Research: Exercise and Physiotherapy for MS

Using exercise and physical therapy for recovery from the effects of MS, and for maintaining physical function.
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2017 study: (Aquatic) Exercise Is Good For You...

Post by jimmylegs » Tue Oct 24, 2017 3:24 pm

Influence of aquatic exercises in physical condition in patients with multiple sclerosis
https://www.ncbi.nlm.nih.gov/pubmed/28462574
"Abstract
BACKGROUND:
Multiple Sclerosis (MS) is a disabling chronic disease of the nervous system in which the myelin system of the central nervous system is deteriorated.
PURPOSE:
This study aimed to evaluate the effectiveness of an aquatic exercise program on the physical condition of patients suffering from multiple sclerosis.
METHODS:
The study included 26 participants divided into two groups: an experimental group (EG) with 13 individuals and a control group (CG) also with 13 individuals. The EG underwent 12 weeks of aquatic exercise, three times per week and 45-60 minutes per session. The groups were evaluated pre- and post-intervention, and were later compared to check for differences between groups. Data was collected by using functional tests such as the Timed "Up and Go" test, the Timed 7.62 Meters Walk test, the Getting up from a Sitting Position test and the Balance test.
RESULTS:
Significant differences were found between the groups in the post-intervention stage. Furthermore, significant differences were also observed in all domains of physical condition of EG patients, in the post-intervention stage. Results obtained from the intention- to-treat analysis were consistent with those found in the literature.
CONCLUSIONS:
Therefore, this study's results suggest that aquatic exercise programs can effectively improve multiple sclerosis patient's physical condition and should be considered when coping with this public health problem."

long term good makes sense. short term, mixed blessing in my xp. helps keep you cool when you're working hard but oh, that gravity when you get out!
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Re: 2017 study: (Aquatic) Exercise Is Good For You...

Post by Brainteaser » Tue Oct 24, 2017 10:27 pm

This sounds good but what did the control group do? Also, it would be interesting to know the type of exercises undertaken and the variation of results between the two groups.

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Re: 2017 study: (Aquatic) Exercise Is Good For You...

Post by NHE » Tue Oct 24, 2017 11:07 pm

You can access the full text of this article for 2 days at a price of: € 85,00.
They must be very proud of their journal. That's $100 US for a single article!

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Re: 2017 study: (Aquatic) Exercise Is Good For You...

Post by jimmylegs » Wed Oct 25, 2017 2:42 am

provisional copy currently posted says the control group did not participate in any of the prescribed exercises

experimental session info:

walking out of water 5-10 mins
walking in chest high water 5-10 mins
water bicycling using noodle 5-10 mins
exercises for upper and lower limbs (had water dumbbells etc) 5-10 mins
breathing exercises 5 mins
swimming 10 mins
recovery 5 mins
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2016 study: Effects of exercise modalities on ataxia in MS

Post by jimmylegs » Mon Nov 20, 2017 2:25 pm

Effects of different exercise modalities on ataxia in multiple sclerosis patients: a randomized controlled study
http://www.tandfonline.com/doi/abs/10.1 ... 16.1236411

Abstract

Purpose: To investigate the effects of different exercise protocols on ataxia in patients with multiple sclerosis (MS).

Method: A total of 42 MS patients, 17 male and 25 female (Expanded Disability Status Scale (EDSS): 3–5), were enrolled in this randomized controlled study. The patients were divided into three groups: a balance training (BT) group, a lumbar stabilization (LS) group and a task-oriented training (TT) group. All groups received balance training; additionally, the LS group received lumbar stabilization exercises, and the TT group received task-oriented training. The Berg Balance Scale (BBS), International Cooperative Ataxia Rating Scale (ICARS), Functional Reach Test (FRT), 2-Minute Walk Test (2MWT), Sensory Organization Test (SOT), and measurement of Somatosensory Evoked Potentials (SSEPs) were performed before and at the end of the 18 training sessions.

