Spinal Decompression

If you have any interest in inversion therapy, you probably already know about inversion tables and benches. What you may not know is that inversion chairs/recliners also exist. The most obvious difference between an inversion chair and table is that the chair doesn't allow you to hang freely during inversion, since you are in a sitting position. Unlike inversion boots and tables which allow full, 90-degree, inversion, a typical inversion therapy chair only allows an inversion of about 70 degrees. So why would anyone pick an inversion chair over an inversion table, you ask?

Most of the people who choose to go with the chairs are either afraid of falling to the ground or have really painful ankles which would make hanging upside down by the ankles extremely uncomfortable. Recliners have several safety belts including one that goes over you lap making you feel more secure. In addition, doctors often advice individuals who have certain back problems and heart problems to use chairs for inversion therapy.

Contrary to popular belief, just because the chair doesn't allow 100% inversion doesn't mean that the degree of spinal decompression will be affected. That's because the degree of spinal decompression depends as much on the amount of weight below the lower back during inversion as it does on the angle of inversion. Therefore, whether you use a chair or a table, the amount of weight below the lower back will remain the same. The prices of inversion recliners are just about the same as those of inversion tables. For this reason, price isn't really a factor to consider when choosing between inversion tables and chairs.

Obviously, one of the most notable disadvantages of an inversion recliner is that you can only invert to about 70 degrees. Though this will not affect the degree of decompression, you may not receive the full benefits of inversion therapy. Secondly, it is nearly impossible to perform back strengthening exercises while sited. Thirdly, being strapped to a chair by the ankles isn't exactly the best experience. For most people, it feels as if they are being held against their will thus they may end up having a panic attack.

In conclusion, if you are a perfectly healthy individual, you would be better off using an inversion table or bench. This way, you can enjoy a wider range of inversion therapy benefits for roughly the same price. If you are a little nervous about using an inversion table on your own, try visiting a gym and using an inversion therapy table under the supervision of a certified trainer.

Back ache is a very common problem nowadays, and almost every individual faces lower back pain at least once in a life time. It can be caused by a number of factors, and can affect your life to quite an extent. The best cure to back ache is care.

Here are some tips for reducing the back ache:

1. The best way to sleep is on your side with your knees bent. You can use a pillow under your head to support your neck. You may also put a pillow between your knees.

2. If sleeping position doesn't reduce pain, try adjusting your sleeping surface. The choice of the firmness of the surface varies from person to person. Choose the one that suits you the most.

3. In case you have to stand for long periods, rest one foot on a low stool to relieve pressure on lower back. Switch your foot every 5 to 15 minutes. If case you have to stand with both feet firmly placed on ground, for example in case of a security guard, place both your feet inline with your shoulders.

4. While sitting (in your office) maintain a good posture by keeping your ears, shoulders and hips in a straight line, with your head up and stomach pulled in. Keep your lower back and feet supported, elbows at sides, shoulders relaxed and wrists straight. Don't forget to stretch occasionally.

5. Wear flat shoes and low heels.

6. Exercise regularly. An inactive life style can also lead to lower back pain.

7. If you sleep on your back, you can place a pillow under your lower back.

8. Heating pads can help relax painful muscle spasms. Use heat for 20 to 30 minutes at a time. Massage can also be helpful in most of the cases.

9. Remember, lower back pain can be caused by using your back muscles in activity they are not used to, like lifting heavy furniture or twisting your body. It can also lead to a disc slip, a condition knows as herniated disc.

10. Push rather than pull when you must move heavy objects. Don't lift by bending over. Instead lift by bending your knees and squatting to pick the object. Avoid twisting your body while lifting.

Just follow the above mentioned easy tips to cure your back ache. In case you don't feel any relief, please seek medical help immediately.

Spinal Stenosis is a medical condition that is found mostly in elderly people. The spinal canal, which stretches from the bottom of the head to the top of the pelvis, might become narrow and the spinal cord and nerves get compressed. This causes low back pain, pain or numbness in legs, thighs and buttocks, and sometimes loss of bladder and bowel control in severe cases.

