Pain - Part 3

Well I hope you were able to try out the Myofascial Compression Techniques on your Soleus muscles over the past few days, and you were able to see what an amazing difference there was during the reveal tests.

I have been using Self Myofascial Release (SMR) techniques for years, on myself and my athletes with great success.  These techniques have been applied using foam rolls and tennis balls...not the TP Therapy products...and I can honestly say that I have seen far better results in increased mobility, pain reduction, and improved muscle elasticity by using the Trigger Point products.

This is not to say that the 'standard' SMR techniques do not provide benefit...I just feel as though there is significantly more benefit gained through the use of the TP products.

Today, we are going to explore the Quadriceps muscle group which, as most of you know, makes up our 'thigh' muscles.

The Quadriceps muscle group is made up of the Vastus Lateralis, Vastus Medialis, Vastus Intermedius, and the Rectus Femoris.  The quadriceps are primarily responsible for knee extension, but just as with the calf muscles, the quads have other functional responsibilities such as knee joint stabilization, hip-complex stabilization, and the deceleration of knee flexion.

Remember, the Trigger Point system was developed around six distinct areas...The Ultimate 6 Areas for improved biomechanics.  The first area we worked on was the Soleus muscle, and today we are going to work on both the medial and the lateral aspects of the Quads - targeting the Rectus Femoris and the Vatsus Lateralis muscles of the thigh.

Before we do that however, lets gain a little deeper understanding of each muscle.

Rectus Femoris

The Rectus Femoris (RF) is positioned down the center of the thigh.  This muscle originates from the anterior-inferior iliac spine of the pelvis.  This means that it attaches to the pelvis itself, thus having some degree of control over our hips.  The RF inserts at the base of the patella, at the tibial tuberosity on the anterior tibia.  As the RF crosses over the knee joint, it also has some degree of control over the knee.  

Muscles that cross two separate joint articulations are often referred to as bi-articulate, meaning they control movement at two joints.  In comparison, the Soleus muscle is considered a mono-articulate muscle as it only crosses the ankle joint, and is only responsible for movement of foot-ankle complex.

RF's isolated, or primary function, is two-fold (remember, it's bi-articulate)...Knee extension and hip extension, through concentric contraction.  The integrated function of the RF is also two-fold, as it decelerates (slows) the extension of the hip, and flexion of the knee, via eccentric contraction.  The RF also stabilizes both the lumbo-pelvic-hip complex (LPHC) and the knee through isometric contractions.

Rectus Femoris muscle in red

 Vastus Lateralis

The Vastus Lateralis (VL) is positioned laterally along the thigh, hence the name lateralis.  The VL originates from the anterior and inferior border of the greater trochanter, the lateral region of the gluteal tuberosity, and the lateral lip of the linea aspera of the femur.

What?

Basically, the VL's attachment is confined to points below the pelvis, so it is a mono-articulate muscle.  The VL inserts at the base of the patella, and the tibial tuberosity - the same insertion points as the RF. 

Vastus Lateralis muscle is outer portion in red, not the inner portion

OK, now let's learn a little about what the VL does.  In an isolated manner, the VL is responsible for knee extension, and knee extension only.

Pop Quiz time!

Why isn't the VL responsible (like the RF) for action at the hips?  HINT:  the answer is right above!

Excellent!  Because it does not cross or attach to the pelvis.  Very Good!

Alright, back to it's functions.  The VL does have integrated functions...both eccentrically, and isometrically.  Eccentrically, the VL is responsible for the deceleration of knee flexion, while isometrically, it stabilizes the knee, along with it's counterpart - the Vastus Medialis Oblique (VMO).  The VMO is the inner muscle that is highlighted in red, in the illustration above.

Now that you have gained an understanding of the functional anatomy of the Quadriceps (or at least some of the quad muscles), let's talk about why we should be applying Trigger Point Therapy's Myofascial Compression Techniques (or other forms of self myofascial release) to this area.

Many athletes, young or old, are quad-dominant.  This means that the normal patterns of muscle recruitment have been altered, and have resulted in movement dysfunction.  This can be the result of injury, chronic overuse, or pattern overload.

As I have mentioned in previous posts, we spend a great deal of time sitting.  Our muscles adapt to this position, through the process of adaptive shortening, and over time, the normal firing patterns of our muscles become altered.  