Results: The BBS, ICARS, FRT, 2MWT, and composite balance score of the SOT were improved in all groups. The ICARS kinetic function sub-score and the left limb cortical onset amplitudes of SSEPs were increased significantly in both the TT and the LS groups. The ICARS total score, composite balance score, and 2MWT were different between groups (p < 0.05). According to multiple comparison analyses of the ICARS total score and the composite balance score, the LS, and the TT group were different from the BT group (p < 0.005), while the LS and the TT groups improved similarly (p > 0.005). The 2MWT results were better for the LS group than the BT group, while the BT and the TT groups improved similarly.

Conclusion: Balance training alone is not sufficient for rehabilitation of ataxic MS patients. A combination of lumbar stabilization exercises or task-oriented training increases the success of balance rehabilitation.

Implications for rehabilitation
Multiple sclerosis is a chronic inflammatory and autoimmune disease of central nervous system and ataxia is one of the most challenging symptoms of this disease.

Different exercise modalities are commonly employed to control ataxic symptoms in MS patients.

Lumbar stabilization exercises or task-oriented training should be considered as complementary approach to improve balance and coordination in ataxic multiple sclerosis patients.
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is there an athlete in the house? 2017 study on serum zinc

Post by jimmylegs » Tue Dec 19, 2017 5:54 pm

the things you never thought athletes and ms patients might have in common!
(well i did, but, you know)

Lower Serum Zinc Concentration Despite Higher Dietary Zinc Intake in Athletes: A Systematic Review and Meta-analysis
https://link.springer.com/article/10.10 ... 017-0818-8

Background
Zinc is an essential trace element that has been implicated in numerous biological functions, including immunity, energy metabolism and antioxidative processes. Recent evaluations of the literature have provided evidence of significant acute changes in zinc metabolism following a bout of aerobic exercise.

Objective
The aim of this study was to determine the zinc status of trained athletes compared with control populations, as described in cross-sectional studies.

Design
We conducted a systematic literature search of the PubMed, Scopus, SPORTDiscus and Cochrane Library electronic databases from inception to 28 January 2016 to identify cross-sectional studies that determined the zinc status of athletes compared with a control population. Meta-analysis of the differences in serum zinc concentration and dietary zinc intake between groups were conducted.

Results
Twelve studies were included in the systematic review. Of the included studies, nine and eight studies provided sufficient data for the meta-analysis of serum zinc concentration and dietary zinc intake, respectively. Serum zinc concentration was significantly lower in athletes [− 0.93 μmol/L, 95% confidence interval (CI) − 1.62 to − 0.23] despite significantly higher dietary zinc intake compared with the control population (2.57 mg/day, 95% CI 0.97–4.16). Data on erythrocyte and urinary zinc from the included studies were insufficient for meta-analysis.

Conclusions
Despite higher total dietary zinc intake, athletes generally have lower serum zinc concentration, which suggests that athletes have higher requirement of zinc than those who are physically inactive. Further investigations of zinc metabolism during exercise and dietary zinc requirement in active populations are needed to establish evidence-based recommendations.

(0.93 umol/l is equivalent to about a 6 unit difference for those used to seeing serum zinc in ng/ml, or whatever it is typically when in non metric units)

when i have more time i'll see if i can grab the serum means from the full text, not just the differences btw athletes and controls. would be interesting to see how far off the athletic group were from your average ms patient.
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Harvard: For people with MS, can exercise change the brain?

Post by jimmylegs » Wed Aug 15, 2018 6:19 am

one report on one study (hardly a position statement), but fwiw:

For people with MS, can exercise change the brain? (2017)
https://www.health.harvard.edu/blog/for ... 7083112304

"Multiple sclerosis (MS) is a condition of unknown cause in which the covering lining of nerve fibers (called myelin) is damaged. Myelin is like insulation on a wire — when it is damaged, nerve impulses are not transmitted properly. This leads to an array of symptoms including weakness, vision problems, numbness, tingling, and poor coordination or imbalance that can be debilitating.

MS is thought to develop when the immune system mistakenly attacks the central nervous system, including the brain and spinal cord. The severity of the disease varies. The most common pattern is one in which symptoms wax and wane. People who experience this are described as having “relapsing-remitting” disease.

Although there are more and better treatments for MS than ever before, there is no known cure. And the disease can progress even with the best treatments.

