a jog.

2 Ridiculously Small Changes


Change stimulates your brain. You can start small by changing one daily routine, brushing your teeth with the opposite hand, or doing ten shoulder rolls in the shower each morning. It really doesn’t need to be monumental – it just has to be different. After a while, an accumulation of small changes (doing something different) will help you accomplish your goals, and you will start feeling unstuck.

3 Buy a Fancy New Journal


I can’t remember when it was that I fell in love with design and writing, but a pretty journal definitely romances me into creativity. I don’t journal as such. I write down things I’m grateful for, my to-do lists for the day, or ideas that bubble up at any given moment – that happens a lot!

I use my journal as a productivity tool for work and life mostly. It allows me to coach myself through challenging situations and walk away with greater perspective and clarity.

Don’t forget to buy a writing utensil that feels good in your hand – a chubby pencil was my choice, but a lovely pen, marker, crayon all work well. I like to write over breakfast and think of the day and week ahead and what I want to accomplish.

4 Begin That Course


Over 12,000 of you have enrolled in one of my online posture courses – you rock! How many of us have enrolled in an online course but never started? An unviewed course, is a little like a lightbulb that has been burnt out in your hallway for months, and every time you walk by, it reminds you that you suck – sad face.

It’s a little bit like the clock by my front door. It often takes me 3-4 months before I get around to changing the time after spring ahead fall back. Argh, why do we do that?!

Whatever course/s you are enrolled on, go now (or today) and watch the first lecture. I promise you, you will feel so darn good and you’ll probably end up watching more than one lecture – but only aim for the first lecture – anything else is a bonus and a bigger win!

Further Resources: Posturecise Crash Course

5 Walk


This one is probably my favorite one of all. I’m a big walker. I walk and walk and walk until the worries of the world melt away. I have one Golden Rule when it comes to walking – NEVER take your phone. Never!


The answer we’re looking for is often found in the doing. It feels weird to start writing without an idea, painting without a concept or walking, just for the sake of walking. It might feel wrong to quit a job we dislike or to start a business without having the perfect plan or to take up a musical instrument, when we don’t naturally have rhythm. And yet, that’s exactly what we should do when we’re stuck:

Start doing. And start DOING SOMETHING DIFFERENT!

It doesn’t have to be right or perfect, but it will move the energy around, and lead you to new ideas, emotions, and connections you wouldn’t discover if you waited for inspiration to come and find you.

X-Ray or MRI to Assess Posture?|Posture Doctor

An MRI machine is really just a gigantic magnetic that provides 3D images – it’s like been placed in the middle of a massive donut.

In this 3-part mini-series, we’re going to discuss X-Ray vs. MRI imaging. In Part 1 we’ll briefly talk about how each of these modalities works and whether or not they emit harmful radiation.

In Part 2 we’ll look at which one is the better choice for analyzing your posture, and finally in Part 3 we’ll look at some real examples of neck and low back X-Rays and MRIs and compare the two.

Part 1 – How do they work?


Lets start with MRI – Magnetic Resonance Imaging. An MRI machine is really just a gigantic magnetic that provides 3D images – it’s like been placed in the middle of a massive donut.

You don’t really need to know how it works, but I happen to think it’s fascinating. 

So humans are made of water and water is made of hydrogen and oxygen. Hydrogen has a positive charge because if you recall from highschool chemistry, it has one proton.

When the body is placed in a strong magnetic field, such as an MRI scanner, the protons in each hydrogen atom line up along the same axis. When the magnetic field is then turned off after say 20 minutes, the protons flip back again and this causes a signal; and this signal is used to create the image.

Because an MRI uses magnets, or magnetic radiation, it isn’t considered harmful to your body.

X-Rays work differently; they also use energy but not from a magnet. The beam of energy from an x-ray, comes into contact with your body, and is absorbed in different amounts by different tissues, depending on the tissue density.

An x-ray beam passes straight through softer tissues and looks black on film, but gets absorbed by denser materials like bone and these structures look white on film.

Xray imaging is ionizing radiation. In other words it delivers much more energy into the body than an MRI. This high frequency energy causes atoms or molecules to gain or lose electrons. This can damage a cell. Damaged cells divide and create more damaged cells. That’s why we don’t x-ray pregnant women; because there is a lot of cell division happening there.

Before we freak out about having an x-ray. Let’s put this into perspective. There are many items we use daily that emit low dose radiation. Sunlight, cell phones, tablets, computers, wifi routers, microwaves, cigarettes, television and fertilizers. It’s the cumulative effect of yearly radiation that’s important here.

In Canada, the Nuclear Safety Commission sets a limit of 50 mSv of maximum allowable radiation in a single year and 100 mSv over 5 years; or an average of 20 msv per year.

Perspective is what’s important here. The benefit from having a structural diagnosis of your neck (0.2 mSv) provided by x-ray far outweights the risk of radiation harm. In fact, one seven-hour flight will give you the equivalent radiation dose of two neck x-rays, according to the x-ray risk calculator.

The only reliable means for analysing the bony structure of your spine, is x-ray. Your healthcare practitioner can not, under any circumstance, diagnose your structural problems with only a physical examination; regardless how skilled there are!

It is therefore crucial to have an x-ray before the start of treatment and/or exercise programs begin. We will discuss this in much detail in Part 2 of this mini-series on X-Ray and MRI.

Further Resources: Forward Head Posture – Cause and Cure