Sports Spine Specialist Chiropractic Team: Athletes strive to achieve their body’s maximum performance by participating in numerous training regimens consisting of strenuous exercises and physical activity and ensuring they meet all of their body’s nutritional requirements. Through proper fitness and nutrition, many individuals can condition themselves to excel in their specific sport. Our training programs are designed for athletes that look to gain a competitive edge in their sport.
We provide sport-specific services to help increase an athlete’s performance through mobility, strength, and endurance. Occasionally, however, the excess workouts can lead many to suffer injuries or develop underlying conditions. Dr. Alex Jimenez’s chronicle of articles for athletes displays in detail the many forms of complications affecting these professionals while focusing on the possible solutions and treatments to follow to achieve overall well-being.
Types, location, and stability of tears are v. important during MRI Dx
Vertical/longitudinal tears especially occur in acute ACL tears. Some longitudinal tears found at the periphery or “red zone” may heal
Bucket handle tear: longitudinal tear in the inner edge that is deep and vertical extending through the long axis and may displace into a notch
Oblique/flap/parrot-beak are complex tears
Radial tear at 90-degree to plateau
Axial T2
Axial T2 WI fat-sat and coronal STIR slices of the posterior horn of the medial meniscus.
Note a radial tear of the posterior horn of the medial meniscus near the meniscal root. This is potentially an unstable lesion requiring operative care
The meniscus, in this case, is unable to provide a “hoop-stress mechanism.”
MRI Slices Coronal & Sagittal
Fat-sat coronal and sagittal proton density MRI slices revealing horizontal (cleavage) tear that is more typical in the aged meniscus
In some cases, when this tear does not contain a radial component, it may partially heal obviating the need for operative care
T2 w GRE Sagittal MRI Slice
Complex tear with a horizontal oblique and radial component.
This type of tear is very unstable and in most cases may need operative care
Bucket Handle Tear
Bucket handle tear are m/c in the medial meniscus esp. with acute ACL and MCL tear
MRI signs; double PCL sign on sagittal slices
Absent “bow-tie” sign and others
Most cases require operative care
DDx From Meniscal Degeneration
Occasionally meniscal tears need to be DDx from meniscal degeneration which may also appear bright (high signal) on fluid-sensitive MRI
The simplest rule is that if there is a true meniscal tear aka Grade 3 lesion, it always reaches/extends to the tibial plateau surface
The Role of MSK Ultrasound (US) in Knee Examination
MSK US of the knee permits high resolution and dynamic imaging of primarily superficial anatomy (tendons, bursae, capsular ligaments)
MSK US cannot adequately evaluate cruciate ligaments and the menisci in their entirety
Thus MR imaging remains modality of choice
Potential Pathologies Successfully Evaluated by MSK US
Patellar tendionosis/patellar tendon rupture
Quadriceps tendon tear
Prepatellar bursitis
Infrapatellar bursitis
Pes Anserine bursitis
Popliteal cyst (Baker cyst)
Inflammation/joint effusion with synovial thickening and hyperemia can be imaged with US (e.g., RA) especially with the addition of color power Doppler
Patient Presented With Atraumatic Knee Pain & Swelling
Radiography revealed sizeable soft tissue density within the superficial pre-patella region along with mild-to-moderate OA
MSK US demonstrated large septated heterogeneous fluid collection with mild positive Doppler activity on the periphery indicating inflammation d/t Dx of Superficial pre-patella bursitis
Long Axis US Images
Note normal lateral meniscus and fibers of LCL (above bottom image) compared to
Horizontal degenerative cleavage tear along with protrusion of lateral meniscus and LCL bulging (above top image)
Major limitation: unable to visualize the entire meniscus and the ACL/PCL
MRI referral is suggested
Rupture of Distal Tendon of Quadriceps
Note rupture of distal tendon of the Quadriceps muscle presented as fiber separation and fluid (hypo to anechoic) fluid collection within the substance of the tendon
Advantages of MSK US over MRI to evaluate superficial structures:
Dynamic imaging
Availability
Cost-effective
Patient’s preparation
Disadvantages: limited depth of structures, inability to evaluated bone and cartilage, etc.
Osteochondral Knee Injuries (OI)
osteochondral knee injuries can occur in children 10-15 y.o presented as Osteochondritis Dissecance (OCD) and in mature skeleton m/c following hyperextension and rotation trauma, particularly in ACL tear.
