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Every few years, something new finds its way into our drinking water, causing confusion at best and justifiable panic at worst.
Fortunately, most of what we hear about is nowhere near the levels that we saw recently in West Virginia (ie a severe MCHM contamination incident from earlier this year.) Even the recent finding of E. Coli in New York City, while horrifying and inexcusable, represents an issue that can be treated fairly easily once discovered.
In speaking to our customers, an impurity that is coming up more frequently is chloramine. While certainly not a new disinfectant, the use of chloramine as a disinfectant of choice over chlorine is becoming more common in larger cities, including Los Angeles. This is due in large part to chloramine's stability, making it more effective at disinfection when water must travel longer distances.
Without a doubt, chloramine is an interesting disinfectant. Formed when ammonia is added to chlorine to treat drinking water, is both a more stable and weaker disinfectant than chlorine. While weaker, it is up to ten times harder to reduce from water, especially with a basic carbon water filter. Chloramine will also not effectively boil out of water or dissipate, as can be counted on with chlorine.
As is common, because the addition of chloramine in water is not always fully understood or fully communicated, it's a cause for concern that we see driving some of our purchases. And while we are happy to offer you a chloramine filter that will help to meet your needs, our goal is not to sell you something that you simply do not need – especially as a chloramine filter will typically cost you more out of pocket.
So before investing in a more expensive water filter than you are accustomed to, review the ten questions below to see if upgrading to reduce chloramine is something you truly need. You may also call our customer service team at 1-800-277-3458 if you have any additional questions:
1. Why are water companies putting chloramine in water?
In referencing the story above, that shares more about the recent switch to chloramine in Los Angeles, most municipalities and water companies see chloramine as a safer alternative to chlorine as it remains more effective over long distances and ensures less risk of toxic Disinfection By-Products (DBPs.) As such, using chloramine as a water disinfectant has been deemed a safer alternative whether your water will be consumed by humans or animals, with some exceptions discussed below.
Illinois American Water shares that despite this being a new disinfectant in many areas, cities throughout the US and Canada have used chloramine for decades. Denver, Colorado, in fact, has used it since 1917. Everpure, a brand we are proud to carry at our online store here, shares that 25% of the largest public water supplies in the US are using this disinfectant.
The answer to this depends upon whether your municipality or water company reached out to you to share that they'd be making the switch to chloramine as a disinfectant. If not, it's possible that they've used it for years. If this is the case, this information will be available either on your local water company's website or by calling them directly.
3. Were you contacted by your water company regarding overuse of chloramine?
As with any other incident impacting your water, your municipality or water company is required to inform you if you are at a health risk from your drinking water, whether due to a contaminant that can be boiled out or an impurity that risks impacting taste or odor. If your municipality has not issued any such alert, you are likely not at a high risk of chloramine contamination in your home, and would likely not need to invest in a chloramine filter.
4. If you have been contacted by your water company regarding overuse of chloramine, is this the first time or just the latest time?
On the other hand, if your water company has contacted you several times regarding the overuse of chloramine, it may be time to invest in a water filter or filtration system that puts your mind a bit more at ease. Whether this means you've been warned just one time or several times is a matter of personal opinion.
5. Have you noticed a much heavier chlorine taste and odor in your water?
As much as we always like to give local municipalities and water companies the benefit of the doubt, there have been some troubling instances where drinking water alerts were sent out late (the recent E. Coli contamination incident in Portland comes to immediate mind.)
If your drinking water smells and tastes like a swimming pool, it is definitely worth placing a quick call to your water company if you haven't received any alert.
6. What health effects does overuse of chloramine cause?
Fundamentally, the levels at which chloramine is used to treat municipal water is safe, as is any other type of similar disinfectant. It's certainly safer than virtually anything you'll find in untreated water, including any number of harmful bacteria.
Illinois American Water shares:
"Everyone can drink water that's chloraminated because the digestive process neutralizes the chloramines before they reach the bloodstream. It's only when water interacts directly with the bloodstream that chloramines must be removed."
Note that it's this direct contact with bloodstream that makes chloraminated water dangerous for fish or dialysis patients, rather than those just drinking chloraminated water. Even treating a cut with chloraminated water would not result in virtually any chloramine finding its way into your bloodstream.
In the event that you are exposed to higher than safe levels of chloramine, the EPA reports health effects including a stinging in the eyes or nose, stomach discomfort and dry, itchy skin. If you are experiencing any of these symptoms and are concerned that it may be due to exposure, call a doctor first. Check-in with your water company, and consider a water test kit and chloramine filter next.
7. Have you tested your water?
Chloramine is fairly easy to detect in water. You can use a $7 Culligan water test kit, found on our site and pictured, to effectively determine whether or not there are higher than safe levels of this disinfectant in your drinking water. If needed, we can even ship this out for you overnight.
8. Is anyone living in your home a kidney dialysis patient?
As stated by Illinois American Water:
In the dialysis process, water comes in contact with the blood across a permeable membrane. Chloramines in that water would be toxic, just as chlorine is toxic, and must be removed from water used in kidney dialysis machines.
In other words, yes, those that live with kidney dialysis patients need to take special precaution when it comes to chloramine. However, these patients need to take the same precaution when it comes to chlorine, making a switch in the disinfectant used by a municipality more of a lateral shift as far as their habits are concerned.
All kidney dialysis patients should consult with their physician on the most appropriate water treatment or filter options, whether due to chloramine or any other water contamination or disinfection issue.
9. Do you have an aquarium?
Similar to dialysis patients, any disinfectant used in water will come into contact with a fish's bloodstream, making filtration critical for those with more expensive aquarium set-ups.
If you have or are thinking about investing in an aquarium, we recommend researching the information that your local water company makes available to see what disinfectants are used, or asking your local aquarium shop if you should invest in a whole house or chloramine filter.
10. Are you a home brewer?
In researching the topic of chloramine, and specifically whether or not you need to employ a chloramine filter, you'll find a lot of content from the aquarium and home brewing communities.
With the home brewing community, the issue comes down to whether or not chloramine causes taste issues, particularly as this disinfectant is difficult to reduce using standard methods such as trusting a carbon filter or boiling.
More Beer puts it most effectively in stating:
If your water district is changing over to chloramination, or if you're moving to a chloraminated-water area, you may be wondering how you can get chloramines out of your brew water. First, however, you should ascertain whether chloramines really are a problem. Does your beer have off-flavors? If you can't taste anything and are not a trained taster, have it tasted by someone who is. If you aren't getting the medicinal or plastic-like taste of chlorophenols in your beer, don't worry about removing chloramines.
If you've come this far and determined that a chloramine filter is needed in your home, your options would include:
- Investment in a whole house water filtration system that will accept chloramine reducing cartridges, including the 10.5 x 4.5 inch cartridge from Pentek (pictured) or a larger 20 x 4.5 inch version
- Usage of appropriate water filtration media in your treatment system, including this catalytic carbon filter media we offer from Watts
- Trusting a point-of-use system, including a Doulton system that will fit onto your countertop or beneath your sink and accept an appropriate ceramic filter candle (including the candle linked here,) this refrigerator filter from Water Sentinel, or this shower filter from Crystal Quest. Our customer service team can provide you with several additional options.
Whether or not you need a chloramine filter will primarily come down to how sensitive you are to the smell and taste of disinfectant, rather than any health related issues. That said, this is small comfort if you are among those most sensitive to this type of water issue. It's also small comfort to those of you suffering through legitimate issues with chloramine contamination.
After reading this, if you feel as though a chloramine filter is right for your home, please review the products above for the right fit. I also invite you to call our customer service team with any questions at 1-800-277-3458.
Please like us on Facebook, follow us on Twitter or +1 us on Google+ to be the first to see exclusive new filter sales and discounts.
Are you a veteran, currently serving in the Armed Forces, or buying a gift for a veteran or soldier? Use the discount code 'VETERAN' at checkout to take 5% off your entire order!


