Table of Contents
Your doctor may have you see a physical therapist who will design
a neck-care program just for you. Your physical therapist will evaluate
your condition to determine the best way to help ease your pain
and help your neck move better. You will also be given ways to take
care of your neck so you can avoid pain and prevent further injury
to your neck.
On your first visit, your physical therapist will want to gather
some more information about the history of your neck problem. You
may be given a questionnaire that helps you tell about the day to
day problems you are having with your neck. The information you
give will help measure the success of your treatment. You may also
be asked to rate your pain on a scale of one to ten. This will help
your physical therapist gauge how much pain you have now and how
your pain changes once you've had treatment. Your physical therapist
will probably ask some more questions about your neck problem to
begin zeroing in on the source of your pain and to know what will
be needed to help relieve it. Here are some questions your therapist
may ask you:
How long have you had neck pain?
Where do you feel the pain?
What makes the pain better or worse?
How does your pain affect your daily activities?
Do you have headaches?
Do you have pain in your shoulder, arm, or hand?
Do you have any numbness or tingling?
Once all this information has been gathered, your neck condition
will be evaluated.
Posture/observation: Your physical therapist will begin
by checking your posture to see if your soreness is coming from
changes in posture. Imbalances in the position of your spine can
put pressure on sore joints, nerves, and muscles. Postures used
for a long time at school, with hobbies, or when working can change
the balance of muscle strength and flexibility. Muscles that have
been stretched over time tend to be weaker, while muscles that are
put in shortened positions can begin to overpower the weaker ones.
This can put added strain on areas around the neck that can cause
a problem or make a sore area worse. Helping you improve your posture
can oftentimes make a big difference in easing pain.
Range of motion (ROM): Next, your physical therapist will
check the ROM in your neck. This is a measurement of how far you
can move your neck in different directions. Neck movements include
bending the neck forward and backward (flexion and extension), bending
to either side (side bending), and turning the neck to one side
and the other (rotation). Measurements may also be taken of upper
back and/or shoulder movements. Your ROM is written down to compare
how much improvement you are making with the treatments.
Neurological screen: Your physical therapist may need to
do some tests to check the nerves of your neck. This part of the
evaluation looks at your reflexes, sensation, and strength in your
neck, shoulders, and arms. The results of these tests can help your
physical therapist know which area of the neck may be causing problems
for you and can guide the type of treatment to help your condition.
Manual examination: You may be given a manual examination
of the muscles and joints of the neck. Your physical therapist will
carefully move your neck in different positions to make sure that
the joints are moving smoothly at each level of the neck. This will
help guide treatment to the joint that is tight (called a hypomobility)
or where a joint may have been injured and is moving too much (called
a hypermobility). Some of the movements you'll feel are where your
physical therapist is looking at the flexibility of the muscles
around your neck. This type of examination can help guide your therapist
to know where your soreness is coming from and which type of treatment
will help you the most.
Special tests: Other special tests may be done if your physical
therapist thinks your neck pain is coming from other areas or causes.
Other areas that may need to be looked at include:
* Thoracic outlet: This is where a group of nerves and vessels
make their way out of the chest cavity and travel down the arm.
Problems in this area can cause numbness, pain, or even coldness
in the arm and hands.
* Temporomadibular joint (jaw): Problems here can cause headaches,
pain in your upper neck, and even spasm in muscles of the neck.
* Thoracic spine: Problems beginning in the upper back can include
joints and muscles of the thorax or even in the alignment of one
or more ribs, which can cause pain to radiate toward the neck and
shoulder.
* Nerve tension: Nerves of the mid and lower neck travel down the
arm to service the arm and hand. Irritation or scarring around the
covering of these nerves can cause pain that radiates from the neck
to the upper back or even into the arm. By locating scarred or irritated
areas along the nerve, a treatment called "neural mobilization"
can be used to free up movement in the nerve and to ease the soreness
you feel.
* Ergonomics: Ergonomics is a way to look at where and how you
do your work or hobby activities. Your physical therapist may want
to understand your ergonomics to figure out if the way you do your
activities is making your condition worse. Sometimes even simple
corrections of your hobby or work station can make a big difference
in easing neck sypmtoms.
Palpation: The evaluation usually ends with palpation. Palpation
is when your physical therapist feels the soft tissues around the
neck. This is done to check the skin for changes in temperature
or texture, which could tell if you have inflammation or nerve irritation.