Overuse is another reason for these alterations in normal movement, and serves as justification for employing myofascial release techniques.  Take for instance, my sport of cycling.  During a typical three hour road bike ride, I usually average a pedal cadence of 85 RPM.  This means that, on average, I complete 15,300 pedal revolutions during a typical three hour training session.  

That's overuse.  That's pattern overload. 

Applying the principle of adaptive shortening as a result of chronic overuse/pattern overload...when the hip flexors are tasked repeatedly, or placed in a shortened position for extended periods of time (such as sitting), they tend to adapt by remaining in a shortened position.  This occurs even after we have stood up, or stopped the incessant pedaling.  

The position of the pelvis is controlled, in great part, by the hip flexors and hip extensors.  The hip flexors are positioned anteriorly, while the hip extensors are along our backside.  Proper positioning of the pelvis is dependent upon the harmonious relationship between these agonist and antagonist muscles...basically, balance between these muscle groups must exist for the pelvis to remain properly positioned.

A battle (of sorts) ensues when the hip flexors become adaptively shortened.  The battle takes place between the flexors and extensors, and is more often than not, won by the smaller, weaker hip flexors.  You see, our most powerful muscles - the gluteals, tend to give up the fight to the smaller, weaker hip flexors.  This results in an anteriorly tilted pelvis, a condition which is often referred to as Lower-Crossed Syndrome (LCS).  

Individuals with LCS often complain of low back pain.  This is a result of the compressive forces being applied to the intervertebral discs of the lumber spine...which result from the severe curvature created in the low back, as we instinctively stand up straight.

Let me explain...

Our spine attaches to our pelvis.  When we tip our pelvis forward (anteriorly), our spine naturally follows, resulting in a forward lean at the hips.  Instinctively however, we upright ourselves so that we are not leaning forward.  This creates a greater-than-normal curvature in our lumbar spine - usually L3-L5.  Over time, the compressive forces created, coupled with athletic activity, can cause the disc to bulge.  When this happens, the nerves that emanate from within this region of the spine, can become compressed - which ultimately causes pain and numbness in the low back, buttocks, and the back of our legs.  If left unaddressed, these bulging discs can rupture, creating a host of more severe problems.

How's that for a reason to employ these Trigger Point techniques?!

To restore proper positioning of the pelvis, the over-active flexors must be relaxed, and allowed to return to their normal resting length.  Additional, work needs to be performed to 'retrain' the gluteals as well, however, this post will only be addressing our work on the hip flexor muscles.

Now let's take a look at how we will use the Trigger Point Therapy products to help restore proper biomechanics in the knees and hips.   I will warn you...there is a fair amount of discomfort associated with this manipulation...it is similar that which you experience while getting a deep tissue or sports massage.  With the Quadballer however, you control the amount of pressure applied to the tissues, thus placing you in control!

The video below briefly describes the Quadriceps manipulation, and provides a little video demonstration.  Unfortunately, it may be a little vague for some, so I will walk you through the steps.

Click here to see the video demonstration

The photo below shows the proper body position when performing the Quadriceps manipulation.  The Trigger Point team refers to this as the "GI Joe" position.  As this blog is directed toward aging athletes, I am sure all of you understand the GI Joe reference...right?

 

Here we go...grab your Quadballer (you have purchased a TP Therapy kit by now haven't you?) and place it on the floor in front of you. The easiest way to position yourself correctly is to kneel on the floor, placing the Quadballer (QB from here on out) directly in front of your left thigh, so that it actually makes contact with your leg.  Next, lean forward, placing your hands on the floor, allowing your body to settle comfortably (HA!) with the QB positioned about 1-2 inches above your knee.  Extend your left leg, and bend your right leg as shown above...the GI Joe position.

You will feel an immediate sensation of discomfort...the tell-tale sign that you really need to be doing this!  Similar to the Soleus manipulation, there are multiple passes that are going to be made, each of which will focus on a different area of the muscle group.

The first pass will remain centered on the thigh, the second pass will be approximately 45-degrees off center, laterally...and the final pass can either be performed on the IT Band, or run the reverse direction along the lateral aspect of the thigh.  Due to the fact that I believe the IT Band can benefit significantly from SMR techniques, this description will include it in the third pass.

