Clinical results of endoscopic treatment without repair for partial thickness gluteal tears. 53 This will include: After a subjective assessment we will then conduct an objective assessment which may contain: What treatment will you receive from Gold Coast Physio & Sports Health: 33,40,42 -42, 50, 51, 53, 55. As a result, this injury can lead to significant pain or the disfunction of the gluteal muscles. Coulomb R, Essig J, Mares O, Asencio G, Kouyoumdjian P, May O. Previous systematic reviews have not differentiated treatment outcomes based on the grade of tendinopathy, which may account for the broad range of treatment methods described. A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram outlining the systematic search process is shown in Figure 1. In 5 of these studies, outcome reporting did not allow for a differentiation of their results according to the disease stage, while 1 study This drives a vicious cycle of pain and further muscle weakness due to prolonged avoidance of pain-provoking activities. It can affect your ability to be active, sleep well and enjoy life. 26 The main purpose of a tendon is to transfer the force of a muscle contraction to the bone for movement. As you can see, tendon injuries are not to be shrugged off, but rather something that will require your time and attention in order to heal properly. Greater trochanteric pain syndrome: does imaging-identified pathology influence the outcome of interventions? Hence, surgery can be considered early in the course of grade 3 tendinopathy and should be recommended for symptomatic grade 4 tendinopathy. 21,22,31,42 Hip Arthroscopy Australia, Richmond, Australia. A hammer-type massage gun may be beneficial for people who have pain in their shoulder or elbow. were involved in the study selection. How To Fix a Massage Gun That Wont Charge, , tennis elbow, trigger finger or thumb, tendonitis of the wrist and. Davies JF, Stiehl JB, Davies JA, Geiger PB. 23 Exercise improves patient satisfaction, while specific treatment protocols for SWT and physical therapy are lacking. reported that both a greater preoperative level of fatty degeneration and gluteal muscle atrophy were correlated with increased pain and decreased patient-reported function and satisfaction scores after endoscopic hip abductor tendon repair. ), Oxford Hip Score (6 studies Carlisi et al showed that SWT achieved better pain reduction compared with therapeutic ultrasound at short-term and midterm follow-up. They will likely order an MRI to see if there is any damage to your tendons. By using pressure and heat, a massage gun can help to improve the pain and swelling around your injury. If you make regular treatment a priority, you can speed up the healing process and improve the long-term outcomes. The mean age was 53.7 years (range, 17-88 years), and the mean body mass index was 28.3. 50 You can ease symptoms and regain mobility with physical therapy. Free shipping. ) for all treatment groups was 26.2 months, while patients undergoing surgery experienced symptoms for a mean of 32.0 months before their surgical treatment. -23, 29, 31, 40, 50, 53. This is an acute injury, meaning the pain is immediate, but its easily treated and damage is not permanent. The authors gratefully acknowledge the contribution to this work by Swiss Orthopaedics and Epworth Knowledge Services. (Table 1). One study excluded male participants Ultrasound has been reported to have a high sensitivity of 79% to 100% and a positive predictive value of 95% to 100% for gluteal tendon tears but requires a skilled practitioner. This study showed the best management of gluteal tendinopathy comes from an approach combining progressive exercise . They are among the strongest soft tissues in the human body. Radiological confirmation of the diagnosis was most commonly obtained using magnetic resonance imaging. Chronic tendonitis can greatly affect a person's mobility, range of motion, comfort, and quality of life, which can lead to increased stress . A summary of the studies and their results is provided in the Appendix Table A1 (available as Supplemental Material). You can find information about different types of massage guns on the internet, and you can also talk to your doctor or therapist about how they would recommend using a massage gun. This therapy is often called hot compress because it uses pressure and heat together. A total of 27 studies (6 randomized controlled trials) with 1103 patients (1106 hips) were included. ) was 28.3 (range, 19.4-40.2). reporting nonoperative treatment measures before the treatment of interest was initiated, while this was routinely the case in studies reporting surgical treatment modalities. -42, 50, 53, 55. If it seems like you have tendinopathy, then book an appointment today, and we will get you started on the road to recovery! ). was not superior to the effect of a single PRP injection alone shown by Fitzpatrick et al. But the most common cause is overuse. This is a growth caused by irritation of the local