Back pain for no reason that is non-specific is also known as idiopathic, meaning there is no definitive cause like a herniated disc, vehicle accident/crash, falling accident, work, school, or sports injury. An aching sore back that came out of nowhere can be baffling. However, there are reasons for pain, including age, unhealthy posture, work occupation, muscle spasms, lifestyle habits, family medical history, and viscerosomatic reflexes.
Back Pain No Reason
Individuals will trace back their steps and often find that there was no heavy lifting of packages, overdoing it working out, or bending, twisting awkwardly, but the pain is present.
Age
Age is a primary cause of back pain. After the age of 20, the discs in the spine begin to dehydrate, shrink, and compress/flatten out. This can cause everyday activities to generate back strain and pain as the discs begin to slip, slide, and rub against each other. This is known as degenerative disc disease and is a process that continues as the body gets older.
Back Muscle Spasms
Muscle spasms are a common manifestation of back pain and occur when the muscles involuntarily contract. Spasms often happen from bending, heavy lifting, or other physical activities.
Lifestyle Factors
Lifestyle factors can be a causation factor for back pain that comes out of nowhere.
Smoking increases the risk as nicotine increases the wear and tear on the discs as well as other organs.
The smoke/nicotine causes the discs to age faster because it breaks down the collagen, an essential part of the discs.
Individuals that are out of shape, overweight, and/or obese are more likely to have back pain from the added weight.
Unhealthy Posture/Mechanics
Practicing unhealthy postures will no doubt begin to cause back or some type of pain from the strain and awkward positioning placed on the muscles being used. Strains, twists, pulls, or tears can occur if repeating the same motion.
Viscerosomatic Reflex
Viscera means organ, and somatic refers to the body or musculoskeletal system. A viscerosomatic reaction happens when a pain signal from an organ is transmitted via the spinal cord, where neurons and motor structures like the muscles, blood vessels, and skin are interconnected. The body’s organs can become distressed or suffer an infection/disease that causes signals to be sent that there is something wrong. However, the signal could be pain that materializes in the spine/back muscles but is not a spinal injury or condition.
Diagnosis and Treatment
The first step to successfully treating back pain is scheduling an appointment with a spine specialist or chiropractor. A series of specific questions will be asked to gain insight into the underlying cause of the pain. These include:
Location of the pain
Intensity of the pain
Frequency of the pain
Medical history
Diet habits
A careful examination is necessary for the doctor to identify the reasons in any individual patient. Once the physician has learned about the symptoms and history, they can determine a possible cause and create a personalized treatment/rehabilitation plan to get the body back to optimal health.
Decompression Patient Testimonials
References
Koes, B W et al. “Diagnosis and treatment of low back pain.” BMJ (Clinical research ed.) vol. 332,7555 (2006): 1430-4. doi:10.1136/bmj.332.7555.1430
Lankhorst, G J et al. “The natural history of idiopathic low back pain. A three-year follow-up study of spinal motion, pain and functional capacity.” Scandinavian journal of rehabilitation medicine vol. 17,1 (1985): 1-4.
Walker, Bruce F et al. “Combined chiropractic interventions for low-back pain.” The Cochrane database of systematic reviews vol. 2010,4 CD005427. 14 Apr. 2010, doi:10.1002/14651858.CD005427.pub2
Asthma, coughing, and heavy breathing can contribute to back muscle strain, soreness, and pain. An asthma attack can cause the body to heave during intense gasping, leaving the back muscles physically exhausted. Chiropractic adjustments and decompression can bring back pain relief, strengthen and stretch the spine and spinal muscles, and prevent it from returning, along with asthma management.
Asthma
The bronchial tubesdivide into smaller passages called bronchi and then into bronchioles. The bronchioles have tiny air sacs called alveoli, where inhaled oxygen is delivered to the blood. After absorbing the oxygen, the blood leaves the lungs and travels to the heart. Asthma is a lung condition that can affect anyone at any age. Asthma narrows the lungs’ airways causing inflammation in response to respiratory triggers, making it harder for air to travel out of the airways when exhaling. Symptoms include:
Wheezing
Difficulty breathing
Gasping to get air
Coughing
Tightness in the chest
Triggers can include:
Hot and/or humid weather
Exercise
Cold air
Pollen
Pets
Viral infections
Respiratory infections
Asthma Coughing and Back Strain
Asthma symptoms can take a toll on the back muscles and spine. Asthma attacks that cause gasping and heavy breathing cause the primary muscle (diaphragm) that supports breathing to weaken and strain. The diaphragm helps the spine but cannot do so effectively when under constant strain.
