Hangman’s Fx aka traumatic spondylolisthesis of C2 with a fracture of pars interarticularis or pedicles (unstable)
MVA is the most common cause
Mechanism: acute hyperextension of upper C/S similar to judicial hanging (never actually seen and most deaths are due to asphyxiation)
Secondary flexion may tear PLL and disc
Associated injuries: 30% have other c-spine fx especially Extension teardrop at C2 or C3 due to avulsion by ALL
Cord paralysis may only present in 25% due to bony fragments dissociation and canal widening
Hangman fx and extension teardrop
Cervical degeneration and previous fusion is a key predisposing factor due to the lack of mobility and suppleness, rendering C/S easy to fracture
Imaging: initial x-radiography then CT that helps to delineate another injury such as facet/pedicle Fx further. MRI may help if complicated by Vertebral A. damage
Management: if type 1 injury then closed reduction and rigid collar for 4-6 weeks, halo bracing if type 2 (>3-5mm displacement) Fx/instability, anterior or posterior spinal fusion at C2-3 if type 3 Fx (>5-mm displacement)
Extension teardrop Fx (stable) potentially unstable if put in extension
Avulsion of an inferior anterior body by ALL. More seen in elderly with superimposed C/S spondylosis
Key radiography: a smaller anterior-inferior body corner, no disruption of ligamentous alignment. Typically at C2 or C3 due to sudden hyperextension and ALL avulsion
Complication: central cord syndrome (m/c incomplete cord injury) esp. in superimposed spondylosis and canal stenosis by the laxity of ligamentum flavum and osteophytes
Management: hard collar isolation
Vertical (axial) Compression Injury
Jefferson Fx (named after British neurosurgeon who defined it) (unstable but neurologically intact Fx) 7% of all C/S injuries. Stability is dependent if the transverse ligament is intact or torn, which can be noted by overhanging of C1 lateral masses over C2 >5-mm combined (left image)
Mechanism: C1 compression (e.g., diving into shallow waters) causing burst Fx-classically 4-parts of the anterior and posterior arch of C1. Variations exist.
Complications: 50% show other C/S Fx, 40% show Odontoid C2 Fx esp. if extension and axial loading occur
Imaging: x-radiography followed by CT scanning to evaluate subaxial injury and complexity of C1 injury. Note Jefferson Fx with pillar and transverse foramina fx requiring posterior occipital-cervical fusion (below right image).
Management: rigid collar immobilization if the transverse ligament is intact. Halo brace or fusion if the transverse ligament is ruptured
Cervical Injuries With Variable Mechanisms of Trauma
Odontoid process fractures:
These occur�with a variety of mechanisms, flexion, extension, lateral flexion. Elderly with superimposed spondylosis are at higher risk.
Anderson & D’Alonzo classification (below). Type 2 is the most common and most unstable. Type 3 has the best chance of healing d/t more massive bleed into C2 body and better healing potential.
Imaging: x-radiography can miss some Fx. CT scanning is essential.
On x-radiography note tilting of the Dens on lateral and APOM views. CT will reveal the injury and classify it.
Complications: cord injury, non-union
CT scanning: type 2 odontoid fracture (unstable)
Management: type 1 (alar ligament avulsion) most stable�observed and treated with rigid collar.
In young patients, Halo brace is used to treat type 2
Older patients do not tolerate Halo
Operative C1-2 fusion if unstable is Dx and cord signs or other complicating factors are present
Normal Radiographic Variants & Anomalies Simulating Pathology
Pediatric spine appears different especially in children younger than 10-years old.