A new study suggests that exercise may alter the brain
A new study looks at exercise as a potential treatment for people with relapsing-remitting MS. What’s different, and exciting, about this study is that it not only analyzed the impact of exercise on symptoms of the disease, it also assessed how the brain changed with exercise treatment.

As published in the Multiple Sclerosis Journal, researchers enrolled 35 patients with relapsing-remitting MS. Half began a 24-week program of twice-weekly supervised exercise, while the other half continued to see their doctors for routine care. At the end of 24 weeks, the assignments reversed (although the group assigned to start with exercise could continue unsupervised exercise). The exercise program included progressive resistance training such as free weights, elastic bands, or exercise machines with increasing resistance over time. After the exercise program, researchers evaluated each study volunteer with measures of function, disability, and brain MRI.

Here’s what they found after the period of exercise.

Measures of overall function improved while measures of disability did not change.
Overall MRI findings (including brain volume and damage from MS) did not change. Since MRI findings of MS damage tend to worsen over time, this could suggest that exercise might keep MS from worsening, or slow its progression.
Certain parts of the brain appeared to “thicken” by MRI (suggesting preservation of brain tissue or even regeneration). However, this was observed for only 19 of 74 brain areas examined.
What does this mean?
These findings are intriguing and potentially quite important. And this is not the only study looking at the capacity of exercise to change the brain. Previous studies of the healthy elderly who exercise, those with Parkinson’s disease who exercise, and practitioners of tai chi have found evidence of brain changes by MRI.

Even so, the real importance of this study is uncertain because:

Even though the study subjects with MS improved with exercise, the overall appearance of the brain, including evidence of damage, did not improve.
The relevance of the MRI changes is not entirely clear. We don’t know whether areas of “cortical thickening” function normally or account for improved symptoms.
The study was quite small and short-term. Relapsing-remitting MS cycles through periods of improvement and worsening. So longer-term studies are needed before we know whether improvements associated with exercise are actually due to exercise, reflect the pattern of the disease, or have some other cause.
In conclusion…
Clearly, improvement in MS symptoms that seems related to exercise is reason to continue recommending physical activity for this condition. Supervised exercise may be helpful, with little chance of causing serious side effects. I think that in the future we will see more and more research into non-medication treatments of MS and other chronic diseases.

Many people, myself included, believe that the usefulness of non-medication approaches for chronic disease may be underrecognized. While it seems unlikely that exercise alone can reverse brain damage from MS or cure the disease, it might play an important role when combined with other standard treatments, including medications."

(emphasis added)
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Re: Harvard: For people with MS, can exercise change the bra

Post by Zyklon » Wed Aug 15, 2018 6:50 am

Since MRI findings of MS damage tend to worsen over time, this could suggest that exercise might keep MS from worsening, or slow its progression.
Certain parts of the brain appeared to “thicken” by MRI (suggesting preservation of brain tissue or even regeneration
More research please. I still go to GYM (strength training) 3 days a week. I feel good. I hope more people can benefit from it.
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Re: Harvard: For people with MS, can exercise change the bra

Post by jimmylegs » Wed Aug 15, 2018 7:33 am

interesting to note 5770 scholar results on ms and exercise for 2018 alone. wonder how many of those made it into this related 2018 literature review (probably loads given the january pub date):

Multiple Sclerosis and Exercise: A Literature Review (2018)
fft: https://journals.lww.com/acsm-csmr/Full ... re.12.aspx

"Multiple sclerosis (MS) is the most common autoimmune disabling neurological conditions of young adults and affects more than 2.3 million people worldwide. Given the high likelihood for disability and decreased neurological function, there have been concerns about the role of exercise in MS patients with a fear of increased injury. This article looks at recent articles evaluating the role of exercise in MS and can hopefully be used by patients, caregivers, and health care providers to guide decision making about the role of exercise in patients with MS...