OCD-typically develops from repeated forces in immature bone and affects m/c postero-lateral portion of the medial femoral condyle.
OI in mature bone occurs m/c during ACL tears mainly affecting so-called terminal sulcus of the lateral femoral condyle at the junction of the weight-bearing portion opposed to tibial plateau and the part articulating with the patella
Osteochondral injuries may potentially damage the articular cartilage causing secondary OA. Thus need to be evaluated surgically
Imaging plays an important role and should begin with radiography often followed by MR imaging and orthopedic referral.
OCD Knee
95% associated with some trauma. Other etiology: ischemic bone necrosis especially in adults
Other common location for osteochondral injuries: elbow (capitellum), talus
1st step: radiography may detect osteochondral fragment potentially attached or detached
Location: a posterior-lateral aspect of the medial femoral condyle. Tunnel (intercondylar notch) view is crucial
MRI: modality of choice >90% specificity and sensitivity. Crucial for further management. T1-low signal demarcating line with T2 high signal demarcating line that signifies detachment and unlikely healing. Refer to orthopedic surgeon
Management: stable lesion esp. in younger children>off weight-bearing-heals in 50-75%
Unstable lesion and older child or impending physeal closure>operative fixation.
Result from valgus or varus stress with or w/o axial loading
Associated with periarticular soft tissues injury
High-stress injury m/c due to jumps falls and axial loading, often with the splitting of the tibial plateau. Men>women. Patients are in their 30s
Low impact or no trauma in patients with osteoporosis d/t insufficiency fractures
Impaction injury is more common with depression of tibial plateau. Women>men. Patients are in their 70s
Lateral Tibial Plateau Fractures More Common
Functional anatomy plays a significant role
60% of weight bearing is by the medial plateau
The medial plateau is more concave
Lateral plateau is slightly higher and more convex. Valgus stress impacts lateral plateau.
Tibial plateau fractures considered intra-articular and prone to delayed healing, non-union, meniscal injury (m/c lateral) ACL tear, secondary OA. Other complications: compartment syndrome, vascular injury.
Management: operative in many cases especially if >3-mm step-off at the plateau
If medial plateau or bicondylar Fxs present, ORIF will be required.
Imaging Plays A Crucial Role
Begins with x-radiography. X-radiography may not reveal the complexity and extent of this injury.
CT scanning w/o contrast will further delineate fracture complexity and pre-operative planning
MR imaging may be considered to evaluate for internal derangement: meniscal, ACL injuries.
Shatzke classification may help to evaluate the complexity of this injury
Key Diagnostic Sign
AP and lateral horizontal beam (cross table) left knee radiograph. Note subtle depression of the lateral plateau manifested by the lateral plateau appearing at the same level or lower as the medial. A critical diagnostic sign is the presence of fat-blood-interphase or FBI sign on cross-table lateral (above arrow) indicating intra-articular knee fracture
Lipohemarthorosis aka FBI Sign
Can be detected by radiography, CT or MR imaging
FBI sign is a reliable secondary radiographic sign of intra-articular knee fractures, regardless of how small they are
Mechanism: fracture results with acute hemarthrosis
Hemarthrosis will also occur w/o Fx. However, Fx will result with a fatty marrow being released into the joint cavity. Fat is a less dense medium (lighter) and will appear on the top of the hemorrhage if the patient is held in the supine position for 5-10-minutes before the cross-table radiograph is taken
FBI sign confirms the intra-articular Fx.
ACL/PCL, meniscal tears will not result in FBI sign
Lateral Tibial Plateau Fx
Lateral tibial plateau Fx that was managed operatively
Most common complication: premature secondary OA
More complex injuries may result in more extensive operative care
Knee Internal Derangement
Acute or chronic injuries of meniscal fibrocartilages and ligamentous restraints
Tears of the ACL and posterior horn of the medial meniscus are the most common
Acute ACL tears, however, often result with a lateral meniscus tear
Acute ACL tear may occur as a combined injury of the ACL, MCL, and medial meniscus
Functional anatomy: ACL prevents anterior displacement of the tibia and secondary varus stress
MCL functions together with ACL in resisting external rotation of the tibia especially when the foot is planted (closed chain position)
MCL is firmly attached to the medial meniscus, explaining the classic triad of ACL, MCL and medial meniscal tear (O’Donahue terrible triad)
Cruciate ligaments (ACL/PCL) are intra-articular but extra-synovial. Less likely to be torn in closed pack position (full extension). When all articular facets of tibia and femur are in full contact, the ACL/PCL are at least tension and stable
When the knee is flexed 20-30-degrees or more ACL is taut and remains unstable
ACL is a significant mechanoreceptor that feeds the info to CNS about the joint position. Thus the majority of previous ACL tears will lead to some degree of knee instability
Functional Anatomy of ACL
Diagnosis of ACL Tear
Diagnosis of ACL tear requires MR imaging
Concerns exist of not only ligamentous injuries but injuries to the articular cartilage and menisci.