Constant Coughing and Spinal Health
Coughing is the body’s way of expelling unwanted foreign bodies. Chronic coughing stresses, strains, and overexerts the spinal support muscles and impacts posture. Individuals unconsciously take on a tense, forward-leaning posture/position that can cause:
Neck and shoulder stiffness, upper/lower back tightness, disc herniation, and pain.
Vertebrae subluxations/spinal misalignments can interfere with circulation and nerve function.
For short-term back pain following an asthma attack or coughing episode, it is recommended to rest, apply heat or ice, and take over-the-counter pain medication.
Massage therapy and myofascial release can stretch and relax the muscles.
Chiropractic manipulation relieves the stress on the nerves and muscles and stimulates the spinal cordand nerves to regain proper functioning.
Breathing Exercises and Yoga
Strengthened and conditioned core muscles can help to breathe more efficiently. When breathing normally it is usually a shallow inhale/exhale that does not fill the lungs to the total capacity. Diaphragmatic breathing is a technique to fully engage the diaphragm and abdominal muscles to fill the lungs with air more efficiently. Using the diaphragm correctly will:
Strengthen the diaphragm.
Use less energy to breathe.
Slow down the breathing rate.
Decrease the work of breathing hard.
Decrease the demand for continuous oxygen.
Yoga is another core-strengthening technique that encourages focused breathing that can help improve asthma control.
Lunardi, Adriana Claudia, et al. “Musculoskeletal dysfunction and pain in adults with asthma.” The Journal of asthma: Official Journal of the Association for the Care of Asthma vol. 48,1 (2011): 105-10. doi:10.3109/02770903.2010.520229
Rasmussen-Barr, E. et al. “Are respiratory disorders risk factors for troublesome low-back pain? A study of a general population cohort in Sweden.” 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. 28,11 (2019): 2502-2509. doi:10.1007/s00586-019-06071-5
Solakoğlu, Özge, et al. “The effects of forward head posture on expiratory muscle strength in chronic neck pain patients: A cross-sectional study.” Turkish Journal of physical medicine and rehabilitation vol. 66,2 161-168. 18 May. 2020, doi:10.5606/tftrd.2020.3153
Older and elderly individuals have an increased risk of developing a herniated disc/s. The age of the intervertebral discs/cushions causes deflation, drying out, and shifting, making it easier for discs to herniate. Muscle mass also reduces/lessens with age; specifically, the muscles parallel to the spinal column are responsible for stability. When the spine loses strength, the risk of injuries like slips and falls can damage the spine and the rest of the body. Herniated disc decompression will keep the vertebral cushions healthy, functioning, and properly aligned.
Symptoms of Disc Herniation
A herniated disc bulge or tear/s will press on the spinal nerves causing discomfort that can range from mild to severe pain and can last for weeks to months. The symptoms of disc herniation vary and depend on the injury angle, how much of the disc ruptured and if it is touching or has leaked out on the nerve roots. The most common symptoms include:
Pulls the herniated disc back into its correct position.
Fills the injured/damaged areas and the rest of the spine with blood, oxygen, nutrients, and lubricating fluids.
Helping to rebuild joint and muscle strength.
Increasing flexibility in the muscles that support the affected area of the spine.
The therapy duration depends on the herniation, injury, and damage severity. The objective is to bring significant improvement that will last.
Chiropractic, Physical/Massage Therapy, and Health Coaching
A chiropractor and physical massage therapy team will develop a personalized herniated disc decompression treatment plan with specific goals. The therapy will include:
Mechanical decompression.
Manual chiropractic adjustments.
Massage sessions.
Health coaching.
Exercises and stretches will be given that will help maintain pressure relief and flexibility.
Core stabilization exercises will strengthen and stabilize the spine and muscles.
Aerobic conditioning will help increase endurance.