text:
"Psalm 23," John August Swanson. Used by permission from the artist.
Image © by John August Swanson. Artwork held in the Luther Seminary Fine Arts Collection, St. Paul, Minn.
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Introduction to the Narrative Lectionary
Introduction Commentary
by Rolf Jacobson
The narrative lectionary is a set of readings for Christian worship, which moves through the overarching biblical story in a ninth-month period.
The narrative lectionary respects the traditional Christian church year, with its principal festivals and seasons -- Advent, Christmas, Lent, Easter, and Pentecost. It also respects the rhythms of the school year or program year, which influence the program lives of many congregations.
| Bible Text
2020-21 Readings (Year 3)
2020-21 Worship Resources
The narrative lectionary is a four-year cycle of readings. Read more.
Narrative Lectionary 000: Introduction
September 04, 2011
Join Profs. Rolf Jacobson, Kathryn Schifferdecker, and Craig Koester for "I Love to Tell the Story," a weekly conversation on the narrative lectionary.

subset: commoncrawl


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Earlier this week Collider was invited to visit Disney's animation studios to check out almost half-an-hour of footage from its upcoming video game riff, Wreck-It Ralph and chat with the film's director Chris Moore and several of the animators. During the visit, we saw how the film moved from concept to screen and got a peek inside the technical challenges involved in bringing the Ralph's five wildly different worlds to pixelated life. Hit the jump to find out about Paperman, the innovative new short that will be paired with Ralph, and the top 25 things to know about the feature.
Paperman is a sweet and romantic new short that combines traditional animation with computer renderings to create a whimsical world that mixes the two art forms in a way that I have never seen before.
The film, which tells the story of a work-a-day stiff who tries to get the attention of the girl of his dreams with the help of some paper airplanes, was created using CG models that artists then drew over in places. It's kind of like Waking Life or A Scanner Darkly, but much more inviting.
First time director John Kahrs shows some serious chops. While the short is sort of an experiment to test out new technology, the characters and visual storytelling never once stop to call attention to the technical prowess. Instead, all we see is the magical realism of the film's 1940s world and the plucky sincerity of its characters.
A great short, both technically, aesthetically and emotionally.
Top 20 Things to know about Wreck-It-Ralph
1. The general concept for Wreck-It-Ralph is over 10-years old. One previous version was Joe Jump and High Score. Moore had long wanted to do a movie about a character who has been stuck doing the same thing for thirty years, "What better world to set that in than a video game," said Moore. He didn't look at any work from the previous versions. "After a couple of days working on the idea, I thought, "This is a horrible idea because video game characters have no free will, you know? They're programmed, they don't get to do what they want. It would be dull to watch a movie about that, you know?' But then I thought, 'Well that's a great conflict for my main character to be banging his head against."
2. This film is Disney's 52nd animated film.
3. There are five worlds in the movie: Niceland (Ralph's home inside the Fix-It-Felix game cabinet), Game Central Station (where video game characters travel between worlds after the arcade closes), The actual arcade where all the games are held, Hero's Duty (a Halo style FPS) and Sugar Rush (a Mario Kart style racer set in a world made of candy).
4. Art Director Mike Gabriel described the movie's scope. "It's a big movie, bigger than normal," said Gabriel. "I have some of the numbers: The normal film has 40-60 unique characters. This one has 188. Most films about 25 master sets. This one has 79, almost 80 sets.
5. Gabriel described how the filmmakers gave a different favored shape to each world in order to differentiate them more fully. Niceland is square and clean, Game Central Station is clean lines, "Almost a sorbet to cleanse the pallet," said Gabriel. Hero's Duty is triangular and features an evil acid green. Gabriel compared it to the work of Ridley Scott. Sugar Rush is predominantly made of soft colors, pastels an circular.
6. The design for the interior of Game Central Station came from cutting up power strips and looking inside.
7. The design of Sugar Rush is heavily influenced by the work of Antoni Gaudí.
8. One abandoned concept was taking Ralph into a world that Moore describes as, "The Sims meets Grand Theft Auto" for his low point. The game would have been called, Extreme Easy Living 2. Ultimately, the idea was abandoned because it didn't make sense to have a social gaming platform inside of an arcade. John Lasseter reassured Moore, "Lasseter said, 'You know, on Toy Story there were tons of ideas we had to table because they just didn't fit. But they came back in Toy Story 2 and Toy Story 3, so just put it aside. If the movie does well, you can always bring it back."
9. Original concepts for the world of Niceland were thrown out because they felt too similar to videos readily available on the internet. Instead, the filmmakers developed a more complex three-dimensional take on the 8-bit world they kept the feeling of an old Nintendo cycle, but still looked and moved like a big budget Disney feature.
10. Meetings for the film included, "Throwing rocks into frosting."
11. Other research including racing go karts, playing tons of video games, eating lots of candy and traveling to Barcelona to look at architecture.
12. The whole of Disney's Animation Studio is decked out with Wreck-It-Ralph gear. Each stage of development is plastered on the wall. Early takes on Ralph and Felix hang as posters, mock up designs for Sugar Rush, made entirely of candy, sit next to the entrance under glass. They even retrofitted the snack room to look like an old 1980s arcade, complete with button mashing game cabinets.
13. This is not unique to Ralph. The animation studio is constantly reworked to help create a positive atmosphere for each new project.
14. Ralph went through dozens of different character designs but most often stayed a humanoid with a small head and giant hands, except during the three weeks where he was a giant white ape.
15. The filmmakers wrote the script with all the cameos before going to clear any of them. They went and personally spoke to the heads of many different gaming companies in order to secure the character rights to the film's many cameos. They also allowed for the game companies to give notes and final approval on the use of characters.
16. One of the strangest notes on character usage came from Nintendo, who insisted that Bowser would drink tea differently.
17. Though the film stays true to the essence of each video game cameo there was one major concession, size. Many of the gaming companies complained that their characters, particularly their villains would be much, much bigger. Eventually, the filmmakers decided to cheat that aspect so that M. Bison could share the screen with Bowser without necessitating ridiculous angles.
18. John Lasseter's name came up dozens of times during the day. Though this is not a Pixar film, it is clearly following a more Pixar model.
19. One of the Lasseterisms we heard was:
"There are three keys to making a great movie: a great concept filled with memorable characters and set in a believable world."
Ralph had to figure this model out five times over.
20. Another Lasseterism, "Celebrate the style" of each world. Figuring out Niceland took a lot of celebrating the 8-bit.
For more on Wreck-It-Ralph, here's our recap of the footage we saw including our recap on the process of creating the films five unique worlds.


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Today I'm happy to announce the release of JSDuck 3.0.
The project has grown quite tremendously since the initial 0.1 release almost a year ago. No more is it an alternative documentation generator, but an official one. Therefore I'm closing the old forum thread which has lots of outdated information and start a new fresh one.
Check out JSDuck at Github.
Although a lot has changed, the main features of JSDuck have remained the same:
* Support for Markdown, so you can write human-readable comments.
* Strong adherence to the DRY principle, so you don't have to repeat in comments what you already have said in code.
Over time JSDuck has been extended outside the realm of basic API documentation, allowing the creation of guides, examples and other things you see in the official Ext JS 4 documentation.
But for most users, these aren't as useful, so for this 3.0 release I'd like to highlight the latest and greatest API documentation related features:
* Inline examples allow you embed live demos of your components (no more limited to Ext JS 4 components) inside the documentation. No more will you need to create screenshots to show how your component looks like. Simple add an @example tag, and there you have it.
* Custom tags allow you to add support for metadata tags that JSDuck doesn't support natively, like @license, @date, @version.
Read the Advanced Usage Guide for details.
Like always, JSDuck is just a simple gem install away:
For Windows users, there is a downloadable binary version.Code:$ [sudo] gem install jsduck
For latest changes, see the changelog.


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Redwood Retirement Village
Please contact us if there is something not covered here.
Can I make alterations?
