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Investigators at Northwestern University's School of Medicine (Baliki et al 2008) discovered an alteration in brain function in people suffering from chronic pain. They feel that this alteration in brain (CNS) function may explain how chronic pain can trigger such symptoms as insomnia, depression, anxiety and/or mental sluggishness.

Baliki et al further explained that the front region of the brain, in a person suffering from chronic pain, is consistently active. This, they suggest, will prematurely wear out the neurons, altering their connections to one another. They believe this may lead not only to the symptoms above, but also to permanent brain damage. 

Based on nearly 40 years of clinical research, Rothbart (2009) suggests that focal areas of hyperactivity within the cerebral cortex (CNS) may result from ischemia (decreased blood flow) due to a positional compression of the carotid arteries on either side of the neck. 

Compressing these carotid arteries can diminish the flow of blood to the brain much like a kink in a water hose can diminish the flow of water through the water hose (Rothbart 2009. Forward head position can lead to debilitating symptoms within the brain).  Diminished blood flow can lead to cellular death in the brain.  The end result are symptoms such as insomnia, depression, anxiety and/or mental sluggishness and finally, permanent brain damage. 

What causes a positional compression of the carotid arteries?  Rothbart suggests that this compression can result from a forward head position (See Diagrams below).  The impact a forward head position has on the blood flow to the brain is clinically observable by taking the carotid pulses:  

  • When the head is in a forward position, the carotid pulses are weaker
  • When the head is over the spine, the carotid pulses are stronger

A forward head position is part of apostural distortional pattern caused by an abnormal embryological foot structure, now known as the Rothbarts Foot. 

Forward head position

Head over Spine

FHP Rear View

All feet have mechanical receptors on their plantar surfaces, which send signals from the feet to the brain. The brains responds by adjusting the posture.  But the Rothbarts Foot sends distorted signals to the brain. The brain responds by distorting the posture.  Part of this postural distortion is a forward head position, which is seen in most chronic musculoskeletal pain patients.  

This forward head position can be effectively reversed using a type of therapy that now bears my name (e.g., Rothbart Proprioceptive Therapy). Rothbart Proprioceptive Therapy provides a stimulation underneath the feet. This stimulation sends a corrected signal to the brain. The brain, in turn, automatically corrects the posture and brings the forward head back over the spine.  When this takes place, the compression on the carotid arteries is diminished.  This allows the blood to flow more freely to the brain.  The brain cannow function optimally.

In summation, Rothbart suggests that:

  • when the head is forward over the spine, the brain may not be receiving sufficient blood flow and oxygen due to compression of the carotid arteries.  If this compression is severe enough, it can result in cerebral ischemia (CNS dysfunction).  Clinically what we see is disturbed sleeping patterns, increased anxiety and mental sluggishness.
  • when the head is in its correct position over the spine and the brain is receiving sufficient blood flow and oxygen, brain function improves. Clinically, what we see is improvement in sleeping, anxiety abating, mental alacrity improving and a greater sense of wellbeing.


     Baliki MN, Geha PY, Apkarian V, et. Al. 2008. Beyond Feeling: Chronic Pain Hurts the Brain, Disrupting the Default-Mode Network Dynamics. Journal Neuroscience. 28(6):1398-1403.     

    Rothbart BA 2009. A forward head position can lead to debilitating symptoms in the brain. Heal Yourself Magazine, July 25     

    Rothbart BA 2009.  Chronic Pain Changes How the Brain Functions.  Research Blog, August.