Non-Surgical Spinal Decompression El Paso, Texas
References
Carla Vanti, PT, MSc, OMPT, Alice Panizzolo, PT, OMPT, Luca Turone, PT, OMPT, Andrew A Guccione, PT, Ph.D., DPT, FAPTA, Francesco Saverio Violante, MD, Paolo Pillastrini, PT, MSc, Lucia Bertozzi, PT, MSc, Effectiveness of Mechanical Traction for Lumbar Radiculopathy: A Systematic Review and Meta-Analysis, Physical Therapy, Volume 101, Issue 3, March 2021, pzaa231, doi.org/10.1093/ptj/pzaa231
Dydyk AM, Ngnitewe Massa R, Mesfin FB. Disc Herniation. [Updated 2022 Jan 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK441822/
Maistrelli, G L et al. “Lumbar disc herniation in the elderly.” Spine vol. 12,1 (1987): 63-6. doi:10.1097/00007632-198701000-00012
Suri, Pradeep, et al. “Nonsurgical treatment of lumbar disk herniation: are outcomes different in older adults?.” Journal of the American Geriatrics Society vol. 59,3 (2011): 423-9. doi:10.1111/j.1532-5415.2011.03316.x
Sciatica Sleep: Poor sleep can leave the body feeling off and unable to function. Not getting the proper amount of sleep can decrease health, decrease work or school productivity, and cause burnout. If it becomes chronic, it can have serious side effects on the brain and body that include:
When sleeping, certain positions/postures can place added pressure on the spine, irritating the nerve. The best sleeping positions maintain the spine’s natural curve and are different for everybody. For example, many individuals sleep on their side. They do not start sleeping this way, but they end up on their side and wake up in pain to find their sciatica flaring up. Other individuals can turn on a specific side, and the symptoms fade or go away.
Positions
The best sleeping position for one individual may not be the best for another. A lot of this depends on the placement of the injury/pinching that can affect how certain sleep positions work, causing no symptoms, while other sleep postures generate all kinds of symptoms, especially pain. Individuals are recommended to sleep in the position that works for them, provided with the correct posture.
Side Sleepers
Side sleepers are recommended to place a pillow between their knees for healthy sleep and pain avoidance results.
A pillow between the legs helps to prevent twisting.
A firm pillow will work or a soft pillow folded in half.
It is also recommended to consider a small pillow under the waist to maintain the alignment between the ribs, hips, and the spine.
Back Sleepers
Back sleepers can benefit from a pillow under the knees to maintain a neutral curve of the spine.
This keeps the legs slightly elevated helping prevent the legs from tilting the pelvis and pulling the spine out of a neutral position.
Individuals that sleep on their back but end up on their side, are recommended to use a large pillow or body pillow placed on the side they turn on to prevent this.
Stomach Sleeping Not Recommended
Sciatic pain can become worse with sleeping on the stomach.
Sleeping on the stomach can collapse the spine and the pelvis as there is no support underneath. This causes damage to the nerves, increasing symptoms and pain levels.
Try to avoid sleeping on the stomach until the sciatic nerve has healed or try to train the body to sleep on the side or back.
Non-Surgical Spinal Decompression Can Help Sciatica Sleep Symptoms
Non-surgical spinal decompression therapy relieves pressure on the sciatic nerve, spine, and surrounding muscles by pulling/stretching them in small increments. The decompression creates negative pressure within the discs that floods the area with an abundance of nutrients to activate and expedite the healing response.
The chiropractic physical therapy team uses motorized medical equipment with sensors linked to a computer-aided system to perform the procedure.
The equipment is designed to adjust the pull force accordingly to prevent muscle resistance.
The adjustable table also allows the spine to be stretched at different angles to target all areas of the back.
Relieves Pressure On The Sciatic Nerve
Decompression stretches the nerve out and increases the space around the impinged and inflamed nerve.
Pain Relief
Decompression relieves tension in tight, spasming, or injured muscles.
Stimulates the nervous system to release the body’s natural pain killers.
Spinal tissue healing from fluids, cells, and other substances that enter the damaged tissue.
Restores Disc and Joint Alignment
Decompression realigns the joints and discs, preventing pain, inflammation, mobility/flexibility problems, and dysfunction.
Encourages Sleep
There are toxins in the body, decompression causes these toxins to be expelled.