Alterations for reason such as a disability may be arranged with managements approval. You will be required to cover all costs associated with the alteration. You may be required to revert the unit to its original state (at your cost).
Can friends and family stay over?
Yes, you are welcome to have visitors to stay for up three weeks per year and thereafter with the village manager's approval.
What do the weekly fees cover?
Residents pay a village weekly fee, monthly in advance, which is calculated as a proportion of the cost of the village outgoings. This fee includes costs such as rates, insurance, rubbish collection, security patrols, lawn & garden maintenance of the common areas and will vary by facility.
What does the entry fee cover?
The entry cost gives you the right to live in the unit for their lifetime or as long as they choose as well as use the services and communal areas in the village.
What does the deferred management fee cover?
The deferred management fee (also known as the amenities fee) represents a contribution towards the provision of accommodation and communal village facilities and buildings.
What are my rights if the village got into financial difficulty?
Residents are protected through a first ranking mortgage with the Village's Statutory Supervisor. They hold first ranking mortgage over the village land in order to ensure priority and security for the rights of all residents. The statutory supervisor also ensures the operator of the village acts in accordance with the Disclosure Statement and the village is run in a financially responsible manner.
How long is the 'cooling off' period once the contract is signed?
As per the Retirement Villages Act, the cooling off period after an Occupation Right Agreement has been signed is 15 working days.
When leaving the village, what is the process for units being sold and can the resident or their families participate in the sale?
We will market your apartment and on resale refund the money you paid minus the Amenities Fee, and any other monies owing. Residents are welcome to introduce a prospective resident as long as they meet the normal entry criteria of the village.
What happens if there is a delay in sale?
If your unit has not been sold within six months of your licence termination, Bupa will pay what you are owed. If it sells sooner, Bupa will repay you upon settlement.
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Oster® 2-Slice Toaster
TSSTTRJB0Oster TSSTTRJB0K https://www.oster.com/on/demandware.static/-/Sites-master-catalog/default/dw474527e7/images/highres/TSSTTRJB0K-3.jpg
Start your day with toast made your way.See More...
- Dimensions: H: 7.3" x W: 7.1" x D: 10.2", Weight: 3lbs.
- Cord length: 24"
- Watts: 800W
Additional Information
This 2-slice toaster is equipped to toast breads, bagels and more to your taste. Advanced toasting technology and settings from light to dark provide consistent results every time. You can enjoy the perfect texture and shade of toast, bagel, waffle or english muffin. With the Oster® brand, you can cook with passion and serve with pleasure.
- Settings: Cancel, Frozen, Bagel
- Extra wide slots to accommodate a variety of breads
- Dual auto-adjusting bread guides adjust to bread thickness for even toasting
- Anti-jam feature automatically shuts toaster off
- Advanced toasting technology for consistent toasting every time
- Toast lift elevates breads for easy retrieval
- Removable crumb tray for easy cleaning
- 7 toast shade settings for light to dark toasting
Oster® 2-Slice Toaster is rated out of 5 by 132.
Rated 1 out of 5 by meno from Inconsistent Performance I bought my toaster two months ago, choice based on Oster brand and reputation. To date, not one piece of satisfactory toast. No matter how I many times I adjust the settings, am unable to get consistent results--too dark, too light, one side dark, one side light, etc. While the markings (toast that reflects wire patterns) don't actually affect toast, I see no need for them. In reviewing the posted comments, I consistently see "call phone number ### so Oster can help. This should NOT be necessary for a simple toaster!!! Unfortunately I no longer have my sales slip; otherwise this toaster would have been returned weeks ago.
Date published: 2017-01-11
Rated 5 out of 5 by Miffin712 from Stunning color The toaster is beautiful. Compliments my kitchen wonderfully. It toasts a little more evenly than most toasters. However, it is quite sensitive. It will take getting used to setting adjustment right. I put it on 2, and it was too "done" for me. I had my other toaster a little past 3, but that may just be because this is newer. The bagel setting also makes it toast browner, and not quite as even as the regular setting, but still better than my old one. I usually have to turn it and put it back down, but not on this one. Overall, it is a very good toaster, and definitely more attractive than most. I received this as a sample to review.
Date published: 2015-05-30
Rated 4 out of 5 by cassiew from Toasts to your taste! I was given this toaster as a sample to test out. I was a little skeptical at first because the first few times I used it, I smelled burning plastic. It scared me and I thought that maybe I left some of the packing materials inside the toaster. After a while the smell went away. The toaster works better than any other toaster I have had. It is very simple to use with only a couple of buttons and toasts to the level of doneness that you specify. I have not had any burnt toast, which I used to experience frequently on the lower settings of my old toaster. I highly recommend this toaster and am very pleased with it's performance
Date published: 2015-05-27
Rated 4 out of 5 by WifeMomGrandmaPunkin from Oster® 2-Slice Toaster, Metallic BLUE. Oster® 2-Slice Toaster, BLUE. I think this Toaster is really pretty! Remodeling our kitchen, we chose to accent with blue... This Toaster is described as Turquoise/Blue, however I would classify it as TEAL (it is on the verge of being green, compared to my other blue appliances). It toasts very well -- evenly, and on both sides. I am including photos for color comparison; without using the camera's flash (in just normal kitchen overhead light) you see the Teal/almost greenish hue... ONLY when using 'camera flash', does the Toaster appear a TRUER Blue. On the #5 Setting, our toast came out perfectly for us. Dropping from 5 to 4 stars, only because of the disappointment over (what I perceive to be) the Teal (not Turquoise) color.
Date published: 2017-01-09
Rated 4 out of 5 by Chelle from Decent The positive: The toaster is a very sleek and stylish model. Great on counter space. The slots are wide and accommodated even my largest bagels with ease. The negative: I toasted several different types of breads, pastries, and waffles. Frozen and unfrozen items as well. Many times one side was either cooked unevenly or burned even on the lowest setting. I found using the frozen setting was usually the cause for the item to become unevenly heated or burned. Overall, It did a decent job of toasting and I would recommend it to others. I received this product as a sample to review and feel the unit is a decent value.
Date published: 2015-11-04
Rated 5 out of 5 by ke2ke2 from a simple, sturdy toaster I don't have much complaints about this toaster; it's a nice toaster, and it does what a toaster does. I was a bit confused about the setting, however, and I still don't really know the difference between the "bagel" setting and "default." I'm assuming that the "frozen" setting begins at lower heat and increases. the toaster comes with an easily removable tray that can be pulled out for cleaning. It seems sturdy, and it's been serving the purpose of a toaster pretty well since I've had it. I had received the toaster for the purpose of writing this review, and in writing an honest one. I initially had no great expectations for it, but it has come in handier than expected.
Date published: 2015-11-09
Rated 4 out of 5 by CBritt from Classy Toaster! I was very pleased with this Oster 2-Slice Toaster! Not only is it very chic looking--I have the black/dark gray version--it's quality as far as toasting is superb. It toasted both slices of bread very evenly and, unlike some toasters I've had in the past, it didn't burn. I also liked the features on this product. You can set the 'darkness' of the toast as well as choose what type of bread you are toasting. This toaster also allows for a pretty thick slice of bread or a nice large bagel to be toasted. The only downside is it smells quite electrical with the first few uses. It eventually goes away but it can be a little bothersome at first. I received this product as a sample to review.
Date published: 2015-11-09
Rated 2 out of 5 by Jackie21 from Pretty but not the greatest Let me begin by saying the first use of f his toaster made my house smell like something burning for a good bit of the day. I always thought I would like a toaster that had a frozen button but I have changed my mind. When I used it for my frozen breakfast item it was cold after a couple of minutes. Retoasting on the lowest setting to heat back up came close to burning it, and I waited a few minutes between toasting. When I used it to make toast I had to put the bread on its side in order to toast the slice of bread. My cheap black friday toaster does a better job. DISCLAIMER: I received the Oster 2 - Slice Toaster as a sample to review.
