Back Clinic Chiropractic Examination. An initial chiropractic examination for musculoskeletal disorders will typically have four parts: a consultation, case history, and physical examination. Laboratory analysis and X-ray examination may be performed. Our office provides additional Functional and Integrative Wellness Assessments in order to bring greater insight into a patient’s physiological presentations.
Consultation:
The patient will meet the chiropractor which will assess and question a brief synopsis of his or her lower back pain, such as:
Duration and frequency of symptoms
Description of the symptoms (e.g. burning, throbbing)
Areas of pain
What makes the pain feel better (e.g. sitting, stretching)
What makes the pain feel worse (e.g. standing, lifting).
Case history. The chiropractor identifies the area(s) of complaint and the nature of the back pain by asking questions and learning more about different areas of the patient’s history, including:
Family history
Dietary habits
Past history of other treatments (chiropractic, osteopathic, medical and other)
Occupational history
Psychosocial history
Other areas to probe, often based on responses to the above questions.
Physical examination: We will utilize a variety of methods to determine the spinal segments that require chiropractic treatments, including but not limited to static and motion palpation techniques determining spinal segments that are hypo mobile (restricted in their movement) or fixated. Depending on the results of the above examination, a chiropractor may use additional diagnostic tests, such as:
X-ray to locate subluxations (the altered position of the vertebra)
A device that detects the temperature of the skin in the paraspinal region to identify spinal areas with a significant temperature variance that requires manipulation.
Laboratory Diagnostics: If needed we also use a variety of lab diagnostic protocols in order to determine a complete clinical picture of the patient. We have teamed up with the top labs in the city in order to give our patients the optimal clinical picture and appropriate treatments.
The nervous system communicates with the entire body and reacts to internal and external changes using electrical and chemical impulses to send and receive messages. Messages travel/synapse from one neuron to another using specialized chemicals known as neurotransmitters. Paresthesia refers to sensations of numbness, tingling, prickling, skin crawling, itching, or burning, usually in the arms, hands, legs, and/or feet, but can affect other areas of the body. Chiropractic care, massage therapy, decompression therapy, and functional medicine can relieve tissue and nerve compression, improve flexibility, range of motion, and mobility, and strengthen the muscles surrounding the affected nerve to maintain optimal health and prevent worsening or further injury.
Paresthesia
The sensation comes on without warning and is usually painless and described as tingling or numbness. There are different causes of paresthesia, including:
Some individuals have chronic or long-term paresthesia, which can be a sign of a more serious nerve injury or condition. Added physical stress can cause surrounding tissues to irritate or entangle the nerve leading to building pressure. This pressure causes paresthesia in the area interrupting circulation and function. A pinched nerve can happen anywhere in the body, like the neck, shoulder, wrist, back, and face.
A herniated disc in the lower spine can cause back pain and paresthesia in the leg or foot on the affected side.
Carpal tunnel syndrome is a pinched nerve in the wrist that causes numbness and tingling in the hand and fingers.
Pinched nerve symptoms can be intermittent or constant.
Usually, a temporary sensation is caused when pressure is placed on the affected nerve.
Once that pressure is relieved, the discomfort goes away.
Individuals with an Increased Risk
Overuse Injury
Individuals with jobs or hobbies requiring repetitive motions are at a higher risk for nerve compression, paresthesia, or injury.
Anyone can get a pinched nerve, and most individuals will experience paresthesia at some point.
Weight and water gain can cause swelling and increase pressure on nerves.
Thyroid Disease
This puts individuals at risk for carpal tunnel syndrome.
Rheumatoid arthritis
This causes inflammation, which can also compress nerves in the joints.
Diagnosis
To diagnose paresthesis, a doctor will look at the individual’s medical history and ask questions about the symptoms. They will perform a physical examination and, depending on the findings, may recommend tests that can include:
Nerve Conduction Study
This measures how fast nerve impulses travel in the muscles.
Electromyography – EMG
To look at the electrical activity of how nerves and muscles interact.
Magnetic Resonance Imaging – MRI
This looks at the different areas of the body in high definition.
Ultrasound
Used to produce images, this can be applied to the smaller areas to look for nerve compression or damage.
