Cheerleading and the physically intensive gymnastics and acrobatics put participants’ body’s/musculoskeletal systems at an increased risk of injury. A wrong move or falling at the wrong angle can cause permanent damage. Cheerleaders must follow a balanced diet and maintain physical fitness, strength, endurance, and flexibility to be successful cheerleaders. Cheerleading conditioning builds the musculature and spinal strength to decrease the risk and prevent injury.
Cheerleading Conditioning
Cheerleaders must have a solid musculoskeletal system to ensure their safety and the safety of their squads. Workouts include cardio, strength training, and flexibility exercises.
Warming Up
Before any workout, the muscles need to be warmed up.
Spend five minutes jumping rope, running in place, jogging on a treadmill, or doing any mild activity to raise the heart rate.
Try tree pose by standing on the right foot, and the left leg bent on the right knee.
The left thigh should be parallel to the ground.
Raise arms overhead and make a V motion keeping the abdominal muscles pulled in tight.
Balance for up to one minute.
Switch to the other foot.
Once balance is mastered on the ground, try balancing on a cushion to add instability.
Repeat three to five times on each foot.
Common Injuries
Common injuries include:
Hand and finger injuries.
Ligament sprains in the knees and ankles.
Muscle strains in the hip, low back, and legs.
Overuse injuries
Cheerleading is becoming a year-round sport.
Starting with tryouts during spring.
Teams may hold or go to organized summer cheerleading camps to learn new skills, improve skill sets, and create routines for competition.
Continuous training and competitions increase the chance of overuse injuries.
The wrists, elbows, knees, and ankles can be injured by repetitive stress.
More severe injuries are:
The repetitive tumbling places significant pressure on the spine and can cause stress fractures.
Dislocation of the shoulder or elbow.
Injury Causes
Lack of arm and shoulder, foot, and ankle strength.
Little to no core and abdominal strength.
Flexibility problems.
Improper conditioning.
Unhealthy diet.
Performing skills that are advanced for the cheerleader’s current level.
Chiropractic Enhancement
Chiropractic care can treat injuries and strengthen the body’s musculoskeletal system to prevent injuries. Chiropractic’s goal is optimal body performance by redistributing blood circulation, nerve energy flow, correct muscle positioning, and skeletal alignment. Many cheerleading teams are incorporating chiropractic. Injury Medical Chiropractic and Functional Medicine Clinic also specializes in sports medicine rehabilitation, strength training, nutrition, and health coaching.
Cheerleading Strength Training Workout
References
Boden, Barry P, and Christopher G Jarvis. “Spinal injuries in sports.” Neurologic clinics vol. 26,1 (2008): 63-78; viii. doi:10.1016/j.ncl.2007.12.005
Miners, Andrew L. “Chiropractic treatment and the enhancement of sport performance: a narrative literature review.” The Journal of the Canadian Chiropractic Association vol. 54,4 (2010): 210-21.
Mueller, Frederick O. “Cheerleading injuries and safety.” Journal of athletic training vol. 44,6 (2009): 565-6. doi:10.4085/1062-6050-44.6.565
Pang, Yanbin, et al. “Premature exhaustion of mesenchymal stromal cells from myelodysplastic syndrome patients.” American journal of translational research vol. 9,7 3462-3468. 15 Jul. 2017
Wan, Jing-Jing, et al. “Muscle fatigue: general understanding and treatment.” Experimental & molecular medicine vol. 49,10 e384. 6 Oct. 2017, doi:10.1038/emm.2017.194
Children, teens, and adults participate in organized and recreational sports activities for fun, exercise, and social benefits. Individuals and parents are used to scrapes, bumps, bruises, sprains, and strains. However, internal abdominal injuries from the body colliding with another player or object are less common but dangerous. Abdominal injuries make up less than 4 percent of sports injuries but can be severe when they occur. These injuries are common in sports like wrestling, gymnastics, soccer, basketball, football, skiing, snowboarding, BMX freestyle, motocross, skateboarding, ice/field hockey, and lacrosse. Early symptoms are not always obvious or apparent and can be mild or seem to go in a different direction away from the abdominal region, which is why it is essential to know what to look for.