This causes exhaustion because the body needs time to adjust after expelling the negative energy.
After a short time, energy levels will return.
The decompression relaxes the entire body which allows for more restful sleep.
DRX9000
References
Kim, Shin Hyung et al. “Risk factors associated with clinical insomnia in chronic low back pain: a retrospective analysis in a university hospital in Korea.” The Korean journal of pain vol. 28,2 (2015): 137-43. doi:10.3344/kjp.2015.28.2.137
Radwan, Ahmed, et al. “Effect of different mattress designs on promoting sleep quality, pain reduction, and spinal alignment in adults with or without back pain; a systematic review of controlled trials.” Sleep health vol. 1,4 (2015): 257-267. doi:10.1016/j.sleh.2015.08.001
Santilli, Valter, et al. “Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized, double-blind clinical trial of active and simulated spinal manipulations.” The spine journal: official journal of the North American Spine Society vol. 6,2 (2006): 131-7. doi:10.1016/j.spinee.2005.08.001
As the world moves, so does the body. When the body does everyday movements like running, jumping, and walking without feeling pain. When people incorporate daily habits to live longer and have healthier bodies, the body will not succumb to injuries and pain. However, when certain circumstances like stress, anxiety, and unhealthy habits start to take hold of the person’s body, it can lead to complications like obesity, chronic inflammatory responses, and low back pain affecting the body. Treatments like physical therapy and decompression therapy have been used to help many individuals trying to get their lives back together. Today’s article focuses on how obesity is associated with low back pain, how it affects the body, and how decompression therapy can help weight loss patients experiencing low back pain. By referring patients to qualified and skilled providers specializing in spinal decompression therapy. To that end, and when appropriate, we advise our patients to refer to our associated medical providers based on their examination. We find that education is the key to asking valuable questions to our providers. Dr. Alex Jimenez DC provides this information as an educational service only. Disclaimer
Can my insurance cover it? Yes, it may. If you are uncertain, here is the link to all the insurance providers we cover. If you have any questions, please call Dr. Jimenez at 915-850-0900.
Obesity and Low Back Pain
Feeling sluggish after walking around all day long? Do you feel shortness of breath? How about aches on your lower back? Experiencing any of these symptoms could result from obesity and low back pain affecting you. Research studies have mentioned that low back pain and obesity are the most common concerns for everybody worldwide. Since low back pain is the most musculoskeletal health concern and obesity is a health problem, many individuals will have an increased risk of lumbar radicular pain. This is due to the mass body index affecting the person’s body, as research studies have mentioned that obesity can have both biomechanical and meta-inflammatory effects on the spine. Since both male and female bodies are different in fat composition, it is more likely that female bodies tend to have more fat masses stored around the torso area, causing lower back pain issues than male bodies. In regards to that, lifestyle habits and changes can also cause obesity to progress further in both male and female bodies causing low back pain issues to develop further.
How Does It Affect The Body
When obesity and low back pain start to affect the body, research studies have shown that chronic conditions like diabetes and hypertension are associated with obesity and can influence the path for diseases in the tendons and ligaments of the body. As the body goes through the natural aging process, this can lead to low back pain and cause many overweight individuals to be at risk of osteoarthritis. The excess weight starts putting more pressure on the knees, hips, feet, and lower back when this happens. This causes the pelvis to pull forward in the body, causing the lower back muscles to become strained. All is not lost as there are treatments to lose weight and alleviate the symptoms of low back pain.
DRX9000 Decompression Therapy-Video
Do you feel aches and strains on your lower back? How about feeling out of breath from walking? Do you feel the weight bearing down onto your legs and feet? Your weight could be affecting your back, and non-surgical treatments like physical therapy and decompression therapy might be able to help you out. The video above shows how the DRX9000 decompression machine can help alleviate low back pain by gently stretching the spine to elongate the disc height and loosen up the lower back muscles. While decompression therapy helps with low back pain, research studies have found that physical therapy can help promote weight loss. Losing the excess weight can alleviate low back symptoms that are causing the muscles and joints to relax and take the stress off the spine. Suppose you want to learn more about decompression and how it can benefit you in relieving low back pain and other low back pain conditions? This link will explain what it does for the lower back.