...Conclusion
Overall, it can be reasonably concluded based on current research that exercise should be a mainstay of treatment for patients with MS"
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Re: Harvard: For people with MS, can exercise change the bra

Post by Petr75 » Sun Aug 26, 2018 6:14 am

2018 Aug 6
UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham
The Effects of Movement-to-Music (M2M) and Adapted Yoga on Physical and Psychosocial Outcomes in People with Multiple Sclerosis
https://www.ncbi.nlm.nih.gov/pubmed/30092206

Abstract
OBJECTIVE:
To investigate the effects of two 12-week exercise training interventions, movement-to-music (M2M) and adapted yoga (AY), on physical and psychosocial outcomes in people with multiple sclerosis (MS).
DESIGN:
Three-arm randomized controlled proof-of-concept trial.
SETTING:
A community-based fitness facility.
PARTICIPANTS:
Participants (N=81) with MS (Patient Determined Disease Steps [PDDS] self-reported disease status scores: 0-6) between ages of 18 and 65 years were randomized to: M2M (n=27), AY (n=26), or waitlist control (n=28).
INTERVENTIONS:
Both M2M and AY completed three 60-minute exercise sessions per week for 12 weeks. Waitlist controls received biweekly newsletters via mail that contained educational information on living with MS.
MAIN OUTCOME MEASURES:
Primary measures were Timed Up and Go (TUG, seconds), Six-minute Walk Test (6MWT, meters), and Five Times Sit-to-Stand Test (FTSST, seconds). Secondary measures were self-reported outcomes assessed using PROMIS Fatigue and Pain Interference Short Form 8a. Participants were evaluated at baseline and post-intervention. Primary analyses were performed using an intent-to-treat mixed model ANCOVA.
RESULTS:
Comparisons across all three groups revealed significant group differences in TUG and 6MWT. Post hoc analyses indicated significant improvements in TUG (LSM difference [95% CI]=-1.9s [-3.3, -0.5], p=0.01, d=0.7) and 6MWT (41.0m [2.2, 80.0], p=0.04, d=0.6; controlled for PDDS) in M2M compared to controls, while no significant differences were observed when compared AY to controls. No significant group differences were found on FTSST, fatigue and pain interference.
CONCLUSION:
Movement-to-music may be a useful and enjoyable exercise form for people with MS in improving mobility and walking endurance and merits long-term study in larger study populations.

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2018 study: Vit D & physical activity in multiple sclerosis

Post by jimmylegs » Wed Aug 29, 2018 11:26 am

Vitamin D and physical activity in multiple sclerosis (2018)
http://n.neurology.org/content/90/15_Supplement/P2.347
Abstract
Objective: To investigate the effect of physical activity on Vitamin D levels in MS patients.

Background: Lower than normal vitamin D levels have been observed in multiple sclerosis (MS) patients, similar to almost all chronic diseases. Although oral supplementation increases vitamin D blood concentrations and there is a negative correlation between vitamin D levels and disease progression, no study so far could demonstrate a positive clinical effect of vitamin D supplementation. Despite this fact many MS patients take vitamin D.

Design/Methods: In the time between 15 August and 15 September, we included 40 MS patients with an EDSS score of <= 4.0 and measured physical activity by a tracking device, time spent outdoors by diary, and vitamin D blood levels. Patients did not take vitamin D supplementation before and during the study.

Results: Thirty-eight patients, 23 women and 15 men, were finally analysed. Average age was 39.9 years with women being somewhat older (42 vs. 37 years). Mean vitamin D levels were 85.54 nmol/L. Activity variables were measured, such as active time, walking distance, number of steps, outdoor time, and calorie consumption. The primary outcome was correlation between vitamin D levels and total physical activity [minutes/day] as well as outdoor time with EDSS scores as co-variate.

In multiple regression the dominant determining factor of vitamin D levels was total physical activity (standardized beta coefficient: 0.222) and there was a very weak negative correlation with outdoor time (standardized beta coefficient: −0.082). Activity was similar in women and men, but calorie consumption was higher in men (2122 vs. 1615). More detailed analyses will be presented.

Conclusions: There is a correlation between physical activity and vitamin D blood concentrations in MS patients. Physical activity has been shown to improve clinical outcome. Alternative pathways of the correlation between disease progression and vitamin D levels need to be considered.

