Sedentary lifestyle prevention through chiropractic is highly recommended for seniors. With advanced age, the body’s muscles, bones, and spinal system begin to wear down and need to be maintained to retain their mobility and flexibility. Regular chiropractic adjustments are recommended as part of an active/fitness lifestyle for seniors and can help older individuals maintain optimal health.
Sedentary Lifestyle Prevention
Many seniors tend to reduce physical activity after reaching retirement age. Many individuals just want to kick back and relax. However, living too laid-back can impact overall health. A lack of exercise and physical activity can cause the muscles, cardiovascular system, and skeletal system to prematurely wear out. Living an active lifestyle will keep individuals at their best when retiring and maintain a healthy quality of life.
Pain Management
Chiropractic can help individuals realize their full potential. The chiropractic approach to achieving top health means treating the source of symptoms, and not just the symptoms. This helps maintain a high quality of life. Chiropractic sedentary prevention includes:
Adjustments
Adjustments to the body are the core of chiropractic. Adjustments are utilized to realign the spine that helps treat various nervous system-related conditions. These include subluxations, slipped discs, sciatica, nerve damage, and more. Adjustments also increase the immune system’s functionality. This is extremely beneficial for older individuals.
Nutritional Recommendations
Older individuals can benefit from a customized nutrition plan to help with any deficits in their diets. Often older individuals need more calcium to help fortify bone health. Chiropractors and health coaches can provide individuals with nutritional information needed to live a healthy life.
Exercise Program
An active lifestyle is an essential component of staying healthy. Chiropractors can provide individuals with specialized exercises that take into account their specific and specialized needs.
Physical Therapy
Physical therapy is another component of chiropractic, as it helps enhance the adjustments.
Health Coaching
Health coaching can provide individuals with the tools necessary to take charge of their health. Counseling involves exercise recommendations, nutritional advice, healthy habits development, and more depending on the individual’s abilities.
Stay Moving
A sedentary lifestyle places an older individual’s spine in a compromised position. Older individuals have an increased risk of developing detrimental spinal conditions. Overexertion happens more easily in weakened bodies. The solution is to maintain physical activity with proper support. Chiropractic is designed to improve the whole-body. If you�re looking for sedentary prevention and the latest care approaches, contact us, we’re ready to help!
Chiropractic Shoulder Pain Treatment
Dr. Alex Jimenez�s Blog Post Disclaimer
The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*
Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
References
Hawk, Cheryl et al. �Best Practices for Chiropractic Care for Older Adults: A Systematic Review and Consensus Update.��Journal of manipulative and physiological therapeutics�vol. 40,4 (2017): 217-229. doi:10.1016/j.jmpt.2017.02.001
Chiropractic alignment is often the go-to option when injured or experiencing various types of pain. And for good reason, because it works. However, chiropractic medicine goes beyond injuries, and pain conditions. Individuals can reap the benefits of regular chiropractic for increased well being and maintaining optimal health.
Chiropractors understand the importance of balancing all areas of the body’s health. This is done through a combination of spinal adjustments and educating individuals on how to develop healthy lifestyle habits. Chiropractic care can increase positivity, overall life, and well-being.
Regular Chiropractic Alignment Benefits
Being able to enjoy a full and healthy life is more than just being free of pain or injury. It means all of the body’s functions are operating properly and cleanly. Understanding what helps the body thrive can take an individual’s quality of life to another level. Chiropractic can help guide individuals to feel their best with recommendations and regular spinal monitoring and alignment. The benefits of chiropractic include:
Energy levels increase
Anxiety, stress, and depression are reduced
Sleep quality improves
Pain reduces and alleviates
The body�s natural healing abilities are activated
Mood and positivity increases
Muscle strength increases and physical performance improves
Inflammation is reduced
Spinal Alignment and Increased Positivity
The science behind chiropractic is based on the health of the nervous system. A well-balanced nervous system keeps the body functioning at an optimal level. The primary focus of chiropractic is making sure the spine is in proper alignment. Once a balance has been achieved further recommendations and treatment options can be incorporated into a full maintenance regimen.