tissues due to the hip replacement device. Duplicates were removed. Here are some tips on how to find the best massage gun for tendonitis. The Oswestry Disability Index, No statistical difference between the 2 treatment methods was seen. -33, 36, 38, 40 51 no improvement in clinical retear rates, patient-reported outcomes, or pain was seen when a platelet-rich fibrin matrix (PRFM) was added to tendon repair, but improvements in iHOT-12 and SF-12 scores suggest that the PRFM might have a role in improving subjective outcomes of hip-specific and overall physical function (LoE 3). Nonoperative measures should be applied to treat grades 1 and 2 tendinopathy. Greater trochanteric pain syndrome: percutaneous tendon fenestration versus platelet-rich plasma injection for treatment of gluteal tendinosis. Not only that, but they agree that involving massage in the treatment plan can improve healing time and positively impact long-term outcomes. Over the past several years, Cody has run over 10 marathons and half-marathons all over the country. Interestingly, pain data showed a different effect profile at 52 weeks, with no difference seen between the exercise group and the CSI group. Dead Butt Syndrome (DBS), technically known as gluteus medius tendinopathy (GMT), is a painful condition caused by inflammation in the tendons of the gluteus medius muscle. -33, 36 Yes, massage guns can help reduce the pains that come with Achilles tendonitis. 14,21,31 ), and Patient Acceptable Symptom State (3 studies However, the mHHS scores obtained from this population at 52 and 104 weeks from baseline were at the same level as those at the 6-week mark and were significantly higher than were baseline values. f Search doctors, conditions, or procedures . Although massage therapy has a multitude of benefits for everyones health & wellness, there are specific massage techniques that are uniquely qualified to help with tendinopathy. 16 Step each foot back onto the floor. Massage therapists have extensive knowledge of our musculoskeletal system and how to provide various forms of treatment that will encourage healing and overall improvement. Corticosteroid injections for greater trochanteric pain syndrome: a randomized controlled trial in primary care. a. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram. Please enter a valid 5-digit Zip Code. Best massage gun for a foam rolling . Its caused by repetitive motions, such as those involved in everyday activities like walking or running. Appointments 216.444.7246 Generally, cortisone improves pain for about 3 months with gluteus medius tendonitis but the pain typically returns. This was significantly higher than was the patient-rated success rate for a CSI or the wait-and-see approach. Does Dynamic Tape change the walking biomechanics of women with greater trochanteric pain syndrome? Gluteal tendinopathy is the most common lower limb tendinopathy. The best defense is a good offense: Under the advice of your doctor, adding in gentle strength training exercises is a great way to build muscle in the weakened area. Outcome scores for a single CSI were significantly worse compared with a single PRP injection. Tendinitis is an acutely inflamed swollen tendon that doesnt have microscopic tendon damage. How To Use A Massage Gun On Patellar TendonitisBob and Brad explain patellar tendonitis and how to use a massage gun to treat it at home for quicker pain rel. A pseudotumor (3). Pain or aching which becomes worse when moving up or down the stairs. It presents with varying severity but may cause debilitating lateral hip pain. The absence of previous treatment was stated in 1 study. with 54.3% of left hips treated. Without using proper techniques that will protect our musculoskeletal system, that elbow grease youve been putting into your casserole dish could cause some damage. The good news is that there are many effective massage guns that can help relieve your symptoms. References 4, 9, 10, 14, 17, 18, 21 b Follow-up times were provided in all but 1 study. This injury can occur on one side or either side of the gluteal area. Established treatment methods for grades 1 and 2 tendinopathy need to confirm their efficacy in grade 3 tendinopathy, and higher level research is required for surgical interventions for this disease. Blakey et al Augmentation devices may provide a mechanism to protect the repair site while the tendon heals, similar to an abduction sling employed after rotator cuff repair, Gluteal tendinopathy is the most common hip tendonitis (hip tendinopathy). Tendinitis is still a very common diagnosis, though research increasingly documents that what is thought to be tendinitis is usually tendinosis. $39.99. Answer: Hamstring tendinopathy is a uncommon overuse injury for both middle and long distance runners. And this tendon plays a vital role in ankle mobility and range of motion. Following this, you want to apply ice to the area for a few minutes or until the area is numb. Generating an ePub file may take a long time, please be patient. Apply friction in this way for one to two minutes until any sensitivity subsides. If not taken care of appropriately, you may possibly wind up with a chronic condition. 