Back Clinic Lower Back Pain Chiropractic Team. More than 80% of the population suffers from back pain at some point in their lives. Most cases can be linked to the most common causes: muscle strain, injury, or overuse. But it can also be attributed to a specific condition of the spine: Herniated Disc, Degenerative Disc Disease, Spondylolisthesis, Spinal Stenosis, and Osteoarthritis. Less common conditions are sacroiliac joint dysfunction, spinal tumors, fibromyalgia, and piriformis syndrome.
Pain is caused by damage or injury to the muscles and ligaments of the back. Dr. Alex Jimenez compiled articles outline the importance of understanding the causes and effects of this uncomfortable symptom. Chiropractic focuses on restoring a person’s strength and flexibility to help improve symptoms of lower back pain.
Individuals with persistent low back pain can choose from a variety of proven nonsurgical treatments, including: medications, physical therapy, and exercise, to name a few. A 2017 study discussed another therapy for chronic low back pain and sciatica: massage.
In a first-of-its-kind study, researchers used a real world� strategy that was � compared to running the study in a managed setting.
More than 50 percent of the research participants reported, �clinically purposeful development� in their low back pain after their massage therapy plan, composed co-first authors William G. Elder, PhD, Family and Community Medicine at the University of Kentucky, and Niki Munk, PhD, LMT, School of Health and Rehabilitation Sciences at Indiana University-Purdue University Indianapolis.
�Clinical massage therapy appears to be effective for low back pain, and patients should discuss with their provider and consider clinical massage therapy before attempting highly debatable opioid drugs,� says Dr. Elder, who was the lead researcher of the study.
A Closer Look in the Study
The research team collaborated with primary care providers in Kentucky who referred patients for 10 massage sessions with licensed massage therapists in the community over a 12-week interval. The massage therapists crafted exceptional massage therapy recommendations on the foundation of the specific patient�s requirements.
The participants were measured before they began their massage program, in the close of the 12-week program, then at 24 weeks after the onset of system. At 12 weeks, 54.1 percent shown clinically significant development in their long-term low back pain. At 24 weeks, their development was kept by 75 percent of patients who demonstrated improvement at 12 weeks.
Some crucial insights related to drug regimen, and patients� age, weight were found by the researchers: Adults age 50 and over were more prone to possess significant progress inside their particular long-term low back pain as an outcome of massage therapy. The advantage didn�t hold, although heavy patients had great results from massage.
Patients who reported taking opioid pain drugs did report reduced pain as a result of the massage treatment, but they were two times not likely to have clinically significant change in comparison to patients not taking opioids.
While Dr. Munk, who is a licensed massage therapist, says she expected the patients to have favorable results from the course of massage treatment, some facets of the study results surprised her.
�I was a bit surprised the baby boomer generation was more likely to have better results,� Dr. Munk says.
Dr. Munk hypothesizes that old people may have a distinct perspective on pain tolerance. Since elderly individuals likely have had more time including every one of the state she also wonders if folks that are older might be more accustomed to living with pain and had heightened perceptions of pain alleviation.
Massage Drawbacks and Expectations
While the study suggests that massage could offer individuals with chronic low back pain with pain relief that is purposeful, it truly is not a fast repair. Dr. Munk says people should level-confirm their expectations by taking into consideration how long they�ve lived with their state when they go to their first massage.
�If you�ve had a state for 10-15 years, the chance that a one-hour session will fix it is probably not realistic,� Dr. Munk says.
Dr. Munk notes that massage, given its foundation as a muscle treatment, should be viewed as a care therapy�not a short term strategy.
The body goes back to routines its used to and has, and also �Muscle patterns grow to be retrained she says. � you also must take another dose for alleviation, and Like a pill that wears off after a couple of hours, it could take several sessions to get the job to �hold.��
Another consideration patients must understand is the cost of massage, as the treatment isn’t covered by most health insurance plans. Investing in massage is an individual decision that requires weighing pros and cons. If massage therapy can help you manage your chronic back pain without the significance of spinal column surgery or other treatments which can be more significant, you might find it’s worth the out of pocket price.
Tips on Making Massage Effective
In case your doctor recommends massage therapy, building a trusting and comfortable therapeutic relationship is significant. Request your doctor if he or she recommend a massage therapist in the locality.