Spine misalignment occurs with the regular stress placed on the body. Poor posture, too much sitting, and developing injury are a few reasons the spine slips out of alignment. These misalignments are hard to detect without the help of a trained professional chiropractor. Spinal misalignment causes the neural tissues and energy to become compromised and progresses little by little to health degradation.
Health to the Next Level
Chiropractic medicine specializes in the best possible spinal alignment treatment. An in-depth science-based approach focuses on whole-body results to help an individual feel their best. Get in touch with a chiropractor to see how they can help boost health.
Migraine Treatment
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Dr. Alex Jimenez�s Blog Post Disclaimer
The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*
Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
References
Ernst, Edzard. �Chiropractic: a critical evaluation.��Journal of Pain and symptom management�vol. 35,5 (2008): 544-62. doi:10.1016/j.jpainsymman.2007.07.004
Individuals with neck and back pain should consider adding a few pain-relieving therapeutic tools to the holiday wish list. Spine specialists/experts have some tools for their patients and others who are dealing with back and neck pain. Looking at various points, these therapeutic tools offer the gift of helping to reduce neck and back pain, when unable to see a chiropractor or physical therapist.
Foam Rollers
Foam rolling is effective for different types of aches and pains, especially backaches. Foam rolling benefits include:
Releasing muscle knots and tension
Reduces inflammation
Decreases pain
Improves range of motion
Returns flexibility
Wedge Pillow
A wedge pillow for the back is a necessity. A wedge pillow removes the stress from the spine and neck when lying down. Flipped around will take the tension off the legs also bringing back pain relief.
Deep Percussive Massager
Percussive massagers can provide a deep massage to various areas of the body especially the lower back. There are a variety of brands available with different levels of technology. However, careful use of these instruments must be exercised. This is because the massage can be intense and can exacerbate or cause further injury, and individuals can develop a tolerance making the massage no longer effective.
Seat Cushion
If sitting at a desk throughout the day or working from home a proper seat cushion is mandatory. Many individuals who sit the majority of their day utilize a combination cushion that includes the seat cushion with lower back support. Individual cushions are great because they can be moved easily and adjusted to fit where needed. Therapeutic seat cushions come with various features available, here are a few to keep in mind. Memory foam and air cells offer the most pressure relief. If there is tailbone pain, focus on a seat cushion with the tailbone cut out for extra relief. An office chair with these features should also be considered.
Inversion Table
Inversion tables are available at reasonable prices, starting around $100. Used correctly this therapeutic tool can successfully help relieve back pain. Inversion tables and cervical traction provide decompression and postural alignment for the spine helping with pain relief. These devices offer gentle decompression through the angle used. Wider angles or full inversion provides more decompression on the back. Individual spinal needs should be discussed with a chiropractor, physical therapist, or physician before using this therapeutic tool.
Pain Patches and Topical Agents
Pain-relieving patches like Lidocaine, IcyHot, and Salonpas patches are widely recommended for tight and sore areas of the body.
Sitting Standing Desk
A sitting and standing desk can be highly beneficial to back pain. In addition to burning off bonus calories throughout the day, Changing positions and postures throughout the day are recommended. This is to keep the muscles, ligaments, tendons moving, and not in a static position for too long. Changing every 20 to 30 minutes is the recommended time. Sitting and standing desks can provide positional changes that will help with posture, core stability, and circulation. This will help reduce and alleviate pain in the low back, neck, and shoulders. However, the desk needs to be stable and adjusted to the proper height.
Lower Back Sitting Support
These therapeutic tools help reinforce the low back region when seated. Most of us start to slouch forward with the head and shoulders hunched forward after some time at the computer. This strains the whole body, specifically the low back. Lower back supports can help maintain proper alignment of the spine when seated.
Knee, Thigh, Pelvis Pillow
These pillows have different names but are used in the same way. This is a pillow that can be placed between the legs while sleeping takes the pressure off the pelvis and spine. These types of pillows are great for individuals that sleep on their side. This is because the top leg often shifts down, leading to increased stress on the hips and low back. These pillows help keep the legs aligned during sleep relieving pressure on the low back.