38 The ratio of female to male patients was 7:1. Sometimes wearing a recommended brace or splint, or not using the injured body part can lead to atrophy and stiffness. The type of preparation, platelet concentration, activity of PRP (activated vs nonactivated), and frequency of applications have been acknowledged as contributing to the variability of the treatment effect. The overall mean age (sample size adjusted) was 53.7 years (range, 17-88 years), and the mean body mass index (14 studies We innovate the way you think about recovery and well-being. 50 Then, using small movements, will work perpendicular (or transverse) to the tendon fibers in a back and forth manner. Gluteal tendinitis, also referred to as Gluteal tendinopathy, is an injury or inflammation of the tendons of gluteal muscles and is a common cause of hip pain. Massage therapy has proven to be a beneficial form of treatment for tendonitis. and case series (LoE 4). The existing literature did not allow for the assessment of effect variability in different stages of the tendon disease. This helps to improve the healing process, and it can also be used to address tenderness or inflammation. Is it Tendinitis, Tendinosis, or Tendinopathy? What is Gluteal Tendinopathy: Gluteal tendinopathy is a common condition that causes pain in the hip and buttock muscle. A retrospective cohort analysis by the same group concluded that 54% of patients treated using tendon fenestration for grade 2 or 3 tendinopathy of the gluteus medius or minimus tendon reported marked improvement of their symptoms. A buttock massage uses a variety of techniques to help treat muscle tightness and tension. No standard protocol for SWT in gluteal tendinopathy has been established according to the literature screened in this review. According to the existing evidence, a single LR-PRP injection is a reasonable option. Jumper's knee is also known as patellar tendonitis or patella tendinopathy. 55 You want to stroke slowly but with firm pressure back and forth across the area at a perpendicular angle to the muscle fibers; not parallel like in other massage styles. Lee et al Davies H, Zhaeentan S, Tavakkolizadeh A, Janes G. Surgical repair of chronic tears of the hip abductor mechanism. The effect of platelet-rich fibrin matrix at the time of gluteus medius repair: a retrospective comparative study, Long-term outcome of low-energy extracorporeal shockwave therapy on gluteal tendinopathy documented by magnetic resonance imaging. Treatment options for partial-thickness gluteal tendon tears require further research. No failure of tendon repair was reported with this technique, but 1 patient underwent revision for removal of the LARS interference screw, which caused local irritation. 29,37,40,50 It used to be called 'bursitis' or 'trochanteric bursitis' but it has been found that most commonly the problem is the tendon that attaches to the trochanter than the bursa itself. A massage gun is specifically designed to help treat tendonitis, so its likely that youll be able to receive the best results with this type of treatment with a massage gun. Unlike tendinitis, tendinopathy rarely gets better with rest. How To Use A Massage Gun On Achilles TendonitisBob and Brad explain achilles tendonitis and how to use a massage gun to treat it at home for quicker pain rel. The therapeutic effect (pain, patient-reported success) of an 8-week exercise program was better than that of a wait-and-see approach over a 12-month period and showed better outcomes than did a single CSI. In addition, the lack of a standardized treatment protocol limits even further the applicability of SWT in the treatment of gluteal tendinopathy. They work by vaccinating the area with heat, which will help to relieve pain and inflammation. The smallest of movements can cause tendinosis when done repeatedly, even typing on your phone or clicking a mouse. 9,33,36 Heat massage guns are great for treating pain in the soft tissues around the area where the tendonitis is located. As the abnormality is thought to have been previously underdiagnosed, greater recognition of the injury combined with an aging population will result in a higher incidence of gluteal tendinopathy and gluteal tendon tears requiring treatment. A third author (J.M.O.) 42 However, only exercise can improve the health of muscles and tendons. 9,10,25,26,33,51 nonoperative treatment including physical therapy in 3 studies, Bone-remodeling procedures (trochanteric reduction osteotomy) should be discouraged. 