Dr. Elder and Dr. Munk additionally propose asking the following questions to any prospective massage therapist before your first session:
Have you ever been a licensed massage therapist?
What kind of training and education have you ever received?
How long are you now practicing?
Would you work with other healthcare professionals?
Have you had further education in other illness-specific areas (like back and neck pain)?
Do you remain current on any specific medical conditions you focus on and improvement in the massage therapy field?
Persistent low back pain can take a crucial cost on your own own life. By good fortune, many nonsurgical treatments can help you manage the pain. The results with this particular study suggest massage is a legitimate decision to lessen pain while you could possibly believe massage is only a relaxing indulgence. Request your doctor if massage is a treatment worth investigating for the specified state.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
By Dr. Alex Jimenez
Additional Topics: Lower Back Pain After Auto Injury
After being involved in an automobile accident, neck injuries and aggravated conditions, such as whiplash, are some of the most commonly reported types of injuries, due to the force of the impact. A study discovered, however, that the seat of a vehicle can often lead to injuries as well, causing lower back pain and other symptoms. Lower back pain is also among one of the most common types of automobile accident injuries in the U.S. alone.
Around 80% of the population is plagued at one time or another by back pain, especially lower back pain. Associated leg pain (called lumbar radiculopathy or sciatica) happens less frequently. Pain could be debilitating and bothersome, restricting daily activities. Leg and back pain can result from a number of reasons, not all of which originate in your spinal column.
With the aim of this particular article, we’ll concentrate on lumbar radiculopathy, which refers to pain in the low extremities in a dermatomal pattern (see picture below). A dermatome is a special place in the lower extremity that’s nerves going from a particular lumbar nerve to it. Compaction of the origins of the spinal nerves in the lumbar region of the back causes this pain. Diagnosing leg and lower back pain begins with assessment and a detailed patient history.
Diagnosing Lower Back Pain and Sciatica
Your medical history helps the issue is understood by the physician. It is essential to be specific when answering medical questions linked to pain beginning but recalling every detail is often not critical. Keeping records of your medical history, including medical issues, medicines you’re taking and surgeries you have had in the past is helpful.
Journal Symptoms
Seeing your leg and back pain, it may be helpful to keep the activities that aggravate your pain, a journal of your actions, when the pain began documenting and those who alleviate your symptoms. It’s also important to ascertain whether your back pain is than visa versa or your leg pain. If you are experiencing any numbness or weakness in your legs or any difficulty walking, maybe you are asked. Remember, understanding the reason for your issue is founded on the advice you supply.
Most of the individuals describe radicular pain as a burning or sharp pain that shoots down the leg. This is what many people call sciatica. This pain may or may not begin in the low back. Leg pain caused by nerve roots that are compressed normally has routines that are particular. These routines of pain is determined by the degree of the nerve being compressed. After reviewing your history, your physician will perform a physical examination. This will assist the doctor determine in case your symptoms are due to an issue that’s caused by spinal nerve root compression. To assist you understand the exam performed by your doctor lets pause to get an instant anatomy lesson.
Understanding the Anatomy of the Spine
The spine is comprised of 33 vertebrae (bones piled on top of each other in a “building-block” fashion) that have 4 distinct areas: cervical (neck), thoracic (upper/mid back), lumbar (low back), and sacrum (pelvis).
Discs are cushion-like tissues that separate most vertebrae and act as the back’s shock absorbing system. Eaach disk is comprised of a tough outer ring of fibers known as the annulus fibrosus, plus a soft gel-like center known as the nucleus pulposus.
There are 7 flexible cervical (neck) vertebrae that help to support the head. Twelve thoracic vertebrae attach to ribs. Next, are 5 lumbar vertebrae; they are large and carry nearly all the body weight. The sacral region helps disperse the body weight to the pelvis and hips.
The spinal cord is placed within the protective components of spinal canal. Spinal nerves exit the spinal canal through passageways between the vertebral bodies and branch from the spinal cord. The passageways are called neuroforamen. Nerves supply sensory (permitting you to touch and feel) and motor information (allowing the muscles to function) to the complete body.