Date published: 2015-11-05


text:
by Jill
Gary the Snail Costume
Rate this costume:
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More views: (click to enlarge)
Gary the Snail Costume
This is Aleck (Benjamin's lil brother, you can see him here as Sponge Bob Ü)
He is in costume as Gary the Snail.
Many thanks to Amy, Benjamin and Alecks Mom,
for great Contest entries. Ü
|Costume type:
|Costumes for Babies
This homemade costume for babies entered our 2008 Halloween Costume Contest.
Similar costumes:


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What is Spondylolisthesis?
Spondylolisthesis refers to a slippage of a vertebral body relative to an adjacent vertebra. Spondylolisthesis (or anterolisthesis) is the forward displacement of a vertebral body in relation to the vertebrae beneath it. The slippage may occur following structural changes (eg fracture or spondylolysis) or degenerative changes in the spine (eg spondylosis or degenerative disc disease). Approximately 5% of the population has a spondylolisthesis.
Retrolisthesis is the opposite. The upper vertebral body is displaced backwards relative to the vertebrae below. Laterolisthesis is a side ways shift that is rare. It can occur in advanced degenerative spines or after asymmetrical fractures or severe scoliosis.
Spondyloptosis refers to dislocated vertebrae. In these instances, your spondylolisthesis is so extensive that the upper vertebrae translates entirely forward and off the vertebrae below. See Grade V below.
What are the Symptoms of Spondylolisthesis?
Spondylolisthesis may not cause any symptoms for years (if ever) after the slippage has occurred. If you do have symptoms, they may include:
- insidious onset low back pain, buttock or leg pain
- pain arching your back
- increased sway back
- tight hamstrings – 80% of cases
- a limp (walking)
More severe cases are those that reproduce neurological signs eg
- numbness, tingling, (sciatica) pain, muscle tightness, muscle weakness in the leg and/or diminished reflexes.
A step deformity may also be observed or palpated in the lower back.
What Causes a Spondylolisthesis?
Isthmic vs Degenerative Spondylolisthesis
The two major causes of spondylolisthesis are isthmic spondylolisthesis associated with spondylolysis and degenerative spondylolisthesis associated with degeneration of the posterior facet joints (spondylosis) and/or intervertebral disc (degenerative disc disease).
Degenerative spondylolisthesis occurs mostly (88.5%) at the L4-5 level as opposed to isthmic spondylolisthesis, which occurs most often at the lumbosacral level (L5-S1) (84.6%). Approximately 75% of spondylolisthesis occur at L5 on S1 and 20% at L4 on L5. One study showed that 26% had suffered a fall.
Dysplastic & Other Spondylolisthesis
Dysplastic or congenital spondylolisthesis is caused by poorly formed facet joint structure at birth leading to the vertebral slippage. Other causes related to traumatic or pathological fractures and post-surgical failure are rare.
Spondylolisthesis and Your Age?
Congenital or dysplastic spondylolisthesis has an early childhood onset as mentioned above.
Isthmic spondylolisthesis is more prevalent in the pre-teen and adolescent years in the athletic youth populations. Sports that involve hyperextension and rotation. eg gymnastics, fast bowling (cricket), hurdling, tennis, wrestling and other throwing or overhead racquet sports are higher risks. Spondylolysis (back stress fracture) initially occurs and about 50% of cases slip to develop into a spondylolisthesis.
Most isthmic spondylolisthesis stabilise at skeletal maturity. The fractures themselves may not heal but it is thought that the muscles controlling the spondylolisthesis provide sufficient functional control to avoid painful symptoms.
Degenerative spondylolisthesis is more common with advancing age. The vertebrae slip forwards without a fracture present. The slippage is related to chronic spinal segment instability due co-existing pathologies such as degenerative disc disease or facet joint arthritis (spondylosis). They are also more likely to cause recurrent symptoms.
Due to the whole vertebrae and arch slipping forwards degenerative spondylolisthesis can cause spinal stenosis and compromise spinal nerve roots. Compromise of the spinal nerve roots may result in a radicular pain syndrome such as sciatica or significant develop motor power deficits (radiculopathy). In extreme cases, the stenosis and slippage could compromise the cauda equina and develop cauda equina syndrome, which is a medical emergency and will require immediate surgical intervention.
Spondylolisthesis Risk Factors
Known risk factors include:
- Sports involving hyperextension and rotation
- Genetic predisposition. You have a 26% chance if a parent has one.
- Spondylolisthesis: Females 2-3 times
- Spondylolysis (no slip): Males 2-3 times
- Generalised hypermobility.
- Spina bifida occulta
- Facet joint morphology
- Inuit population
- Degenerative spondylolisthesis is more prevalent in pregnant women and black individuals.
How is Spondylolisthesis Diagnosed?
Your physiotherapist will begin by taking a history and performing a physical examination. A palpable step or depression may be present to indicate the likelihood of a spondylolisthesis. Your physiotherapist may order X-rays of your back.
A CT scan or MRI scan can show a fracture or pars defect more clearly, plus exclude other potential pathologies such as malignancy, infections or spinal stenosis. They will also show whether any of the nearby facet joints or discs have suffered any degeneration.
If spondylolisthesis is present, it is graded as I (mild), II, III, IV or V based on how far forward the vertebra has slipped.
Classification by degree of the slippage, as measured as a percentage of the width of the vertebral body:
- Grade I: 0-25%
- Grade II: 25- 50%
- Grade III: 50-75%
- Grade IV: 75-100%
- Grade V: greater than 100% (Spondyloptosis)
Please consult your doctor or physiotherapist for your specific diagnosis, grading and recommended treatment plan.
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Spondylolisthesis Treatment
If your physiotherapist or doctor determines that a spondylolisthesis is causing your pain, non-surgical treatment is the primary choice. Treatment will include activity modification plus some specific exercises. Please consult your physiotherapist for a thorough assessment and prescription of the best exercises for your spondylolisthesis. The prognosis is very good for low-grade spondylolisthesis. (Hardwick et al., 2012)
However, the type of exercise that you perform can significantly alter your outcome. One study showed a 73% improvement at 3-months with one exercise group versus only 33% improvement in the alternative exercise group. For advice specific to your spondylolisthesis, please consult with your physiotherapist.
Physiotherapy Treatment
As you begin a physiotherapy treatment regimen your physiotherapist may prescribe manual therapies or other pain relieving techniques to reduce your pain and muscle spasms.
Because your muscles are the only effective way of controlling your slipping vertebrae, exercises will be aimed at the recruitment of your deep spinal stabilising muscles. You may also be prescribed gentle stretches to improve your posture and help to reduce your back pain or leg symptoms.
Flexion based and localised stabilisation/motor control exercises have been shown to improve both pain and disability. (Hardwick et al., 2012, Nava-Bringas et al., 2014)
When you have less pain and improving neurological signs, your exercises will be progressed to improve your flexibility, strength, endurance, and the ability to return to a more normal lifestyle. A comprehensive program may require several weeks or a few months of supervised treatment. For specific advice relative to your spondylolisthesis, please consult your physiotherapist for an individualised assessment.
Spondylolisthesis Prognosis
The presence of a spondylolisthesis by itself usually does not represent a dangerous condition in the adult. Outcomes are excellent for low-level spondylolisthesis with the vast majority of cases having favourable short-term and long-term outcomes.
Most spondylolisthesis Grade I-II patients respond favourably within a few weeks of commencing treatment. A Swedish study showed no significant difference in a long-term randomised study that compared 111 patients who underwent an exercise program versus fusion surgery in adult isthmic spondylolisthesis patients. Patients improved in the short and long-term. Follow-up mean was 9 years. (Ekman et al., 2005)
Grade III+ patients have less favourable outcomes and may require surgery if they do not respond positively to conservative treatment.
Secondary Spondylolisthesis Treatment Options
In recalcitrant cases, Pulsed Radio Frequency (PRF) is a pain management technique that can be administered to your facet joint nerves. Researchers have found it is more effective than epidural steroid injections, which is another short-term pain relieving option. (Hashemi et al., 2014)
Spondylolisthesis Surgery?
