Dupuytrens Contraction (Contracture)

Dupuytren’s contraction or contracture is a disease characterized by the deformity of the hand that develops over decades. A Dupuytren’s Contraction or Contracture affects the underlying connective tissue of the palm’s skin. It happens when tissues form knots beneath the outer layers of the skin, and over time, this would cause the formation of a thick cord responsible for pulling one or more fingers into a bent position.

Dupuytren’s contraction or contracture normally progresses slowly over several years. Sometimes it can develop over weeks or months. However, several people also experience a steady progression, while in others, it may start then stop.

Dupuytren’s contracture usually begins as a thickening and stiffening of the skin on the palm. As Dupuytren’s contracture progresses, the skin on the palm may look wrinkled or dented. A firm lump may form on the palm. This lump may be sensitive to touch but classically is not painful. In the later stages of Dupuytren’s contraction or contracture, cords of tissue form under the skin on your palm and may extend up to your fingers. As the cords constrict, the fingers may be pulled toward the palm and sometimes severely.

The ring finger and pinkie are commonly affected, though the middle finger may also be involved. The thumb and the pointer finger are rarely affected by this. Dupuytren’s contraction or contracture can occur in both hands, though one hand is frequently affected more severely than the other.

Causes of Dupuytrens Contraction or Contracture

Doctors don’t know what causes Dupuytren’s contraction or contracture. Some specialists have speculated that it may be connected with an autoimmune reaction, where an individual’s immune system attacks its own body tissues. Dupuytren’s contraction or contracture often go together with conditions that cause contractures in other parts of the body, such as the feet, which is the Ledderhose disease, and the penis which is Peyronie’s disease.

Risk factors of Dupuytrens Contraction or Contracture:

The following are the factors that cause a higher probability of an incidence in Dupuytrens contracture.

First of all, there is age. This commonly afflicts those of ages 50 and over. Then there is gender. Men are more susceptible to develop Dupuytren’s, and contractures in men are bound to be more severe than in women. Also, there is a particular ancestry that it commonly afflicts. The Northern European descent is at a higher risk of this disease as compared to any other race. Dupuytren’s is genetic, and a high probability of occurrence is existent, especially when Dupuytrens Contraction or Contracture is a heredo-familial disease. Smoking and alcoholism also increase the risk. Lastly, many people diagnosed with Diabetes have also reported increased susceptibility to Dupuytrens Contraction or contracture.

Complications of Dupuytrens Contraction or Contracture

Dupuytren’s Contraction or contracture can make the performance of certain tasks using your hand impossible. Many people, at first, do not experience much disability or inconvenience with predominantly hand-using activities such as writing. But as Dupuytren’s contracture advances, it can decrease one’s capacity to fully open the hand and make it challenging to grasp certain objects or get the hand into narrow spaces.

Preparing for an appointment for the patient with Dupuytrens Contraction or Contracture Usually, you may first ask for a referral from your family doctor to a specialist for this kind of affliction. Once you are ready to have that medical appointment, write the answers to the questions below to help the specialist diagnose and determine the appropriate treatment for your condition.

When did the symptoms arise? Have they been getting bigger or worse? Does something improve or worsen it? How does the contracture impede your activities of daily living?

During the physical exam, the doctor will have a visual inspection of the hands, relate them to each other, and inspect for any crumpling or puckering on the palms. The doctor will also palpate the different hands and fingers’ different regions to check for hardened lumps, knots, or bands of tissue.

Tests and diagnosis

The only diagnostic procedure employed to check Dupuytrens Contraction or contracture is composed of a simple maneuver, called the tabletop test, which can determine if a person has contracture in the hand. If a patient can lay their hand, palm down, and flat on a tabletop, the patient is then free from a contracture. Mostly though, doctors can diagnose Dupuytren’s contracture by simply visual inspection and palpation of hands.

Treatments and drugs

If the disease advances sluggishly, causes no pain, and especially if it has little to no impact on the ability to use hands for everyday tasks, you may not need any drastic treatment. With this, you may choose to wait and check if the Dupuytrens Contraction or contracture progresses, or you may have radiation therapy which is the most advisable for the early stages of this disease.