The spinal canal consists of a number of vertebrae aligned together like a stack. The spinal canal may be divided into cervical spine (in the neck), thoracic spine (the mid back) and lumbar spine (the lower back). The spinal cord passes though the spinal canal. There are nerves coming out from the spinal cord and between the openings (known as foramen) in vertebrae, spreading out to the whole body. The nerves from spinal cord in the cervical region control the arms the nerves from spinal cord in the lumbar region control the legs. Spinal Stenosis is more common in cervical and lumbar spine. Lumbar spinal stenosis causes pain and numbness in legs whereas cervical spinal stenosis can cause pain and numbness in arms, shoulders and legs.

The foremost reason for narrowing of the spinal canal is a gradual degeneration of the spine with age. The gradual changes in bony and soft tissues of the spine may result in spinal stenosis. Osteoporosis or a tumor can also put pressure on the spinal cord and nerves. Arthritis can settle in with age and also affect the spine. This can cause cartilage wear and tear between the bones on the joints of the vertebral column. The discs between the vertebrae might bulge out or ligaments can also thicken in some cases. This cramps the space available for spinal nerves and spinal tissues, resulting in pain and numbness in lower back or legs. Such arthritis only worsens with time and if not treated promptly, can result in loss of bladder and bowel control. If one vertebra slips forward on another, that can also cause spinal stenosis.

Treatment for spinal stenosis depends on the severity of the condition. It is always advisable to start with a non operative course. Medication needs to be taken to reduce inflammation and pain. Some medications meant for nerve pain are particularly helpful. Physiotherapy can also be tried as a treatment option. Application of hot and cold packs can also help. Steroid injections for the lumbar spine can provide relief but should be taken in moderation. A corset can be worn to support the abdominal muscles.

If there is no improvement with these treatments or if the patient experiences loss of bladder and bowel control, it is better to opt for surgery to avoid damaging the spinal tissues permanently. Generally, Lumbar Decompression Surgery is needed to remove whatever might be cramping the nerves in the spinal canal or vertebral foramen. A small portion of vertebra may be removed so that spinal tissues are freed. If the number of restrictive structures to be removed is much, it can cause spinal instability. In such a case, a spinal fusion is required to attach the vertebrae together. This surgery can successfully eliminate the pain and numbness in legs.

Piriformis Syndrome is a condition in which irritation of the sciatic nerve causes pain in the buttock, radiating down the leg. The main difference between Sciatica and Piriformis Syndrome is the cause. Sciatica is due to pressure on the sciatic nerve from a bulging or herniated lumbar disc. With Piriformis Syndrome, the irritation of the sciatic nerve is due to spasms or tightening of the piriformis muscle, resulting in pain. The piriformis is a small muscle located deep within the hip and buttocks region. It connects the sacrum, which is the 'tailbone' or lower end of the spine, to the top of the femur, the hip bone. The piriformis muscle aids in external rotation, turning out, of the hip, leg, and foot. The sciatic nerve usually passes underneath the piriformis muscle but, in approximately 10% to 15% of people, it travels through the muscle. In both cases, spasms and tightening of the muscle irritate or pinch the sciatic nerve, causing painful symptoms. Symptoms of Piriformis Syndrome

- Pain deep within the buttocks
- Pain becomes worse with sitting, climbing stairs, performing squats.
- Sitting is often difficult and the patient can't sit flat on a seat.
- Sufferers tend to sit with their weight off the painful buttock, which is tilted up off the seat.
- Sciatica type pain radiating from buttock down thigh, calf, possibly to foot
- Numbness and muscle weakness may develop in affected limb.

Causes Of Piriformis Syndrome Contractions and spasms of the piriformis muscle cause the pain and pressure on the sciatic nerve. The most common reasons for this are:

- Improper stretching or warming up before exercising
- Overly-strenuous exercises
- Prolonged sitting - sometimes sitting with a wallet or pressure causing object in the hip pocket
- Exercising on a hard surface, like concrete
- Exercising on uneven ground
- Increasing exercise intensity or duration too quickly
- Exercising in worn or poorly fitting shoes
- Excessive running or bicycle riding, unless accompanied by lateral strengthening and stretching exercises
- A fall onto the buttocks

Diagnosing Piriformis Syndrome A differential diagnosis must be made to determine the cause of the sciatica pain. It includes:

- Complete History and Physical Exam
- Checking to see what movements cause pain
- Evaluating sufferer's posture and gait
- Past history of any injuries or arthritis
- Review patient's exercise habits
- Evaluating muscle strength and reflexes, any other spine conditions
- Lab work may be done to rule out arthritis or infection
- X-rays of the lower back and pelvis, lumbar spine and hips
- A MRI (Magnetic Resonance Imaging) to give a detailed picture of the spine and soft tissues
- Neurography is like a MRI but it examines nerves for irritation. This is often helpful in diagnosing Piriformis Syndrome.
- A Bone Scan will show injuries, inflammation, or infection.
- The most accurate method of diagnosing the syndrome is a diagnostic injection into the muscle with the help of a fluoroscope. An anesthetic is injected into the piriformis muscle and if the pain subsides, the diagnosis is confirmed.