Most vendors will perform at least: one T1 WI in coronal or sagittal planes. Sagittal and coronal Proton-density slices to evaluate cartilaginous structures. Fast spin-echo sagittal, axial and coronal T2 fat-saturated or sagittal and coronal STIR images are crucial to demonstrate edema within the substance of knee ligaments
ACL is aligned along the Blumensaat line or oblique line corresponding the intercondylar roof of Femoral condyles. Lack of such alignment by the ACL is significant for ACL tear
Imaging Dx of Internal Derangement
MRI shows 78-100% sensitivity and 78-100% specificity
Primary signs of ACL tear: non-visualization of ACL (above green arrow), loss of its axis along the Blumensaat line (above triangle heads), wavy appearance and substance tear (above white arrow) or edema and cloud-like indistinctness (above yellow arrow)
Reliable Secondary Signs of ACL Tear
May be observed on the radiographs and MRI
Segond avulsion fracture (80% specificity for ACL tear) (next slide)
Deep femoral notch sign indicating osteochondral fracture (above bottom images) and
Pivot -shift bone marrow edema in the posterolateral tibial condyle d/t external rotation and often valgus impact by the lateral femoral condyles (above top image)
Segond Fracture (Avulsion by ITB)
Segond fracture at Gerdy’s tubercle. A vital sign of the ACL tear seen on both radiographs and MRI
Management of ACL Tears
In acute cases, usually operative using cadaveric or autograft (patella ligament or hamstring) ACL reconstruction
Complications: graft tear, instability and premature DJD, joint stiffness d/t lack of postoperative rehab or gaft shortening. More rare, infection, a formation of intraosseous synovial cysts, etc.
You may have seen professional athletes, dancers, gymnasts, and others who engage in extremely physical activities using a type of tape on various points of their bodies. It is sometimes colored and does not seem to inhibit range of motion. While it looks like tape or maybe a very fancy bandage, it is a highly technical, specialized tape that is used to treat patients of all ages and activity levels. It is called Kinesio tape, and it is often used by chiropractors to help address specific injuries.
What is Kinesio Tape?
Also called Kinesio Tex Tape, Kinesio Tape is a special adhesive tape that has elastic properties. It was developed by Dr. Kenzo Kase, a chiropractor, and acupuncturist, in 1979. It is safe for all ages including pediatric and geriatric patients. The tape is comprised of a 100% cotton fiber strip with medical grade acrylic adhesive. It is soft and gentle, but it works.
The tape is hypoallergenic and latex free, so it is appropriate for a vast audience. It is also water resistant, making it wearable for many activities. When worn, the tape does not limit or inhibit range of motion, and the same tape can be worn for several days without losing its effectiveness.
How does Kinesio Tape Work?
The tape can stimulate or relax muscles, depending on the tension that it puts on the body when applied. When worn, it lifts the skin by microscopic increments which aids in lymphatic drainage.
It also helps to decrease inflammation and swelling which reduces pressure in the area. This allows the blood and lymphatic fluid to flow freer and more effectively in and out of the affected area.
When used correctly, Kinesio Tape can reduce inflammation, promote better circulation, prevent injury, facilitate healing, the re-educate the neuromuscular system. This helps the body return to homeostasis. It can be applied in many different configurations, but often the applications are a single �I,� �Y,� or �X.�
The Kinesio Taping Method
The Kinesio taping method is a systematic, therapeutic technique that offers a two-prong approach of supporting the patient and rehabilitating the condition or affected area. It can alleviate pain reduce swelling, providing relief to the patient. There are specific taping shapes that are specialized to address certain areas of the body as well as certain conditions. While it provides stability and support to the body�s joints and muscles, it does not restrict the range of motion. The technique is designed to address soft tissue injury by manipulating that area and facilitating healing.