Treatment includes eliminating or breaking apart the cords that are pulling the fingers in the direction of your palm. This can be done in several different ways. The choice of technique depends on the severity of the symptoms and any other health complications a patient may have.

Needling is a method that uses a needle that is inserted through the skin to puncture and break the hardened cord of tissue that’s contracting a finger or fingers. Contractures can recur; however, the procedure can be repeated if necessary. Some specialists now use ultrasound to guide the needle. This advancement can really reduce the risk of unintentional injury to the surrounding nerves or tendons of the contracture site. The greatest advantage of the needling technique is that there is no incision, and it can be done on multiple fingers at just one time. Afterward, usually, very minimal physical therapy is needed. The disadvantage of this procedure is that it cannot be employed in some locations due to the risk of damaging a nerve.

The Food and Drug Administration also approves enzyme injections as a treatment for Dupuytren’s Contraction or contracture. The injections contain an enzyme, collagenase clostridium histolyticum (Xiaflex), which is geared for treating Dupuytren’s contracture. The enzyme in this medication relaxes and deteriorates the rigid cord in the palm of an afflicted hand. A day after the administered injection, the doctor will manipulate the hand to break off the cord and straighten the fingers. In many ways, this is similar to the needling technique except that the manipulation of the hand happens the following day instead of the same day for the injection procedure. They have the same advantages and disadvantages as the Needling technique.

Another option is to surgically get rid of the tissue in the palm which is affected by the disease. This may be in the early stages of the disease as the tissues cannot easily be identified. It may not be a preferred method for patients due to it being invasive, but it can prove very effective for patient recovery.

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


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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.

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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!

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.


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


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


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


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.


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.


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

Solutions For One Leg Longer Than The Other

I have one leg longer than the other. 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 an x-ray while I attended Chiropractic University over two decades ago.

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

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

Leg Length Inequality

Before the 1970s, leg-length inequality (LLI) data was unreliable in 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 use accurate radiological methods were excluded from his review.

Leg-length inequality (LLI) is a topic that has been examined extensively. However, several questions have mainly remained 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 an 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 that science backs this decision 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. No difference between males and females was found, suggesting that gender plays little role in LLI.

The data also demonstrates no preference for the left or right leg, which fascinates me. Many musculoskeletal diagnoses have a one-sided inclination. For example, 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 Knutson’s studies identified subjects with LLI as symptomatic (subjects = 347) or asymptomatic (subjects = 165). Symptoms included knee and hip problems and low back pain (mainly within the last 12 months).

I find it amazing 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 the body’s weight in the pelvis (on the short leg side) induces a downward force towards the feet in the standing position. With asymmetry of the leg-lengths, the pelvis, being pushed down on the femoral head (hip), must 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 twists through the pelvis. This would mean that your pubic bone (green dot) would be visualized 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 the pubic symphysis joint and the gluteal fold, illustrated by the green arrow.

With more significant amounts of leg-length inequality (greater than 22mm), subjects in this study developed knee flexion 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, 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 an LLI of 5.2 mm or more.

As you can see, the correlation between LLI and chronic low back pain 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 conditions such as prolonged standing or gait, such as 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 more extended leg hip joint gets impacted with increased load, as forces are pushing upwards, 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. However, 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. However, 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 seemed almost universal and was ninety percent of the population. However, 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 typical situations) does not seem 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 that 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 decrease active muscular compensations through heel lifts, effective exercise programs, and manual treatment.

Further Resources: Scoliosis Exercises You Can Do From Home


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

Why Women Have an Increased Rate of Low Back Pain | Posture Doctor

What was most interesting was that for men low back pain was associated with older age, low education (I’m guessing this suggests the likelihood of more physically demanding jobs), high blood pressure and smoking; but for women if was occupational and ergonomic factors.

Recently I came across this study about the factors that affect low back pain in men and women. This was a fairly large study of 600 participants. They looked at the prevalence of low back pain over a one week period. The men’s prevalence of low back pain was 40% and for women, a shocking 60%!