This would have no effect if the cause of the sciatica was pressure on the sciatic nerve from a lumbar disc.

Spinal decompression therapy is a non surgical treatment for chronic lower back pain caused by degenerative disc disease, herniated disc or other deformities of the disc. This treatment is also adopted for pain in the neck, arms or legs and involves reducing the load to the spine. Spinal decompression therapy is otherwise called Vertebral Axial Decompression (VAX-D). In the early days, major surgeries were the only relief for chronic lower back pain. Now we can avoid surgeries by making use of spinal decompression therapy. This therapy has an FDA approval for lower back ailments. This treatment is adopted for treatment of conditions such as pain in the lower back, buttocks, and hip with or without numbness in the foot or leg.

Spinal decompression therapy is meant for patients suffering from back pain due to herniated disc for more than four weeks. Those having recurring back pain even after back surgery, which is more than six months old, can also make use of spinal decompression therapy.

Medical researches have supported decompression therapy as recent studies have proved it to be safer and more effective than spinal surgery. Sciatica, spondylosis, degenerative disc disease, herniated discs, soft-tissue spinal stenosis, and facet arthropathy are caused by compression of discs. Spinal decompression therapy offers the best treatment for these conditions.

A bulging or herniated disc can cause excruciating pain in the lower back portion. This can be returned to the normal condition using spinal decompression. Spinal decompression lengthens the bulging disc by placing traction. This activity helps the disc absorb the nutrients required to heal the disc. This is done by producing a negative pressure inside the disc. Thus the pain and discomfort produced by the bulging disc is eliminated.

The cost for spinal decompression therapy is only about 10% that for lumbar surgery, which makes it an economical option. It is ideal therefore to opt for spinal decompression therapy for a more effective and safer treatment involving minimum cost and in minimum time.

What is sciatica? Sciatica is one of the most difficult conditions for medical practitioners, even those experienced in treating back pain and sciatica patients, to identify and treat. Sciatica often presents itself as a tingling and/or numbness, not unlike the feeling one may experience with a pulled hamstring muscle, the biceps femoris at the back of the leg. The sensation may be dull, almost an ache, with periods of tingling and/or numbness occurring during certain activities. The tingling and/or numbness experienced, if not treated, may develop into a full-blown chronically acute phase with pain shooting across the buttocks and radiating down the leg. Sciatica may affect one or both legs, usually one, beginning as a pain radiating from some point in the lower back, the lumbar spine, then across the gluteal muscles (the buttocks), and finally down the back of the leg. In advanced cases, sciatica reaches all the way into the feet and toes, causing discomfort and an eventual loss of feeling.

Interestingly, sciatica is not a specific condition, it is simply a catch-all medical term applied to a constellation of symptoms in order to describe a state the back pain sufferer is in. In this case, sciatica is used to describe a patient's complaint of pain radiating across the buttocks, down the leg, and into the feet and toes...along with the associated tingling and/or numbness. Sciatica may be caused by a number of conditions, from stress and trauma at a specific location on the spine, the lower back or lumbar curvature, to a more generalized condition such as obesity or pregnancy. There are a number of other conditions associated with sciatica, all requiring varying degrees of medical intervention and treatment. Some of the conditions likely to present with sciatica are:

1. Osteomyelitis: An infection of the bone or bone marrow. Osteomyelitis may be debilitating and in extreme cases may even cause death. It is difficult to diagnose and may go undetected for a long time unless appropriate blood tests are ordered and the medical practitioner is well trained in infectious diseases affecting the bones.

2. Tumors on or near the spine: Tumors, particularly tumors or abnormal growth (e.g., scar tissue) affecting the nerves or nerve roots as they exit the spinal canal and intervertebral foramen, will sciatic nerve pain or sciatica.