Chiropractic
Treatment options depend on the cause of the paresthesia. Body misalignments can cause nerve interference that can lead to health problems such as migraines, or can disrupt nerve communication and block proper circulation. Chiropractic care focuses on treating the nervous system and is a safe and effective method for treating nerve problems that cause discomfort and sensations. After a thorough examination of problem areas, massage, decompression, and chiropractic adjustments will:
Bova, Joseph, and Adam Sergent. “Chiropractic management of a 24-year-old woman with idiopathic, intermittent right-sided hemiparesthesia.” Journal of chiropractic medicine vol. 13,4 (2014): 282-6. doi:10.1016/j.jcm.2014.08.002
Christensen, Kim D, and Kirsten Buswell. “Chiropractic outcomes for managing radiculopathy in a hospital setting: a retrospective review of 162 patients.” Journal of chiropractic medicine vol. 7,3 (2008): 115-25. doi:10.1016/j.jcm.2008.05.001
Freihofer, H P Jr. “Parästhesien” [Paresthesia]. Schweizerische Monatsschrift fur Zahnheilkunde = Revue mensuelle suisse d’odonto-stomatologie vol. 89,2 (1979): 124-5.
Karne, Sampada Swapneel, and Nilima Sudhakar Bhalerao. “Carpal Tunnel Syndrome in Hypothyroidism.” Journal of Clinical and diagnostic research: JCDR vol. 10,2 (2016): OC36-8. doi:10.7860/JCDR/2016/16464.7316
A big part of sports is avoiding and preventing injuries, as injury prevention is far better than rehabilitation and recovery. This is where prehabilitation comes in. Prehabilitation is a personalized, constantly evolving, and developing strengthening exercise program. The program aims to provide sports-specific targeted exercises and activities to maintain athletes’ physical abilities and mental preparedness for their sport. The first step is for an athletic trainer, sports chiropractor, and physical therapist to examine the individual.
Prehabilitation
Everybody is different when it comes to developing an effective prehabilitation program. Every individual’s program should be progressive and re-evaluated to adapt and adjust to the athlete’s needs. The first step is learning to prevent injuries and following basic injury prevention protocols. Knowing what to do when the body sustains an injury, like home treatment and when it’s time to see a doctor.
Athletes
Athletes of all levels are recommended to incorporate a prehabilitation program into their training. As athletes engage in their sport, their bodies adjust to the physical demands of practicing, playing, and training. Imbalances can happen naturally with normal activity but become more pronounced with each practice, game, and training session and often are the cause of injury. The repetitive movements and regular stresses can cause neuromusculoskeletal symptoms to present. This includes:
Tightness of muscle groups.
Pain and discomfort symptoms.
Stabilization issues.
Strength imbalances.
Program
A chiropractic therapist will measure the individual’s range of motion and strength, biomechanics, evaluate medical history, and present health status. Individuals with an injury or a condition can also benefit from prehabilitation.
Each program is personalized and will address total body balance, sports-specific needs, and weaknesses.
The exercises will balance strength, coordination, range of motion, and stabilization.
The premise is looking at and comparing movements from left to right, front to back, and upper to lower body.
Activities can be subtle, focused exercises or a complex movement sequence to stabilize or improve a specific skill.
Programs focus on strengthening and stabilizing the core, abdominals, hips, and back.
Instability is common and often presents from a lack of core training, as athletes tend to focus on what parts of the body their specific sport utilizes, leaving the core without a regular training routine.
A prehabilitation program has to be constantly updated to adjust to the individual’s progress.
Tools like foam rollers, balance boards, weights, and exercise balls are used.
Training
Prehabilitation should start before any acute or chronic injury occurs, but often it takes a few injuries for individuals to decide to get into a prehabilitation program. Depending on an athlete’s training cycle, prehabilitation can be incorporated into practice or as an independent workout and become part of an athlete’s training routine. A session can include the following:
Warm-up and cool-down exercises.
Exercises to perform while resting or waiting during practice.
A targeted workout on specific weaknesses.
A complete workout for days off or active rest days.
Mini workouts for when traveling and recovery days.
For athletes, feeling challenged and motivated can be the difference between success and failure. Working with a trainer, sports chiropractor, and therapists who know sports, understand athletic needs, and communicate well, will contribute to a successful prehabilitation program.