Palpation is also done to find whether there are tender points or
spasm in the muscles around the neck and upper back. This too can
give your therapist a good idea about which treatments will help
you the most.
Treatment plan: Once the examination is done, your therapist
will put together a treatment plan. The treatment plan lists the
types of treatments that will be used for your condition. It gives
an indication of how many visits you will need and how long you
may need therapy. It also includes the goals that you and your therapist
think will be the most helpful for getting your activities done
safely and with the least amount of soreness. Finally, it will include
a prognosis, which is how your therapist feels the treatment will
help you improve.
Controlling your pain and symptoms
Easing pain: Your therapist may choose from one or more
of the following tools, or modalities, to help control the symptoms
you are having:
Rest: Resting the painful joints and muscles helps calm
soreness, giving your neck time to heal. If you are having pain
with an activity or movement, it should be a signal that there is
still irritation going on. You should try to avoid all movements
and activities that increase your pain. In the early stages of your
problem, your doctor or therapist may want you to use a soft or
hard neck collar to limit neck movement nearly completely.
Specific Rest: Specific rest encourages safe movement of
the joints and muscles on either side of a painful area, while protecting
the sore spot during the initial healing phase. Select exercises
can be given to encourage safe movement of the shoulders and upper
back. If you've been prescribed a collar, you will likely be instructed
to take it off a few times a day so you can do some gentle and controlled
exercises.
Positioning: The results of the evaluation will give your
therapist a clear picture of ways you can position your neck for
the greatest comfort. A special pillow, called a contour pillow,
may be suggested to help get your neck in the most comfortable position
while sleeping or resting. A commercial neck roll, or even a rolled
towel, can be slid inside your pillow case so that when you lie
back, the roll fills in and supports the curve in your neck. Other
special ways to rest your head and neck may be given by your therapist
to help take away arm pain that is coming from your neck.
Ice: Ice makes the blood vessels in the sore area become
more narrow, called vasoconstriction. This helps control inflammation
that is causing pain. Some ways to put ice on include cold packs,
ice bags, or ice massage. Cold packs or ice bags are generally put
on the sore area for 10 to 15 minutes. Ice massage is done by rubbing
an ice cube or ice cup on a sore spot or tender point. It's as easy
as freezing a small paper cup full of water. Once the water freezes,
simply tear off the top inch of the cup and rub the exposed ice
on the sore spot for three to five minutes, or until it feels numb.
Heat: Heat makes blood vessels get larger, called vasodilation.
This action helps to flush away chemicals that are making your neck
hurt. It also helps to bring in nutrients and oxygen which help
the area heal. True heat in the form of a moist hot pack, a heating
pad, or warm shower or bath is more beneficial than creams that
merely give the feeling of heat. Hot packs are usually placed on
the sore area for 15 to 20 minutes. Special care must be taken to
make sure your skin doesn't overheat and burn. It's also not a good
idea to sleep with an electric hot pad at night.
Ultrasound: An ultrasound machine produces high frequency
sound waves that are directed toward the sore area. Passing through
the body's tissues, these waves vibrate molecules. This causes friction
and warmth as the sound passes through the tissue. The rest of the
sound changes to heat in the deeper tissues of the body. This heating
effect helps flush the sore area and brings in a new supply of nutrient
and oxygen-rich blood. Ultrasound treatments are a way for your
therapist to reach tissues that are over two inches below the surface
of your skin.
Phoresis: This means to "carry or transmit." There
are two methods that therapists can use to transmit substances across
the skin. Phonophoresis uses the high frequency sound waves of ultrasound
to "push" a steroid medication (cortisone) through the
skin. Iontophoresis uses a small machine that produces a mild electrical
charge, which is used to carry medicine, usually a steriod, through
the skin. The steroid is a very strong antiinflammatory medication
that actually stops the pain-causing chemical reaction within the
cells of the sore tissue in your body. Either type of phoresis may
be used in place of a cortisone injection.