Disclosure: Dr. Deisenhammer has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Biogen, Genzyme-Sanofi, Merck, Novartis, Roche, TEVA-Ratiopharm. Dr. Bauer has nothing to disclose. Dr. Lechner has nothing to disclose.
without having access to full text, several questions:

re d3 exposure and serum response lag time, i want to know

-the location of the study,
-if local constraints on cutaneous synthesis were considered in study design,
-if this crew spent more/similar/less time outside between say, march and august 15 (and for that matter, whether they spent more/similar/less time engaged in physical activity over a similar period) and
-when the authors ran the serum test, in relation to d3 exposure and physical activity.
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Re: Harvard: For people with MS, can exercise change the bra

Post by jimmylegs » Mon Sep 03, 2018 7:41 am

nice find, p
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2018 research letter: get your any-sized MS butt moving ;)

Post by jimmylegs » Sat Sep 15, 2018 6:19 am

Effect of Short-Term Interval Exercise Training on Fatigue, Depression, and Fitness in Normal Weight vs. Overweight Person With Multiple Sclerosis (2018)
https://www.sciencedirect.com/science/a ... 0718301277

Abstract
Context

Excessive weight is a health problem that can exacerbate multiple sclerosis (MS) symptoms and its associated comorbidities such as depression and fatigue. In addition, weight may be a moderator of exercise effects on depression and fatigue symptoms.

Objective
This study aimed to investigate the effects of exercise training on fatigue and depression in normal and overweight individuals with MS.

Methods
Sixty-six persons with MS were randomly assigned into an exercise or control condition based on body weight status (overweight vs. normal weight). The exercise conditions involved 8-weeks of interval exercise at 60%–75% Wattpeak, while the control condition did not involve any exercise. Fatigue, depression, aerobic capacity, time up and go (TUG) and body mass index were measured before and following the 8-week period.

Results
There were no significant relationships revealed for weight status interactions for any of the variables examined. There were significant condition main effects for fatigue, depression, aerobic capacity and TUG, and significant improvements were noted for the exercise conditions, but not in the non-exercising control group.

Conclusion
The results from this study confirm that exercise is an effective therapeutic intervention for improving fatigue, depression and functional parameters, independent of initial weight status, in persons with MS
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2018 study: Physical activity and decreased MS risk

Post by jimmylegs » Fri Sep 21, 2018 11:18 am

Physical activity is associated with a decreased multiple sclerosis risk: The EnvIMS study (2018)
http://journals.sagepub.com/doi/abs/10. ... 8517694088

Abstract
'Background:
The lifestyle factors smoking and obesity have been associated with the risk of multiple sclerosis (MS). Physical activity (PA) may also be of importance.

Objective: To examine the association between PA and MS risk in Italy, Norway, and Sweden and to evaluate the possible influence by established risk factors.

Methods: In this case–control study, 1904 cases and 3694 controls were asked to report their average weekly amounts of light and vigorous PA during adolescence on a scale ranging from none to more than 3 hours activity. We used logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) and adjusted for potential confounders.

Results: Vigorous PA was inversely associated with MS risk in the pooled analysis (p-trend < 0.001) with an age- and sex-adjusted OR of 0.74 (95% CI: 0.63–0.87) when comparing the highest and lowest levels. Adjusting for outdoor activity, infectious mononucleosis, body size, and smoking yielded similar results. The association was present in all countries and was not affected by exclusion of patients with early disease onset. Light PA was not associated with the risk of MS.

Conclusion: Our findings suggest that vigorous PA can modify the risk of developing MS independent of established risk factors.'

while physical activity is very important and underpins modern evidence based food guides, i can just see (and have in fact encountered) people going overboard with physical activity alone, with insufficient attention given to nourishment.
take control of your own health
pursue optimal self care at least as actively as a diagnosis
ask for referrals to preventive health care specialists eg dietitians
don't let suboptimal self care muddy any underlying diagnostic picture!

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2005 preliminary report: Physio for ophthalmoplegia (A+++)

Post by jimmylegs » Fri Sep 21, 2018 2:15 pm

i am filing this previously-posted info here because finding it was so helpful to me earlier this year, when i had a severe infection and excruciating headache, followed by double vision.