Improving Athletic Performance
References
Durrand, James et al. “Prehabilitation.” Clinical medicine (London, England) vol. 19,6 (2019): 458-464. doi:10.7861/clinmed.2019-0257
Giesche, Florian, et al. “Evidence for the effects of prehabilitation before ACL-reconstruction on return to sport-related and self-reported knee function: A systematic review.” PloS one vol. 15,10 e0240192. 28 Oct. 2020, doi:10.1371/journal.pone.0240192
Halloway S, Buchholz SW, Wilbur J, Schoeny ME. Prehabilitation Interventions for Older Adults: An Integrative Review. Western Journal of Nursing Research. 2015;37(1):103-123. doi:10.1177/0193945914551006
Smith-Ryan, Abbie E et al. “Nutritional Considerations and Strategies to Facilitate Injury Recovery and Rehabilitation.” Journal of athletic training vol. 55,9 (2020): 918-930. doi:10.4085/1062-6050-550-19
Vincent, Heather K, and Kevin R Vincent. “Rehabilitation and Prehabilitation for Upper Extremity in Throwing Sports: Emphasis on Lacrosse.” Current sports medicine reports vol. 18,6 (2019): 229-238. doi:10.1249/JSR.0000000000000606
Vincent, Heather K et al. “Injury Prevention, Safe Training Techniques, Rehabilitation, and Return to Sport in Trail Runners.” Arthroscopy, sports medicine, and rehabilitation vol. 4,1 e151-e162. 28 Jan. 2022, doi:10.1016/j.asmr.2021.09.032
Healthy sleep is vital for having enough energy, thinking clearly, and managing everyday stresses confidently. Chronic unhealthy sleep patterns and/or insomnia can lead to and contribute to various health issues. This includes daytime fatigue, irritability, difficulty concentrating, delayed reaction time, constantly getting sick, and memory problems. Sleeping health problems can get worse with every night of poor rest. Injury Medical Chiropractic and Functional Medicine Clinic provide treatment, training, and tools to realign and relax the body and restore healthy sleep.
Sleeping Health Problems
Lack of sleep disrupts and slows down nerve impulses and transmissions throughout the body. This can lead to health problems that can include:
Excessive fatigue
Brain fog
Slow responses
Physical performance problems
Inability to remember
Low sex drive
Chronic illness
Over time the risk of developing a serious medical condition increases and can include:
Anxiety
Depression
High blood pressure
Diabetes
Weakened immune system
Stroke
Heart attack
Seizures
Staying On
There is some research that insomnia is associated with hyperarousal or the state of staying on. It often starts with a stressful event that sets off the body’s systems, causing the inability to relax completely. Body discomfort and pain symptoms can also present when the mind and body can’t relax. The entire body can tighten/stiffen, causing aches, soreness, and pain. Continuation of sleeping health problems of the cycle leads to more stress.
Chiropractic care, massage, and decompression therapy can help break the cycle. Breaking the process is necessary to help the body recover and rehabilitate properly. Treatment retrains the body to relax; stretching and pulling the muscles increases blood circulation, as well as advanced and improved brain signals telling the body to relax. A chiropractor will evaluate the individuals sleeping patterns and recommend various solutions. The benefits for individuals with sleep issues include:
Alleviates muscle tension.
Stimulates nerve circulation and blood flow.
Relaxes the whole body.
Enhances central nervous system function.
Relieves pain and discomfort.
A chiropractor will also provide the following:
Sleeping position recommendations.
Postural stretches and exercises.
Recommendations on supportive mattresses.
Ergonomics for work, home, and bed.
Chiropractic’s Evolution
References
Hale, Deborah, and Katherine Marshall. “Sleep and Sleep Hygiene.” Home healthcare now vol. 37,4 (2019): 227. doi:10.1097/NHH.0000000000000803
Nerve irritation occurs when the nerves exiting the spine become irritated and sensitized. Also known as nerve gliding restriction, it is a condition whereby a nerve becomes irritated by inflamed swelling of structures close to the nerve, such as joints, ligaments, muscles, or discs, that have sustained an accumulative strain which results in swelling and inflammation. A thorough chiropractic assessment and examination can diagnose the extent of the irritation and develop a personalized treatment plan.