Internal Abdominal Injuries Athletes
There are about 3oo 000 abdominal sports-related injuries. Kids and young athletes risk injuring their abdominal organs because their abdominal wall is thinner and still in development. However, internal abdominal injuries to the stomach, small and large intestine, spleen, liver, and kidneys can and do happen in adults.
Injury Types
Sports-related internal abdominal injuries are considered rare, but studies suggest they are increasing. The most common sites include:
Liver
This causes pain in the upper right side of the abdomen.
The right lobe is the one that gets injured more often because it is bigger and presses against the ribcage.
A torn liver can cause severe bleeding.
Shock can develop from the bleeding, causing heart palpitations, rapid breathing, shortness of breath, and a pale, grey, and/or sweaty appearance.
The liver and spleen are the most commonly injured organs in sports. They are filled with blood and can get bruised, or ruptured, and can cause severe bleeding when torn or cut. Bleeding in the abdomen can irritate the diaphragm, which can cause pain in the shoulder. Sometimes shoulder pain is the only symptom making it difficult to diagnose and because bleeding can take time to develop, the symptoms might not present for several hours.
Spleen
This causes pain in the upper left side of the abdomen.
The spleen filters around 10% of the body’s blood supply every minute.
A torn spleen can cause rapid and life-threatening internal bleeding.
Kidneys
The kidneys can be injured by a blow/hit to the back or flank that causes bruising or laceration.
This injury can cause flank/side pain, blood in the urine, nausea, and/or vomiting.
Abdominals
A single organ or multiple organs can be injured.
This can be the pancreas, diaphragm, stomach, gallbladder, bladder, or intestines.
Bruising discoloration or bruising, particularly around the belly and flanks.
This can cause abdominal pain with movement that does not get better that could be accompanied by fever, nausea, or vomiting.
Running into an object, another player, or falling hard can cause bruising, laceration, or create a tear/opening of a bowel wall. Symptoms can be delayed days to weeks after the injury when inflammation or infection develops.
Recognizing Internal Injuries
Signs and symptoms to look for include:
Abdominal pain
Bruising around the abdominal area.
Tenderness over the injured area.
Rigid abdomen.
Left-arm and shoulder pain.
Right-sided abdominal pain and right shoulder pain.
Blood in the urine.
Cold, sweaty skin.
Nausea and vomiting.
Rapid heartbeat.
Low blood pressure.
Loss of consciousness.
Treatment
Chiropractic focuses on whole-body health and can help with abdominal injuries. The nervous and digestive systems are interconnected, meaning that damage could lead to viscerosomatic reflexeseven if not directly injured. If internal damage or bleeding has occurred, individuals will be referred to a specialist, surgeon, or another emergency medical professional. If internal damage is ruled out, a chiropractic treatment plan that includes adjustments, massage therapy, manual and mechanical decompression, exercises, stretches, and health coaching will help with tissue injuries and problems that are causing gastrointestinal distress.
Spinal Non-Surgical Decompression
References
Arumugam, Suresh, et al. “Frequency, causes and pattern of abdominal trauma: A 4-year descriptive analysis.” Journal of emergencies, trauma, and shock vol. 8,4 (2015): 193-8. doi:10.4103/0974-2700.166590
Barrett, Cassie, and Danny Smith. “Recognition and management of abdominal injuries at athletic events.” International journal of sports physical therapy vol. 7,4 (2012): 448-51.
Kucera, K. L., Currie, D. W., Wasserman, E. B., Kerr, Z. Y., Thomas, L. C., Paul, S., & Comstock, R. D. (2019). Incidence of Sport-Related Internal Organ Injuries Due to Direct-Contact Mechanisms Among High School and Collegiate Athletes Across 3 National Surveillance Systems. Journal of athletic training, 54(2), 152–164. https://doi.org/10.4085/1062-6050-271-17
Slentz, Cris A et al. “Effects of aerobic vs. resistance training on visceral and liver fat stores, liver enzymes, and insulin resistance by HOMA in overweight adults from STRRIDE AT/RT.” American journal of physiology. Endocrinology and metabolism vol. 301,5 (2011): E1033-9. doi:10.1152/ajpendo.00291.2011
When the body goes through intense trauma like a car, truck, crash, or accident, the trauma can slip, bulge, herniate, or rupture the spinal fluid-filled discs that can extrude from the disc space, causing the nucleus pulposusto tear through the annulus fibrosus and compress the nerve roots causing pain. Depending on the severity and force of the crash or accident, a herniated disc can cause the vertebrae to push into the spinal canal, where it can compress, irritate, and/or injure the spinal cord, which can lead to other health issues. Nerve impingement from a herniated disc can also cause numbness and tingling in the hands, arms, legs, and feet. A chiropractic spine disc herniation decompression treatment plan can heal the herniation, realign the spine, stretch the muscles and joints, and rehabilitate the body back to top form.