Surgery is occasionally warranted if you have failed your exercise-based conservative treatment. 10-15% of patients with degenerative spondylolisthesis have surgery. Surgery is considered when there is a failure to improve a radiculopathy eg muscle weakness, poor function or another neurological deficit such as loss of bowel or bladder function. Persistent severe pain is also a consideration for surgery.
Surgery for isthmic spondylolisthesis is considered for athletes with Grade III+ slips if they have failed 6-months of conservative exercise rehabilitation. (Radcliff et al., 2009)
Your surgery options are best discussed with your Spinal Surgeon, but they would normally involve a spinal decompression +/- spinal fusion.
Fortunately, conservative exercise options are successful in the vast majority of Grade I-II cases. Please consult with your physiotherapist for their professional assessment and specific treatment guidance for your spondylolisthesis.
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FAQs about Spondylolisthesis
Common Lower Back Pain Causes
The following conditions may cause lower back pain.
General Information
Muscle-related Injuries
- Back Cramps
- Back Muscle Pain
- Core Stability Deficiency
- DOMS - Delayed Onset Muscle Soreness
- Fibromyalgia
- Side Strain
Bone-related Injuries
- Back Stress Fracture
- Osteoporosis
- Scheuermann's Disease
- Scoliosis
- Spinal Stenosis
- Spondylosis
- Spondylolysis
- Spondylolisthesis
- Stress Fracture Spine (Cricket Bowlers)
Disc-related Injuries
Back Joint Injuries
Nerve-related Injuries
Pelvis-related Injuries
Pregnancy-related Pain
Systemic Diseases
Nerve PainNerve pain is pain that is caused by damage or disease that affects the nervous system of the body. It is also known as neuropathic pain or neuralgia. Nerve pain is a pain that comes from problems with signals from the nerves. It is different to the common type of pain that is due to an injury. This is known as nociceptive pain.
What Causes Nerve Pain?Neuropathic pain is caused by a problem with your nerves themselves, which sends pain messages to the brain.
What is Nerve Pain Symptoms?Nerve pain is often described as burning, stabbing, shooting, aching, or like an electric shock.
What Causes Nerve Pain?Various conditions can affect your nerves and cause nerve pain. Common sources of nerve pain include:
- Shingles (post-herpetic neuralgia).
- Trigeminal neuralgia.
- Diabetic neuropathy.
- Phantom limb pain following an amputation.
- Cancer.
- Multiple sclerosis.
- Chemotherapy.
- HIV infection.
- Alcoholism.
- Other nerve disorders.
Nerve Pain & Nociceptive PainYou can suffer both nerve pain and nociceptive pain simultaneously. Both pain types can be caused by the same condition.
Nerve Pain TreatmentNerve pain is less likely than nociceptive pain to be helped by traditional painkillers such as paracetamol, anti-inflammatories and codeine. However, other types of medicines often work well to ease the pain. Nerve pain is often eased by anti-depressant or anti-epileptic medicines. Please ask your doctor for more advice.
Pain LinksPain & Injury
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Pins and Needles - Paraesthesia
What Causes Pins & Needles?
A moderately pinched nerve is the most common cause of "pins and needles". Pins and needles are referred to as "paraesthesia" in the medical community. Did you know that feeling "pins and needles" can be a worse sign than having pain in your arm or leg? The reason is that you can't even feel pain anymore when you significantly squash the nerve.
Even worse than "pins and needles" is "numbness" or "anaesthesia", which is a total lack of sensation. You will experience anaesthesia when there is severe nerve compression. Anaesthesia or numbness that persists for more than a few hours can be a sign of permanent nerve compression. Please seek prompt medical attention to prevent the nerve from permanent damage and the muscles it innervates to weaken drastically.
The majority of pinched nerves and nerve compressions are only transient and quickly reversed with early treatment. However, neglect can lead to permanent nerve compression injuries, which may never recover.
Common Causes of Pinched Nerves
The most common forms of nerve compression are in the spinal joints where either a disc bulge or a bony arthritic spur can irritate and compress the nerve. Compressions can also occur as the nerve passes through or around muscles. Your physiotherapist will know where to look.
How Can You Fix "Pins and Needles"?
If you know of someone who is experiencing chronic or permanent "pins and needles", "numbness" or "muscle weakness", please encourage them to seek urgent professional advice. The secret to quick success is the correct diagnosis. A highly trained health practitioner such as your physiotherapist or doctor is your best port of call.
More info
Youth Spinal Pain
Teenager Neck & Back PainTeenagers can be particularly vulnerable to back pain, mainly due to a combination of high flexibility and low muscle strength and posture control. The competitive athlete and most individuals who exercise regularly or maintain a level of fitness and core stability control are less prone to spine injury and problems due to the strength and flexibility of supporting structures. Your physiotherapist can assist the resolution of any deficits in this area. Luckily, issues involving the lower lumbar spine are rare in athletes and account for less than 10% of sports-related injuries. Injuries do occur in contact sports and with repetitive strain sports. Sports such as gymnastics, cricket fast bowlers, and tennis have a higher incidence of associated lumbar spine problems related to repetitive twisting and hyper-bending motions. Spondylolisthesis is a significant concern and needs to be appropriately treated by a physiotherapist with a particular interest in these type of injuries. Luckily, most injuries are minor, self-limited, and respond quickly to physiotherapy treatment.
Common Adolescent Spinal Injuries
Lower Back (Lumbar Spine)
Midback (Thoracic Spine)
Neck (Cervical Spine)
PelvisCommon Youth & Teenager Sports Injuries Common Youth Leg Injuries Common Youth Arm Injuries
Back Muscle StrainsBack muscle injuries are the most common form of back injury. Muscle fatigue, excessive loads or poor lifting postures are the most common problems. Inefficient back muscles can lead to poor joint stabilisation and subsequent injury. More info: Back Muscle Pain
Ligament SprainsLigaments are the strong fibrous bands that limit the amount of movement available at each spinal level. Stretching ligaments too far or too quickly will tear them with subsequent bleeding into the surrounding tissues, causing swelling and pain. Awkward lifting, sports injuries, and motor vehicle accidents are very common causes. Just as in other regions of the body, physiotherapy hastens ligament healing and relieves pain so that you can enjoy life again as soon as possible. More info: Back Ligament Sprains
Bulging DiscsA bulging disc injury is a common spine injury sustained to your spine's intervertebral disc. Spinal discs are the shock-absorbing rings of fibrocartilage and glycoprotein that separate your bony vertebral bodies while allowing movement at each spinal level, and enough room for the major spinal nerves to exit from the spinal canal and travel to your limbs. The annulus is the outer section of the spinal disc, consisting of several layers of multi-directional fibrocartilaginous fibres all densely packed to create a wall around the glycoprotein filled jelly-like disc nucleus. A disc bulge (commonly referred to as a slipped disc), can potentially press against or irritate the nerve where it exits from the spine. This nerve pinch can cause back pain, spasms, cramping, numbness, pins and needles, or pain in your legs. More info: Bulging Discs
Bone InjuriesYou can also fracture your spine if the force involved is highly traumatic or you have a low bone density (e.g. osteoporosis). More info: Osteoporosis
Poor PosturePoor posture when sitting, standing or lifting at work can place unnecessary stress on your spine. Muscles fatigue, ligaments overstretch, discs stretch and this places spinal joints and nerves under pain-causing pressure. More info: Poor Posture
What Can Cause Severe Low Back Pain?A sudden injury most often causes acute low back pain. The most common injury sources are the muscles and ligaments supporting the back. The pain may be caused by muscle spasms or a strain or tear in the muscles and ligaments. But occasionally, it can have a more sinister cause.
Warning Signs of a More Serious Back Injury?In these instances of neurological deficit, please urgently consult your nearest hospital, doctor or physiotherapist. The following neurological signs warrant prompt assessment:
- pins and needles (paraesthesia),
- numbness (anaesthesia),
- leg muscle weakness,
- altered reflexes,
- difficulty walking,
- loss of control of bladder or bowels.
