Where others may see just a curved back or forward head posture, Krista Burns, DC, DHA, DACNB, sees the potential for serious health outcomes down the line. In fact, postural changes are considered a public health problem, as some may predispose people to degenerative conditions of the spine in
adulthood. Dr. Burns, an instructor of clinical sciences at National University of Health Science and the founder of the American Posture Institute, has devoted her career to correcting postural distortions and educating other providers about them. At Engage 2026, she will present, “Postural Decline: Neurologic Impact and Public Health Consequences.”
Read more about Dr. Burns and her upcoming presentation below, and register for Engage 2026 here.
How is the topic you are presenting at Engage 2026 relevant to today’s chiropractor?
Dr. Burns: According to research published in 2023, 81% of young adults present with postural distortion patterns. Researchers state, “Postural changes are considered a public health problem, especially those that affect the spine, as they may predispose to degenerative conditions of the spine in adulthood. Musculoskeletal disorders are the main cause of chronic pain, illness, reduced educational performance, productivity, and quality of life, and are responsible for increased absenteeism” (Pacheco et al., 2023).
Another study from the American Journal of Epidemiology and Public Health showed that more than 70% of school aged kids present with moderate to severe forward head posture (Chandoliya et al., 2021). These researchers highlighted the importance of posture and ergonomics for proper childhood development.
The majority of the population presents with postural distortion patterns including forward head posture and postural hyperkyphosis. Modern risk factors for postural distortion patterns include slumped sedentary posture while on devices for prolonged periods of time. This is alarming as postural distortion patterns and postural instability are linked to neurologic consequences and decreased longevity.
These research studies reveal the neurologic impact of postural distortion patterns:
- Researchers in 2022 used sagittal spinal alignment of hyperkyphosis as predictors of mild cognitive impairment in community health exams. They concluded that more anteriorized spinal balance and kyphotic posture were significantly associated with lower cognitive test scores, supporting spinal posture assessment as a simple screening marker for early cognitive decline (Nishimura et al., 2022).
- Another study, published in the Frontiers of Neuroscience Aging states that cognitive memory deficits are associated with less upright posture. This study provided the first empirical support for a link between postural alignment and memory function in healthy older adults (Cohen et al., 2016).
- A study in 2025 confirmed that greater kyphosis was independently associated with lower language-domain scores and that assessing gait and posture are relevant to detecting early cognitive decline (Nakamura et al., 2025).
- Young adults with recurrent low back pain showed altered primary motor cortex organization for trunk muscles, including changes in map area, overlap, and corticomotor excitability compared with healthy controls. These authors suggest that cortical reorganization of sensorimotor representations is related to ongoing pain and impaired sensorimotor control of the trunk, highlighting that abnormal postural demands and recurrent pain together reshape the cortical body map (Klerx et al, 2022).
- These studies reveal the link between posture and longevity:
- Kyphosis is independently associated with increased risk of mortality, such that more severe kyphosis predicts earlier mortality. These findings highlight the importance of identifying excessive kyphosis in the clinical setting and intervening early to prevent the progression of kyphosis with back extensor strengthening and posture training (Cours et al., 2022).
- Height loss is caused by osteoporosis, vertebral fractures, disc reduction, postural changes, and kyphosis. Height loss ≥ 5 cm correlated significantly with an increased risk of mortality in both men and women. Even a small decrease in height over two years was associated with the risk of all-cause mortality and might be a helpful marker for stratifying mortality risk (Iwasaki et al., 2023).
The chiropractic profession is uniquely positioned to help patients suffering with postural distortion patterns through manual adjustments, posture rehabilitation, and posture habit re-education. With the onset of the digital age, emphasizing postural correction has never been more important for the chiropractic profession.
What makes you an expert in this area?
Dr. Burns: In addition to leading the charge against postural decline as the founder of the American Posture Institute, I am the author of the textbook The Posture Principles and an international and TEDx speaker. I have a dual doctorate as a Doctor of Chiropractic and a Doctor of Health Administration. I also have a diplomate in Functional Neurology from the American Chiropractic Neurology Board. In addition, I am an instructor of clinical neurology at National University of Health Sciences.
My work at the American Posture Institute has been featured on media including ABC, CBS, NBC, Fox News Radio, and Global Woman Magazine, and prestigious stages including the World Congress of Neurology and Neurological Disorders and the World Congress of Falls and Postural Stability. I was recognized as a Top 100 Doctor by the Global Summits Institute and am the host of the International Posture Symposium.
What first interested you in this topic?
Dr. Burns: My path to chiropractic was forged by personal experience and elite athletic competition. As a nationally ranked competitive mogul skier, I competed in national championships and earned a place on the U.S. Freestyle Development Ski Team, on track for the World Cup circuit. A significant spinal injury abruptly altered that trajectory and ignited my passion for natural, restorative health care.
Through my own recovery, I discovered chiropractic and made it my life’s mission to ensure that no one else would miss out on their life goals due to back pain or posture-related dysfunction. That mission continues to define my clinical, academic, and educational work today.
After earning my Doctor of Chiropractic degree from Palmer College of Chiropractic in Davenport, Iowa, I pursued a second doctoral degree in Health Administration. As a dual doctorate, I can offer a rare and powerful perspective, combining individualized, patient-centered care with a population-level public health approach. Through this lens, I have identified postural distortion as a critical, yet under-addressed, public health issue impacting performance, longevity, and quality of life across entire populations.
I believe postural correction is the bridge that allows chiropractors to serve a far greater portion of the population. I’m also a board-certified functional neurologist, emphasizing the posture–brain connection and utilizing brain-based strategies to create lasting postural change.