Keeping the hips low creates more pressure on the thigh...which is exactly what we want, so do your best to maintain a position with your hips low to the ground, and your foot slightly elevated.  While pushing through your elbows, begin your first pass by moving your body downward...this rolls the QB upward toward your hips.  Your first pass will consist of four incremental movements, whereby you will roll up one inch, and down one-half inch.  Each incremental movement is then followed by two Cross Friction moves.  To perform the cross friction, maintain pressure on the QB while quickly moving your thigh back and forth, laterally on the QB.  Perform two cross friction passes.  Next you will perform two leg bends by flexing your knee and bringing your lower leg up, approximately 45-degrees.  Perform two leg bends.  This completes the first pass.  The QB should be roughly 1/4 of the way up your thigh.

Perform one more series of incremental movements, cross-friction passes, and leg bends with the QB aligned along the center of your thigh.  When finished with the second pass, the QB should be located close to the midpoint of your thigh.  

The third pass will focus on your Vastus Lateralis, so you will need to rotate your foot internally, which causes the femur (and thigh) to internally rotate, positioning the VL directly on the QB.  Do not lift your leg off of the QB when rotating it inward!  The goal is to maintain constant pressure on the thigh throughout the entire manipulation.  

Now that the QB is positioned on the VL, perform two more series of passes, working your way to the upper end of the thigh.  When you are finished with the last pass, the QB should be located directly on the Tensor Fascia Latae (TFL).  The TFL is point of origin for the IT Band, and must (for best results) be released prior to rolling the IT Band (ITB), which is exactly what your last pass did.  

Now it's time to work the IT Band.  Again, do not ease up on the pressure while repositioning...simply rotate your foot inward even more, and shift your weight to the left to direct the pressure onto the ITB.  Your hips will be opened up significantly, in this position, as it is not necessary to keep the hips low and level to the floor for this series of passes.  You will be working your way back down towards your knee, performing the same series of incremental passes, cross-friction, and knee bends.  The only difference is that now you will be rolling down one inch, and back up one-half inch.

Once you have completed the entire series for the left leg, switch sides with the QB and perform the series for the right leg.  The video below provides a brief demonstration of the incremental pass, the cross-friction technique, and the knee bend.

Click here to see the video

Thanks for reading, and as always...please leave me a comment about this blog.  And...if you have not yet purchased your Trigger Point Therapy kit, and  you are an athlete (aging or not), you don't know what you are missing!  I can honestly say that over the course of my 15 years within the sports performance industry, this is the best tool I have come across for performing self-myofascial release techniques.  This could be a game changer for you!

Yours in Health and Performance!

John

Why do I bother?

Why do I bother to blog?

That's not how the question was asked...but that is the question I asked myself before I responded.

Last night, a great friend asked me how my blog was going, and what it was exactly, that I hoped to accomplish with it.  It's funny how we hear what we want to hear...what we sometimes need to hear.  So what I heard, was not what she asked, but what I have asked myself time and time again, as I sit here in front of my computer typing away..."Why do I bother to blog?"

Am I hoping to get rich off of my affiliate sales programs?  Nope.

Am I hoping to develop an audience that is worthy of advertisers paying me to peddle their wares on my site?  No, not really.

So why the heck do I bother?

I think it has something to do with giving back...and giving back the right stuff, so to speak.  I have been very blessed over the years to have had the opportunity to learn from some of the best in the business -  the business of human performance.  Much of what I learned was from outside the 'classroom'...there was no tuition, there were no text books...it was simply one person sharing his or her knowledge with someone who was willing to learn.

That's not to say I don't possess the formal education that I feel is necessary in the world of health and human performance...no, no...I certainly put in my time within the classroom environment!  

What I am saying however, is that there have been some key people in my life who have recognized my desire for learning, and have been willing to pass along a great deal of 'real world' knowledge to me, which ultimately bolstered what I had learned in the classroom...for which I am forever grateful.

Now I am in the position to pass along some of my experience and knowledge to others who themselves, are thirsty for information...the right information.

We live in a world of misinformation.  Misinformation that has the ability to be spread worldwide with the simple click of the SEND button.  While the ability to rapidly spread information to such a vast audience can be quite beneficial - the wrong information can certainly have the inverse effect.

Once again, let me qualify what I am saying here...