Non-Musculoskeletal Causes of Low Back PainAlthough most low back pain is musculoskeletal in origin, other health conditions can cause low back pain.
- Abdominal aortic aneurysm
- Infection of the spine (osteomyelitis, discitis)
- Kidney infection or kidney stones
- Spondyloarthropathies: e.g. rheumatoid arthritis, psoriatic arthritis.
- Female reproductive organs: e.g. pregnancy complications, ovarian cysts or cancer, endometriosis
What Causes Lower Back Pain?Researchers and spinal health care practitioners categorise lower back bain into the following categories: 1. Specific Spinal Pathologies (<1%) 2. Radicular Syndromes (5-10%)
- Radicular pain, e.g. sciatica
- Radiculopathy
- Spinal Stenosis
Specific Spinal PathologiesSome conditions that cause back pain do require an urgent and specific referral and treatment. These conditions include:
- spinal infections
- cancer (malignancy)
- spinal arthropathies (e.g. rheumatoid arthritis or ankylosing spondylitis)
- cauda equina syndrome
- spinal fractures.
Radicular SyndromesLower back pain can result from structural damage that can irritate or pinch a nerve. Researchers believe that radicular syndrome causes 5-10% of the presentations of back pain to general practitioners.
Radicular pain (e.g. sciatica)The most common pinched nerve in the lower back is your sciatic nerve. You may be diagnosed with sciatica if you are suffering radicular pain down your leg due to a back injury. While the sciatic nerve is the most common nerve that can be affected by a spinal injury, you can modify any spinal nerve function (e.g. femoral nerve). The following back injuries may cause radicular pain:
- Herniated disc (slipped disc)
- Facet joint sprain
- Spondylolisthesis
- Spondylolysis
- Degenerative disc disease
- Spondylosis
- Back ligament sprain.
RadiculopathyLumbar radiculopathy can result in functionally disabling conditions such as foot drop, foot slap or eversion muscle weakness that can affect your ability to walk.
Spinal StenosisSpinal stenosis is a slightly different condition and relates to the narrowing of the spinal canal. Spinal stenosis is usually more prevalent as you age.
Non-Specific Lower Back Pain (NSLBP)Non-Specific Lower Back Pain (NSLBP) is the diagnostic term used to classify sufferers of lower back pain with no specific structure injured. It is a diagnosis of exclusion. In other words, your spinal health care practitioner has excluded specific spinal pathologies and any of the radicular syndromes mentioned above as the cause of your back pain or symptoms. Fortunately, these conditions account for approximately 90-95% of lower back pain and can nearly always successfully rehabilitate without the need for surgery. Most improve within two to six weeks. They can be fast-tracked with pain relief and physiotherapy techniques such as manual therapy and back exercises.
NSLBP CausesThe causes of NSLBP are numerous but roughly fall into either a sudden (traumatic) or sustained overstress injuries. Most people can relate to traumatic injury such as bending awkwardly to lift a heavy load that tears or damages structures. However, sustained overstress injuries (e.g. poor posture) are probably more common but also more straightforward to prevent. In these cases, positional stress or postural fatigue creates an accumulated microtrauma that overloads your lower back structures over an extended period to cause injury and back pain. Most commonly, NSLBP causes include back muscle strain or back ligament sprain. Other chronic back conditions such as degenerative disc disease may underly your acute disc health and predispose you to the severe pain. The good news is that you can take measures to prevent or lessen most back pain episodes. Early diagnosis and specific individualised treatment is the easiest way to recover quickly from lower back pain and to prevent a recurrence.
What is Back Muscle Pain?Back muscle pain or its aliases: pulled back muscle, back muscle spasm, torn back muscle or back muscle strain, is very common. Back muscle pain is the most common source of back pain. The good news is that it is also one of the quickest to heal and rehabilitate.
What Causes Back Muscle Pain?Most causes of low back pain are muscle, ligament or joint-related. Commonly, these muscular strains, ligament sprains and joint dysfunction arises suddenly during or following physical loading of your spine. Muscle fatigue, excessive loads, high speeds or poor lifting postures are the most common causes. The causes of pure back pain are numerous but roughly fall into the following categories.
Back Muscle StrainsMuscle pain is the most common source of back pain. Muscle fatigue, excessive loads or poor lifting or sitting postures are the most common problems. Inefficient, weak, or back muscles that lack endurance or normal contraction timing can lead to reduced joint stabilisation and subsequent injury to your back muscles, ligaments, joints or even spinal discs.
Poor PosturePoor posture, when sitting, standing and lifting at work, can place unnecessary stress upon your spine. With muscle fatigue or overstretching, your ligaments and discs can stretch, and this puts spinal joint muscles and nerves under pain-causing pressure or strain, that results in back pain.
Ligament SprainsLigaments are the durable, fibrous bands that limit the amount of movement available at each spinal level. Stretching ligaments too far or too quickly will tear them with subsequent bleeding into the surrounding tissues, causing swelling, muscular spasm and pain. Awkward lifting, sports injuries and motor vehicle accidents are prevalent causes. Just as in other regions of the body, physiotherapy hastens ligament healing and relieves pain so that you can enjoy life again as soon as possible.
What are the Symptoms of Back Muscle Pain?Back muscle pain symptoms may range from a mild ache to sudden debilitating back pain. Typical back muscle pain symptoms include:
- Localised back pain, with no radiation into your buttock or leg.
- Back muscle tenderness and spasm.
- Protective back stiffness.
- Sudden back pain onset.
How is Back Muscle Pain Diagnosed?Differentiating a back muscle strain from a ligament sprain can be difficult, as both injuries will show similar symptoms. In general, it doesn't significantly matter what you call the problem because the treatment and prognosis for both back muscular strains and ligament sprains are similar. Most spinal practitioners refer to both injuries as a category called a "Back Strain" or "Musculoligamentous Strain". X-rays and CT scans do not identify muscle or ligament injury. MRI scan is probably the best diagnostic test to determine the muscle or ligament structures injured.
What is Back Muscle Pain Treatment?
Seek a Professional Diagnosis!A spinal healthcare practitioner, such as your physiotherapist, should thoroughly; examine you to exclude more severe sources of back pain. Numerous injuries can cause back pain, and the treatment does vary significantly depending on your diagnosis. Physiotherapy treatment aims to protect your damaged tissue while hastening your muscle and ligament healing and then look at strategies to prevent a recurrence. Your physiotherapist has some nifty tricks for quickly relieving your back pain so that you can enjoy life again as soon as possible.
Back Strain CausesWe do know that some people are vulnerable to repeated lower back sprains and strains. While it is easier to understand that lifting a heavy load in an awkward position can cause back pain, it's harder to comprehend how a simple movement can hurt your back. Yes, it can happen by merely leaning forwards to pick up your teacup or when bending to brush your teeth! The reason is poor local joint control. The main reason for this is inadequate or non-existent muscle activation of the deep core stability muscles. These muscles are small but are right next to the joint to control excessive slides and glides. When they don't work correctly, the joint can slide too far and strain its supporting ligaments. Ouch! That hurts. The good news is poor core stability can be easily corrected to prevent back pain. Please contact your physio for more information or to have your core activation accurately assessed. High-risk factors of back pain include:
- sudden forceful movement
- lifting a heavy object
- twisting the back
- coughing or sneezing
- prolonged sitting with poor posture
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What is Physiotherapy Treatment?
Physiotherapists help people affected by illness, injury or disability through exercise, manual joint therapy, soft tissue techniques education and advice. Physiotherapists maintain physical health, help patients to manage pain and prevent disease for people of all ages. Physiotherapists help to encourage pain-relief, injury recovery, enabling people to stay playing a sport, working or performing activities of daily living while assisting them to remain functionally independent.
There is a multitude of different physiotherapy treatment approaches.