Normal variations; ADI 5-mm and may increase or decrease on flexed/extended views by 1-2-mm
C2-3 may appear as pseudo-subluxation due to normal ligamentous laxity in children (below arrow)
Pediatric vertebral bodies usually are narrower and anteriorly wedged due to the presence of cartilaginous tissue
APOM view appears different in children, and some asymmetry of C1 articular masses is normal (below top image) and should not be confused with Jefferson Fx
In adults, any asymmetry or “overhanging” of C1 articular masses is pathological and may indicate Jefferson fx
Standard ossification centers of the Atlas synchondrosis in children should not be mistaken for fractures
Persistent ossiculum terminal of Bergman is a typical variant/anomaly of tenacious un-united ossification center and should not be confused with type odontoid fx
Os odontoideum
Un-united growth center that currently considered as an un-noticed injury that disturbed normal growth in a child younger than 5-years-old
It may be a cause of C1-2 instability and should be evaluated with flexed and extended cervical views
Should not be confused with type 2 Dens fracture because it typically more demonstrates greater mineralization of bone
Incomplete bilateral agenesis of the C1 posterior arch
Anomalous closure of C1 posterior arch
Should not be confused with a fracture
However, local or cord symptoms may develop after trauma in some cases
Relatively rare anomaly developing due to failed chondrogenesis and ossification of posterior ossification centers of the Atlas
Patients with Down syndrome may suffer from increased ligamentous laxity and other abnormalities
Increased risk of subluxation at C1-2
Burst Fx (unstable) 2-columns are damaged
Mechanism: axial loading with frequent flexion after falls and MVAs
The thoracolumbar region is the most vulnerable due to the increased fulcrum of motion
Key radiography: acute compression fracture and�collapse of body height, retropulsion of posterior body and acute kyphotic deformity on the lateral view
On the frontal view: interpedicular widening (below yellow arrow), regional soft tissue swelling (below green arrow)
Imaging: x-radiography should be followed by CT scanning w/o contrast
MRI if neurologically unstable due to cord or conus injury
Complications: cord damage by acutely retropulsed bone fragments
Management: non-operative if neurologically intact and <50% body retropulsed with minimal kyphosis
Operative (fusion) if 50% or more body retropulsed, laminar/pedicle Fx, neuro compromised
18-Year Old Female Following Trampoline Accident
AP & lateral L/S views
Note acute compression fracture, a vertebral body extending to posterior elements
Widening of the inter-spinous distance between T11-T12 (below arrow)
Radiolucent fracture line is seen through the T12 body on the AP projection
CT scanning was performed
Sagittal reconstructed Thoracic and Lumbar CT slices in bone window
Note acute compression fracture, the T12 body extending into pedicle and lamin
Dx: Chance fracture of T12
MR imaging was performed
T2 Wl sagittal MRI
Findings: acute compression fracture T12 body extending to posterior elements causing rapture of interspinous and flavum ligaments
Mild compression of the distal cord above the conus is noted with a minimal signal abnormality
Dx: Chance fracture
Chance Fx aka (Seatbelt Fx) – is a flexion-distraction injury (unstable)
M/C in lower thoracic-upper lumbar
All 3-columns fail: column 3 torn by distraction, columns 1 and 2 fail on compression (Denis classification)
Causes: MVA, falls
Imaging: initial x-radiography should be followed by CT scanning w/o contrast to assess bone fragments retropulsion/canal compression. MRI may help to evaluate potential cord damage and ligaments tearing
Management: non-operative immobilization if neuro intact
Cranio-cervical and upper cervical stability is dependent on transverse, superior and inferior bands of the C1-C2 ligament, alar ligaments, along with a few other ligaments
Cervical Trauma
The C/S is vulnerable to injury. Why?
Stability has been sacrificed for greater mobility
Cervical vertebrae are small and interrupted by multiple foraminae
The head is disproportionately heavy and acts as an abnormal lever especially when forces act against a rigid torso
Additionally, C/S is prone to degeneration which makes it more vulnerable to trauma
In young children, ligaments are more luxed vs. disproportionately large head size
In children, the fulcrum of movement is at C2/3 thus making injuries more common in the upper C/S and craniocervical junction. In children, S.C.I.W.O.R.A. may occur when no evidence of fracture present
In adults, the fulcrum of movement is at C5/6 thus making lower C/S more vulnerable to trauma especially during extremes of flexion
Cervical Trauma categorized according to mechanisms of injury (Harris & Mirvis classification)
Hyperflexion Injury: Stable vs. Unstable
Flexion teardrop Fx (most severe fracture, unstable)
Begins with x-radiography especially in cases with no significant neurological compromise
Clear neutral lateral view first
If x-radiography is unrewarding but high probability of severe trauma and neurological deficit present, CT scanning w/o contrast is required
Consider CT scanning in patients with pre-existing changes: advance spondylosis, DISH, AS, RA, post-surgical spine, congenital abnormalities (Klippel-Feil syndrome, etc.)