What Conditions is Kinesio Taping used to Treat?
Many conditions throughout the body can benefit from Kinesio Taping. Chiropractors use it for:
Lower back strain
Plantar fasciitis
Back strain
Carpal tunnel syndrome
Rotator cuff injury
Ankle Sprains
Whiplash
Herniated disc
Post-surgery edema
Tennis elbow
Pre-surgery edema
Patella tracking
Athletes may also use it for additional support or to prevent injury. Because it relies on the body�s natural healing process, many people find it to be preferred treatment for many painful conditions. When combined with chiropractic care, Kinesio Tape is very effective.
When treating a condition with Kinesio Tape, the chiropractor may use a variety of techniques, depending on the illness or injury. They may use spinal manipulation, massage, and other treatments, combining them with recommendations for lifestyle changes and diet modifications.
The draw for this treatment is that it encourages the body to heal itself, eliminating the need for drugs with their undesired and unpleasant side effects, or more invasive procedures like surgery. Kinesio Taping is safe, natural, and a perfect complement to chiropractic care.
Back pain can be debilitating, causing immobility, inflexibility, and have a significant impact on a person�s quality of life. It can make even the most mundane daily activities extremely difficult � and even excruciating. Building the muscles that make up your core (abdominals and back) can help support your spine and reduce back pain. In many cases, strengthening these muscles can assist a patient to avoid medication with its unpleasant side effects and even avoid surgery. With just a few smart moves you can significantly decrease your back pain, increase your mobility, and take back your life.
The Role of Abs and Back Muscles
The spine is the supporting structure for the back, but it also is a vital infrastructure for the entire body. It houses the central nervous system, and neural impulses are transferred along what is�a spinal superhighway.
The arms, legs, neck, and head are all connected and stabilized by the spine through an intricate network of ligaments and muscles. The back muscles and abs, or abdominal muscles, are at the center, or core, of this muscle network. They keep the body upright and facilitate movement. When these core muscles are not in good condition, it puts stress on the spine, impacting its ability to support the body. This often results in back pain and even injury in some cases.
Postural Alignment
Postural alignment is a frequent contributor to back pain. This is often due to weak core muscles.
As the muscles fail to do their job to stabilize the spine, the body adjusts structurally to accommodate the weakness. This can result in postures that cause joint pain as well as muscular pain and even headaches.
For instance, stooped or hunched shoulders can cause back pain, but it can also create tension in the shoulders and neck. This, in turn, can cause tension headaches and migraines in patients.
A sway back, where the lower back bows, causing the pelvis to tilt up, can cause severe lower back pain, especially after standing for long periods of time. Swayback can be the result of weakened core muscles or a combination of a weak core, combined with obesity or pregnancy.
The weight in the abdominal area pulls the spine forward so that it curves. A pregnancy sling can sometimes help with the pain, but it is just a band-aid. The real cure is to strengthen the core muscles so that they are better able to support the spine and body adequately.
Foundation Training
Eric Goodman, a chiropractor, developed Foundation Training as a way to help his patients who suffer from lower back pain but are not physically able to do Pilates or yoga. It is also designed to help those who sit for long periods of time to counteract the associated adverse health effects.
Foundation training incorporates powerful yet straightforward movements that work to integrate the body�s muscular chains, increasing strength and realigning the core and spine. It does not require any equipment so the actions can be performed anywhere. The muscles are trained how to move correctly and work together so that you the body learns to move how it is designed to move. The critical, essential exercise can be viewed in this video.
Creating a strong core can help relieve back pain but also have added benefits such as increasing energy, better mobility, and an improved mood. By allowing the body to support itself, it can naturally relieve pain and heal certain conditions without invasive surgery or medication which can have unpleasant or even harmful side effects. When you take good care of your body, it will take good care of you.
Every new parent has experienced a fussy baby with colic � some more often than others. It is always the same, though, an inconsolable baby and frustrated, frazzled parents who only want to comfort their child but can�t. It hurts to know that your baby is uncomfortable, or worse, in pain, and there is nothing you can do about it.