3. Degenerative Disc Disease: Once again, degenerative disc disease is not a disease any more than sciatic nerve pain, called sciatica, is a specific condition. Degenerative disc disease is a breakdown of the IVDs, the intervertebral discs, and is usually a consequence of aging combined with the any or all of the 5 principal factors affecting the spine as we age.

o Excess weight and/or obesity

o Muscle weakness

o Muscle Imbalance

o Inadequate nutrition and diet

o Inadequate hydration or dehydration

4. Herniated (i.e., ruptured) or bulging disc: This condition may be particularly problematic if the herniated disc or bulging disc is protruding posteriorly (to the back) and into the spinal canal, or impinging on the nerve root at the intervertebral foramen, thus placing pressure on the spine and/or nerve root; and, sciatica is the result in many instances.

5. Piriformis syndrome: We will cover the piriformis syndrome and how it relates to sciatica in depth in a subsequent video and article. Recent research has demonstrated that this little-known syndrome, at least in the lay community, may be a factor in as many as eight out of ten sciatica cases. The piriformis muscle works particularly hard in runners and others who are physically active, often resulting in RMI or repetitive motion injury.

6. Spinal stenosis: This is a narrowing of the spinal canal and/or intervertebral foramen. In fact, any narrowing of a structure can be defined broadly as a stenosis. The stenosis, the narrowing affects and/or obstructs the pathway for nerves, thus exacerbating pain...in this case creating the sciatic nerve pain associated with sciatica.

7. Spondylolysis: In layman's terms, it is a stress fracture at the back of the vertebra, the vertebral body (the front part) breaks away from the back part of the vertebra (everything else). In osteological terms, the break occurs at the pars interarticularis of the vertebra, usually at the fifth lumbar vertebra, the last vertebra before the lumbar spine articulates with the sacrum or tailbone. This is usually associated with spondylolisthesis, the next contributor to sciatic nerve pain.

8. Spondylolisthesis: Usually associated with spondylolysis in younger back pain and sciatica patients but may present without spondylolysis in older adults. Spondylolisthesis is the result of an anterior (forward) shift in the vertebra body, in fact the entire vertebra when spondylolysis is absent, or the vertebral column in relationship to the remainder of the vertebral column below. There are a number of reasons why this condition may occur but in younger patients it is usually found with spondylolysis. We will discuss this condition in depth in a subsequent article and video but suffice it to say that any change in the overall structure of the spine, particularly at the lumbar curvature, will create sciatic nerve pain.

9. Trauma: Trauma and stress go hand in hand when it comes to back pain and sciatica. Trauma may be localized, meaning the spine will take the brunt of the stress at a specific location, or it may be generalized and affect several levels simultaneously. The better equipped we are in terms of muscle strength, muscle balance (or imbalance), and the other factors affecting spine health, the better equipped we will be to handle appropriate levels of stress. The IVDs are remarkably resilient and very strong but if the discs undergo change as a result of any of the 5 factors listed above, or the traumatic event is profound enough, damage to the spine may occur; and, sciatica may be the outcome. In this case, a medical practitioner should always be the first step in any bad back treatment strategy.

In reality, any one of the factors above, or several of the above mentioned conditions together, may cause low back pain and sciatica. Sciatica is, once again, the presentation of a specific type of pain. The actual condition causing the sciatic nerve pain may be any of the above or a number of other conditions not discussed here; these are some of the main ones.

Your medical practitioner may refer to sciatica as radiculopathy, particularly lumbar radiculopathy, because sciatica originates in the lumbar curvature or lumbar region of the spine. This has become a catch-all, in much the same was sciatica has; and, both are used when a more appropriate designation should be applied. But for now, understand that if your medical practitioner refers to sciatica and/or lumbar radiculopathy, he or she is usually referring to pain radiating from the lumbar region of the spine, at times across the buttocks, down the back of the leg, and even into the feet and toes. We will discuss sciatica in much greater depth in upcoming articles and videos.

If you are looking for a program that will burn fat and build muscle this is the exercise routine for you. This workout is designed to work your entire body at the same time.

The problem with most exercise regimens is that they break up the body into compartments. On Monday they have the work your legs, your back on Tuesday, your chest on Wednesday, your shoulders on Thursday, and biceps and triceps on Friday. And of course they will mix in a bunch of exercises throughout the week end 60 minutes of cardio four to six times a week.