Vertical compression:
Jefferson aka burst Atlas Fx (unstable especially if the Transverse ligament is torn, cord paralysis in 20-30% only)
Why? Due to fragments dissociation and canal widening
Burst Fx of the Thoracic or Lumbar spine (unstable, cord paralysis may occur)
How to Assess Spinal Radiographs in Trauma Cases:
Construct 5-lines on the lateral view
Note if facets are well-aligned and symmetrical
Ensure symmetry of the disc height
Note any widening or fanning of the inter-spinous distance
Carefully examine prevertebral soft tissues
Evaluate atlanto-dental interval (ADI)
In cases of trauma, evaluate and clear neutral lateral first
Do not perform flexed and extended views in acute cases before x-rays or CT scanning exclude significant instability
Pay extra attention to prevertebral soft tissues
If thicker than normal limits, consider severe post-traumatic bleed
Subtle asymmetry and widening of posterior disc height and facets with inter-spinous fanning may be a key feature of significant tearing of posterior ligaments
Hyperflexion Injuries (M/C Mechanism)
More frequent in sub-axial C/S C-3-C7)
Unstable injuries:
Flexion teardrop fracture (M/C C5 & C6) v. unstable
Key rad features:
Large “teardrop” triangular anterior body fragment
Fanning of the SPs, posterior disc and facet widening indicating tearing of major spinal ligaments and instability
A posterior shift of the vertebral body fracture suggests direct anterior cord/vessels compression
Bulging prevertebral soft tissue >20-mm at C6-7
80% of cases may be paralyzed on the spot or develop significant paralysis soon after
Acute Neck Trauma. What are the vital radiographic features? What is the diagnosis?
Most people don�t even think about visiting a chiropractor until they�ve sustained an injury or need a quick adjustment to help ease the pain. They typically see it as a treatment for injuries or conditions that they�ve already endured, not as a preventative health care option. And while chiropractic care is an exceptional way to treat existing conditions and injuries, that is only half of the picture. It is also a viable health care approach that is effective in improving overall wellness. There are some very compelling reasons to incorporate chiropractic into your everyday life. Chiropractic can:
Help lower your risk of injury
When the spine is out of alignment, it can put stress on other parts of the body including ligaments and joints. Regular chiropractic care helps keep the spine aligned thus reducing your risk of injury.
Elevate your mood
Chiropractic treatment can help to balance your hormones. It increases the feel-good hormone dopamine while decreasing the stress hormone cortisol. It makes it an excellent drug-free option for patients who suffer from anxiety, depression, or mood swings. As part of your treatment, your chiropractor may also recommend dietary and lifestyle changes that can help even more.
Makes you feel more energetic
When your spine is out of alignment, your entire body suffers. You can feel stiff, sore, and fatigues. Most patients report feeling invigorated after their treatment. They can move more naturally and have much more energy. Part of this is due to the effect the treatment has on the body as well as the hormones that are released that provide a boost in your mood.
Help you sleep better
More than 60 percent of people in the United States, both children, and adults report having problems with sleep. Studies show that chiropractic can help with insomnia allowing you to get better, more restful, and more beneficial sleep.
The combination of pain alleviation, increased flexibility, and overall wellness, as well as stress relieving properties, allow your body and mind to relax so that you can fall asleep easier and stay asleep. Incorporating chiropractic care into your everyday routine can help you get a better night�s sleep.
Strengthen your immune system
Studies show that patients who receive regular chiropractic care have a significantly stronger immune system than patients who don�t see a chiropractor. One of the most significant studies to date that explored the connection between regular chiropractic care and a healthy immune system conducted by Dr. Ronald Pero, Ph. D. of New York�s Preventive Medicine Institute where he was the chief of cancer research. He was also a professor of medicine at New York University. The study, which spanned several years, found that patients who received chiropractic care on a regular basis had a 200 percent greater immune competence than non-chiropractic patients.
Manage your pain
Chronic pain, as well as pain from injuries or certain conditions, respond very well to regular chiropractic care. Any discomfort can negatively impact your quality of life, but pain medications can have unpleasant side effects that can be debilitating. It doesn�t help that many pain medications are highly addictive.
Treatments offer a natural remedy for pain that is medication free. What�s more, regularly scheduled therapies work to fix the cause of the problem so that the issue gets permanently resolved.
Make you feel better without medication
Chiropractic treatments are non-invasive and drug-free. It uses the body�s healing properties to address issues naturally and achieve results. It is low risk and very useful, treating the cause of problems, not just the symptoms the way pain medication does.