How To Self-Care for Back Pain Books
There are a variety of books that offer tips, and therapies for self-care. These products are not a cure-all. They are intended to help in combination with proper treatment, especially for certain spinal conditions. If pain is limiting daily function, consult a chiropractor, physical therapist, or physician about using the above therapeutic tools.
Doctor of Chiropractic Near Me
Dr. Alex Jimenez�s Blog Post Disclaimer
The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*
Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
References
Furlan, Andrea D et al. �Massage for low-back pain.��The Cochrane database of systematic reviews,9 CD001929. 1 Sep. 2015, doi:10.1002/14651858.CD001929.pub3
The nervous system helps regulate the body’s immunity. Any dysfunction can initiate or aggravate issues associated with autoimmune disease. Chiropractic medicine focuses on the body�s ability to heal itself. These natural abilities function optimally when the body, and the nervous system, are well-balanced. Total body homeostasis elevates:
Mood
Immunity
Overall health
Quality of life
Autoimmune Disease
The immune system goes after any foreign bodies that the body comes in contact with to combat/prevent illness and disease. This could be:
Bacteria
Cancer cells
Viruses
However, the system can over-activate and start attacking its own cells and organs. This can manifest as an autoimmune disease. The type of disease depends on the specific area of the body that is being attacked. Common autoimmune diseases include:
Rheumatoid arthritis
Lupus
Multiple sclerosis
Irritable bowel syndrome
Psoriasis
A chiropractic approach to addressing autoimmune disease will usually begin with stress reduction. Therapies include:
Chiropractic adjustments to get the body balanced
Massage to loosen and relax the body’s tissues
Meditation to help manage stress, learn strategies of healthy coping
Yoga to keep the body limber
Exercise to strengthen the body inside and out
Diet to help with gut health and inflammation
The Nervous System and Immunity
The nervous system has a significant role in the body’s immunity. The system transmits signals when to battle illness when to engage in the healing process, and so on. If the nerve’s path is compromised it can interfere with the brain�s ability to properly function and regulate immunity. This can lead to an underactive or overactive immune system that translates into an autoimmune disease.
Proper spinal alignment is vital for maintaining optimal nervous system function. When the spine is out of alignment/balance, the communication highway/s are inhibited, deteriorating the body’s health and neural tissue response. Spinal misalignment restoration is a chiropractic specialty that will increase the body’s natural healing power and promote whole-body balance. The nerve circulation is optimized and can properly communicate without sending improper/damaged signals.
Chiropractic
Any type of misalignment can be overlooked as a cause for body dysfunction. Chiropractic is about naturally sustained spinal and whole-body health. It will optimize the body to manage the disease and possibly reverse it. Injury Medical and Functional Chiropractic Clinic can offer a variety of customized treatment plans to achieve optimal health and maximum quality of life.
Back Pain Treatment
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Dr. Alex Jimenez�s Blog Post Disclaimer
The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*
Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
References
Stojanovich, Ljudmila, and Dragomir Marisavljevich. �Stress as a trigger of autoimmune disease.��Autoimmunity reviews�vol. 7,3 (2008): 209-13. doi:10.1016/j.autrev.2007.11.007
Weakness, pain, and numbness can find their root in the spine. It is known as radiculopathy. If left untreated, health problems will only continue to get worse, with the potential to become a chronic condition. When it comes to degenerative pain conditions they usually start small. There is occasional discomfort that gradually develops into pain, then weakness and numbness.
Usually, by the time an individual seeks help, the original condition has devolved into radiating pain. This is why it is important to address the issue right away.Chiropractic works with individuals to help them understand the degenerative nature of pain and how to address and prevent it. Early intervention will prevent minor discomfort from turning into debilitating, chronic pain.
Radiculopathy
Radiating pain root cause is a compressed or inflamed nerve. It happens at the site of compression and spreads outward growing larger with time. It can be a catalyst for different pain conditions and syndromes like sciaticaor complex regional pain syndrome. There are a variety of terms for nerve pain, they are typically a form of radiculopathy.