How Decompression Can Help Weightloss Individuals
As stated in a previous article, physical therapy and decompression go hand in hand in alleviating low back pain. For individuals suffering from obesity, physical therapy can help get them back in shape. With the right motivation to exercise, lose weight, and eat healthier, individuals will begin to see the excess weight be taken off and take the pressure off their lower backs. Research studies have mentioned that individuals who lose weight are allowed to do spinal decompression therapy. After a person starts to lose weight, the residual low back pain is still there and can be a nuisance to the back. Luckily, that is where decompression therapy comes in, and as research shows, decompression therapy can help relieve low back pain and reduce the symptoms of leg pain. This is beneficial for weight loss individuals as both of these therapies can help improve a person’s quality of life and help them on their weight loss journey.
Conclusion
Overall, obesity and low back pain can cause a person to become miserable and be in pain. When a person is obese, the excess weight around the torso can pressure the lower back, hips, knees, and feet. If a person is suffering from lower back issues, it can cause them to develop other back problems that can cause them to lean and find relief. Incorporating physical therapy and decompression therapy is a match made in heaven as many individuals lose weight and start to take the pressure off their lower back. Eating healthy foods, exercising, and changing certain lifestyles can help promote a healthy body without pain, and many individuals can benefit from that.
References
Chou, Louisa, et al. “The Association between Obesity and Low Back Pain and Disability Is Affected by Mood Disorders: A Population-Based, Cross-Sectional Study of Men.” Medicine, Wolters Kluwer Health, Apr. 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC4839843/.
Frilander, Heikki, et al. “Role of Overweight and Obesity in Low Back Disorders among Men: A Longitudinal Study with a Life Course Approach.” BMJ Open, BMJ Publishing Group, 21 Aug. 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC4550727.
Kakiuchi, Masaaki, et al. “Relief of Low Back Pain after Posterior Decompression for Lumbar Spinal Stenosis.” Spine, U.S. National Library of Medicine, 15 Sept. 2021, pubmed.ncbi.nlm.nih.gov/34435987/.
Mirtz, Timothy A, and Leon Greene. “Is Obesity a Risk Factor for Low Back Pain? an Example of Using the Evidence to Answer a Clinical Question.” Chiropractic & Osteopathy, BioMed Central, 11 Apr. 2005, www.ncbi.nlm.nih.gov/pmc/articles/PMC1151650/.
Ross, Donald A, et al. “Trends in Weight and Body Mass Index after Spinal Surgery for Degenerative Disease.” International Journal of Spine Surgery, International Society for the Advancement of Spine Surgery, Aug. 2021, www.ncbi.nlm.nih.gov/pmc/articles/PMC8375684/.
Many complex spinal surgeries take place in a hospital environment. The individual spends a night or two in the hospital, so medical staff can monitor them if any complications arise. However, outpatient surgeries have increased with new developments in minimally invasive procedures, pain management, and home rehabilitation. The improvements compared to traditional spinal surgical procedures are significant. These advancements have made it possible to perform more complex surgeries outside of a hospital. Outpatient surgeries have:
Accelerated recovery times
Decreased complications
Decreased infections
Healthier overall outcomes
Outpatient Surgery Candidates
Determining if outpatient surgery can be performed effectively depends on the injury/s and/or conditions that the individual is going through. An individual who is debilitated or has underlying medical conditions that increase their risk for complications or do not have support at home to assist with recovery and rehabilitation is recommended to have the surgery done in a hospital. To be considered for outpatient spine surgery, a surgeon looks at:
Standalone ambulatory surgery centers offer same-day surgical procedures for individuals that meet specific criteria. Medical staff assess the patient’s condition and determine recovery at home. If issues arise, the individual can be transferred to a hospital. Some facilities are single-specialty facilities, focusing on one medical specialty, and others are multi-specialty, meaning they offer a range of medical services from:
Orthopedic
Podiatry
Pain management services
Procedures
Anterior Cervical Discectomy and Fusion – ACDF
ACDF is a two-part surgery. First, the surgeon removes part of an intervertebral disc with bulged and compressed nerves from the spinal cord. Because there is less cushion, the vertebrae above and below are fused to prevent and eliminate painful movement. The discectomy:
Provides more accessible access to the vertebrae
Reduces healing time
Causes less pain
ACDF outpatient procedure treats several neck conditions that include:
Cervical spinal stenosis
Cervical radiculopathy
Neck-related degenerative disc disease
Herniated disc
Cervical spinal fracture
Individuals recover in the surgical center for one to several hours following the surgery before returning home. Traditional ACDF procedure takes three weeks to three months to recover.