I am certainly not saying that what everyone else is sharing is wrong...and mine is right.  What I am saying is that there are countless opportunities for others to share information that is simply personal opinion, and often counterproductive...and even harmful.  Oh yeah, and they charge you a great deal of money for it.

This is where I would like to make a difference...be it a small one, but a difference nonetheless.

My information is evidence-based.  There is a great deal of peer-reviewed and journal published research to support what I share.  I vow to do my best to provide you with sound information, and I am not too proud to come back and tell you that I made a mistake...if that is the case.  Oh by the way...I am not charging for this information.

It's my way of giving back.

It's why I bother.

Yours in Health and Performance,

John

Pain - Part 2

Welcome back for Part 2 of my series on pain...and how to alleviate, or even eliminate it from your life.

As I mentioned yesterday, we will be using the Trigger Point Therapy system of Myofascial Compression Techniques (MCT).  MCT is a proprietary myofascial release system, developed by Cassidy Phillips and his team at Trigger Point Therapy.  To get the utmost benefit from these exercises, you need to be using the TP Therapy products, as they are designed specifically for this purpose.  Use of other products such as foam rolls, will provide some degree of benefit however, due to their physical size and shape, the use of these products will not provide nearly the benefit.  So, once again, if you do not own a TP Therapy kit, you can order one today by clicking on the banner at the top right corner of this page.  Clicking on the banner will take you to my TP Therapy Affiliate Sales storefront, where you can order a variety of TP Therapy products.

Alright, let's get rolling!

Today we begin with the Soleus muscle, but before we get started let's learn a little about this muscle.  The Soleus is part of the calf complex, which is ultimately responsible for control of both the foot/ankle complex, as well as the knee joint.  The Soleus originates at the posterior surfaces of both the fibula and tibia.  The muscle's insertion point - meaning it's end point - is the Calcaneus (heel).  The muscle inserts into this area via the Achilles Tendon.  

Okay, so what is this muscle responsible for?

The Soleus muscle has both isolated functions and integrated functions.  Let's back up for a second.  When we think of a muscle's action, we often think of a single, isolated function of that muscle.  Let's take the Biceps muscle for instance.  When we look at the Biceps we tend to think elbow flexor, right?  We would be wrong however, to think that was all this muscle was responsible for.  Sure, when we contract our Biceps muscle, our elbow flexes, but did you know that the Biceps was also responsible (in an integrated manner) for, and plays a major role in elbow extension, supination and pronation of the hand, shoulder extension, and stabilization of the elbow and shoulder girdle?

That's what Integrated Function means...how it integrates, and works synergistically and antagonistically, to control human movement.

So...back to the Soleus!  The isolated function of the Soleus is to accelerate, or produce plantar flexion.  Plantar flexion is the act of pushing your foot downward, into the ground.  It's integrated functions include deceleration of ankle dorsoi-flexion (pulling your foot upward), and stabilization of the foot-ankle complex.  The Soleus muscle is innervated by the Tibial nerve, which is a branch of the sciatic nerve.

Wow!  In less than a minute you learned functional anatomy of the Soleus muscle...well done!

The Soleus muscle is identified by the thin lines pointing to it.

The picture above shows that the Soleus muscle lies 'deep' to, or underneath the Gastrocnemius (Gastroc), which is the bulkier part of the calf complex. The majority of the Soleus muscle is hidden from view (in the picture) by the Gastroc muscle and tendon.  

Why should we be concerned about this muscle?

The Soleus is a major contributor within the biomechanical chain, and is frequently over-worked.  As one of the muscles that insert into the bottom of the foot, it takes much of the brunt of everything we do while on our feet.  Over-activity of the Soleus muscle places a great deal of tension and torque on the Achilles tendon, which can result in decreased functionality of the foot-ankle complex, as well as pain due to plantar fasciitis.  

Releasing tension across the muscle via MCT can help to restore proper mobility to the foot-ankle by restoring the normal elasticity of the soleus muscle, as well as alleviating the forces being applied to the Achilles tendon...thereby alleviating or eliminating the pain of plantar fasciitis.

Now that you have become functionally knowledgeable on the Soleus muscle, let's take a look at the application of MCT, using the Trigger Point Therapy products.  The video below describes the process of using the components of the TP Therapy kit to perform the Soleus manipulation.  I apologize for the poor video and audio quality...it's the best I could do with my iPhone!