Colic can leave parents feeling helpless. There is a treatment, though, that has given many parents hope and brought relief to their little ones. Chiropractic is an effective treatment for colic that is drug-free and gentle. Both infants and their parents reap the benefits because when a baby is happy, mom and dad are happy.
What is Colic?
Colic is a condition that occurs in healthy, well-fed infants, beginning when the baby is a few weeks old. By the time the baby is three months old, the condition usually improves, and by five months it is often no longer occurring. It is marked by inconsolable crying that meets three criteria regarding length:
More than three hours a day
Three days a week or more
For three weeks or longer
During these episodes, it seems as if there is nothing that can be done for the baby. The good news is, it is relatively short-lived, but while it is happening it can cause a great deal of distress to the baby and the parents.
Symptoms of Colic
All babies cry and even get fussy from time to time. That is just normal baby behavior; it does not necessarily point to colic as the culprit. When a baby that is well fed and otherwise healthy, symptoms of colic may include:
Episodes of crying that are often predictable. Colic usually occurs in the latter part of the day � late afternoon or evening � and at around the same time each day. So a baby with colic will usually get fussy at the same time and the period of distress can last a few minutes to several hours.
Baby is inconsolable with intense crying. The baby with colic will seem very distressed. The cry is very high pitched and no response to attempts to comfort. The baby�s face may become flushed, and near the end of the episode they may pass gas or have a bowel movement.
The crying does not seem to have a source or reason. Babies cry, all babies � but they are usually crying because they need something. They may cry because they are hungry, need a diaper change, or want to be held by mom or dad. A colicky baby will cry for no apparent reason.
There are Changes in posture. Several posture changes are relatively consistent with colic. The baby will often clench their fists, curl their legs, and tense the abdominal muscles.
Chiropractic for Colic
Childbirth is not easy, and it isn�t gentle. As the baby passes through the birth canal and emerges, it�s little body is stretched and compressed which can cause misalignment of the back and neck. If the labor was extensive, there was prolonged pushing, or if a device like forceps or vacuum extraction is used, the chances of misalignment are very likely. These misalignments can lead to difficulty nursing and even impede normal organ function. This can lead to digestive issues which may lead to colic.
Some parents may be uncomfortable at first when they consider getting chiropractic care for their infant, but it is safe and gentle. The popping and cracking that is associated with chiropractic is not a part of infant and child chiropractic. The doctor applies gentle pressure to areas on the neck and back, using his fingers. Many times the baby will completely relax during these adjustments.
Chiropractic for colic is very useful. Parents considering this type of treatment for their baby should look for a chiropractor who has experience providing treatment for babies. It can make a world of difference for a colicky, distressed baby.
Yoga has long been touted as a healing activity that extends beyond its known fitness benefits. It can help alleviate depression, relieve stress, and decrease anxiety as well as tighten and tone the body.
A 2016 study by Yoga Alliance and Yoga Journal shows that the more than 20 million people who practice yoga spend more than $10 billion on related classes and products. Chiropractors have picked up on the benefits of yoga and are recommending it to their patients. Why, because it helps to improve flexibility as well as spinal health.
Chiropractic and the spine�s role in the body.
Chiropractic is primarily intended to align the spine and balance the body. The spine is the primary support for the body. It houses most of the central nervous system and provides pathways for neural impulses to move throughout the body.
When the spine is out of alignment, it can affect how the central nervous system functions. It can also affect flexibility and even overall mobility as well as cause pain and stiffness.
Chiropractic treatment brings the spine back into alignment. It helps to balance the body and treat injuries as well as help with the changes the aging body experiences.
One of the best-known uses for chiropractic is to treat pain. It is a medication free, non-invasive treatment for chronic pain, sports-related injuries, and even automobile accidents. Many patients had reported finding relief with chiropractic when nothing else worked.
Combining yoga with chiropractic increases the effectiveness of the treatment while strengthening the body and making it better able to respond to it. It is the perfect complement to chiropractic care, and many patients are discovering tremendous health benefits from this winning, healthy combination.
What is Yoga?
In its purest form, it is an ascetic and spiritual discipline that comes from Hindu culture. It involves simple meditation, conscious breathing or breath control, and performing certain body postures.
While an ancient practice long used for spiritual and emotional healing as well as physical wellness, yoga has been adopted in western culture and widely accepted as a form of fitness as well as a therapeutic practice used for relaxation and overall good health. It focuses on inward healing for outward results.