Electrical Stimulation: This treatmemt stimulates nerves
by sending an electrical current gently through your skin. Some
people say it feels like sort of like a massage on their skin. Electrical
stimulation can ease pain by sending impulses that are felt instead
of pain. Two respected scientists discovered a theory, called the
Gait Theory. This theory says that when you feel a sensation other
than pain, like rubbing, massage, or even a mild electrical impulse,
your spinal column will actually "close the gate" and
not let pain impulses pass to the brain. In the case of electrical
stimulation, the electrical impulses speed their way across the
skin and on to the central nervous system much faster than pain.
By getting there first, the electrical information "closes
the gate" to pain, blocking its passage to the brain. Once
the pain eases, muscles that are in spasm begin to relax, letting
you move and exercise with less discomfort. Other settings on the
machine can be used to help your body release endorphins. These
are natural chemicals formed within your body that behave like a
strong drug in reducing the perception of pain for up to eight hours
at a time.
Soft tissue mobilization/massage: Physical therapists are
trained in many different forms of massage and mobilization when
treating the neck. Massage has been shown to calm pain and spasm
by helping muscles relax, by bringing in a fresh supply of oxygen
and nutrient-rich blood, and by flushing the area of chemical irritants
that come from inflammation. Soft tissue treatments can help tight
muscles relax, getting them back to a normal length. This will help
you begin to move with less pain and greater ease. Physical therapists
have special training in a variety of different ways to mobilize
or massage. These can include gentle strokes, called effleurage.
Myofascial release techniques help restore better movement by getting
the thick layer of fascia below the skin and around muscles to "give".
Strain-counter-strain is a type of therapy that is especially helpful
when tender points are causing muscles to restrict movement. The
treatment is usually done in a way that the muscle is put in a special
position, usually where the muscle is shortest. The position is
held long enough to "reset" the nerve input to the muscle.
Another way to help soft tissues "move" is by the use
of muscle energy technique. Your therapist will place your muscle
in a certain position and then direct you to use your muscles against
the therapist's force. As you relax, your therapist will gradually
"take up the slack", giving a stretch on the muscle.
Joint mobilization: These are graded pressures and movements
that are done by skilled physical therapists. Gentle graded pressures
help lubricate joint surfaces, easing stiffness and helping you
begin moving with less pain. Pain that is left unchecked can quickly
escalate to an uncomfortable "cycle of pain and muscle guarding."
In other words, the pain can make your muscles go into spasm, in
which your muscles try to guard the sore joints, keeping you from
wanting to move your neck at all. When movement stops, your brain
gets an uninterupted flow of pain sensation. Ouch! This leads to
a cycle of even more muscle spasm and pain because your muscles
try to "protect" you from painful movement. By applying
gentle pressures, or mobilizations, your therapist will begin to
halt the flow of pain information, which helps muscles relax. Once
your muscles begin to relax, you will begin to feel other sensations
than pain. As your pain eases, more vigorous grades of mobilization
may be used to lengthen tissues around the joint helping restore
better movement in your neck.
Traction: Sore joints and muscles in the neck often feel
better when a traction "pull" is used. Your therapist
will test at first to see if you can get relief with this type of
treatment. Traction can be done in a variety of ways. There are
traction machines that allow you to relax comfortably with either
a halter or cusion behind your neck. The machine is set to pull
on this halter or cushion for a certain amount of time and pressure.
Manual traction is another way for your therapist to put a graded
pull on your neck. There are also traction devices that can be issued
for you to use at home. The amount of pull that is used will depend
on your condition. A gentle on/off pressure may be better early
on to help control pain or if there is pain from arthritis. More
vigorous traction can help take away pain if a joint is mildly sore
or tight.
Strengthening your neck
Exercise is important during all stages of recovery from neck pain.
Different types of exercises will be used by your physical therapist
as you get better. In the early stages, when your neck is still
quite painful, specific exercises may be suggested to help reduce
your pain. Supporting your neck in certain positions as suggested
by your therapist can take pressure off sore or injured areas. These
positions are sometimes easier to get into by using a pillow, rolled
towel, or commercial neck roll. You may need to relax back on a
recliner or matress for best results. In cases of significant pain,
you may be given a set of breathing exercises. Deep, diaphragmatic
breathing, helps air to reach even the lower lobes of your lungs.
Combining deep breathing to a slow relaxing count can help muscles
relax, while bringing much needed oxygen to sore tissues. Neck pain
can be physically and emotionally draining. Relaxation exercises
may not correct your problem, but they can help control pain and
its accompanying stress.
Movement is also important, even when your neck is still painful.