Spine Disc Herniation
Symptoms of Herniation
Signs and symptoms depend on the spinal area and whether the disc is rubbing or compressing a nerve. Pain is often described as a sharp or burning sensation. A herniated disc usually affects one side of the body.
Pain Presents When Sitting Down – sitting causes a significant strain on the lower spinal discs. When sitting, the pain experienced can worsen.
Arm or leg pain – Depending on the herniated disc, pain can spread to other surrounding areas.
For a lower herniation, this could be the buttock, thigh, calf, and foot.
For a herniated disc in the neck region, pain can be felt in the shoulder and arm.
Pain can present in the arm or leg when coughing, sneezing, or moving into certain positions.
Numbness or tingling – presents from the compressed nerves and spreads as the average blood/energy flow is disrupted.
Muscle Weakness – the affected nerves that support the spinal muscles can lose normal strength causing awkward postures and fatigue.
A herniated disc can be present without symptoms – individuals won’t know unless spinal imaging is ordered.
Sciatica Sensations – the damaged nerve roots affect the ability to function correctly and can cause burning pain, numbness, weakness, and tingling along the front and/or back of the thigh, leg, and/or foot. This can result from direct compression or chemical irritation from a leaked out herniated disc that causes inflammation around the nerve root area.
Chiropractic Injury Care
When a disc herniates, it inhibits the body from communicating and healing itself. To activate proper communication from the brain to the rest of the body, chiropractors perform spine disc herniation decompression which clears the neural system and opens the lines of communication.
Spine Disc Herniation Decompression
Nonsurgical spinal decompression gently stretches the spine to relieve pressure and heal the herniated disc. It is a safe procedure considered a natural alternative compared to surgery or pharmaceutical approaches. Spinal decompression therapy:
It is safe for all ages
It is non-invasive
Sessions take between 30 to 45 minutes, depending on the individual and the injury that could require multiple sessions.
Offers a quicker recovery time
It is performed on a computer-controlled table customized to the individual’s specific needs and injuries.
A treatment plan can expedite the recovery process, rehabilitate and strengthen the whole body, and help avoid minimally invasive spine surgery.
Neurosurgeon DRX9000
References
Atlas, Steven J et al. “The impact of disability compensation on long-term treatment outcomes of patients with sciatica due to a lumbar disc herniation.” Spine vol. 31,26 (2006): 3061-9. doi:10.1097/01.brs.0000250325.87083.8d
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: https://www.ncbi.nlm.nih.gov/books/NBK441822/
Gane, Elise M et al. “The Impact of Musculoskeletal Injuries Sustained in Road Traffic Crashes on Work-Related Outcomes: A Systematic Review.” International journal of environmental research and public health vol. 18,21 11504. 1 Nov. 2021, doi:10.3390/ijerph182111504
Scuderi, Gaetano J et al. “Symptomatic cervical disc herniation following a motor vehicle collision: return to work comparative study of workers’ compensation versus personal injury insurance status.” The spine journal: official journal of the North American Spine Society vol. 5,6 (2005): 639-44; discussion 644. doi:10.1016/j.spinee.2005.04.007
Food is more than just energy. Diets have a profound effect on everything in an individual’s life. Some foods can help the body heal or interfere with the recovery/healing process from injury/s and/or conditions that include sciatica. Making changes to a diet plays a significant factor in the recovery/rehabilitation phase, and adding certain foods will improve and expedite the healing process. A fully functional sciatic nerve nutrition diet plan must be personalized to each individual’s needs.
