if you can be free from a previously unknown,

common source of chronic musculoskeletal pain

(This questionnaire is not a replacement for a thorough medical examination

nor should it serve as a tool for making a medical diagnosis.)

____  Are the heels on my oldest pair of shoes worn unevenly?

         (See Fig.1 below)  

____   Do I have calluses on the bottom of my feet?

____   Do I have bunions?                                                      

____   Do I have a head forward position? (See Fig.2 below)

____   Do I have bad posture?

____   Do I have scoliosis (severely curved spine)?

____   Was I clumsy or awkward as a child?

____   Are my shoulders rounded?

____   Do I have crooked teeth?

____   Did I wear braces to straighten my teeth?

___   Do I have poor balance?

____   Do I have a tipped pelvis (swayback)?

____   When I walk with someone side by side, do I have a

         tendency to bump into them?

____   Has my chiropractor told me that I have one leg shorter

         than the other?

____   Do I have pains that come and go in different joints?

____   Do I prefer to walk barefoot around the house?

____   Do I have tight and/or stiff muscles?

____   Have I seen multiple healthcare practitioners in an effort to resolve                    my chronic musculoskeletal pain?

        Figure 1 - unevenly worn heels             Figure 2 - forward head position