Careful movements suggested by your therapist can safely ease pain
by providing nutrition and lubrication to injured and sore areas.
Movement of joints and muscles also signals the nervous system to
block incoming pain. Common movement exercises include active range
of motion, in which you are encouraged to move your neck toward
directions that don't hurt. Your therapist will evaluate which movements
will be safest and best for you. In some cases, pain will ease with
the addition of pressure into one or another direction. Again, your
therapist will need to determine which movements are best for your
condition. Avoid movements that hurt or seem to irritate the soreness
in your neck.
As your neck becomes less painful, the exercises will be changed
to focus on improving the overall health of your neck. These changes
will focus on exercises for:
- Flexibility
- Strength
- Coordination
- Aerobic conditioning
Exercises that increase flexibility help to reduce pain and make
it easier to keep your neck and spine in a healthy position. Tight
muscles cause imbalances in spinal movements. This can make injury
of these structures more likely. Flexibility exercises for the neck,
chest, and upper shoulders can be helpful in establishing safe movement.
A slow progression of stretching exercises can increase flexibility
in these areas, ease pain, and reduce the chance of reinjury.
The next stage of exercise focuses on the strength of the muscles
that support the neck. These muscles help bring the spine into a
safe position--and keep it there! Trained muscles can keep your
neck healthy by getting it into better posture. A series of strengthening
exercises, called stabilization training, is a way to get better
balance in the muscles around your neck, chest, and upper back.
These stabilization exercises are helpful in supporting your neck
in safe positions while you are working or when you are doing other
daily activities. Strengthening and stabilization exercises are
simple to do at home and don't have to require any expensive equipment.
By practicing these exercises often, you will become comfortable
keeping your neck in healthy positions and postures with all your
activities.
Strong muscles need to be coordinated. As the strength of the spinal
muscles increases, it becomes important to train those muscles to
work together. Learning any physical activity takes practice. Muscles
must be trained so that the physical activity is under control.
Muscles that are trained to control safe movement of the spine help
reduce the chance of injury. You will be taught exercises to help
train your neck, chest, and upper back muscles to work together
in protecting your spine.
Finally, attention will be directed to increasing your overall
fitness. The word aerobic means "with oxygen". By using
oxygen as they work, muscles are better able to move continuously,
rather than in spurts. Fitness training allows the muscles to become
more efficient at obtaining nutrients and oxygen from the blood.
As the muscles use up the nutrients and oxygen, chemical waste products
are created that can cause pain. Training also increases the ability
of muscles to get rid of these waste products.
Exercise has other benefits as well. Vigorous exercise can cause
chemicals called endorphins to be released into the blood. These
chemical hormones act as natural pain relievers in reducing your
pain. It will be important that you pick an aerobic activity you
can enjoy and stick with it!
Once your pain is controlled, your range of motion is improved,
and your strength is returning, you will be progressed to a final
home program. Your therapist will give you some ideas to help take
care of any more soreness at home. You'll be given some ways to
keep working on the range of motion and strength too. Before you
are done with physical therapy, more measurements will be taken
to see how well you're doing now compared to when you first started
in therapy.
Is this is your first experience with a neck problem? Maybe you've
had ongoing problems for many years. In either case, your best bet
for avoiding neck problems in the future is to get a handle on ways
you can prevent further neck pain and/or injury. It is also helpful
to know how to take care of your neck if pain strikes again.
Posture: Using healthy posture is like holding a defense
shield against future neck problems. Pain and injury CAN be prevented.
When your joints are positioned in their safe--or neutral posture--the
body works like an elegant machine. It works safely and even more
productively. When unbalanced postures are used, problems are more
likely to happen. Prevention of neck pain and injury has alot to
do with keeping a balanced position of the spine and extremities.
When standing, this balance follows a plumb line from ear to ankle.
In a seated position, this line descends from the ear to the hip.
A rule of thumb for the extremities is to keep them in thier relaxed
positions.
There are three natural curves in the spine. From a side view,
the neck (cervical spine) curves slightly inward. The midback (thoracic
spine) curves slightly outward. The low back (lumbar spine) curves
slightly inward. Keeping this relationship while standing, sitting,
or moving is the basis for healthy posture. When moving, bend at
the hips to avoid rounding or straightening the spine. This keeps
the spine safe during activities like lifting and walking.