Sciatic Nerve Nutrition
Sciatica can cause numbness, tingling, electrical shock-type pain, or a combination in the back, hip, outer side of the leg, and the foot. Clinical nutrition is a powerful tool when combating sciatica. Enzymes in certain foods can help reduce the inflammation associated with sciatica. A high percentage of individuals dealing with sciatica can enhance pain relief by adjusting their diets. Quick recommendations include:
Oily fish like salmon and halibut are rich in omega-three fatty acids that decrease inflammation in the body and the sciatic nerve.
Fresh pineapples and berries are anti-inflammatories that aid in healing and increase immune system function.
2-3 cups of green tea contain antioxidants that help control peripheral sensations and help manage pain.
Turmeric, ginger, and garlic contain anti-inflammatory agents that relieve swelling by reducing levels of inflammation-stimulating enzymes.
B-Vitamins are essential to maintain normal nerve function and can be found in green peas, spinach, navy beans, nuts, and bananas.
Magnesium-rich foods can ensure the body is not deficient and help control muscle spasms.
Sciatica can also be triggered by a poor diet that causes constipation that can place pressure on the nerve. Therefore it is recommended to incorporate fiber-rich foods that include plenty of fruits and vegetables to prevent constipation.
Foods That Make Sciatica Worse
Inflammatory foods to avoid:
Sugar and high-fructose corn syrup.
Trans fats include margarine and any hydrogenated/solidified or partially hydrogenated oils.
Refined vegetable oils – These are vegetable, nut, or seed oils that have been highly processed. Cut down on french fries, chips, or other foods fried in these oils.
Refined carbohydrates – Carbohydrates that have fiber removed increase the growth of inflammatory gut bacteria. These include white flour, refined corn products, white rice, and various commercial cereals and sugars.
Excessive alcohol – Moderate amounts of alcohol can provide health benefits, but higher amounts increase inflammation.
Processed meats – are often processed at high temperatures, creating chemicals/substances associated with inflammation.
Avoid Surgery
References
Davis D, Maini K, Vasudevan A. Sciatica. [Updated 2022 Feb 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507908/
Garfin, SR et al. “Spinal nerve root compression.” Spine vol. 20,16 (1995): 1810-20. doi:10.1097/00007632-199508150-00012
Kumar, M. Epidemiology, pathophysiology and symptomatic treatment of sciatica: A review. nt. J. Pharm. Bio. Arch. 2011, 2.
Safari, Mir Bahram, et al. “Efficacy of a Short-Term Low-Calorie Diet in Overweight and Obese Patients with Chronic Sciatica: A Randomized Controlled Trial.” Journal of alternative and complementary medicine (New York, N.Y.) vol. 26,6 (2020): 508-514. doi:10.1089/acm.2019.0360
Massage is the manipulation of the body’s muscles and tissues using controlled force, gentle and slow kneading, and assisted instrumentation. Decompression Massage Centertailors treatment plans to the individual’s health needs to help expedite recovery. A medical decompression massage can:
Bring pain relief
Relieve stress
Relieve muscle aches and tension
Release knotted or cramped muscles
Improve sleep
Improve mental/emotional state
Accelerate injury rehabilitation
Strengthen the musculoskeletal system
Release toxins
Boost the immune system
Trained professionals perform massage therapy in a clinical or hospital setting to find and focus on problem areas. The therapeutic massage involves focused work on the body’s:
Soft tissues
Muscles
Tendons
Ligaments
Discomfort and Pain Relief
A massage therapist works on several medical issues that are either chronic or acute, which include:
Overuse/Repetitive stress injuries.
Neck pain
Whiplash.
Migraines.
Tension headaches, cluster headaches, and sinus headaches.
Shoulder pain.
Back pain.
Radiating pain.
Strains and sprains.
Tendonitis.
Post-surgical scar tissue rehabilitation with a doctor’s clearance.