Lumbar Discectomy
A lumbar discectomy is a minimally invasiveprocedure that repairs a lower back herniated disc compressing the surrounding nerves. This procedure provides compression relief and allows the nerve to heal. A traditional lumbar discectomy takes four to six weeks to recover.
Lumbar Laminectomy
This minimally invasive procedure removes thickened ligaments and lamina from the lower back. This opens the spinal canal space, relieving pressure and bringing pain relief. The surgery commonly treats lower-back spinal stenosis. A traditional laminectomy takes four to six weeks to recover.
Lumbar Spinal Fusion
Outpatient lumbar spinal fusion permanently connects two or more vertebrae in the lower back. The surgery helps stabilize the spine from severe arthritis or herniated disc removal. Spinal fusion has been found to be effective for correcting certain spinal deformities. The surgery involves a short recovery time at the outpatient center, after which the individual can return home the same day. A traditional or open spinal fusion requires a two-to-three-day hospital stay. After four to six weeks and with a doctor’s clearance, individuals can return to light activities, with full recovery requiring six months.
Chiropractic Spinal Decompression
References
International Journal of Spine Surgery. (April 16, 2021) “The expanding frontier of outpatient spine surgery.” pubmed.ncbi.nlm.nih.gov/33900984/
Injury Medical Chiropractic Decompression Clinic focuses on the whole body, realigns the bones and joints, and helps strengthen the muscles. This helps prevent pain and injury and maintains spinal stability. Strong back muscles can help promote correct posture and keep the spine free from restriction. A stable spine is achieved when the back muscles can support and balance the everyday forces and stress of rigorous physical activity. Strengthening the back muscles can be done through yoga, weightlifting, and other recommended chiropractic exercises.
The core is a crucial area of the body. The body utilizes the core for all movements and as a stabilization unit. Lack of strength places unwanted tension and pressure on the spine. Chiropractic ensures all the joints function correctly and enhances the core to brace more effectively and efficiently.
Chiropractic Balance
Adjustments and decompression realign the muscles into the proper position and help lubricate the muscles to help ease the stabilizer muscles that could be tight or tense. Treatments used can include:
Spinal manual and motorized decompression
Extremity adjustments
Myofascial release
Active Release Technique
Trigger point therapy
Benefits
Natural pain relief
Injury prevention
Enhanced muscle performance
Expedited recovery
Increased endurance
Mobility enhancement
Increased strength
Core strength and stability play a huge factor in everyday life and functions. Maintaining health results requires attention to detail. Injury Medical Decompression Clinic will create a personalized optimal health treatment plan that focuses on whole-body realignment, simple lifestyle adjustments, health coaching/nutrition, and strength training to improve balance, strength, and core stability.
Spinal Decompression DRX9000
References
Globe G, Morris C, Whalen W, et al., “Chiropractic Management of Low Back Disorders: Report from a Consensus Process,” Journal of Manipulative and Physiological Therapeutics November/December 2008: 651-658.
Keller, MD, et al., “Trunk Muscle Strength, Cross-sectional Area, and Density in Patients With CLBP Randomized to Lumbar Fusion or Cognitive Intervention and Exercises,” Spine, 2004 29(1): 3-8 (3)
Mayer J, DC, Ph.D. Mooney V, MD, Dagenais S, DC Ph.D., “Evidence-informed management of CLBP with lumbar extensor strengthening exercises,” T Spine J, 2008;8:96-113. (3)
McKenzie, RA, “The Lumbar Spine: Mechanical Diagnosis and Therapy,” Spinal Publications/Printed by Wright & Carman, LTD, Upper Hutt, New Zealand, 1989 reprinted.
Sculco AD, Paup DC, Fernhall B, Sculco MJ, “Effects of aerobic exercise on low back pain patients in treatment,” Spine J, 1(2):95-101 (2001).
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