Low back pain occurs in about 60–80% of people at some point in their lives. Menstrual cycle fluctuations can influence pain sensitivity and may help to explain the sex difference. Further explanation may include, biologic response to pregnancy and childbearing, and perimenopausal abdominal weight gain.

Postmenopausal women also show accelerated spinal disc degeneration due to relative estrogen deficiency. While overall females have higher prevalence of low back pain (LBP) across all age groups, LBP prevalence further increases after menopause. Cue the violins for us over 50s.

What was most interesting was that for men low back pain was associated with older age, low education (I’m guessing this suggests the likelihood of more physically demanding jobs), high blood pressure and smoking; but for women if was occupational and ergonomic factors. Even more interesting is that those occupational hazards were standing posture leaning forward and sitting posture leaning forward.


These postures can be described as stooping and perching. They cause forward flexion of the spinal column; and flexion increases compressive forces, that can cause inflammation of spinal joints (facet joints) and disc degeneration and pain.

Even more interesting was this study on the effect of regular posture exercise in improving skeletal pain. The studied concluded that, shoulder pain, mid back pain, and low back pain were relieved with a posture correction exercise program performed for 20 minutes, 3 times a week for 8 weeks.

The reason why a regular posture habit reduces skeletal pain, is that correct posture minimizes the strain on the human body by maintaining balance of the muscles and skeletal alignment. Correct posture implies not inclining the body forward (stooping) backward, left, or right.

Further Resources: Posturecise – How to Create a Healthy Posture Habit

Posture School

If you’re interested in our posture community it’s probably because you look at your health differently. You’re different from most people and you want take control of your own health. You’re different from most people, because you are willing and motivated to take action. However, even though you are more action oriented (I know this because you are still reading), you may still suffer the same challenges as your common variety slouch potato.

My job is to support you before your posture becomes a chronic problem.

The symptoms

Here’s a summary of why you find it challenging to correct your posture:

Doing it wrong

We often jump in great guns with new posture exercises, not knowing if we’re even doing the exercises correctly.


Awareness seems to be a big problem. It’s not so hard to do the posture exercise, but 5 minutes later, we are slouching again.

Pain sucks

Sometimes trying to correct our posture is painful, which isn’t exactly encouraging.

Habit formation

It’s fine doing an exercise here and there, but putting exercises together into a daily practice seems challenging, to say the least.

Further Reading: The Neurology of Habits

Going it alone

There’s a lot of pressure on us to do it all and we find ourselves alone when we need others the most.

It’s OK not to be OK

We need to be OK with opening up and sharing our doubts and struggles. Poor posture affects self esteem and confidence, and this is a universal problem.

The cure

Invest in your well-being

We should hold ourselves accountable for investing in our well-being and development. We should set time and money aside to spend on wellness or self-care.

Remember the mind-body connection

We need to watch what we eat and consider activities such as Posturecise, meditation (even just 1 minute a day), and walking outdoors to help boost our mood, sharpen our focus and enhance our emotional resilience.

Enjoy micro wins

You know that course you are enrolled on at Posture School but haven’t yet started? Set aside 20 minutes and begin watching your first lecture. email me and let me know you did it. Micro win … YES!

Set mini goals

Ridiculously simple wins every time. Pick a favourite posture video, re-watch it, and do the exercise daily – at exactly the same time – for 7 days straight.

Connect, connect, connect

We need to surround ourselves with a trusted support network.

The low back pain study specifically dealt with low back pain, but I found it a useful reminder, that pain is often influenced by our posture.

Did any of the symptoms mentioned above resonate with you? If so, which of the cures will you be taking on? Make sure to pick one and make it a tiny habit, as small positive changes can have huge effects over time.

Are you ready to make posture correction a daily habit?

If you believe in healthy posture in the same way you believe in getting 7-8 hours sleep each night and eating right, AND you really don’t want to live at the gym, then join our tribe. The road to good posture isn’t a quick-fix strategy; it’s a life-long journey and investment in yourself and your health; and may determine how well you age.

Still not sure yet? Feeling like something is holding you back and you don’t know whether to invest in yourself by becoming a member? Then why not watch this video to get some inspiration:

Dupuytren’s Nodules: 3 Natural Remedies – Posture Doctor

I have Dupuytren’s Disease. Your Posture Doctor’s body is far from perfect. I wanted to share my diagnosis because many of you have journeyed with me since I left private practice to take my posture tips online, full-time.