11,20,28 Park KD, Lee WY, Lee J, Park MH, Ahn JK, Park Y. 42 a Saratoga Springs, NY, Niskayuna The pain may feel like it is radiating around and/or out of the affected joint. $80.81. One or more of the authors has declared the following potential conflict of interest or source of funding: This work was supported through a research grant provided by the Swiss Orthopaedic Association (Dr Ladurner). If you don't have any symptoms, the best massage gun for tendonitis might not be a problem. If you have an overuse injury, your tendinitis may develop if you do the same activity multiple times in a short period of time. Best massage gun for the gym: MuscleGun Carbon Go. , which is a membrane that covers and protects the tendon. 18,32,38,55 What do we assess at Gold Coast Physio & Sports Health if we believe you have Gluteal tendinopathy: Unlike tendonitis, it is not marked by inflammation and is a chronic condition. Sonography was the preferred imaging technique in 6 studies, Most tendon injuries are the result of gradual wear and tear to the tendon from overuse and aging. To review the therapeutic options for different stages of gluteal tendinopathy, to highlight gaps within the existing evidence, and to provide guidelines for a stage-adjusted therapy for gluteal tendinopathy. the display of certain parts of an article in other eReaders. sj-pdf-1-ojs-10.1177_23259671211016850.pdf, http://journals.sagepub.com/doi/suppl/10.1177/23259671211016850, https://creativecommons.org/licenses/by-nc-nd/4.0/, https://us.sagepub.com/en-us/nam/open-access-at-sage, No or minimal changes within gluteal tendons, Increased tendon signal on T1-weighted images and normal appearance on T2-weighted images, Tendinosis, angiofibroblastic hyperplasia, and disorganization and fragmentation of collagen fibers, Increased signal intensity on T2-weighted images, Depletion of functional tendon cells and breakdown of collagen and extracellular matrix, Discontinuity of 1 or both gluteal tendons, Gross structural disruption and mechanical failure, No. Gluteal tendinopathy is a source of lateral hip pain, yet common clinical diagnostic/assessment tests for this condition have limited validity. Because none of the studies on nonoperative treatment results included patients with full-thickness tears, there is no evidence for the efficacy of nonoperative treatment measures in this stage of the tendon disease. while a series of trochanteric reduction osteotomy was found to have a 30% complication rate at 2-year follow-up. In Gluteal Tendinotpathy, gluteal muscles play a major role in stabilisation of the pelvis during walking and running, making it the hardest working muscle in the hip. Data from multiple studies were combined if they were obtained from a single patient population (eg, reporting of 2 different follow-up times of a single patient population). Surgical treatment of hip abductor tendon tears, Identification and differentiation of gluteus medius tendon pathology using ultrasound and magnetic resonance imaging, A review of surgical repair methods and patient outcomes for gluteal tendon tears. Bhabra G, Wang A, Ebert JR, Edwards P, Zheng M, Zheng MH. The more severe the tendinopathy, the less likely stretching would help. 19,56 Radiological examinations were consistently carried out in all studies, with MRI being the diagnostic tool most commonly used (16 studies Tendons on the backside of your hand connect to muscles in your forearm, allowing you to move your fingers. A diagnosis can be obtained from a physiotherapy assessment and confirmed on ultrasound or MRI scans. Tendinosis happens when the tendon doesnt have time to heal and rest, and there is a decrease in blood circulation. 55 If you have tendonitis pain, you could probably go for a good massage right now its a great way to encourage healing. Statistically significant and clinically important (greater than the minimal clinically important difference) improvements in mHHS, HOS, and iHOT-33 scores were shown over a mean follow-up time of 19.7 months. Few publications allowed for separate outcome assessments according to the stage of the disease in their results. References 8, 9, 17, 18, 21, 22, 29, 31, 38, 40 Once gluteal tendinopathy is confirmed, your physiotherapist will be able to identify which factors have contributed to your condition and help to address these. Answer: Ultimately, deep tissue massage may be the best massage style to combat tendonitis, according to a study published in the International Journal of Therapeutic Massage and Bodywork. *These statements have not been evaluated by the Food and Drug Administration. You can do a version of friction tendonitis massage therapy yourself, as it involves gentle rubbing in a back and manner forth over the inflamed tendon. Grimaldi A, Mellor R, Hodges P, Bennell K, Wajswelner H, Vicenzino B. Gluteal tendinopathy: a review of mechanisms, assessment and management. already built in. Gluteus Medius Tendinopathy. A LEAP forward in the management of hip pain. You will also find advice and exercises prior to commencing Physiotherapy. I didnt cover it in this article, but there certainly is an emotional component to any kind of injury. When it becomes severe, it can cause pain and deformity. Turn the gun on and use it on the front of the proximal (high part) thigh. The reported complication