When you look at all of the benefits of regular chiropractic care and realize that those results can be achieved naturally, it�s easy to see why more people are incorporating it into their health care routines.
April Hermosillo enjoys fitness. She enjoys exercising and eating healthful foods. As an athlete since age 14, neck and low back pain which caused her to get feet cramps had been undergone by April. April Hermosillo tries everyday not to let her symptoms affect her everyday life. April expresses just how much pain relief Dr. Alex Jimenez has supplied her and how thankful she is for having a doctor she can expect with her health issues. She recommends him as the non-surgical option for back pain.
Chiropractic Maintenance Care
Eight out of 10 adults experience debilitating back or neck pain at some time in their lives. Back pain is the second cause of missed workdays because of illness, and also the most common cause of disability in the United States. Chiropractic care’s goal is to provide safe and effective treatment which permits individuals to come back to a lifestyle when possible. Spine experts can ascertain which treatment strategies are best for each health problem. Non-surgical remedies are the most suitable treatments for neck and back pain.
We are blessed to present to you�El Paso�s Premier Wellness & Injury Care Clinic.
As El Paso�s Chiropractic Rehabilitation Clinic & Integrated Medicine Center,�we passionately are focused on treating patients after frustrating injuries and chronic pain syndromes. We focus on improving your ability through flexibility, mobility and agility programs tailored for all age groups and disabilities.
If you have enjoyed this video and we have helped you in any way, please feel free to subscribe and recommend�us.
Your spine goes through a lot each day. It provides structural support and houses the central nervous system which carries impulses from the brain throughout the body. When it isn�t working as it should, the entire body can be affected. Chiropractic has long been praised as a way to keep the back healthy. Well, now we�ll get down to the nitty-gritty and examine just why it is so good for your spine.
It Improves Your Posture
Posture is not only good for your spine; it is beneficial for the entire body. It keeps the body in proper alignment which, in turn, allows the muscles to work as they should.
This prevents abnormal wearing on the surfaces of the joints and allows joint and muscles to work more effectively and efficiently. Good posture helps to avoid injury and even helps with proper organ function.
However, many people have poor posture and don�t even realize it. Chiropractic can help align the body and improving position which dramatically benefits the spine. The patient then enjoys an improved range of motion and even more energy as the body does not have to work so hard to compensate for misalignments and poor posture.
It Helps To Relieve Pain
As much as 90 percent of people experience back pain at some point. Considering all that the back goes through in a typical day, it isn�t much of a stretch to think that there might be some pain involved at times. It is especially true if the back is not correctly aligned.
Chiropractic thought of as a treatment for back pain, but what many people don�t realize is that it is also used to treat pressure in the knees, ankles, feet, hands, and jaw. Pain in the body�will often try to compensate by adjusting to take the pressure off of certain areas.
It can cause misalignment which can impact the entire system, causing pain and stiffness. A Doctor of Chiropractic may treat these problems with various chiropractic techniques, specific exercise recommendations, and even dietary changes to relieve the pain.
Get Healthy Green Road Sign with Dramatic Clouds, Sun Rays and Sky.
It Strengthens The Spine To Support The Body
The spine is the primary support for the body. When it breaks down, the body suffers. Regular chiropractic treatment ensures that the spinal column remains in proper alignment which, in turn, keeps the body in proper alignment.
It helps with joint health as well as the health of the related muscles and ligaments. Your chiropractor can also recommend stretching and strength building exercises to help keep your spine healthy and supple.
Chiropractic helps to keep the back flexible which aids in preventing injury. A healthy spine is also less likely to become misaligned or experience pain. It can significantly improve your quality of life as you are more flexible and mobile.
It Improves Overall Health
Chiropractic is right for your spine which means it is good for your overall health. While many people think that its only purpose is to treat back pain, chiropractic focuses on total body wellness.
All too often problems within the body are interrelated. For instance, back pain could be the result of an altered gait due to an ankle injury.� A misaligned neck could cause a headache due to awkward sleep positions (or even the wrong pillow).
Chiropractors do treat the symptoms, but they also delve into the problem to discover the root so that true healing can occur. It not only makes the spine healthy but the entire body as well.
It is required to perform minimum 2-views orthogonal to each other:
1 AP (Anterior to Posterior) or PA (Posterior to Anterior)
2 Lateral
Supplemental views: Oblique views etc.