About three months ago, I discovered a small lump in the palm of my hand. Having had a similar lump in my plantar fascia a year ago, I assumed my overly tight tendons have some calcific build-up.

Dr Paula Moore’s Dupuytren’s Nodule

I’ve also got a bunion on my right big toe – maybe you’ve seen my bunion mobilization videos – and an anatomical short leg that gives me functional scoliosis. I also have a video explaining the mechanism of short-leg scoliosis.

I’ve had chronic headaches since my early 20s, and I believe the underlying structural cause was initiated by an accident I had at age 9 when I was hit in the head with a wooden baseball bat, receiving eight stitches. Fortunately, my ongoing posture work keeps them at bay.

As a result of having an anatomical short right leg with scoliosis and being crazy active in sport up until university, I eventually had a disc herniation (slipped disc) while I was in practice as a chiropractor many years ago.


When I tell you that I know what it is to have problem posture and understand the frustration that regaining attractive upright posture takes time – there is no quick-fix solution – I MEAN IT! I feel your pain.

The imperfections of my body are, in many ways, the bane of my life, and yet I know they are also my gifts. For if my body alignment and health were perfect, I most likely wouldn’t have become a Chiropractor or gone on to study the physics of posture.

It has become my absolute mission to correct my own posture, and along the way, I’m continually reminded of my student’s struggles and humbled by my own.

Dupuytren’s Disease

Dupuytren’s Disease is a disease of collagen tissue dysfunction. It is genetic. My grandfather had it. My grandfather was a supreme court judge in Canada. I am certain he was the man, the word gentleman was modeled after. In fact, we called him Grandfather as children. He even wore a dress shirt on our picnics and enjoyed smoking his pipe as we played in the sand.

Apparently, as a child, I used to hold my hands with my fingers bent, just like he were. He had Dupuytren’s contractures on both hands. I was not particularly eager to hold his hand crossing the street because his bent fingers felt funny to me.

Last night I Googled, ‘nodule in the flexor tendons of the hand,‘ and Dupuytren’s Nodule popped up. I don’t know why I hadn’t immediately clued in, but I hadn’t.

There isn’t a lot known about Dupuytren’s Disease. The treatment options are minimal and invasive:

Treating the symptoms or cause?

Just like posture, you can treat the symptoms (forward head posture, for example, with a chin tuck) or the cause (the structural alignment in the neck – after x-ray diagnosis).

Oddly, Dupuytren’s Disease doesn’t really worry me. Do I need my hands?! Obviously, yes, I’m extremely active and write a lot. I could have an injection and watch the early sign (nodule) perhaps disappear. I know, however, that this approach fails to address the cause of Dupuytren’s. The problem is collagen. I am very interested in the WHY. Why is my collagen running amok?


Do you want to use a quick-fix youtube video exercise? I have plenty of those posture videos for you online. Or, do you want to address the underlying cause of your posture issues, and jump on board for the long run, and correct your posture for good?

Magnesium and Dupuytren’s Disease

I did some more research. This time I Googled, ‘Dupuytrens Nodules nutrition.’ I found Magnesium and Dupuytren’s Disease.

The article explained that my mother was a gene carrier for Dupuytren’s (thanks, mum), but more interesting to me was that some people had responded to topical Magnesium treatment. However, I realize that topical is still a symptom-based approach. I read on …

How does magnesium help?

The article explains that in Dupuytren’s Disease, collagen cells shrink or contract and that calcium is needed to allow this to happen.


The cell’s pulling mechanism requires calcium. In theory, magnesium might block the cells from pulling on the tissues by reducing the effect of calcium … magnesium might make the cells relax and allow a finger to loosen.

My next step …

Get magnesium levels tested! I’m going for a lab test tomorrow. The author goes on to explain:


Laser for Dupuytren’s Disease?