People who regularly practice find they are more centered, handle stress better, and aren�t as likely to experience depression and anxiety. They also are more flexible, have better mobility, and have stronger leaner bodies.
What happens when you combine yoga and chiropractic care?
Because yoga helps to lower blood pressure, decrease stress, and strengthen the body�s core, it is perfect therapy for the chiropractic patient. While chiropractic care is working to align the spine and balance the body, yoga is helping to strengthen the muscles surrounding the spine, providing better support. The numerous health benefits, particularly regarding blood flow and relaxation help to increase chiropractic�s effectiveness as a pain management tool.
Patients who combine yoga and chiropractic will also often find that they see the effects of both treatments much faster than they would if they were only doing one or the other. Both chiropractic and yoga help with balance, flexibility, and mobility, but they come at it from somewhat different approaches. The benefit of this is that it provides a more balanced, well-rounded treatment in these areas as one supports the other.
Yoga also tones and tightens the body, preparing it for much more profound levels of healing, cleansing and releasing the body of tensions that may have been held�in for years. It also works to stretch muscles that have been restricted for years, or even for the patient�s entire life. It prepares the body to accept the full benefits of chiropractic and respond faster and more thoroughly.
Everyone knows that exercise is great for overall wellness, better health, and a healthy body. Many chiropractors will often recommend regular exercise to their patients who need to lose weight, want better mobility, or are seeking relief from depression. Some chiropractors are turning to Pilates to help their patients get stronger, more flexible, and more mobile.
What is Pilates?
In the early 20th century Joseph Pilates developed the exercise program to help World War I soldiers improve their physical fitness. It was used to rehabilitate patients who had been injured. By incorporating resistance, stretching, and target strengthening exercise, Pilates uses resistance bands, individual machines, and floor work to reshape and rehabilitate the body. Dancers, gymnasts, athletes, and celebrities use Pilates to stay in shape. However, anyone can do it for a healthier, more supple spine.
Care of the spine is at the core of Pilates. By keeping it in a neutral, or natural, position, this exercise can prevent back pain as well as help ease it. When done correctly, Pilates can:
Improve muscle control and movement efficiency through mental focus.
Make you more mindful of your body�s position, specifically, remaining aware of the spine�s position and keeping it neutral
Improve centering and mental focus through special, breathing techniques
Support and improve posture by strengthening the abdominal and back muscles.
Benefits of Pilates for Chiropractic Patients
The benefits of Pilates tremendous, but for chiropractic patients, it is even more so. By regularly incorporating Pilates into your exercise routine, you can enjoy these incredible benefits.
You can adapt Pilates to your fitness level and needs. Whether you are just starting a fitness program or you�ve been working out for years, Pilates can be tailored to your fitness needs and level.
It helps you strengthen your core. The deep muscles of your abdomen, back, and pelvic floor make up the core muscles of your body. Many of the movements focus on these muscles, making a body that is strong and the frame is supported.
Allows you to strengthen your muscles without bulking up. With Pilates your muscles get strong, but it also stretches the muscles so that they are lean and long. You will look toned and tight but not bulky and muscular.
It focuses on whole body fitness. Many types of exercise only work certain parts of the body, but this focuses on entire body fitness. It works every part of the body so that the muscle development is balanced.
It helps to improve your posture. It strengthens your body and helps to keep your spine in proper alignment due to a strong core. As a result, your posture naturally improves. By incorporating it into your exercise routine, you will find yourself standing taller, stronger, and more graceful.
You can become more connected through your mind and body by increased awareness. Pilates engages your mind and increases body awareness. It unites the mind, body, and spirit for complete coordination. Each movement is done with full attention.
It improves your flexibility. Pilates is a gentle but powerful exercise that works to safely stretch the muscles, making them longer, and increasing the range of motion in the joints.
It can protect you from injuries. By strengthening your body, Pilates can help protect you against injury. It conditions your whole body so that your muscles and strength are balanced. This reduces your risk of injury.
You get a natural energy boost. Just like with any exercise, it will give you an energy boost. However, it is increased even more thanks to the focused breathing and increase in circulation stimulating the muscles and spine.
It can help you lose weight and attain a lean, long, healthy body. It tones and strengthens the body, and if you do it regularly, it will reshape you. The body is more muscular and more balanced. It also helps you move with more grace and ease.
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