My problem with this type of workout schedule is that there are not many physical activities that you will do in the course of the day that does not require you to use your body as an entire unit. That is why my programs require the use of your whole body.

Here was the program:

• Jog for five minutes as a warm-up


• 25 Hindu push-ups


• 35 jump squats, holding a dumbbell in each hand, if possible, for extra resistance


• Sprint 40 yards as fast as you possibly can


• 30 V-ups


• 30 Burpees


• One minute of mountain climbers


• 35 jump squats, again holding a dumbbell in each hand and possible


• Sprint 25 yards as fast as you can


• Bear crawl for 50 yards


• 20 reverse push-ups


• 50 jump squats, holding a dumbbell in each hand and possible. If you can do more than 50 jump squats continue till you reach value.


• Walk for 10 minutes as it cool down.

So there you have it. By high-intensity entire body exercise routine that will burn fat and build muscle.

Of course, before you do this exercise routine please consult your doctor.

Arnold Chiari (pronounced key-are-ee) Malformation is a rare malformation of the brain located in the area where the brain and spinal cord connect. This malformation occurs when the cerebellum is too large to fit within the confines of the skull.

When the cerebellum is over-sized, the cerebellar tonsils are forced to extend down into the spinal cord canal through the small opening in the base of the skull. As the cerebellar tonsils elongate, they may restrict or cut off the normal flow of cerebro-spinal fluid of the brain and around the spinal cord as well as apply pressure to the brain stem and the top of the spinal cord. This condition is usually a congenital abnormality but there have been a few reported cases of spontaneous development due to trauma.

According to the Duke Center for Human Genetics, "The affected regions of the brain are the lower brainstem and cerebellum. The lower brainstem controls breathing, swallowing, balance, the vocal cords, eye movements, and sensation and movement of the arms and legs. The cerebellum's most important function is to coordinate body movements."

The symptoms of Chiari vary with each individual and are quite extensive. Most commonly, Chiari patients have some or all of the following symptoms:

• Headache in the back of the head that may radiate behind the eyes and into the neck and shoulders.


• Disordered eye movements, vision changes.


• Dizziness, autonomic symptoms (orthostatic intolerance, NMH).


• Muscle weakness.


• Unsteady gait.


• Cold, numbness and tingling in the extremities.


• Chronic fatigue.


• Tinnitus (ringing, buzzing or watery sounds in the ears).


• Sleep apnea.


• Speech impairment.


• Hearing loss.


• Gastrointestinal problems, irritable bowel syndrome, frequent urination.


• Lack of gag reflex, difficulty swallowing.


• Symptoms are exacerbated by exertion, and especially by leaning the head backward or coughing.


• and the list continues beyond the symptoms listed above...

Some patients with Chiari have no visible symptoms. For these patients, careful monitoring by a neurologist or neurosurgeon is all that is needed. These patients may live a full life with no adverse effects appearing. Other patients with the adult onset variety of Chiari Type-I will begin to exhibit symptoms in their late 20's or 30's. For most people who are exhibiting symptoms, surgery is the only option available to help stop the progression.

Generally, the surgery is meant to decompress the area of the brain that is being squeezed. Surgery to correct the malformation may not be able to reverse any neurological damage that has already been done. Once the pressure has been relieved, the patient may see some of their symptoms lessen or disappear.

The long-term effects of the surgery are still being studied. However, surgeons will not guarantee that symptoms will disappear after the surgery, or that symptoms, either old or new, will not return in the future. The main goal of the surgery is to attempt to prevent the patient from worsening from their current neurological status. For some patients, a second decompression surgery will be needed some years after the first surgery was completed.

As a person living with Chiari, I can not stress enough the importance of finding and staying with a neurosurgeon that specializes in dealing with Chiari. This is a complex disease. Receiving the wrong medical advice can be extremely detrimental to your health. To find qualified medical care near you, I suggest that you join a Chiari support group and ask the other members for their help and guidance.

The support group that I belong to and rely on is very active and is filled with helpful, sympathetic, and concerned group members. The members have been where you are now and are eager to share their stories and advice.