Decompression Massage
A therapeutic decompression massage is more profound, with individuals experiencing more tenderness as the therapist works through the tissue using various techniques and instruments that could incorporate:
A decompression massage could be recommended as an extended part of a treatment plan. Spot work focuses on areas of concern for a shorter period while enhancing the decompression treatment. Focused massage techniques will:
Alleviate pain
Increase range of motion
Restore movement and function
Assist in healing faster
Spinal DRX9000
References
Demirel, Aynur, et al. “Regression of lumbar disc herniation by physiotherapy. Does non-surgical spinal decompression therapy make a difference? A double-blind, randomized controlled trial.” Journal of back and musculoskeletal rehabilitation vol. 30,5 (2017): 1015-1022. doi:10.3233/BMR-169581
Keller, Glenda. “The effects of massage therapy after decompression and fusion surgery of the lumbar spine: a case study.” International journal of therapeutic massage & bodywork vol. 5,4 (2012): 3-8. doi:10.3822/ijtmb.v5i4.189
Menard, Martha Brown. “Immediate Effect of Therapeutic Massage on Pain Sensation and Unpleasantness: A Consecutive Case Series.” Global advances in health and medicine vol. 4,5 (2015): 56-60. doi:10.7453/gahmj.2015.059
Zainuddin, Zainal, et al. “Effects of massage on delayed-onset muscle soreness, swelling, and recovery of muscle function.” Journal of athletic training vol. 40,3 (2005): 174-80.
Non-surgical spinal decompression relieves pain related to spinal conditions, injuries, and disorders that provides a comfortable, affordable alternative treatment option to costly and invasive surgical procedures. Non-surgical spinal decompression can also relieve pain associated with post-surgical rehabilitation. A key to successful outcomes is including added components of the treatment that includes spinal decompression nutrition.
Spinal Decompression Nutrition
Proper nutrition and a balanced diet are essential elements of overall health. Individuals suffering from herniated discs, bulging discs, degenerated discs, sciatica, and chronic low back and neck pain are often deficient in vitamins and minerals, leading to inflammation and pain. These deficiencies can cause or exacerbate the pain and prevent or slow down healing. The bones, muscles, and other structures in the spine need proper nutrition to be strong enough to support the body and perform functions optimally. A health coach and nutritionist can recommend the proper diet and supplements to expedite healing, depending on the patient, the circumstances, and the individual situation. A non-inflammatory diet can make a big difference in patients’ symptoms and the effectiveness of decompression therapy.
The Right Foods
Eating a balanced diet with the right amount and variety of vitamins and nutrients can reduce back problems by nourishing the spine’s bones, muscles, discs, and other structures. While a healthy diet calls for various vitamins and nutrients, several healthy choices can directly benefit the spine. First and foremost is:
Sugar and Nitrate Reduction
High sugar diets lack the nutrients needed to prevent the release of inflammatory mediators.
The average individual consumes around 100 lbs of sugar per year.
Dessert foods are high infatty acids, which increase inflammation.
Any foods containing high fructose corn syrup like salad dressings and sodas.
Processed foods high in nitrates like hot dogs, sausage, and lunch meats.
Super Foods
Increase healing of the spine at the cellular level with superfoods that include:
Water – maintaining hydration is important for re-hydrating degenerated, dried-out discs.
Pre Spinal Decompression Nutrition
The human body was created to heal itself; however, getting the proper nutrition can be difficult as circulation is impeded/blocked when going through a back injury or spinal condition. Eating and/or supplementing with essential nutrients and minerals could be recommended to encourage and engage the healing process. Using nutrients to improve recovery and healing is known as immunonutrition. Pre-decompression allows the tissues to begin healing. Then the chiropractic health team can prepare the tissues for decompression through therapeutic massage, heat, low-level laser therapy, and ultrasound.
DRX9000 Explained by a Neurosurgeon
References
Calder, Philip C. “Fatty acids and inflammation: the cutting edge between food and pharma.” European journal of pharmacology vol. 668 Suppl 1 (2011): S50-8. doi:10.1016/j.ejphar.2011.05.085
Gay R. “All About Spinal Decompression Therapy.” Spine-health. http://www.spine-health.com/treatment/chiropractic/all-about-spinal-decompression-therapy. Published September 2013. Accessed April 2015.
InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. What is inflammation? 2010 Nov 23 [Updated 2018 Feb 22]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279298/
Innes, Jacqueline K, and Philip C Calder. “Omega-6 fatty acids and inflammation.” Prostaglandins, leukotrienes, and essential fatty acids vol. 132 (2018): 41-48. doi:10.1016/j.plefa.2018.03.004
Automobile accidents and crashes can cause all kinds of damage to the body even when the accident/crash is not severe. Physical symptoms might not present at all for several days, even weeks. This is known as having delayed injury symptoms. These can include:
Swelling.