The next thought that I had was recalling my mother’s success with laser for her Plantar Fasciitis. I next Googled, ‘laser for Dupuytren’s.’ This is what I found:

A Toronto Chiropractor had some success using Low-level laser therapy and Graston Technique. The theory goes that laser stimulates tissue repair and promotes proper soft tissue alignment as it heals. This is controversial, but it’s got to be better than cortisone injections, which can degrade and further damage tissues over time.

Pairing the physical tissue breakdown of laser with the myofascial release used in the Graston Technique makes sense to me!

What is Graston Technique?

Graston Technique is a patented form of manual therapy that uses stainless steel tools to perform tissue mobilizations. It is a kind of soft tissue mobilization used mainly by manual practitioners – Chiropractors, Osteopaths, Physical Therapists, etc.

What am I going to do about my Dupuytren’s Disease?

I’m going to take action. Many of you, reading this post, have followed me for several years – Read my posts, watching my videos, and maybe even tried some of my exercises. But how many of you have committed fully to your posture correction and long-term health?

Enroll International Dupuytren’s Data Bank

What is the difference between those of us who dabble and those who really create change in our lives?

It’s simple, but it’s not necessarily easy …


Dupuytren’s Disease action plan

Done! Do I feel worried about my Dupuytren’s? Not really. Taking action gives me freedom from worry. When I am proactive about my health, I know I am doing everything I can to have the best healthy future possible.

Paula’s Dupuytren’s Nodule

I want to be skiing at 80, not checking into a nursing home.

What about you? Are you a victim of your circumstance or the doctor of your destiny … I hope the latter.

Further Resources: Posturecise (Level 1) – How to create a healthy posture habit for life

Foot Pain: Causes, Symptoms and Exercises – Posture Doctor

When the fascia fails to offer the appropriate shock absorption, too much pressure on your feet can damage or tear the ligaments; the fascia becomes inflamed, and the inflammation causes pain and stiffness.

What is plantar fasciitis?

Plantar fasciitis means pain in the bottom of the heel. Plantar is the sole of the foot; Fascia is the tissue; and itis is Greek for inflammation. For example, colitis is literally colon inflammation.

The plantar fascia is a thick ligament (ligaments attach bone to bone) that connects your heel to the front of your foot. It supports the arch of your foot and helps you walk.

What are the symptoms of plantar fasciitis?

The major complaint of those with plantar fasciitis is pain on the bottom of the foot near the heel. It usually affects just one foot, but it can affect both feet. Some people describe the pain as dull, while others experience a sharp stabbing pain.

The pain is usually worse in the morning when you take your first few steps, although it can also be triggered by long periods of standing or rising after a period of sitting. Climbing stairs may also be difficult due to heel stiffness. The pain is usually worse after exercise, not during.

Who gets it?

Plantar fasciitis a very common orthopedic complaint. Your plantar ligaments experience a lot of compression in your daily life. These ligaments act as shock absorbers, supporting the arch of the foot, unless the mechanics of your feet are altered in some way.

When the fascia fails to offer the appropriate shock absorption, too much pressure on your feet can damage or tear the ligaments; the fascia becomes inflamed, and the inflammation causes pain and stiffness.

You’re at a greater risk of developing plantar fasciitis if you are:

  • Weight – being overweight increases the pressure on your ligaments – especially if you have sudden weight gain, for example, during pregnancy.
  • Types of exercise – Activities that place a lot of stress on your heel and attached fascia. Long-distance road runners – off road runners are at less risk – jumping sports and ballet dancing for example.
  • Occupation – a job that requires being on your feet most of the day, such as working in a factory or a restaurant, and even teachers.
  • Foot mechanics – Having very high arches, flat feet or tight Achilles tendons.
  • Shoewear – Sudden change to your usual shoewear.

Active men and women between the ages of 40 and 70 are at highest risk, and it is also slightly more common in women.

What helps?

Home treatment:

Initial home treatment includes staying off your feet and applying ice for 15 to 20 minutes, three or four times per day to reduce inflammation. Using generic arch supports in your shoes (bought at most drug stores) and doing some soft tissue work and stretching exercises may also help to relieve pain.

Soft tissue work:

Soft tissue work may help to break up sticky tissue adhesions and stimulate healing. Use ice after each session.