Studies have determined that the most common causes of recurring low back and neck pain are problems related to the spinal column. Unlike musculoskeletal ailments, degenerative disc diseases can cause intolerable back pain that can render one completely immobile and bedridden. Thanks to spinal decompression treatment, there is a new ray of hope for people suffering from chronic back pain. The question that often arises is as to how many spinal decompression treatments are required before a patient gets relief. This would largely depend on the condition of the patient. Treatment sessions last about 30 to 45 minutes, and frequent sessions may be essential to ensure the best results.

Effective Non-surgical Treatment for Back Pain

Spinal decompression is a non-surgical, traction based treatment for almost all kinds of major back pain. It is an advanced modality which constitutes a specifically designed table connected to a computer controlled workstation that can be programmed to effectively decompress structures in the spine that cause major pain and discomfort.

This decompression traction therapy decompresses the inter-vertebral discs and facet joints within the spinal column with a gentle stretching and relaxing motion. This causes a vacuum effect within the disc, which draws back displaced disc material to relieve pressure on nerves and replenish the spine with essential nutrients, fluids and oxygen to aid in the healing of the damaged disc. Spinal decompression also helps strengthen the spine and provide stability.

Spinal decompression is an FDA approved treatment. Safe and gentle, it quite effective in relieving chronic pain symptoms such as tingling, burning and dull sensations. Patients experience notable improvement in their medical condition in as few as 3 to 4 visits with hopefully, full relief by the end of the treatment program. The total number of sessions required would vary among patients, depending upon the severity of the condition. In most cases, physicians recommend about 2 to 3 visits per week with each session lasting about 30 to 45 minutes.

Spinal decompression treatment works best for patients diagnosed with the following medical conditions:

• Nerve Compression
• Lumbar Disorders
• Lumbar Strains
• Sciatic Neuralgia
• Herniated Discs
• Injury of the Lumbar Nerve Root
• Degenerative Discs
• Spinal Arthritis
• Lumbar Instability

It is equally effective for patients who have not had much success with back or neck surgery.

Pain Relief through Maximum Therapeutic Benefit

Spinal decompression treatment has great therapeutic benefits and in most cases, patients do not require follow-up treatment. The cost depends on the number of sessions and duration of the treatment. This is one of the factors that cause patients to ask the question: how many spine decompression sessions are required before relief? Most health centers recommend a package of therapies for the best results. As with any comprehensive pain management or rehabilitation program, your physician may recommend home exercises along with modifications in some daily activities for long-term pain relief. Periodic visits to the doctor's office would help physicians evaluate improvements in your spinal health and reduce the possibilities of recurrence.

At any one point in time, cervical radiculopathy from a pinched nerve affects millions of Americans. It involves a burning, searing type of pain that goes down an invididual's arem, resulting from a "slipped" disc in the neck pushing on an a person's nerve root in the cervical spine. Can it cause permanent nerve damage?

The answer is yes. If you take your finger and push on a nerve root of the neck while a person is awake, it will not hurt. That would be an impossible experiment to perform, but the point is that neck radiculopathy does not come from nerve roots being compressed. It comes from the inflammation that is sparked up by the pinching.

The inflammation elicits pain and it often travels through the region where that nerve root has its path for supplying sensation. For various cervical nerve roots, that may be part of the forearm, or part of the hand. These regions supplied vary slightly between individuals, and not all patients are similar to a textbook drawing.

If a neck disc herniation is pinching a nerve root, eliciting inflammation, and ending up with radiculopathy pain, it may also lead to numbness or pins and needles. These symptoms are painful and annoying to patients, but do not mean surgery is required. With these issues the surgery becomes a quality of life decision.

If conservative treatments do not work, surgery has about a 95% chance of alleviating pain. Even a successful surgery may not take away the numbness. A large amount of individuals have numbness that simply will not go away, even if the surgery was technically done perfect. Most people don't care as long as there is no more pain.

This is tough to predict, and is not the surgeon's fault of the surgeon. It's the person's body's fault. If an individual develops muscle weakness from the cervical nerve root being compressed, and it does not get better over 2 months, surgery should be considered. The reason is that the longer the neck muscle weakness persists, such as a bicep weakness, the higher the chance it will not improve after an operation. Even if the operation is performed perfectly.

Epidural steroid injections into the neck may allow individuals to avoid surgery. They may allow two things by reducing the inflammation around pinched nerve roots. They may relieve pain, and maybe permit the muscle weakness to to get better.