ER ophthalmologist verdict: nystagmus and (unilateral) internuclear ophthalmoplegia (INO).

follow up cranial MRI, corresponding brain damage with more long words like medial longitudinal fasciculus (brainstem).

the fact that this regimen worked not only for me but has since worked for others (ok one other so far) here on the forum (and at that, without even having a clear INO dx) prompts me to file it under exercise and PT, rather than as part of more general forum conversations.

New facilitation exercise using the vestibulo-ocular reflex for ophthalmoplegia: preliminary report (2005)
http://journals.sagepub.com/doi/abs/10. ... 505cr895oa

Abstract
Objective:
To study the effect of facilitation exercises using the vestibulo-ocular reflex on ophthalmoplegia due to brainstem injury.

Design: A single-baseline design (A–B: A without specific therapy, B with specific therapy) across individual subjects.

Setting: Inpatient rehabilitation facility.

Subjects: Eight patients with ophthalmoplegia (total of 15 affected muscles) due to brainstem injury.

Interventions: Basic rehabilitative treatment that included physical therapy, occupational therapy and/or speech therapy for impairments such as hemiplegia, ataxia or dysarthria was administered for two weeks (control treatment). Then, two facilitation exercise sessions (100 times/day, five days/week for two weeks) were administered in addition to the basic rehabilitative treatment for four weeks to the eight patients with ophthalmoplegia. Ophthalmoplegia was evaluated at study entry and at the end of each two-week session. The goal of the facilitation exercises is to facilitate voluntary eye movement using conjugated eye movements in the direction opposite to passive movements of the head.

Main measures: To assess ophthalmoplegia we measured the distance between the internal/external corneal margin and the canthus of the affected eye on images recorded on a video tape recorder.

Results: After the initial two-week basic rehabilitative treatment, the distance between the corneal margin and canthus decreased slightly. Subsequently, after each of the two facilitation exercise sessions, there were significant reductions in the distance between the corneal margin and canthus compared with that at the beginning of the respective facilitation exercise session.

Conclusion: Facilitation exercises significantly improved the horizontal movement of eyes with ophthalmoplegia due to brainstem injury.

Image
***** once i adapted the exercise to solo home use and played with the angles to achieve a stretch i could feel with each rep, this regimen worked immediately and restored normal vision in a matter of days.

http://www.thisisms.com/forum/introduct ... ml#p254670
"at first, as described in the protocol i held my hand over my own right eye, and instead of looking at the therapist's face i looked at a focal point straight ahead, like right now the cherry tree trunk outside the window.
then, still keeping right eye covered, rotated my read abruptly to my left while working to keep my left eye on that forward focal point.
obvi if we need 10 stretches a minute, that's a 6 second count for each cycle
so i would start counting 1,2,3 as soon as i turned my head left (consistent with protocol which says 2-3 second stretch each time), then return my head to the front again for 4,5,6. right eye covered throughout.
i would repeat that 10 times and consider it the first one minute set.
then rinse and repeat until 10 sets were complete.

for three days nothing particular happened but then i realized i needed not a hard 3 o'clock right gaze by itself, but a rotating upward right gaze stretch, ranging from about 1 to 2 o'clock.
so instead of just turning my head left i would keep my eye on my focal point but drop my chin down and to my left, aiming my chin in a sort of 730 kind of direction.
to enhance the stretch i would roll my chin a bit between 7 and 8 o clock, while maintaining the hard upper right gaze on the focal point.

gradually things improved. one fridge across the room, not two. down to one tree across the patio. one chimney across the yard, not two. a single line of trees along the cliff, not a double row. and finally, one set of lines down the centre of the road and not a long v. (added bonus three cars on the road not six omg lol)

for me it was really easy to work on alone but i also know for sure i could feel the stretch working when i had the right angles"

so worthwhile - really hope this info helps others in future. that protocol was not the easiest thing to find!!
take control of your own health
pursue optimal self care at least as actively as a diagnosis
ask for referrals to preventive health care specialists eg dietitians
don't let suboptimal self care muddy any underlying diagnostic picture!

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