Skeletal radiographs typically use AP & lateral views
Chest radiographs and Scoliosis imaging in children will usually use the PA technique
Exceptions for PA chest views: patients unable to cooperate (severely ill or unconscious patients)
X-rays are a form of electromagnetic energy (EME) similar to light photons or other sources
X-rays are a form of man-made radiation
Ionizing effect of x-rays process of removal of atomic electrons from their orbits
Two basic types of ionizing radiation:
Particle (particulate) radiation produced by alpha & beta particles that are the result of radioactive decay of different materials
Electromagnetic Radiation (EMR) produced by x-rays or gamma rays called photons
The energy of EMR depends on its wavelength
Shorter wavelength corresponds to higher energy
The energy of EME is inversely related to its wavelength
X-ray Properties
No charge
Invisibility
Penetrability of most matters (esp. human tissues) depends on “Z” (atomic number)
Making compounds fluoresce and emit light
Travel at the speed of light
Ionization and biologic effect on living cells
The Imaging System
X-rays are produced by an imaging system ( x-ray tube, operator’s console, and high voltage generator)
X-ray tube composed of (-) charged cathode and (+) charged anode enclosed in the evacuated class envelope and housed in the protective coat of metal
A Cathode made up of filament wire embedded within the focusing cup to give electrostatic focus to electrons’ cloud
Filament wire of heat resistant thorium tungsten metal of high melting point (3400 C) that “boils off” electrons during thermionic emission
Focusing cup polished nickel (-) charged that�accommodated� the filament to electrostatically repulse the electrons and confines them to the focal spot of the anode disc where x-rays are produced
Anode (+) charged target for electrons to interact at the focal spot
Conducts electricity
Rotates to dissipating heat
Made of tungsten to resist heat
Anode has a high atomic number to produce x-rays of very high efficiency at the focal spot
There are 2-focal spots large and small, each corresponding to cathode’s filament size (small vs. large) that depends on the magnitude of current in the cathode dictated by a radiographic study of larger or smaller body parts
It is known as the dual focus principle
When Electrons are emitted from the cathode as the cloud, they slam into the Anode’s focal spot resulting in 3 man events
Production of heat (99% outcome)
Production of Bremsstrahlung (i.e., breaking radiation) x-rays that represent the majority of x-rays within the x-ray emission spectrum
Production of Characteristic x-rays very few in the emission spectrum
Newly formed x-rays at the anode are of different energies
Only need high energy or “hard” x-rays to perform the radiographic study
Before x-rays exiting the tube we need to remove weak or low energy photons, i.e., “harden the beam.”
Added tube filtration in the form of aluminum filters is used that removes at least 50% of the “unfiltered” beam thus minimizing the patient’s radiation dose and maximizing image quality
High Voltage Generator
X-ray production requires an uninterrupted flow of electrons to the anode
Regular electricity supplies AC power with sinusoidal currents of “peaks and drops.”
In the past, single-phase high voltage generators would convert AC power into a half, or full wave rectified supply with a measure in the thousands of volts delivered with a “voltage ripple” or peaks of high voltage. Therefore, a term kilo voltage peaks (kVp) was used
Modern generators provide “uninterrupted” flow of electrical potential to the x-ray tube eliminating “voltage ripples” thus referred to as kilovoltage kV without “peaks.”
When x-rays interact with the patient’s tissued 3 events will occur
X-rays will pass through without interaction and “expose” the image receptor
Photoelectric interaction/effect (PE) comparatively lower energy x-rays will be absorbed/attenuated by the tissues
Compton scatter x-rays are “bounced off” to form scatter, contributing no useful information to the film and lower image contrast while potentially giving unnecessary radiation dose to staff
The final image is the product of all three types of interactions known as
Differential absorption of x-ray photons – the result of photons’ absorption via PE, Compton scatter and x-rays passing through the patient
Compton scatter probability decreases with an increase in x-ray energy compared to PE effect
Compton effect probability does not depend on the atomic number (Z)
An increase of total mass density (thick vs. thin) will increase Compton and PE interaction
What cells in the body are considered most vulnerable and most resistant to radiation?