OK, we made it through the first video!  Lets discuss the process in a little more detail than what is included in the video.  First off, let's talk about the discomfort.  This process is not with a little uncomfortableness!  The mere fact that there is some discomfort within the Soleus muscle is proof that you are in need of this type of training.  

We need to be able to distinguish between discomfort and pain.  I always tell my clients that discomfort is normal - we should be able to tolerate discomfort.  Pain, on the other hand, is intolerable.  Sure we may be able to tolerate it, and we often accept it as 'normal', yet we should not tolerate it.  If you are experiencing pain, pain that prevents you from doing this exercise, then you should no perform it, and you should seek medical attention from a Doctor or Physical Therapist.  The discomfort you experience during the Soleus manipulation will actually begin to decrease throughout the process.  Pain however, will continue to worsen.

Breathing correctly during the manipulation is important, as it plays a role in the ability of MCT to 'flush' metabolic waste products from the muscle, and bringing fresh, oxygenated blood to tissues.  

The process begins with foot circles; two to the left, and two to the right.  The top foot is then repositioned and you then perform four knee-bends.  This 2-4-4 pattern is equal to one pass.  The Soleus manipulation is programmed for a total of three passes.  The first pass is performed with the toes of your foot, in a vertical position.  Pass #2 is performed with approximately 45-degrees of internal rotation - as described in the video.  The final pass is performed with approximately 10-15 degrees of external rotation.  Once you have completed three passes on one leg, you are ready to move to the opposite leg, repeating the process.

Prior to moving to the next leg however, I would like each of you to perform a Post Manipulation Reveal Test.  These simple tests serve to reveal the benefits of the manipulation, and are pretty amazing!

The first Reveal is the Single-Leg Bounce.  To perform, stand on the floor, on a single-leg, beginning with the side you just finished manipulating.  Stand up tall with good posture, and begin hopping on one foot.  Perform 5 or 6 hops, then reposition yourself on the non-manipulated leg, performing the same 5 or 6 single-leg hops.  You will notice that your manipulated leg feels much lighter, that you can bounce much easier, and you make far less noise as you land - as compared to the non-manipulated side.  It's like magic!

The next Reveal is the Baller Block Test.  This test will reveal where you are bearing your weight on your foot during your stance.  Due to tightness in the calf complex, many of us have decreased dorsi-flexion of the foot-ankle complex.  This results in our weight being shifted posteriorly along our foot, causing us to rest predominantly on our heels.  If you are a runner, this will prevent you from having a fore- or mid-foot striking pattern, thus causing you to strike with your heels.  Over time, 'heel-strikers' can develop hamstring, calf, IT Band, and low back pain.

Position the Baller Block length-wise in front of you, on the floor.  Stand, placing your manipulated leg on the Baller Block, flexing the opposite leg at the hips, balancing as you do so.  Next, change feet on the Baller Block, following the same procedure.  You should immediately notice that your non-manipulated leg settles back in to Baller Block through the heel.  Biomechanically speaking, the ability to load the fore-foot allows for more efficient and effective movement and locomotion.

Great job, you have completed the first of the Ultimate 6 areas for improving biomechanics!  In my next post we will move on to perform the Quadriceps manipulation...you're gonna love that one!

Yours in Health and Performance,

John

Pain

The title says it all, doesn't it?

For many of us, pain is something that we live with on a regular basis, in some form or another.  For others, pain is something that occurs occasionally...from a traumatic event, or just a hard training day.  And then there are those who thrive on pain.  You know the type...the one's who actually go looking for that 'good' pain...the type of pain that separates them from the rest of the pack, and leads to success.

That's not me.

Nope, I'm the guy who lives in a moderate amount of pain, most every day.  My life as an industrial athlete (firefighter) and as an amateur competitive athlete, has taken it's toll on my body.  Throughout my twenty-three year career in the fire service, I have had arthroscopic repairs performed on both shoulders, and my left knee.  I've endured multiple Grade-3 sprains of my ankles, and have suffered damage to my lumbar spine.

The surgery to my left knee resulted in the removal of nearly 45% of my medial meniscus, which ultimately means that the bones in my knee come in contact with one another, and will most likely result in arthritis at some point.  In fact, I am sure there is some arthritic development already.  When I run, it hurts.  Plain and simple.  So guess what?  I no longer run.