In another article (click the Continue Reading link below), we discuss how your doctor determines what’s causing your lower back pain and sciatica, which is critical to the appropriate treatment strategy and symptom relief.
Comments by way of a Spine Specialist
Lumbar is a familiar problem that results when nerve roots are compressed or irritated. This excellent article discusses the basic anatomy and clinical manifestations of lumbar radiculopathy, which will be regularly referred to generically as sciatica. These symptoms can be due to a selection of causes such as disc bulges, degenerative narrowing of the space for the nerves (spinal stenosis or foraminal stenosis), spinal instability, deformity of the vertebrae, or herniated disc fragments outside the disc space.
In 70-80% of patients, sciatica is ephemeral, and works out with nonsurgical treatments for example anti-inflammatory drugs, physical therapy, exercise, spinal manipulation, or alternative nonsurgical modalities. Surgical intervention is required by a proportion of patients with sciatica in cases where nonsurgical treatments have failed to supply sufficient pain relief, and there is pathology [cause] that is present compressing the nerves. A tiny proportion of patients need urgent surgery. If an extremely large lumbar disk herniation causes serious nerve damage, with paralysis or acute bowel or bladder incontinence, then emergency surgery might be needed.�Curtis A. Dickman, MD
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
By Dr. Alex Jimenez
Additional Topics: Lower Back Pain After Auto Injury
After being involved in an automobile accident, neck injuries and aggravated conditions, such as whiplash, are some of the most commonly reported types of injuries, due to the force of the impact. A study discovered, however, that the seat of a vehicle can often lead to injuries as well, causing lower back pain and other symptoms. Lower back pain is also among one of the most common types of automobile accident injuries in the U.S. alone.
Seeing a doctor of chiropractic, otherwise referred to as DC, chiropractic physician or a chiropractor, can be a beneficial step towards effectively treating low back pain. Below is a quick description of how they help patients resolve their low back pain and what chiropractors do.
What to Expect from a Chiropractor
Chiropractors use a number of treatments made to manipulate joints, the back, and tissues of the body to relieve pain and improve functional ability. Normally, this could be referred to as spinal manipulative therapy (SMT), but you will find several other chiropractic treatment approaches.
A chiropractor tailors her or his treatment strategy depending on the individual needs of a patient, using a traditional philosophy of starting off together with the more natural, less-invasive treatments before moving on to even more aggressive techniques.
At every stage through the procedure, chiropractors preserve a rigorous emphasis on proactively communicating together with the patient exactly what’s going to happen. The chiropractor makes certain the patient comprehends everything that occurs during evaluation, an investigation, and also the proposed procedures, so that you can instruct the patient and receive direct acceptance to start the treatment process.
This emphasis on informed consent is essential because some chiropractic techniques may carry material hazard, which means there could a danger, however, trivial, that an injury could be maybe caused by a particular process.
Nevertheless, a chiropractor also informs a patient of the potential risks attached to abstaining in the process, entirely. Nevertheless, none of this is meant to scare a patient. Make sure that the patient, who has full control over his / her body can make an informed choice and constantly it’s simply thought to remove mistakes.
Chiropractic Procedures
A chiropractor will examine a patient thoroughly prior to making any type of identification or treatment plan. The evaluation can include various aspects, including:
Health history
Look in the characteristics of the pain, keeping an eye out for “red flags,” which suggest that additional diagnostic testing ought to be ran in order to exclude any potentially serious medical problems that may be connected with neck or low back pain-like neurological disorders, fractures, diseases, and tumors.
You will find lots of reasons why low back pain happens. A chiropractor will find out those motives to configure the most appropriate treatment.
Physical examination, including orthopedic and neurological evaluations
Analyze sensory nerves, the reflexes, joints, muscles, as well as other areas of the body.
Advanced Diagnostic Testing
Lab and imaging evaluations aren’t recommended for nonspecific LBP, however they might be required if there are signs of a serious underlying condition.
Severity and Duration of Afflictions
A chiropractor looks at the symptoms and afflictions of sickness or an injury and rationally classifies them based by how serious they are, and the way long they continue.