For better sitting posture, sit with a good upright alignment of
the spine by using a comfortable chair designed to support correct
posture. Avoid slouching by keeping your low back against the back
of the chair. Bending the head forward strains the neck and affects
the nerves and arteries leading to the arms. Your shoulders should
be relaxed, and the elbows, hips, and knees should be bent at right
angles (ninety degrees). Avoid pressure to the back of the knees.
Your feet should be kept flat on the floor or supported by a foot
rest.
Akward posture places stress on the body that can lead to neck
pain. Slouching with the spine or leaning the head forward puts
the body out of alignment, causing the limbs to be stretched and
bent. Too much bending (flexion) or straightening (extension) in
the spine increases the risk of injury. Symptoms of pain, tingling,
or numbness in the arm or hand may also come from poor neck posture.
The slight inward curve of the neck balances the head on the spine.
Avoid extreme postures, like gazing up at the stars, or bending
your head down for long periods when reading a book. Keeping balanced
posture is a measure you can use to prevent further injury and pain
in your neck.
Ergonomics: Ergonomics is a look at the way people do work.
What does ergonomics have to do with the ache in your neck? It could
have alot to do with it. It's possible that even minor changes in
the way you do your work or hobby activities could ease the pain
you feel now while preventing further neck injury or pain.
In some cases, it is best to have someone trained in ergonomics,
like a physical or occupational therapist, check your work station
and the way you do your work. The first step will be for them to
ask you some questions about your work, which makes good sense.
Since you're the one doing the job, you will have an expert opinion
about what seems to be working, what could be done differently,
and what tasks seem to be causing the most problems for you. Once
these questions are covered, the evaluator will want to watch you
do the work tasks. Areas that will be noted include the postures
you use, repetitions to complete the task, rest time between tasks,
and the amounts of weight you are dealing with. For office workers,
the examiner will look at alignment of the computer monitors, chairs,
desk heights, etc. Other areas that may be evaluated include work
heights, tools of the trade, lighting, and temperature. It's also
helpful to look at your work postures and work tasks to see if what
you are doing can be done with less stress and strain on your body.
When the work site evaluation is over, you or your supervisor will
probably be given some recommendations--some of these may even be
ones you came up with! Ergonomics doesn't always have to involve
expensive changes. Even minor adjustments can make a huge difference
in easing your pain and preventing further problems.
Work Place Strategies: These strategies are ideas of how
to work with greater safety and even better productivity. Have you
ever felt stress or tension at work? Chances are good that you wouldn't
have a pain or worry if you didn't. The reality is that people are
often called on to do even more with less resources. They are faced
with more responsibility and more deadlines to get their tasks done.
The health of your neck may be at risk with these mounting pressures.
But scientists have helped us learn that there is a defence in the
face of these mounting pressures. They have shown the importance
of using the "Three R's" to help ease tension and reduce
neck pain at work. Here are the three Rs:
Rest: This includes taking frequent breaks during the work
hour. It also means choosing alternate activities to get your mind
ready for a new job task. Activities include deep breathing, walking,
napping, or exercising.
Relaxation: Take a load off. Lie back. Turn down the lights,
and listen to your favorite tape or CD. Attempt to breath slowly
and deeply, allowing your abdomen to rise and fall rythmically.
Using visual imagery can also aid in relaxation. Try to visualize
each muscle relaxing one after another.
Recovery: Our bodies need a chance to heal. Repeated and
prolonged activities can take their toll if the body doesn't get
a chance to recover. Recovery helps repair these sore and achy tissues
along the way, keeping them healthy.
Whether at work or at home you can use these ideas to help prevent
neck pain and injury. Here are some additional tips to use at work
to avoid tension and keep your neck healthy:
Be Relaxed. Try to work with your muscles relaxed. To stay
relaxed, look relaxed.
Pace Yourself.Keep an even keel. Avoid sudden changes in
your workload. Try to avoid last minute "panics" to meet
deadlines.
Take a Break.Take a thirty second "microbreak"
every twenty to thirty minutes to do some deep breathing and a few
exercises. Take a few minutes each hour to do some exercises, get
a drink, or go bug a coworker. Use your lunch break to take a nap
or a walk.