Stages
The pain can spiral as fast as the underlying condition/s that is causing it. A compressed nerve that generates pain but does not become worse in severity is usually because the compression stays the same. Conversely, minimal discomfort brought on from shifted vertebrae can rapidly progress into weakness, numbness, and reduced mobility as a nerve is continually and severely getting compressed. Radiculopathy pain usually follows a pattern. Understanding the signs and symptoms will help determine to what extent the condition has progressed, and how it can develop into a worsening nerve injury:
Discomfort is the first stage. Subluxation, rotation, or a spinal shift is what is occurring, with the nerve not yet affected.
The pain signals that come from nerve compression along with the severity can help determine the cause of the condition.
Weakness usually follows pain. The nerve that is affected begins to take on permanent damage and cannot function properly.
Numbness follows the weakness reaching the most severe level. Mobility is limited along with a high increase for permanent nerve pain.
Being aware of these radiculopathy symptoms will help an individual stay ahead of nerve injury. Acting on discomfort can prevent progression into pain, addressing pain can stave off weakness, and acting upon weakness may prevent permanent nerve damage. The sooner an individual seeks help for any type of pain, the better chance they have to prevent degeneration.
Long-Term Prevention
It is crucial to consult with a chiropractor at the first sign of discomfort in the spine or if there is radiating/spreading back pain. A chiropractor will be able to provide decisive treatment that will bring relief and prevent the pain from worsening. The pain, weakness, and numbness can be avoided, along with long-term damage to the nerves.
Sciatica Pain Therapy
Dr. Alex Jimenez�s Blog Post Disclaimer
The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*
Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
References
Stochkendahl, Mette Jensen et al. �National Clinical Guidelines for non-surgical treatment of patients with recent-onset low back pain or lumbar radiculopathy.� The European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society�vol. 27,1 (2018): 60-75. doi:10.1007/s00586-017-5099-2
An examination of the cervical/neck region of the spine through chiropractic will help determine a thyroid diagnosis for individuals complaining of chronic fatigue. A thyroid dysfunction means going deeper into the body�s physiology and a thorough examination of the spine. Checking for subluxations in the cervical spine will reveal possible nerve blockage and any other contributing factors to a thyroid condition. Thyroid conditions tend to get overlooked because the symptoms are general. They range from:
Fatigue
Moodiness
Muscle pain
Brain fog
These are cornerstones of a thyroid condition. Under-active thyroid and/or thyroid cancer can have an impact on everyday life regardless of the severity. However, these symptoms can signify numerous other conditions.
The Cervical Spine
The nerves connected to the thyroid gland can be traced down the spine to the last neck/cervical vertebrae, which is C7. A chiropractor will examine this region when individuals complain of fatigue, brain fog, or moodiness. Subluxation, translation, or disc deterioration at C7 could mean that the nerve signals and blood circulation to the thyroid are limited, interrupted, or completely blocked.
Linking cervical spine dysfunction to thyroid dysfunction
Spinal subluxations are not the full cause of thyroid dysfunction. A single vertebra might not show signs of movement, which means a chiropractor could have to look further into the spine. A chiropractic examination will search for problems that correlate with thyroid issues. For example, individuals with a cervical dysfunction could experience general nerve issues in this area. It could be a contributor to nerve signals not being delivered to the thyroid gland. Diagnosis of a root condition that has secondary effects on the gland is another way to qualify a thyroid condition.
Medical History
Questions that will be asked by a chiropractor during an exam could consist of:
Is there a family history of hyper/hypothyroidism?
Is the individual under intense stress from work, home, etc?
Are there other symptoms that could be associated with thyroid dysfunction?
All details are necessary for connecting nerve interruption to thyroid conditions then factoring how spinal manipulation could alleviate symptoms.