Symptoms are subdivided into levels of severity: mild, moderate, or serious. In terms of duration, pain (and other symptoms) might be referred to as:
Acute – lasts for less than 6 weeks
Subacute – persists between 6 and 12 weeks
Long-Term – persists for at least 12 weeks
Perennial/flare up – the same symptom(s) reoccurs sporadically or because of exacerbating the original harm
In case a patient is suffering from acute or subacute low back pain, a normal chiropractic therapeutic trial is 2 to 3 weekly sessions over the course of 2 to 4 weeks, going up to 12 complete sessions per trial. Often, this can be sufficient to entirely solve the pain. Other times, additional treatments may be necessary, especially if a patient is struggling with other issues.
Result measurements certainly are a useful tool to get a chiropractor since they could help determine in the event the treatments are showing significant progress.
Some ways a chiropractor can quantify the outcomes of the treatments include:
Having a patient speed the pain
So a patient can characterize the positioning and nature of the pain, using a pain diagram
Searching for increases (or declines) in day-to-day living practices, as in the capacity to work (employment), exercise and sleep.
Testing practical capacity, such as weightlifting ability, strength, flexibility, and endurance
Some patients’ low back pain may have lasted into and beyond the 12-week mark, which makes it long-term pain. During assessment, chiropractors will look for signs to determine if a patient is at an increased risk of developing long-term pain- the “yellow flags” of chronicity so to speak.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
By Dr. Alex Jimenez
Additional Topics: What is Chiropractic?
Chiropractic care is an well-known, alternative treatment option utilized to prevent, diagnose and treat a variety of injuries and conditions associated with the spine, primarily subluxations or spinal misalignments. Chiropractic focuses on restoring and maintaining the overall health and wellness of the musculoskeletal and nervous systems. Through the use of spinal adjustments and manual manipulations, a chiropractor, or doctor of chiropractic, can carefully re-align the spine, improving a patient�s strength, mobility and flexibility.
Doctor of Chiropractic, Dr. Alexander Jimenez looks at high heels at what they do to the back.
Ladies, ever wonder why you suffer from regular bouts of lower back pain?� Achy hips?� How about crazy tight leg muscles?� Don�t blame it on your cycling class, or too many squats or, the trainer you only see once or twice a week.� Look down.� Are you wearing high heels?� Bingo!� You�ve heard high heels are bad for you.� But it�s not just because they cause all kinds of pain and trauma to your feet.� High heels are also messing up your physical fitness. �They throw you out of proper postural alignment causing your joints and spine to take on more�wear and tear, which means aches and pains.
Is it possible to still look rockin� and save your joints? �My suggestion is more Athleisure-wear. �I know some fashion hard-liners say, no way will I walk around in yoga pants on a weekday!� But we�ve come a long way since those flare-leg, fold-over yoga pants.
Let�s chat for a moment about the evils of high heels.
First there�s the obvious.� They make your feet hurt.� Blisters, calluses and swelling are par for the course.� And pointy toes, fuhgeddaboutit!� I�m sure they were invented by someone on the Marquis de Sade�s payroll.� Second, they can lead to foot injuries like plantar fasciitis (usually from a bone spur that makes your heels hurt), hammertoes, bunions, and neuromas.� �Then there�s the domino effect.
Not only do high heels make your feet hurt, but problems with the feet can travel up the leg and cause injuries in the back, knees and hips. �Your knees take on extra pressure from the weight being pushed forward onto the balls of the feet. �Walking in this position makes your hip flexors and calf muscles short and tight. �And it doesn�t stop there.� Back problems are incredibly common in women who don�t give up their high heels.
Back Problems are incredibly common in women who don�t give up their high heels
Here�s why:
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Postural changes:�The S-curve of your spine has cushiony discs in between the vertebrae that act as a shock absorbers to protect them from stress. Like when you�re bending or jumping. �Wearing heels causes the lower back to arch more than normal because the body weight is pushed forward.� To compensate, the upper body has to lean back to maintain balance.� This puts extra stress on the discs. ��Spending hours with your body in funky alignment can lead to muscle spasms and back pain. �Tight hamstring muscles, which�attach to back of the pelvis and lower back, can also make your back ache.
Anatomical changes: Wearing high heels on a daily, or very regular basis, over years, can actually cause anatomical changes to your body.� In addition to the extra strain on your back and knees, the calf muscles can also shorten and the tendons can get tighter and thicker.
