To achieve lasting results, you must address your patients’ entire kinetic chain from the feet upward rather than focusing solely on symptoms. With the modern tools available today, you can create better care plans for your patients, leading to better outcomes.
The chiropractic profession occupies a unique place in modern healthcare because it is a natural, drug-free answer to the common maladies affecting all humans. Patients commonly seek chiropractic care for their kinetic chain, including: back pain, neck pain, headaches and stress-related conditions affecting digestion, sleep and other bodily functions.
Value of personal experience
Your personal experience can be an invaluable resource to help you learn how to better serve your patients based on previous success or failure. My experience with chiropractic care started with very successful responses to sports injuries. Still, when I started developing low back pain in my late teens, I experienced frustration with having the same problems repeatedly. I would get temporary relief from the pain, but before too long, it was back. I was happy to get adjusted again because I knew it was valuable and beneficial, but the results were temporary.
Shortly before I began my first practice, I was introduced to the idea that the closed kinetic chain involving the feet, knees and hips affected the spine and pelvis in ways I had not been informed of. This seemed like common sense to me, considering my background in studying architecture and working in construction as a young man. Understanding the foundation of the spine starts with the feet led me to realize I needed to evaluate the feet and how they affected the knees, hips and pelvis to successfully care for my patients’ structural needs. I discovered my own feet were contributing to the nagging problems I had with my knees, low back and neck. As soon as I considered my feet as part of my problem and addressed that issue with custom orthotics in addition to chiropractic care, my chronic low back problems were resolved and never returned.
The need for ongoing learning
This approach to evaluating patients does require some additional steps and possibly some additional training, but your calling as a DC is to enhance your patients’ quality of life by continuing to learn new ways to help them. Thanks to technological advances in the past 35 years, we now have some incredible tools to help us efficiently evaluate our patients with new information that allows us to create better care plans, leading to better outcomes.
Begin with normal anatomy
It’s important to start with normal anatomy in mind. The human body is designed to exhibit a particular posture that includes a front-facing vertical spine, eyes, shoulders and hips level with the horizon, and from the lateral view, the ear, shoulder, hip, lateral knee and lateral malleolus should align vertically. This posture requires the least energy to maintain and provides efficient, safe mobility. Your examination should account for any variations from what is considered normal anatomy, posture and functional movement as you assess the cause of the patient’s problem. Those causes can include trauma, genetic variations, repetitive activity and environmental and emotional stressors.
Each patient’s evaluation should include an assessment of the feet. The navicular drop test has been an essential tool in years past to quantify the difference in the flattening of the feet between seated, non-weight-bearing and full-weight-bearing in the standing position. This comparison shows how the foot changes when transitioning between non-weight-bearing and complete, functional weight-bearing. The factors that influence how efficiently the feet function include the plantar fascia and the physical structure of the bones of the feet. Still, we must consider patients’ physical activity, trauma, footwear and many other variables that may be a factor. To simplify the thought process, one can assume that if there are physical and functional differences between a patient’s right and left foot, those differences will be translated up the kinetic chain, affecting the following link in the chain.
Beyond symptom relief
It’s easy to cut to the chase and focus only on the patient’s complaint. Neck pain, headaches, middle back tension and low back pain all respond positively to the chiropractic adjustment, and relief is often rapid. Still, the long-term ramifications of not addressing the entire kinetic chain or educating the patient about those ramifications can lead to significant complications and co-morbidities later in life. Posture is often taken for granted, but the development of hyperkyphosis has been identified as a major contributor to early mortality.
A study published in the Journal of the American Geriatrics Society reported that persons with hyperkyphotic posture had a 144% increased rate of early mortality. Hyperkyphotic posture is associated with restrictive pulmonary disease and poor physical function. Hyperkyphotic posture is more prevalent in men than women. Patients with atherosclerosis and hyperkyphotic spines had an increased rate of premature death compared to those without hyperkyphotic spines.1
I believe our patients deserve to know this fact when they are young so they can use strategies that effectively balance physical discrepancies in their feet, which affect the knees, hips, pelvis and spine. These discrepancies, which are often not symptomatic, become the hard-wired physical gait and posture pattern they will age with due to the phenomenon of neurogenesis, the creation of new neural networks. Neurogenesis cements these suboptimal functional patterns into the patient, accelerating the aging and degenerative processes.
The role of technology and orthotics
Technology has provided the ability to gather 3D information about the plantar surface of your patients’ feet, allowing you to intervene with custom, flexible orthotics that support the three arches of the feet. This creates a proprioceptive neurological response of reflex co-contraction of postural muscles. This intervention ensures the subtle deviations of kinetic chain dysfunction are blocked, allowing efficient posture, functional movement and gait patterns to be neurologically hard-wired into your patients’ nervous system. Improved quality of life, longevity and decreased risk of early mortality are goals worthy of pursuing, and caring for the entire kinetic chain is a powerful strategy for helping your patients achieve those goals.
Final thoughts on the kinetic chain
You can significantly improve patient outcomes, posture and long-term health by evaluating and supporting the whole kinetic chain, primarily through modern tools and custom orthotics.
Brian D. Jensen, DC, is a graduate of Palmer College of Chiropractic and the owner of Cave Spring Chiropractic in Roanoke, Virginia. He has been in practice for more than 35 years. As a Foot Levelers Speakers Bureau member, he travels the US sharing his knowledge and insights. For more information, go to footlevelers.com/more.
References
- Kado D, et al. Hyperkyphotic posture predicts mortality in older community-dwelling men and women: A prospective study. Journal of the American Geriatrics Society.2004;52(10):1662-1667. https://pubmed.ncbi.nlm.nih.gov/15450042/. Accessed August 7, 2025.