Acute & Sub-Acute Injury Management
Hands-On Physiotherapy Techniques
Your physiotherapist's training includes hands-on physiotherapy techniques such as:
- Joint Mobilisation (gentle joint gliding techniques)
- Joint Manipulation
- Physiotherapy Instrument Mobilisation (PIM)
- Minimal Energy Techniques (METs)
- Massage
- Soft Tissue Techniques
Your physiotherapist has skilled training. Physiotherapy techniques have expanded over the past few decades. They have researched, upskilled and educated themselves in a spectrum of allied health skills. These skills include techniques shared with other healthcare practitioners. Professions include exercise physiologists, remedial massage therapists, osteopaths, acupuncturists, kinesiologists, chiropractors and occupational therapists, just to name a few.
Physiotherapy Taping
Your physiotherapist is a highly skilled professional who utilises strapping and taping techniques to prevent and assist injuries or pain relief and function.
Alternatively, your physiotherapist may recommend a supportive brace.
Acupuncture and Dry Needling
Many physiotherapists have acquired additional training in the field of acupuncture and dry needling to assist pain relief and muscle function.
Physiotherapy Exercises
Physiotherapists have been trained in the use of exercise therapy to strengthen your muscles and improve your function. Physiotherapy exercises use evidence-based protocols where possible as an effective way that you can solve or prevent pain and injury. Your physiotherapist is highly-skilled in the prescription of the "best exercises" for you and the most appropriate "exercise dose" for you depending on your rehabilitation status. Your physiotherapist will incorporate essential components of pilates, yoga and exercise physiology to provide you with the best result. They may even use Real-Time Ultrasound Physiotherapy so that you can watch your muscles contract on a screen as you correctly retrain them.
- Muscle Stretching
- Core Exercises
- Strengthening Exercises
- Neurodynamics
- Balance Exercises
- Proprioception Exercises
- Real-Time Ultrasound Physiotherapy
- Swiss Ball Exercises
Biomechanical Analysis
Biomechanical assessment, observation and diagnostic skills are paramount to the best treatment. Your physiotherapist is a highly skilled health professional. They possess superb diagnostic skills to detect and ultimately avoid musculoskeletal and sports injuries. Poor technique or posture is one of the most common sources of a repeat injury.
Aquatic water exercises are an effective method to provide low bodyweight exercises.
Sports Physiotherapy
Sports physio requires an extra level of knowledge and physiotherapy skill to assist injury recovery, prevent injury and improve performance. For the best advice, consult a Sports Physiotherapist.
Vestibular Physiotherapy
Women's Health
Women's Health Physiotherapy is a particular interest group of therapies.
Workplace Physiotherapy
Not only can your physiotherapist assist you in sport, but they can also help you at work. Ergonomics looks at the best postures and workstation set up for your body at work or home. Whether it be lifting technique improvement, education programs or workstation setups, your physiotherapist can help you.
Plus Much More
Your physiotherapist is a highly skilled body mechanic. A physiotherapist has particular interests in certain injuries or specific conditions. For advice regarding your individual problem, please contact your PhysioWorks team.
What is Therapeutic Ultrasound?Therapeutic ultrasound is an electrotherapy modality which has been used by physiotherapists since the 1940s. Via an ultrasound probe through a transmission coupling gel in direct contact with your skin, ultrasound waves are applied. Therapeutic ultrasound may increase:
- healing rates
- tissue heating
- local blood flow
- tissue relaxation
- scar tissue breakdown.
How Could Ultrasound Help?Ultrasound increases local blood flow. This increase may help to reduce local swelling and promote soft tissue healing rates. A higher power density may soften scar tissue.
Specific Ultrasound UsesMastitis or blocked milk ducts successfully respond to therapeutic ultrasound. The effect is quite dramatic, with improvement within 24 to 72 hours. The most common conditions treated with ultrasound include soft tissue injuries such as muscle, ligament injuries or some tendinopathies. Phonophoresis uses ultrasound in a non-invasive way of administering medications to tissues below the skin. This method may assist patients who are uncomfortable with injections. With phonophoresis, the ultrasonic energy forces the drug through the skin.
What is an Ultrasound Dose?A typical ultrasound treatment will take from 3-10 minutes. Where scar tissue breakdown is the goal, this treatment time could be much longer. During the procedure, the head of the ultrasound probe is in constant motion. If kept in continuous motion, the patient should feel no discomfort at all. Some conditions treated with ultrasound include soft tissues injuries such as muscles or ligament injuries, tendinopathy, non-acute joint swelling and muscle spasm.
How Does an Ultrasound Work?A piezoelectric effect, caused by the vibration of crystals within the ultrasound head of the probe creates the sound waves. The ultrasound waves generated then pass through the skin cause a vibration of the local soft tissues. This repeated cavitation can cause a deep heating locally though usually no sensation of heat will be felt by the patient. In situations where a heating effect is not desirable, an athermal application occurs. Athermal doses are typical during acute fresh injury and the associated acute inflammation.
When Should Ultrasound be Avoided?Contraindications of ultrasound include:
- local malignancy,
- over metal implants,
- local acute infection,
- vascular abnormalities,
- active epiphyseal regions (growth plates) in children,
- over the spinal cord in the area of a laminectomy,
- over the eyes, skull, or testes
- and, directly on the abdomen of pregnant women. Treatment ultrasound differs from diagnostic ultrasound!
Lower Back Pain Treatment Guidelines?While lower back pain treatment will vary depending on your specific diagnosis, your physiotherapist will have the following aims.
PHASE I - Back Pain Relief & ProtectionManaging your back pain is the main reason that you seek treatment for lower back pain. In truth, it was the final symptom that you developed and should be the first symptom to improve. Your physiotherapist will use an array of treatment tools to reduce your pain and inflammation. These include ice, electrotherapy, acupuncture, de-loading taping techniques, soft tissue massage. A course of non-steroidal anti-inflammatory drugs such as ibuprofen may also help in this phase.
PHASE II - Restoring Normal ROM and Strength. Early Back Exercises.As your lower back pain and inflammation settles, your lower back pain may feel better. Still, you are more vulnerable to re-injury during this honeymoon period when you don't have pain, but your muscles and ligaments are weak. During this phase, your physiotherapist will turn their attention to restoring your normal lumbar spine motion. Plus they'll assess your muscle length and resting tension, muscle strength and endurance, proprioception, balance and gait (walking pattern). Your physiotherapist may commence you on a lower abdominal core stability program to facilitate your important muscles that dynamically control and stabilise your lower back and pelvis. Your physiotherapist will assess your muscle recruitment pattern and prescribe the best back exercises for your specific needs.
PHASE III - Restoring Full FunctionDepending on your chosen work, sport or activities, your physiotherapist will aim to restore your back's function to allow you to return to your desired activities safely. Everyone has different demands for their lower back that will determine what specific treatment goals you need to achieve. For some, it is merely to walk around the block. Others may wish to run a marathon or be a fast bowler. Your physiotherapist will tailor your back pain rehabilitation to help you achieve your own functional goals.
PHASE IV - Back Exercises - Preventing a RecurrenceRecurrence of lower back pain can occur. The main reason for a recurrence is due to insufficient rehabilitation. In particular, poor compliance with deep abdominal core muscle exercises. You should continue a version of these back exercises routinely a few times per week. Your physiotherapist will assist you in identifying the best activities for you to continue indefinitely.
Suffering Back Pain. What Should You Do?While lower back pain is commonplace, the diagnosis of the cause of your back pain is specific to you, and therefore, the treatment or investigation pathway varies for each case. A spinal health care professional can assist you with a prompt diagnosis, early referral, acute and chronic back pain relief, plus long-term self-management or back pain prevention strategies specific to you. You should feel confident that your practitioner has screened you particular pathologies that require urgent medical attention. They should assess you for neurological deficits such as:
- loss of bowel or bladder function,
- leg muscle weakness,
- loss of sensation,
- diminished reflexes,
- and, day-to-day function.
What Should You Do When You Suffer Back Pain?