And It Can Get Even Nastier If You Get One Of These Spine Injuries:
Spondylolisthesis: it�s a mouthful, but is a common injury that can happen in the lower back from too much hyperextension (arching the back).� It�s when one vertebra slips forward over another.
Foraminal stenosis: I have this one congenitally and it sucks. This is a spine and nerve issue that occurs when anatomical abnormalities reduce the spaces the nerves travel through as they exit the spinal column.� The spaces are called foramina, and when they get blocked, the nerves get squeezed.� The pain can radiate through the buttocks and down the legs.� Symptoms are shooting pains, numbness, tingling, muscle weakness, spasms and, or cramping.
Sciatica:�The sciatic nerve is the longest one in the body. �It runs from the bottom of the lumbar spine all the ways down the legs. �When the sciatic nerve gets compressed it causes radiating pain, tingling, numbness and muscle weakness down the leg and can The pain can travel all the way to the bottom of the foot.
What Can You Do? �My Case for Athleisure-Wear To Combat Back Pain
It�s time for stuffy office attire to retire. �Comfy clothes and flat shoes can be very chic. �Have you seen the boards on Pinterest?� Thanks to this hopefully permanent fashion style, my jeans and heels spend more time in my closet than on my body.� Leggings and cute kicks are my go to�s.� Night out?� No prob.� I reach for my sleek workout leggings, a ruched top or off the shoulder top with some high heel sneaks (they�re wedges so not nearly as bad for you). �I also discovered these by Bluprint which I put to the test at 2 huge conventions where I walking and standing for hours on end.� The soles made of memory foam � like those beds!
My podiatrist friend, Steven Rosenberg, DPM has been preaching the need for comfy shoes to his female clients for years. �(Fortunately for his practice, not everyone listens!) �Dr. Steve says, wearing shoes designed more for comfort can help you live more pain-free. ��Because comfort shoes are made of�soft cushiony materials�with soft foam innersoles, those are what you should turn to for shopping, walking or standing for long periods of time to avoid�blisters, muscle spasms or arch cramps.� � He also says to check for arch support in your shoes. �If there�s none, you can buy ones to put inside.
Even after reading this, you may still not be willing to give up high heels for good. �Me either.� I still get glammed up once in a while.
Here Are Some Tips For When You Must:
Wear them for as little time as possible.
Try to opt for heels around 2� high
Steer clear of pointy toes.
Buy shoes with leather insoles to so your foot doesn�t slide.
Buy arch inserts or use orthotics to support your arches.
Vary your footwear so you�re not wearing high heels every day.
Gradual or lower slopes are a little better, go for platforms or wedges instead of stilettos
Thicker heels are better than spiky heels
Stretch and strengthen the overworked muscles.
Here�s How:
Stretch your leg muscles and hip flexors before and after wearing heels.� For the calves, stand on a step and let one heel hang down until you feel a stretch.
Try this convenient device, the foot rocker by Vive.� It stretches the calf and the sole of the foot relieving pain from plantar fasciitis.
Front of the hip and thigh stretch for before and after wearing high heels
Hamstring stretch for before and after wearing high heels
Massage and stretch the muscles in the soles of your feet.� Roll your foot on a golf ball before and after wearing heels and, get regular foot massages.
Strengthen and increase the range of motion in your ankles and feet.� Put a rag on the floor.� Using your foot, write the letters of the alphabet.� Also put a bunch of marbles on the floor.� Pick one or a few of them up using just your foot.� Put them down about 6 inches away without lifting your foot off the floor.� Try that 10 times.� If you don�t have marbles, you can do it with a hand towel.
So next time you�re shopping for shoes, think about your foot fitness first. �Look for fashion that keeps you closer to the ground and that will hopefully keep you farther away from the doctor.
Doctor of Chiropractic, Dr. Alexander Jimenez looks at the cervical spine and low back pain.
Low back pain and leg pain are the most common cause of disability worldwide. As such new research based treatment approaches are needed. This new randomized trial by BCP Non-profit and Cairo University tested the ability of the cervical Denneroll orthotic to improve cervical spine curvature and its consequent effect on low back and leg pain. Great short term results were found where patients receiving the cervical spine Denneroll improved with low back pain, leg pain, neurological outcomes and disability compared to a PT only interventional group.