Picking up a towel: Sit on a chair and put one foot on a towel. Now grip the towel with your toes and try to pick it up. Hold it for 10 seconds. Repeat five times.

Time required: approx. 2 minutes

Ball massage: Roll a tennis ball quite firmly back and forth over the sole of your foot. Treat the whole sole of your foot from forefoot to heel. Ouch – heads up, this is painful!

Time required: approx. 3 minutes

Achilles stretch: Find a sloping driveway or hill. Look for an angle approximately 45 degrees. This stretch is often shown on stairs, but I prefer to support the heel. If you have a carpenter in the family, have them DIY a stretch block for you.

Time required: 3 minutes

In-clinic treatment

You may benefit from seeing a podiatrist who specializes in custom-made orthotics. They can also recommend appropriate shoewear and exercises.

Your doctor or healthcare practitioner may also recommend ultrasound or Low level laser therapy (LLLT) which is painless and non-invasive; plus my mother swears by laser treatment, after her acute fasciitis resolved with just one session!

Further Resources: Balance Exercises You Can do From Home

Morning Stiffness | Do You Have Wear & Tear?

Sometimes called degenerative joint disease or “wear and tear”. Wear and tear is a euphemism for osteoarthritis (OA); the most common chronic condition of the joints. It occurs when the cartilage or cushion between joints breaks down; often leading to pain, stiffness and swelling.

In front of me you can see four models of the same two lumbar vertebrae, presented as textbook normal and phase 1, 2 and 3 of spinal degeneration. This is also known as osteoarthritis (osteo meaning bone), degenerative disc disease, or commonly wear and tear.

Normal vs. Phase 2

I don’t like euphemisms. I think you can handle the truth and that like me, you probably don’t like being talked down to. So let’s call it what it is … osteoarthrtis or degenerative discs or spinal arthritis. 

A normal lumbar segment has two vertebra and a healthy cartilage disc in between. If you look at the disc from the top, you can see that the gelatinous or gel-like toothpaste substance, is well contained within the cartilage rings of the disc.

There should also be good symmetrical bony alignment. You may choose to have a chiropractor detect whether or not you have any spinal misalignments. Early on, these subluxations are easily detected and corrected.

A normal spinal segment will also have healthy nerve roots. Lots of space for them to communicate with the body (your organs, bloodvessels and glands). Because our nervous system runs our body, we don’t want any interference from misaligned vertebra (poor posture) or degenerative discs.

Incorrect Posture May Cause Degeneration

Asymmetry in the body (incorrect posture) can lead to early degenerative changes. Posture is so much more than what we see on the outside of our body.

Phase 1

In Phase 1 of spinal degeneration, we may start to see wear in the discs. Evidenced only on MRI imaging, this is a kind of dehydration that occurs in the cartilage tissues..

The rings of cartilage that make up our spinal discs, start to break down. The gelatinous center begins to dry out, a little bit like the toothpaste that is stuck around the outside of the cap. There are likely no effects as yet (or mild effects) to your nerve system.

Phase 1

These people may not present with health problems at this early stage, or they may have some mild symptoms.

Phase 2

After a decade with incorrect posture from poor habits, childhood injuries, athleticism and manual labouring, it is more common to see people with Phase 2 degenerative changes.

Typically, discs are now very dehydrated. The gelatinous nucleus (the toothpaste-like substance) has often leaked right through the dried out cracks in the cartilage rings, that buldge into the space where the spinal cord lives. This is known as a slipped or herniated disc.

There is often nerve irritation in Phase 2. These people often present with leg pain (sciatica); as the nerves that exit the lower lumbar segments, travel through the buttocks and down the leg.

Phase 2 – Herniated or Buldging Discs

Further Resources: Sciatic Leg Pain Relief

They may also present with other health issues (bowel and bladder troubles), as these nerve roots supply our organs, blood vessels and glands in the pelvic region.

In Phase 2, the vertebral bones get closer together, and the ligaments and muscles become slack. There is now excess movement in the bony segments. They have become unstable, and the body responds by laying down more calcium to stabilise the segment. These calcium deposits or bone spurs aren’t generally painful, but lead to stiffness.