Internationally, I owned and operated a postural correction clinic in Italy alongside my partner, Dr. Mark Wade. Together, we have worked with professional sports teams, corporate organizations, and public-school systems. We developed the program “Better Posture for Brighter Futures,” integrating posture education and corrective exercises into schools to support students, parents, and teachers, and highlighting the critical role of posture in childhood development and learning.
We are also the founders of the American Posture Institute, an organization dedicated to training healthcare professionals in evidence-based postural correction. I serve as the lead educator and have delivered lectures at medical conferences, chiropractic associations, and universities around the world.
I am currently a proud faculty member at National University of Health Science (Florida campus), where I teach clinical sciences and continue to shape the next generation of healthcare leaders.
Can you provide one or two takeaways from your presentation/topic that Engage 2026 attendees will not want to miss…and why.
Dr. Burns: By attending my presentation at Engage, you will gain a new clinical lens for identifying neurological dysfunction through posture and movement. You’ll learn the characteristic postural and gait presentations associated with neurological conditions. including cognitive decline, Parkinson’s disease, vestibular disorders, and more. Practitioners will discover that postural collapse and abnormal gait patterns are often among the earliest detectable signs of neurodegeneration—frequently appearing well before more obvious clinical symptoms and offering a powerful window for early intervention.
My session will also explore the critical role posture and balance play in longevity and survival. Emerging research shows that hyperkyphotic posture is associated with increased early mortality. Additional studies demonstrate that postural instability—specifically the inability to maintain single-leg stance for at least 10 seconds—is associated with an 84% higher risk of all-cause mortality (Araujo et al., 2022). These findings position posture not merely as a musculoskeletal concern, but as a vital neurologic and public health marker.
Practitioners will leave with a clear understanding of the public health implications of postural distortion patterns, their evidence-based links to neurologic deficits, and their relationship to decreased lifespan. Most importantly, attendees will learn simple, efficient posture assessments and corrective strategies that can be seamlessly integrated into existing clinical protocols—enhancing early detection, improving patient outcomes, and expanding the practitioner’s impact across the lifespan.
How many times have you attended or presented at ACA Engage in the past?
Dr. Burns: I am honored to be returning as a speaker at ACA Engage. I spoke on “Postural Neurology for Chiropractic Practice” at the Engage Conference in 2023.
I have been part of the Engage community since my days as a chiropractic student and active member of SACA. What began as a formative leadership experience has evolved into a cornerstone event I eagerly return to each year. I look forward to reconnecting with, and learning alongside, some of the most accomplished chiropractors from across the United States.
As a Doctor of Health Administration with a concentration in health policy, I am deeply engaged in advocacy and enjoy working directly on Capitol Hill. I greatly respect the leadership of ACA and am honored to represent and advance the chiropractic profession while advocating to Florida’s congressional leaders.
Beyond its exceptional continuing education and leadership programming, Engage stands out as a powerful national networking forum—bringing together forward-thinking chiropractors to exchange ideas, share successes, and shape the future of the profession.
Don’t miss Engage 2026! Join with fellow ACA members Jan. 22–24 in Arlington, Va., at the Crystal Gateway Marriott to learn from top experts, sharpen your clinical and professional skills, and connect with your chiropractic community. ACA has applied for CE credits in California, Florida, Georgia, and Texas, in addition to offering CE in more than 30 PACE-accepted states. Get the details here: Engage 2026 Continuing Education. In addition, take advantage of early-bird rates by registering today for the conference.
References:
Araujo, C. G., et al. (2022). Ability to complete a 10-second one-legged stance predicts mortality in middle-aged and older adults. British Journal of Sports Medicine, 56(1), 34-38. doi: 10.1136/bjsports-2021-104233
Chandoliya, H., Chorsiya, V., & Kaushik, D. (2021). Prevalence and levels of forward head posture among school going children. American Journal of Epidemiology & Public Health, 5(1), 22-25.
Cohen, R. G., Vasavada, A. N., Wiest, M. M., & Schmitter-Edgecombe, M. (2016). Mobility and upright posture are associated with different aspects of cognition in older adults. Frontiers in Aging Neuroscience, 8, 257.
Cours, A., Huang, M. H., Fink, H., Ensrud, K. E., Schousboe, J. T., Katzman, W., … & Kado, D. M. (2023). Hyperkyphosis and mortality risk in older men: The osteoporotic fractures in men study. Journal of the American Geriatrics Society, 71(2), 496-504.
Iwasaki, T., Kimura, H., Tanaka, K., Asahi, K., Iseki, K., Moriyama, T., … & Kazama, J. J. (2023). Association between height loss and mortality in the general population. Scientific reports, 13(1), 3593.
Klerx, S. P., Bruijn, S. M., Kiers, H., Coppieters, M. W., Twisk, J. W., & Pool-Goudzwaard, A. L. (2022). Associations between primary motor cortex organization, motor control, and sensory tests during the clinical course of low back pain. A protocol for a cross-sectional and longitudinal case-control study. Contemporary Clinical Trials Communications, 30, 101022.
Nakamura, M., Imaoka, M., Tazaki, F., Kubo, T., Murakami, T., Shimano, K., … & Hida, M. (2025). Association of kyphosis index with decreased physical function and cognitive domain in community-dwelling older adults: a cross-sectional study. BMC geriatrics, 25(1), 419.
Nishimura, H., Ikegami, S., Uehara, M., Takahashi, J., Tokida, R., & Kato, H. (2022). Detection of cognitive decline by spinal posture assessment in health exams of the general older population. Scientific Reports, 12(1), 8460.
Pacheco, M. P., Carvalho, P. J., Cavalheiro, L., & Sousa, F. M. (2023). Prevalence of postural changes and musculoskeletal disorders in young adults. International Journal of Environmental Research and Public Health, 20(24), 7191.