The multiple traumatic episodes to my ankles have left me with decreased mobility and decreased stability...both of which I work on constantly.  The simple act of stepping out of the fire truck onto the ground, which is something I do many, many times each shift, is done very cautiously now, so as to prevent any further damage to my ankles.

And then there's my back.  I have irreparable damage to my spine.  Both L3 and L4 discs are bulging, and x-rays reveal that there is both stenosis and calcification present.  L5 is the doozie though...I have an annular tear in the disc, and the nucleus pulposis is protruding from from within the 'casing' of the disc.  This means that at times, the nerve root that emanates from within the L5 vertebral body is being impinged upon, and thereby causing a mixture of discomfort, pain, and numbness within my lower back, glutes, and left leg.

To say I am in pain all the time wouldn't be completely truthful.  I do however, believe that without performing the regimen of strength and mobility exercises that have become my staple, I would certainly be in pain...all of the time.  Not only would I be in pain, I would not be able to participate in many of my favorite pastime activities.

I have asked this question before, and I'm asking it again.  How many of you experience some sort of pain, and how often?

I began this blog in an effort to help others...to hopefully reach more people in need of my knowledge and experience with performance enhancement and injury prevention.  In order to meet the needs of my readers, I could really use some insight as to what I can do to help.  The best way to do this, is to leave me comments.  I really love reading your comments, as it allows me to make a fairly generalized blog post, a little more individualized.  You don't have to be a follower of my blog to leave a comment however, I would love it if you would follow me officially...but all you really need to do is type in your comment, then click the ANONYMOUS selection under SELECT PROFILE...it's that easy!

Okay, enough of the public service announcements!

So, I ask again...how many of you are currently battling pain, or have experienced pain in the past?  

Would you like to eliminate or alleviate your pain?

I would imagine everyone of you answered yes to both questions, due to the fact that if you are reading this blog, you are most likely an aging athlete...and we all know athletes have their share of aches and pains.

The most beneficial method I have found for reducing and/or eliminating pain from my body, is self-myofascial release (SMR).  If you've been reading my rants for any amount of time now, then you should be familiar with these techniques.  The specific type method of SMR that I feel has provided the most benefit for me is the Myofascial Compression Technique from Trigger Point.  

Cassidy Phillips, the CEO and developer of the Trigger Point products and system, says it all in this video below.  He says that we tolerate what we accept - and we tend to accept that aches and pain are just a natural part of training, or simply part of getting old.  We accept those myths as truth, when in reality we can alleviate or eliminate pain from our lives.

I have decided to take each of you through what Trigger Point refers to as "The Ultimate Six".  These six areas of the body are key points in the kinetic chain, and if left 'untreated' can create a great del of movement dysfunction, and pain, within our bodies.  The dysfunction and pain can ultimately lead to decreased performance and nagging, chronic injuries.

Each day I will take you through one of the Ultimate Six areas, describing why we need to work on the specific area, the benefits, and how to perform each exercise.  When possible, I will provide a short video for each.

It goes without saying that these techniques cannot be performed without the Trigger Point equipment, so please...if you have not yet purchased one of the Trigger Point Therapy kits, I implore you to do so right now.  It's simple...just scroll to the top right corner of this page - yep, I'm talking to you - and click on the small Trigger Point Banner that says GET RID OF PAIN FOREVER.  That banner is linked to my affiliate store front, where you can purchase everything you need to begin your journey towards living a pain free athletic life.  

Believe me...it works!  I am living proof, as is Mr. Cassidy Phillips who, at one time was an elite level Tri-athlete who competed in Iron Man events.  Cassidy's life changed dramatically when he began to experience pain and fatigue throughout his body, and was ultimately diagnosed with fibromyalgia.  Cassidy underwent years of unsuccessful treatment with doctors and therapists, and ultimately created the Trigger Point system, which has allowed him to return to a normal life.

The Ultimate Six...

The following areas are the six areas of our bodies that we will be working on:

Join me over the next few weeks as we take an amazing journey through the human body - your body - and discover areas of dysfunction that are decreasing your performance as an athlete, and increasing your potential for injury - both acute and chronic.  

Remember, we shouldn't accept aches and pains as a natural part of being an aging athlete.  We CAN do something about it!

I look forward to hearing from you as we take this journey together, towards living a pain free, high performance life!

Yours in Health and Performance!

John