Nerve Irritation
When swelling and inflammation interfere with the nerve root, the nerve transmits signals to the brain to let it know there is a threat. The brain interprets these signals and creates a protective response to avoid worsening the damage to the nerve. The protective reactions vary from person to person but can include the following:
Muscle tightness and guarding
Aching sensation
Cramping
Radiating discomfort or pain
Pins and needles
Tingling
Numbness
Nerve root irritation also inhibits the body from recovering as fast as it should.
Nerve irritation is not to be confused with nerve root compression or radiculopathy. This is when the nerve becomes compressed/pinched, resulting in the loss of its functions like muscle strength and sensation. Sometimes individuals with nerve irritation can also experience increased neural tension. The nerves adapt to the mechanical loads placed on them through regular movements. Restrictions to neural mobility can cause symptoms to worsen along the pathway and distribution of the nerve.
The nervous system consists of the brain, spine, and nerve branches.
The branches, similar to electrical cables, cannot stretch.
Tension is generated when straightening out body areas, creating a pull and gliding of the nerve to the spinal cord.
When nerve irritation occurs, signals are sent to protect the body, brain, spine, and branches.
Causes
Most commonly, nerve irritation occurs when a structure adjacent to the nerve; this could be a joint, ligament, and/or muscle that accumulates strain and becomes dysfunctional, swollen, inflamed, and/or spasms resulting from protective guarding.
Mild nerve irritation can include accumulated strain from postural overload and swelling from a minor tear in an adjacent ligament.
Often nothing shows as a problem on an MRI scan.
Severe nerve irritation can include disc herniation and shows up on an MRI scan; surgery could be required in some cases.
Symptoms
Stiffness
Tightness
Aches
Pains
Persist even after days of rest, stretching, targeted exercises, avoiding movements, etc.
Stretching feels good at first, but the pain returns or worsens a few hours later or the next day.
The irritation blocks the effective recovery of muscle, joint, tendon, and ligament discomfort symptoms.
Chiropractic Care
Treatment involves various therapies and strengthening the supporting structures while relaxing and releasing tight structures to avoid recurring injuries. Chiropractic care realigns the spine, corrects joints that have shifted out of place, helps to regulate the nervous system’s function, and relieves irritation and inflammation. Whether in the form of an adjustment, traction, or guided exercise, all systems in the body are moved closer to a balanced state. This includes the:
Nervous system
Immune system
Respiratory system
Circulatory system
Endocrine system
Skeletal system
All help support the body’s self-healing process and increase the nervous system’s function.
The chiropractic team will guide the patient through the rehabilitation process to get back to full strength.
Peroneal Nerve Irritation
References
Ellis, Richard F, and Wayne A Hing. “Neural mobilization: a systematic review of randomized controlled trials with an analysis of therapeutic efficacy.” The Journal of manual & manipulative therapy vol. 16,1 (2008): 8-22. doi:10.1179/106698108790818594
Gibson, William, et al. “Transcutaneous electrical nerve stimulation (TENS) for neuropathic pain in adults.” The Cochrane database of systematic reviews vol. 9,9 CD011976. 14 Sep. 2017, doi:10.1002/14651858.CD011976.pub2
O’Shea, Simone D et al. “Peripheral muscle strength training in COPD: a systematic review.” Chest vol. 126,3 (2004): 903-14. doi:10.1378/chest.126.3.903
Rozmaryn, L M et al. “Nerve and tendon gliding exercises and the conservative management of carpal tunnel syndrome.” Journal of hand therapy: official Journal of the American Society of Hand Therapists vol. 11,3 (1998): 171-9. doi:10.1016/s0894-1130(98)80035-5
Sipko, Tomasz, et al. “Mobility of cervical spine and postural equilibrium in patients with spinal overload syndrome.” Ortopedia, traumatologia, rehabilitacja vol. 9,2 (2007): 141-8.
Bruxism is an abnormal jaw clenching or grinding of the teeth, either while awake or during sleep. This can cause neck and shoulder tension caused by excess pressure on the neck and jaw muscles. Individuals may not realize they have bruxism until a dentist notices excess wear and tear or a chiropractor examines their symptoms. Bruxism can play a role in temporomandibular disorders. Doctors and dentists agree that factors like stress increase the likelihood of jaw clenching. Dentists usually recommend a mouth guard to prevent grinding. Chiropractic care, massage, and decompression therapy can relieve symptoms, release and relax the muscles, realign the spine, and restore function.