Cervical Misalignment Treatment
Combining the evidence of:
Subluxations
Blocked nerves
Cervical spine dysfunction
Any further symptoms/details will help form a complete picture of a thyroid condition. If that condition is being tested or treated by a general physician, it may still benefit from a chiropractic adjustment. Physicians could recommend diet and medication to bring the thyroid back to proper function, and chiropractic can help improve the nerve function of the gland. This includes:
Re-opening pinched pathways
Restored blood flow to the region
Helping nerve signals fire transmit properly
We advocate for an incremental, customized approach to restore cervical spine curvature and optimal nerve health. We have worked with a variety of individuals experiencing chronic fatigue, mental fog, and moodiness, and have helped link these symptoms to thyroid dysfunction. If it seems that there is constant confusion or disorganized thought patterns, schedule an appointment with us today to learn more about our chiropractic approach.
Neck Pain Chiropractic Care
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Dr. Alex Jimenez�s Blog Post Disclaimer
The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*
Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
References
Arick, Christopher T. �Chiropractic Management of a Patient With Chronic Fatigue: A Case Report.��Journal of chiropractic medicine�vol. 15,4 (2016): 314-320. doi:10.1016/j.jcm.2016.08.006
Covid-19 has impacted everyone in so many ways. There is a possible connection between Covid-19 and a rare spinal disorder known as transverse myelitis. There have been three known cases of acute transverse myelitis brought on from covid-19. Although these case reports are not enough to prove that covid is the cause for transverse myelitis, researchers are delving into the possibility of a connection between the virus and this spinal condition.
Transverse Myelitis
Transverse myelitis causes inflammation of the spinal cord. It can be caused by
Myelin is the layer that forms around nerve cell axons or the wiring of the nervous system and insulates them. It consists of protein, fatty substances, and acts as a defensive sheath that allows electrical impulses to transmit properly. The insulation properties are essential for:
Proper motor function
Sensory function
Cognition
Without the insulation, the electrical impulses traveling through the spinal cord dissipate or weaken. The messages don’t reach the nerves and can lead to:
Muscle spasms
Twitching
Numbness
The most common disorder that destroys the myelin known as demyelination is multiple sclerosis. Transverse myelitis can affect individuals of:
Any race
Gender
Age
There are treatments, but there is no cure. Treatments consist of corticosteroids and other therapies to suppress the immune system. However, their focus is on preventing and minimizing permanent neurological damage.
Recognizing and Identifying
Symptoms of transverse myelitis can include:
Pain that usually starts in the lower back and causes shooting pain/sensations down the legs, arm, and torso
Leg/s and arm/s weakness
Sensory changes in the legs, torso, and genital area
Bladder and Bowel dysfunction
Muscle spasms
General discomfort
Headaches
Fever
Loss of appetite
Depending on the segment of the spine where the damage is occurring will determine which parts of the body are affected. Diagnosis begins with a thorough medical evaluation. A doctor will utilize various methods. A thorough neurological exam will be performed to rule out any issues that require emergency intervention. If a doctor suspects transverse myelitis they will order diagnostic tests like:
Magnetic resonance imaging or an MRI
Blood tests
Lumbar puncture
Treatment
As previously stated, there is no cure for transverse myelitis, and treatment focuses on managing complications. Treatments can include:
The hard facts are that while most people with transverse myelitis have at least a partial recovery, for some, however, recovery can continue for up to two years and longer. A combination of medications, chiropractic, and physical therapy can help improve physical symptoms.
The National Institute of Neurological Disorders and Stroke is working to understand the process, as to how the immune system destroys or attacks myelin. Hopefully, this will lead to answers, improved treatment, and prevention. It is well-documented that Multiple sclerosis, bacterial infections, and other viruses can cause transverse myelitis, research must continue to see if there is a connection to covid-19.
Chiropractic Lower Back Pain Treatment
Dr. Alex Jimenez�s Blog Post Disclaimer
The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*
Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
References
Chakraborty, Uddalak et al. �COVID-19-associated acute transverse myelitis: a rare entity.��BMJ case reports�vol. 13,8 e238668. 25 Aug. 2020, doi:10.1136/bcr-2020-238668
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