Doctor of Chiropractic, Dr. Alexander Jimenez discusses chiropractic care for back pain.
Back pain, especially lower back pain, is a constant for many people in El Paso and around the world. Chiropractors have always been known as �back pain doctors� to a certain degree, and while they can treat a much wider range of ailments, this moniker is certainly true. El Paso chiropractic care for back pain includes a range of individualized treatments designed to remove the pain permanently.
Some Facts About Back Pain
One estimate places the number of back pain sufferers in America at roughly 31 million.
Here are some other interesting facts that illustrate just how serious the problem is:
A 2010 report entitled Global Burden of Disease placed lower back pain as the leading cause of disability around the world.
Back pain is one of the most common reasons for missed work days and the second-leading reason for doctor�s visits behind infections in the upper-respiratory tract.
50 percent of all working Americans say they experience back pain symptoms each year.
Mechanical issues cause the majority of back pain cases, meaning they are not the result of an underlying health condition.
Conservatively, Americans spend about $50 billion on back pain.
Some experts say that as much as 80% of the population will experience back pain at some point in their lives.
Why Do I Have Back Pain?
The causes of back pain can vary quite a bit. With so many muscles, bones, ligaments, and joints all working together in a complex structure, strains and other injuries leading to back pain are common. You may be experiencing back pain due to improper lifting, poor posture, stress, being overweight, a past sports injury, or a car accident. Conditions like arthritis and osteoporosis also cause back pain, as does disease that originates in certain internal organs.
Chiropractic To The Rescue
Chiropractic care is a safe and effective way to treat many types of back pain. With proper chiropractic care for back pain, you will have greater mobility and fewer flare ups. For many patients eliminating the side effects of prescription pain medication is a welcomed benefit they never even considered. Chiropractic treatment focuses on the underlying cause of the back pain while most conventional treatments focus on the symptoms. When only treating the symptom or the pain you may experience relief, but whatever is causing that pain will still be there.
Reputable chiropractors will also suggest lifestyle changes you can make to help prevent back pain from returning. These include maintaining a healthy weight, avoiding prolonged sitting, staying active throughout your life, staying hydrated, wearing low-heel shoes, stretching your body, and using proper body posture. By helping yourself and receiving high quality chiropractic care, back pain should be a thing of the past.
Doctor of Chiropractic, Dr. Alex Jimenez goes through some tips on how to avoid back injuries.
When it comes to avoiding back injuries, your fate is largely in your own hands. It�s true that an unexpected fall or auto accident may cause an injury that�s beyond your control, but a large percentage of back injuries are caused by your own actions, which means you can take measures to prevent them or stop them from getting worse. Here are a few valuable back injury tips from a El Paso chiropractor.
Pay Attention to Your Lifting Technique
How you lift boxes, laundry baskets, children�s toys, a pair of shoes or just about anything else, has a bearing on the health of your back. When you lift correctly your spine is in the proper alignment and there is no added stress placed on your back. This means you should bend your knees and keep your back as straight as possible when you pick anything up off the floor.
If you have a lot of lifting to do try to place items on a table or chair so there isn�t as much bending required picking it up. Your back is not designed to work like a crane so anytime you use it that way you are putting stress on your back that doesn�t need to be there. Take a balanced stance, lift with your legs and move your feet if you need to change direction while holding the object.
Sensible Body Management
Performing activities with your back health in mind is a great strategy to help you avoid back injuries. That means stretching before any type of physical activity, taking it slow if you have a lot of repetitive lifting to do, and taking breaks to rest and stretch during the activity.
Getting yourself into good physical condition also protects your back and helps to avoid injuries. This includes losing weight in your midsection, and strengthening core muscles, to make lifting and general movement less stressful on your back. Most El Paso chiropractors will also tell you that sleeping on a firm mattress is another way you can nurture your back and prevent injuries.
Don�t Let Injuries Linger
If you end up with a back injury despite your efforts to avoid it, you should seek treatment with a El Paso chiropractor as soon as you can. Spinal misalignment, bulging discs, herniated discs, and other injuries often only get worse if you let them linger. Prompt treatment will restore blood flow to the area, relieve any compressed nerves and get you back to normal in the shortest time possible.
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