Stiffness.
Aching.
Pain that radiates all over the body.
Sleep problems.
Headaches.
Brain fog.
Disorientation.
Memory problems.
Chiropractic and physical therapy rehabilitation can restore the body’s alignment, stop inflammation, loosen, stretch and strengthen the musculoskeletal system restoring optimal health.
Adrenaline
When the body is involved in a dangerous physical situation, it protects itself by releasing a surge of adrenaline. This hormone protects the body, causing the fight or flight response when in danger. Adrenaline causes several preservation responses that include:
Intense increase in energy.
Little or no pain.
Enlarged blood vessels and airways increase oxygen flow.
Increased strength from increased blood flow to the muscles.
Changes in vision and hearing that focus on sights and sounds all around.
Endorphins are released that make the body feel calm and in control.
Endorphins affect the way the body responds to pain and stress.
Individuals don’t start feeling aches and pains until the adrenaline and endorphins wear off. However, because everybody is different and the emergency response has turned off, the body still might not feel the injury symptoms. These are delayed injury symptoms.
Rate of Speed
When riding in a vehicle, the body moves at the same speed as the vehicle. During an impact, the vehicle stops, but the body continues moving until it stops, typically with a lot of force from the seatbelt, airbag, or other barriers. The intense momentum change can cause soft tissue damage and ligament or muscle strains from the stretching, pulling, contracting, and tearing. Also, the intervertebral discs can tear, bulge, or herniate over time, creating pressure on nerves and the surrounding tissues.
Delayed Injury Symptoms
Headaches
Headaches that develop days after an accident/crash are common.
They can signal a possible injury to the neck or head, a blood clot on the brain, or a concussion.
Back pain can be caused by injury to the muscles, ligaments, nerves, or damage to the vertebrae.
Low back pain occurs in more than half of rear-impact collisions and almost three-quarters of side-impact crashes.
Chiropractic Rehabilitation
After an accident, soft tissues can sustain minimal damage; however, the minimal damage left untreated can start to worsen and turn into a painful condition. Emergency room visits are to rule out major injuries like brain/nerve injuries, bleeding, punctures, lacerated organs, fractures that require emergency stabilization. Chiropractors look for other symptoms and mechanisms that indicate damage to the body’s soft tissues and nerves to see if they have been stretched or torn and dysfunction in the nervous system.
Body Composition
Calorie Counting
Counting calories can be a stepping stone to change behavior towards food. Tracking what foods are being taken into the body promotes mindfulness of dietary habits. Studies on the subject reveal a significant association between self-monitoring and weight loss. Takeaways include:
Take small steps by saying no to second portions during dinner or take a healthy sweet snack or piece of fruit instead of a pastry, cookie, etc.
Try to start making a habit of eating less processed foods.
Meals high in protein and fiber are generally more filling, making the body feel fuller from fewer calories.
The more attention there is to the food choices, the more likely reexamination occurs.
References
Burke, Lora E et al. “Self-monitoring in weight loss: a systematic review of the literature.” Journal of the American Dietetic Association vol. 111,1 (2011): 92-102. doi:10.1016/j.jada.2010.10.008
D’Elia, Michael A et al. “Motor vehicle collision with seatbelt sign and traumatic abdominal wall hernia should raise suspicion for hollow viscus injury.” Trauma case reports vol. 22 100206. 25 May. 2019, doi:10.1016/j.tcr.2019.100206
Kacprzynski, Gregory, and Joshua Bucher. “Delayed vertebral artery dissection after mild trauma in a motor vehicle collision.” The American Journal of emergency medicine vol. 45 (2021): 678.e1-678.e2. doi:10.1016/j.ajem.2020.11.028
Olinger, Catherine, and Richard Bransford. “Upper Cervical Trauma.” The Orthopedic clinics of North America vol. 52,4 (2021): 451-479. doi:10.1016/j.ocl.2021.05.013
Sterling, Michele. “Whiplash-associated disorder: musculoskeletal pain and related clinical findings.” The Journal of manual & manipulative therapy vol. 19,4 (2011): 194-200. doi:10.1179/106698111X13129729551949
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