rates for these soft tissue interventions are low. We provide a number of different treatments that can be used to treat gluteal tendinopathy, depending on your individual needs and goals. [2]. The final search was performed on January 31, 2020. There are a lot of different brands and models available, so its important to find one thats appropriate for your condition and your needs. Hot compress massages are also helpful because they are not painful as other types of massages. Overall, 10% to 40% of patients with gluteal tendinopathy have unsuccessful nonoperative treatment. When you buy an item using one of our links, we may earn a portion of the sale. The ePub format uses eBook readers, which have several "ease of reading" features Mellor et al Grades of Progressive Tendon Degeneration Trochanteric reduction osteotomy as a treatment for refractory trochanteric bursitis. The follow-up time was 32 and 38 months, respectively. 37 What in the World are our Therapists up to? For years, we have been managing insertional tendinopathy through stretches and exercises, often with varied results. Phone Call Us It can also lead to problems with the tendons themselves, which can be very severe and require surgery. 18 Reported treatment methods were physical therapy/exercise; injections (corticosteroids, platelet-rich plasma, autologous tenocytes) with or without needle tenotomy/tendon fenestration; shockwave therapy; therapeutic ultrasound; and surgical procedures such as bursectomy, iliotibial band release, and endoscopic or open tendon repair (with or without tendon augmentation). Statistical analysis was descriptive. Furthermore, percussion massage tools can help to speed up the healing process. Corticosteroids show good short-term outcomes, while the long-term effect is inferior to results obtained using PRP. Of these, 6 were removed because they reported additional arthroscopic procedures on the hip. In 5 studies, full-text versions of eligible abstracts were not available. The effect of a single CSI declined at 24 weeks. Gluteal tendinopathy is also now believed to be the main cause of lateral hip pain. Greater trochanteric pain syndrome and gluteus medius and minimus tendinosis: nonsurgical treatment, Surgical repair of the gluteal tendons: a report of 72 cases, The diagnostic accuracy of magnetic resonance imaging and ultrasonography in gluteal tendon tears: a systematic review. 4,25,26 Your tendons are designed to withstand high repetitive loading. In cases where tenosynovitis is infectious, treatment involves surgical drainage and antibiotics, which is why its important to speak with your doctor. If youre experiencing tendonitis, there are a few things you can do to help ease the pain and improve the quality of your life. Counselors, support groups, maybe even a therapist that specializes in energetic/emotional work. 2 4 e Clinical and functional outcomes after augmented hip abductor tendon repair. As for partial-thickness tears (grade 3 tendinopathy), we lean toward a single PRP injection before opting for endoscopic tendon repair. Gluteal Tendinopathy is a clinical condition in which there is moderate to severe debilitating pain due to injury of the Gluteal tendons. Thus, 27 articles were considered for this review. Step 1: Begin by standing with your feet a little wider than your hips. While overwhelming evidence supports nonoperative treatment in these stages of gluteal tendon disease, surgery in cases recalcitrant to other treatment methods appears to be a valuable management option. More Importantly, Can Massage Therapy Help Me. [1] Massage therapy is one of many treatments used to ease pain and rehabilitate your tendons. Coulomb et al Wear particles from a metal-on-metal or minimally invasive anterior hip replacement (Birmingham hip or "Hip Resurfacing"). Pain levels were significantly lower at 1 week compared with baseline, and significant improvement was maintained over 27 months in the latter study, even though patient-reported success was rated as good or excellent in only 56% after that period of time. Of 12 patients, 2 were diagnosed with a partial tear (grade 3) of the gluteus medius. Patient satisfaction was reported in 12 studies The reported failure rate of repair was 4.5%. There is a more effective method of treating the HHT. It stands for: While this is a common instruction for the first 48 hours after a tendon injury, many experts believe that too much rest can actually do more harm than good, especially in the case of tendinosis where the injury is a result of underdevelopment. Grade 2 tendinopathy is characterized by an increased signal of the tendon on T1-weighted MRI scans, while the fluid-sensitive image appears largely normal. . The effectiveness of platelet-rich plasma injections in gluteal tendinopathy: a randomized, double-blind controlled trial comparing a single platelet-rich plasma injection with a single corticosteroid injection. A massage gun uses percussive force to simulate a deep tissue massage, which is