Bruxism
There is awake bruxism and sleep bruxism. A tight jaw generates tension extending to the neck, shoulder, and upper back muscles. Over time, that excess strain irritates the joints, causing inflammation. Jaw clenching and teeth grinding can lead to health issues like damaged teeth, neck, shoulder, and upper back pain symptoms, and tension headaches.
Symptoms
Signs and symptoms can include:
Face, jaw, neck, and upper back aches, tightness, and soreness.
Tired or tight jaw muscles.
Headaches that start in the temples.
What feels like earache pain symptoms.
Damage from clenching on the inside of the cheek.
Increased tooth sensitivity.
Teeth that are loose, flattened, chipped, or fractured.
Sleep problems.
Risk Factors
Emotional tension – Stress, anxiety, frustration, and anger.
An unhealthy lifestyle – smoking, excess drinking, caffeine, etc., disrupts brain and cardiovascular functions.
Medications
Chiropractic Care for Jaw Clenching
If there is a jaw clenching or grinding issue, it is recommended to see a dentist for a professional diagnosis. Then a chiropractor can develop a personalized treatment plan that utilizes massage and decompression therapy to re-position the jaw, stretch, release and relax the muscles. They will recommend exercises to strengthen and maintain the relaxed jaw muscles and awareness exercises to help identify triggers and prevent clenching.
Jaw Exercises
References
Capellini, Verena Kise, et al. “Massage therapy in managing myogenic TMD: a pilot study.” Journal of applied oral science: Revista FOB vol. 14,1 (2006): 21-6. doi:10.1590/s1678-77572006000100005
Kuhn, Monika, and Jens Christoph Türp. “Risk factors for bruxism.” Swiss dental journal vol. 128,2 (2018): 118-124.
Nishida, Norihiro et al. “Stress analysis of the cervical spinal cord: Impact of the morphology of spinal cord segments on stress.” The journal of spinal cord medicine vol. 39,3 (2016): 327-34. doi:10.1179/2045772315Y.0000000012
Ohayon, M M et al. “Risk factors for sleep bruxism in the general population.” Chest vol. 119,1 (2001): 53-61. doi:10.1378/chest.119.1.53
Santos Miotto Amorim, Cinthia, et al. “Effectiveness of two physical therapy interventions, relative to dental treatment in individuals with bruxism: study protocol of a randomized clinical trial.” Trials vol. 15 8. 7 Jan. 2014, doi:10.1186/1745-6215-15-8
It is a common scenario, whether sitting or standing when we need to bend down or forward, and suddenly there is a sharp sting on one side of the low back. The sensation can cause the knees to buckle. So we stand up slowly to assess the condition and realize it is almost impossible to stand completely straight and even harder to bend forward. So we sit back down to try and relieve the pressure. It helps a little, but the injury has caused the back muscles to spasm and get tighter and tighter. When we try to get up, there can be one big or several mild to severe electrical shock sensations traveling through the back. A severely over-rotated vertebrae could be the cause and require chiropractic care, massage, and/or decompression therapy.
Over Rotated Vertebrae
The spinal column is made of 26 interconnected vertebrae. When in motion, each vertebra moves, and as the torso rotates, the spine must rotate as well. The spine can move in several ways, including:
Bending
Rounding forward.
Extending or arching backward.
Twisting
Tilting sideways uses some of the same muscles when twisting.
Although the spine can move in various directions, there are limits to how far it can and should go. For example, when bending forward to lift an object, an individual can unknowingly over-extend and over-rotate vertebrae. This is where the risk of injury increases. A rotational injury of the spine occurs when the torso turns too far, and the spinal cord can’t handle it. This can stretch the ligaments in the spine to the point of snapping, causing the facet joints to dislocate. Ligament strains and facet dislocations are two of the most common rotational spine injuries.
Complications
An over-rotated vertebrae injury can also lead to complications that include.
Chronic Pain
Spinal nerve damage can lead to chronic pain conditions.
Mobility Problems
Mobility problems are common following an injury of the spine.
This comes from damage to the nerves that innervate the legs, causing weakness and coordination problems.
Pressure Ulcers
Numbness following a spine injury can cause individuals not to notice pressure ulcers developing.
These can lead to infections and could require hospitalization.