Cells that are rapidly dividing and not terminally differentiated, epithelial cells, etc. are more radiosensitive
Bone marrow cells (stem cells) & lymphocytes are very radiosensitive
Muscle & and nerve cells are terminally differentiated and are less sensitive to radiation
Aged (senescent cells) vs. immature fetal cells are more vulnerable to radiation
However, following low dose radiation in most healthy individual cells will be able to repair likely without any long-lasting changes
Pregnancy & radiation initial 6-7 weeks are the most vulnerable
Do not use routine (non-emergent) radiographic examinations in pregnancy
Apply 10-day rule establish that radiographs can only be obtained during the initial ten days from the onset of the last menstrual cycle
Radiographic imaging of children:
If clinically possible use non-ionizing forms of medical imaging (e.g., ultrasound)
Non-axial imaging studies that use x-ray photons:
Conventional radiography
Fluoroscopy
Mammography
Radiographic angiography (currently less often used)
Dental imaging
Cross-sectional imaging using x-ray photons: Computed Tomography
Indication and Contraindication for conventional radiographic imaging
Advantages of Radiography: widely available, inexpensive, low radiation burden, the first step in imaging investigation of most MSK complaints
Disadvantages: 2D imaging, relatively lower diagnostic yield during an examination of soft tissues, numerous artifacts, and dependence on correct radiographic factors selection, etc.
Indications:
Chest: initial assessment of lung/intrathoracic pathology. Potentially determines or obviates the need for chest CT scanning. Pre-surgical evaluation. Imaging of pediatric patients due to extremely low radiation dose.
Skeletal: to examine the bone structure and diagnose fractures, dislocation, infection, neoplasms, congenital bone dysplasia, and many forms of arthritis
Abdomen:�can assess acute abdomen, abdominal obstruction, free air or free fluid within the abdominal cavity, nephrolithiasis, evaluate placement of radiopaque tubes/lines, foreign bodies, monitor resolution of postsurgical ileus and others
If you sit behind a desk all day with little or no activity, you could be compromising your physical health, mental health, and brain health which could impact your productivity at work. From a physical standpoint, it isn�t healthy to remain in one position for too long. It can lead to various health conditions including diabetes, heart disease, and even cancer. Experts advise movement. By getting up and walking around every hour or so or do exercises at your desk.
Healthy brain function can�be impacted by inactivity if you sit at work without moving for long periods of time your brain could suffer. The lack of activity could cause it to enter into a state of slumber which can lead to a decrease in brain processing speed and short-term memory loss.
It can also impact a person�s ability to learn or retain new information. It is so important to create an organizational culture that encourages moving around as part of their workday.
Create written policies that encourage and advocate movement during work hours. Incorporate moving workstations, moving meetings, flexible scheduling, more breaks when meetings run long, and a movement-friendly dress code.
Provide information and training to all employees and leadership underlining the importance of the policies and explaining the importance of movement as well as what they can do to support the initiative.
Places
Create workspaces that are conducive to movement, adjusting workstations so that they encourage active movement and incorporating dynamic change into current processes and workflows while minimizing the time employees spend sitting.
Seek out software and applications that encourage users to stretch or get up and move while they are working. Make stairwells more accessible and appealing, improve common areas, and promote collaboration that requires moving to various workstations or common areas.
People
Identify employees who are good role models for movement and train them for leadership roles so that they can encourage other employees to move a part of their workday. Train them in the policies regarding movement and task them with helping to create a culture of health and mobility within the organization.
Organize groups to walk during breaks or meet in common areas for light stretching and other types of movement. Sponsor contests and competitions with prizes for employees who achieve set goals.
Permission
Educate all employees and all levels of management or leadership on the benefits of movement and how it can positively impact personal production and performance as well as organizational outcomes. Stress that moving during the work day should become a regular activity and must be welcomed and allowed. Emphasize that it is the task of all employees to make a culture of movement the norm as opposed to the exception.
The benefits of moving around in the workplace extend far beyond healthier employees and increased production. Employees perceive themselves as valuable to the organization and morale is increased. Employee engagement�improves�on the job, and they invest more in their work as opposed to just doing a job. They are happier, empowered, and more productive at work and take more of an active role in business outcomes as well as their health.
Of course, employees will also enjoy individual benefits such as increased blood flow, as well as improved problem solving, better alertness, and enhanced creativity. A workplace that incorporates movement into its culture is a healthier, happier place to work with more robust, and more satisfied employees. You can�t afford to not implement this simple, effective strategy into your own organizational culture.
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