exactly what your tight quadriceps are asking for right now. The role of physical therapy needs to be clarified, as there is evidence for the positive effect of exercise, while there are no treatment protocols that have proven its effectiveness. Based on this, they will be able to design a treatment program with the aim of optimising the hip abductor muscle . The views and nutritional advice expressed by Vigorous Innovations are not intended for the purpose of providing medical advice. The first massage gun for tendonitis is a heat massage gun. The total sample size was 1103 patients (1106 hips). +++, treatment strongly supported by evidence; ++, treatment supported by evidence; +, some evidence supporting treatment but not recommended as first-line treatment; +/, evidence not sufficient to support treatment;, evidence suggesting avoidance of treatment. Be sure to test the gun before using it on a tender muscle. If you are considering using a massage gun, make sure to speak with your doctor before doing so. You may consider also the following items: Massage guns have a lot of benefits for people who have tendonitis. Additionally, a massage gun can help to reduce inflammation and swelling. SWT was reported as effective in reducing lateral hip pain from grades 1 to 3 gluteal tendinopathy in studies published by Carlisi et al Buttock Massage. The irritated muscle may further irritate a nerve root, which can generate sciatica pain. Make sure to read the instructions carefully. The second massage gun for tendonitis is a pressure massage gun. 17,55 34,35. You may also have more hip pain and stiffness during the night or when you get up of a morning. 22 When you choose Orthopaedic Associates of St. Augustine, you are taking the first step towards returning to a pain-free life. Association of preoperative gluteal muscle fatty infiltration with patient outcomes in women after hip abductor tendon repair augmented with LARS. 10,23,32,33,36,39 Thats why its important to get a massage gun that will help you to relieve pain and inflammation. #References 8, 9, 14, 17, 18, 21-23, 29, 31, 32, 36-41, 51, 53, 55. However, with any massage, particularly with tendonitis massage or any massage for injury, it is important to seek out a qualified massage therapist who knows how to provide proper treatment that will not further exacerbate the issue or cause new ones. In addition, there is LoE 1b supporting the use of PRP for the treatment of low- to moderate-grade gluteal tendinopathy (grades 1 and 2). Torres A, Fernndez-Fairen M, Sueiro-Fernndez J. It stands for: While they say to avoid strenuous activities, carefully working the tendon is seen as beneficial and can be made safer with the use of supportive devices like thumb splints and. Tendinopathy: A general term for tendon damage involving overuse, microtears, and collagen degeneration, manifested by inflammation, pain, and weakness. "Deep friction massage in the management of patellar tendinopathy in athletes: short-term clinical outcomes." Journal of sport rehabilitation 29.7 (2019 . Modern imaging techniques are capable of depicting morphological changes that reflect the histopathological findings described. AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. MRI has been shown to be an accurate means of diagnosing gluteal tendon tears, with a reported sensitivity of 73% and specificity of 95% for the presence of tears. In fact, the suffix -itis means inflammation (think about arthritis, bronchitis, tonsillitis). Further scientific work is needed to enhance the evidence base supporting this proposed framework. Gluteal tendinopathy is more common in women, in particular post menopausal women. reported a rate of only 5.6%. 36 What's Achilles Tendonitis The biggest tendon in your whole body is the Achilles tendon. These include overuse, repetitive strain, and overuse injuries. The location you tried did not return a result. Fatty degeneration, atrophy, and retraction can impair surgical repair, while their effect on patient outcomes remains controversial. Therefore, while gluteal tendinopathy is commonly known to affect runners, improving running technique and hip stability can help reduce the chances of sustaining the injury. Of course, it depends on the severity of the injury. 57 FREE SHIPPING ON ALL ORDERS OVER $100 Read more Tendonitis is a common injury that can cause pain and stiffness in the tendons. Longitudinal or cross-shape splitting of the ITB did not have inferior outcomes when compared to Z-lengthening procedures at the level of the greater trochanter or at the supracondylar level. Supplemental Material for this article is available at http://journals.sagepub.com/doi/suppl/10.1177/23259671211016850. 4,12,15,46 5 Robinson NA, Spratford W, Welvaert M, Gaida J, Fearon AM. They will be able to asses your progress and recommend safe exercises for you to perform both for short term recovery, and to continue for long term wellness and performance.

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