Change Positions. Avoid holding your neck, trunk, or limbs
still for a long time. Plan ways to get the job done using different
positions. Sit for a bit--then stand for a bit. Or simply readjust
your approach to the task.
Rotate Duties. Rotating or sharing your tasks can be fun
by offering a new worksetting, while giving your body a chance to
recover.
Avoid Caffeine and Tobacco. These can heighten stress, reduce
blood flow, and elevate the awareness of neck pain.
If you've had neck pain once, there's a fair chance you'll have
it in one form or another in the future. When pain comes back again
and again, it is called recurrent pain. Even though you may have
been treated for neck pain or problems in the past, it's not a guarantee
you won't have pain again. The question, then, is whether you can
take care of your neck if soreness does return.
Your therapist will probably give you a thorough home program when
you get done with your treatments. Some of the exercises will be
helpful to keep up with as a way to keep your neck healthy over
time. You may also be given ways to help control pain or symptoms
if they don't go completely away, or if they return in the future.
Although there are many good "home remedies", you will
want to visit your family doctor if these symptoms appear:
* Pain with no apparent injury that doesn't go away within a week
to 10 days
* Pain that doesn't ease or change with movement
* Pain that actually wakes you up at night
* Pain that shoots from your neck down into your arm when you cough
or sneeze
* "Visceral" symptoms of nausea, diarrhea, dizziness,
blurred vision, ringing in the ears, etc.
* Numbness, tingling, or weakness in your arms or legs
If you feel achiness or pain that is not associated with the red
flags listed above, here are some home treatment ideas you may be
given to ease your symptoms:
Rest: When neck pain strikes, don't do activities that make
your pain worse. Remember the benefits of rest (see above).
Ice: For the first two to three days, you may get help by
appling a home-made cold pack. Simply place two parts crushed ice
in a plastic bag with one part rubbing alcohol. This lets you reuse
the bag without having it freeze solid between uses. When you're
ready to use the cold pack, wrap it in a wet washcloth. Then place
it on the sore area for up to fifteen minutes a few times a day.
Contrast: On day three, you may find more relief by using
a "contrast" of ice and heat. This is where you begin
by placing a cold pack on the sore area for 10 minutes. Then place
a heating pad on for another 10 minutes. You can repeat the process
a couple times, finishing with the heat.
Heat: Once the acute symptoms are controlled (two to three
days), you may get good relief using a heating pad. Remember to
turn off the pad before going to sleep. Check your skin regularly
to make sure you are not getting too much heat.
Traction: In some cases, your therapist may have found out
that you get good relief with neck traction. That can be good news.
There are a number of traction units that can be used at home. Some
of these work by giving a traction pull as water is added to a bag.
Others work by pumping air pressure into a neck cushion. A simple
way to do traction at home is to place two tennis balls in a sock.
Lay down with the sock sideways just below the back of your head.
The two tennis balls will give a gentle traction, and the pressure
of the balls can help relieve headaches, neck pain, and upper back
discomfort.
TENS: This stands for transcutaneous electrical nerve stimulation.
If you've been treated in the clinic with electrical stimulation,
your therapist will have a good idea if this kind of treatment helps
you. If so, there are small, pocket-sized electrical stimulation
units that can be used up to 24 hours a day if needed to keep pain
at bay. Your therapist may choose to issue one of these, but only
if you can't get good pain relief in other ways. Also, a prescription
from your doctor is required for you to use one on your own.
Exercise: Some exercises are designed to help take pain
away. After you have completed your physical therapy visits, your
therapist will have gotten a good idea what types of exercise help
you control your pain. Your therapist will go over the exercises
that will give you the best relief if you get sore again. Remember
to only do the exercises in the way your therapist has instructed.
Overdoing them could make your pain worsen.
Long-term strategies: The best way to treat neck pain is
to avoid it all together. A good exercise regimen can help. Also,
remember the benefits of good posture, ergonomics, and work habits--and
use them. If you are trying to take care of your neck but you're
not getting adequate relief, you may need to revisit your physical
therapist for additional help.
Home program: Once your pain is controlled, your range of
motion is improved, and your strength is returning, you will be
progressed to a final home program. Your therapist will review some
of the ideas listed above to help take care of any more soreness
at home. You'll be given some ways to keep working on the range
of motion and strength too. Before you are done with therapy, more
measurements will be taken to see how well you're doing now compared
to when you first started in therapy.
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