Individuals accumulate tension and/or weakness in the oblique abdominal muscles and other trunk muscles that can lead to chronic tightness and weakness, affecting movement and decreasing the range of motion.
Chiropractic Treatment Plan
Depending on the time and severity of the injury, a personalized treatment plan may consist of the following:
Chiropractic mobilization to release the spasms and reset the spine.
Rest
Facet Syndrome Treatment
References
Janssen, Michiel M A, et al. “Pre-existent vertebral rotation in the human spine is influenced by body position.” 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. 19,10 (2010): 1728-34. doi:10.1007/s00586-010-1400-3
Kruger, Erwin A et al. “Comprehensive management of pressure ulcers in spinal cord injury: current concepts and future trends.” The Journal of spinal cord medicine vol. 36,6 (2013): 572-85. doi:10.1179/2045772313Y.0000000093
Passias, Peter G et al. “Segmental lumbar rotation in patients with discogenic low back pain during functional weight-bearing activities.” The Journal of bone and joint surgery. American volume vol. 93,1 (2011): 29-37. doi:10.2106/JBJS.I.01348
Shan, X., Ning, X., Chen, Z. et al. Low back pain development response to sustained trunk axial twisting. Eur Spine J 22, 1972–1978 (2013). doi.org/10.1007/s00586-013-2784-7
Cue sports use a cue stick to strike billiard balls off and around a pool or equivalent table. The most common game is pool. Although these are not contact sports, various musculoskeletal injuries can manifest. Therefore, it is recommended to know the common injuries so that they can be self-treated or treatment can be sought before the condition worsens. Injury Medical Chiropractic and Functional Medicine Clinic can relieve symptoms, rehabilitate the body, and restore mobility and function.
Cue Sports Injuries
Sports medicine doctors say cue sports players suffer from sprains, strains, and fractures, among other injuries. Cue sports players are constantly:
Bending
Reaching
Twisting
Stretching their arms
Using their hands and wrists
Performing these constant movements and motions for extended periods increases the risk of sustaining injuries. Common symptoms include:
Inflammation
Warmth or heat in affected areas
Swelling
Tightness in the affected areas
Pain
Decreased range of motion
Injuries
Back and Waist
The posturing can cause individuals to tense their muscles, increasing the likelihood of injury. With all the bending, waist and back injuries are common. Back issues include:
Pinched nerves
Sciatica
Sprains
Strains
Herniated discs
Individuals with existing spine conditions or osteoarthritis have an increased risk of injury.
Shoulder, Arm, Wrist, Hand, and Finger
The shoulders, hands, wrists, and fingers are in constant use.
This can lead to overuse injuries affecting the muscles, tendons, ligaments, nerves, and bones.
Consistent stress can lead to sprains, strains, or bursitis.
Tendonitis
Tendonitis occurs when too much pressure is applied, causing tendons to inflame.
This could lead to swelling and pain and could lead to long-term damage.
Foot and Ankle
The feet can slip when stretching too far while setting up and taking a shot.
This injury usually happens when trying to balance on one foot.
Slipping can lead to a sprained ankle or something worse, like a torn ligament or fractured foot.
Chiropractic Care
Chiropractic adjustments combined with massage therapy and functional medicine can treat these injuries and conditions, relieving symptoms and restoring mobility and function. When the tendons, muscles, ligaments, and bones are properly aligned, recovery and rehabilitation progress faster. A chiropractor will also recommend stretching and exercise programs to help maintain the adjustments and prevent injuries.
Physical Therapy and Exercises
References
Garner, Michael J et al. “Chiropractic care of musculoskeletal disorders in a unique population within Canadian community health centers.” Journal of manipulative and physiological therapeutics vol. 30,3 (2007): 165-70. doi:10.1016/j.jmpt.2007.01.009
Hestbaek, Lise, and Mette Jensen Stochkendahl. “The evidence base for chiropractic treatment of musculoskeletal conditions in children and adolescents: The emperor’s new suit?.” Chiropractic & osteopathy vol. 18 15. 2 Jun. 2010, doi:10.1186/1746-1340-18-15
Orloff, A S, and D Resnick. “Fatigue fracture of the distal part of the radius in a pool player.” Injury vol. 17,6 (1986): 418-9. doi:10.1016/0020-1383(86)90088-4
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