Morning stiffness is a strong indicator of spinal degeneration. After waking, it may take a few hours before a person with Phase 2 degeneration feels mobile. 

Phase 3

After a several decades with incorrect postural alignment, past accidents, poor lifestyle, we begin to see advanced arthritic (degenerative) changes. In Phase 3, the discs have completely dried up and can lead to total bony fusion between the vertebral segments of the spine.

Not only is this person extremely stiff, but their spinal segments no longer move independently. This person surprisingly, is often without pain but they are extremely stiff and immobile.

Phase 1, 2 and 3 can only be diagnosed by x-ray and/or MRI. X-Ray imaging show us bony changes and MRI show tissue changes. MRI is the imaging of choice for degenerative disc diagnosis, and x-ray imaging is gold standard for alignment and postural diagnosis.

If you have been diagnosed with wear and tear without an x-ray, you have been done a disservice, in my opinion. A good practitioner can probably accurately guess your diagnosis from signs, symptoms and examination, but they will never be able to accurately assess whether you are in Phase 1, 2 or 3. This is why I would never practice without on-site x-ray facilities.

My first Chiropractic Clinic Align

A person with Phase 3 may present with multiple health issues because the nerve roots are usually seriously comprised in this phase of degeneration. 

Obviously the right time to start paying attention to your posture is at the stage of postural misalignments – before the discs and nerve roots become compromised. While it is never too late to start creating a healthy posture habit for life, the longer we put off getted started, the more likely we are to enter Phase 1, making improvements more challenging and time consuming. 

If I can correct and improve my posture, given my bunion (argh), anatomical short leg, lumbar scoliosis and disc degeneration, anyone can. But please start today!

Why You Should Stop Doing Sit-Ups |Posture Doctor

Many personal trainers are still teaching the wrong position for core exercises – a position that will wear out your discs, cause premature aging and ruin your posture and balance long-term.

Your ‘core’ is comprised of a number of muscles working together to achieve and maintain a stable spine. A strong core and perhaps more importantly, a core with good endurance allow us to move with ease and mechanical advantage; in order to avoid injury!

Your core muscles include: rectus abdominis, internal and external oblique, transversus abdominis, but also – you may be surprised to learn – the quadratus lumborum, and the gluteal muscles.

Your goal when working on your core is to create spinal stability. Stability may be achieved by increasing core strength, but Dr Stuart Mcgill (Professor of Biomechanics at the University of Waterloo) reminds us that improving core endurance may be more important than strength. Endurance provides the ability to maintain a stable spine throughout a variety of activities.

Many therapy approaches have the objectives of strengthening muscle and increasing spine range of motion. This is problematic (Parks et al, 2003) since those who have more motion in their backs have a greater risk of having future back troubles. Strength may, or may not, help a particular individual as strength without control and endurance to repeatedly execute perfect form increases risk. Dr Stuart McGill

McGill goes on to explain that people with ‘troubled backs’ tend to have faulty movement patterns like “gluteal amnesia” and more motion in their backs and less motion in their hips.

With the goal of stability in mind, it would be prudent to strengthen gluteal muscles, increase range of motion in our hips and choose abdominal exercises that do not put unnecessary stress and strain through the low back and discs.

No sit-ups or crunches

It is for this reason, that I will NEVER recommend crunches or sit-ups. Both of these exercises involve repetitive flexion of the lower back (lumbar spine). Repetitive flexion can lead to degeneration of the spinal joints and discs over time.

Effective spinal stabilization should begin with a solid understanding of what stability is. “Stability has little to do with the ability to balance on a gym ball. Sitting on an exercise ball performing movement exercises is generally a poor choice of back exercise until quite late in a therapeutic progression,” says Mcgill. “True spine stability is achieved with a “balanced” stiffening from the entire core musculature.”

Reducing risk of injury

One of the most effective exercises for improving spinal stability is the abdominal brace. Many personal trainers are still teaching the wrong position for core exercises – a position that will wear out your discs, cause premature aging and ruin your posture and balance long-term.

How to Engage Your Core

The abdominal brace is a super little exercise, that teaches you how to engage your core whether you are standing in a line, talking on the phone or simply walking down the street!