Rest?The latest research recommends that you only spend a day or two resting in bed. More extended periods cause muscle weakness which ultimately makes repeat back pain more likely.
Ice or Heat?We recommend ice treatment for 20 minutes every 2 or 3 hours for the first 48 hours. The ice should help reduce your pain, swelling and back spasms. After a few days, you are safe to use heat packs. We usually recommend avoiding heat (and heat rubs) in the first 48 hours. Heat packs encourage bleeding, which could be detrimental if used too early.
Should You Use a Back Brace?A back brace can help you to get back on your feet or allow you to return to work sooner. We don't encourage long-term use because research has shown that your stomach and back muscles will weaken as you become reliant on the brace.
What Medication Should You Use?Your Doctor or Pharmacist may recommend pain relief in the form of paracetamol or an anti-inflammatory. You are best seeking their advice as certain drugs can interfere with other health conditions.
When Should You Commence Physio?In severe cases, when the slightest movement causes unbelievable pain or spasm, it may be best to wait a day or two to start treatment. This delay will allow the majority of swelling to settle. Slight niggles or "my back feels out" sufferers can usually commence treatment (and maybe fixed) on the day of injury. If you are not sure what to do, please call us for advice. We'll happily guide you in your time of need.
What About Core Stability Training?The current trend in physiotherapy and fitness training is 'core stability training' (back and abdominal muscle control).
What If You Do Nothing?Research tells us that symptoms lasting longer than three months become habitual and are much harder to solve. The sooner you get on top of your symptoms, the better your outcome and the quicker you'll get back to living your life."Back pain is something you could be suffering needlessly".
What Results Should You Expect from Physiotherapy?Not only will your physio diagnose the cause of your pain and give you the "peace of mind" associated, but they'll also help you to:
- Relieve your pain quicker
- Cope better with your pain using proven strategies and tips
- Get you back to work and play quicker through faster healing rates
- Loosen and strengthen your back with individually prescribed exercises
- Prevent future bouts of back pain via our holistic back pain management approach
Core ExercisesWhile all back exercises that strengthen the muscles that traverse your back are essential, back pain researchers have emphasised retraining your deep core muscles as a priority. "Core Stability" is your body's ability to control and support your spine via specific muscles dynamically. Your spine is an inherently unstable area of your body. Your lower back has five vertebrae that allow twisting, bending and arching with no other bones to assist. They sit on top of a triangular bone called the sacrum, which wedges itself into the pelvis. Unfortunately, without strong support, all of these bones would fall in a heap on the ground. Your deep core muscles are the main structures that support, control and move your lower spine and pelvis. They are also the most energy-efficient and best-positioned muscles to do the job for 24 hours a day. However, when they turn off, your spine is not fully supported by its usual muscular corset. This lack of support makes it quite vulnerable to injury and chronic pain. Research has shown that our back pain causes your "deep core stability" muscles to STOP working in EVERY case. The first time you experience low back pain, your brain automatically inhibits the regular activity of the Transversus Abdominis (TA) muscle. This inhibition occurs in 100% of sufferers. Unfortunately, even once the back pain has eased the TA muscle does not automatically switch on again. Inhibition of the TA muscle exposes your spine to further trauma and hence "recurrent back pain". Each incident becomes a little more severe, and consequently, further wasting of the TA occurs. Other causes of muscle inhibition include previous abdominal surgery, pelvic pain and post-pregnancy.
What are the Benefits of Core Stability Training?Researchers have shown that the correct use of your core stability muscles not only prevents pain but also alleviates pain if you're already suffering. Also, your body's strength, power, endurance and performance will improve. You'll be able to run faster, jump higher and even throw further when these muscles work correctly. For more information, please contact your physiotherapist.
Core Stability MusclesThe deep core stability muscles of the lower spine include:
- Transversus Abdominis (TA)
- Multifidus (MF)
- Pelvic Floor (PF)
Transversus AbdominisThe Transversus Abdominis (TA) is the deepest abdominal muscle. It is the "corset muscle" of the spine and pelvis. In the typical situation, TA contracts in anticipation of body motion to guard the spinal joints, ligaments, discs and nerves.
MultifidusMultifidus (MF) muscles are very short muscles running from the transverse processes (on the sides) of one vertebra up to the spinous process (the middle of the back) of the next vertebra upwards. Their primary function is back stability. They do not produce an extensive range of movement, but work to provide small, "fine-tuning" postural changes, all day long.
Pelvic Floor & DiaphragmThe TA and the MF work in conjunction with your pelvic floor and diaphragm to make a flexible but stable region around your lumbar spine. It is this ability to stabilise your lumbar spine in its many positions that enable you to overcome back problems and reduce your chances of a reoccurrence.
What Are The Ideal Core Exercises?Your deep core stability muscles retraining uses specific low-level activation exercises. While a very skilled physiotherapist who has training in deep core activation can observe and palpate for the correct muscle contraction, the best way is to see them working on a real-time ultrasound scan. Real-Time Ultrasound Physiotherapy guidance allows you to see how your muscles are contracting in real-time. This visual feedback will enable you to correct your specific deep core muscles inside your stomach, lower back, and pelvic floor as you attempt to contract those muscles.
Beware of "Core Stability" Exercises!The fitness industry is full of fitness instructors who profess to know how to activate your core stability muscles. Unfortunately, the wrong core exercises will do you harm. Most progress your core exercises far too quickly and bypass these critical muscles to strengthen your outer abdominal muscles further and leave your deep core muscles weak. Research evidence has found that this renders you vulnerable to lower back pain and injury.
How Good is Your Core Stability?Research clearly shows that core stability retraining has short and long-term benefits for low back pain sufferers. The good news is that we also know that core stability training markedly reduces your chances of re-injury. Research on lower back pain sufferers has shown us that if you can re-activate your core stability muscles, your chance of recurring back pain reduces. Your chances of not experiencing another bout of low back pain (LBP) within twelve months are almost three times better if you have undertaken an ultrasound-guided exercise program; 84% vs 30%. After three years, you still have a two in three chance of not experiencing low back pain if you did the exercises. Adding even more research support, if you didn't do the exercises, you only have a one in four chance of being pain-free. You're still over twice as likely to not experience another episode of back pain. Hides et al. (2001). PhysioWorks physiotherapists have professional knowledge in the training of core stability muscles. The difficulty has always been how to quantify a patient's level of stability control. That is, until now. The solution has been to develop a useful and clinically practical method of assessing your level of core stability. We can then determine and at what level it fails to cope when the demands placed upon your body. That is, what is the individual client's functional Back Stability Score (BSS)?
How Do We Assess Your Core Stability?Your PhysioWorks physiotherapist will assess you to determine your current symptoms, pathology and functional requirement. Then, they'll physically test you to decide on your back stability based your ability to activate your core control muscles (transversus abdominis, multifidus and gluteals). If you can isolate these muscles, we are then able to test further when your core stability muscles lose control of your spine, become inhibited or fatigue. This testing assists us in determining what tasks make you vulnerable to back pain or injury.
What Happens After Your Core Stability Score is Determined?Based on your functional needs, your treatment directs towards your specific areas of weakness. The result is a much stronger, stable and pain-free back. If you would like to know your Back Stability Score, please contact PhysioWorks.
What are the Benefits of the Functional Back Stability Score?
For Patients
- You have a quantitative guide to your functional goals
- You have a current status score. Progress is measurable.
- You can progress quickly through the BSS levels to maintain motivation and self-esteem
- Individualised treatment. Different retraining options depending upon desired outcomes.
- You can self manage in long-term
- Your goals are functional (task-related) rather than merely a strength score.
- Quantitative Feedback for You, Your Health Practitioners and Insurers.
- Achieve stepped goals and sensible, steady exercise and treatment progressions.
- We'll educate you on how to prevent future injuries.
- You'll be introduced to ergonomics and understand the best postures for you
- You will prevent future bouts or at least minimise their severity
- It's a research-backed solution.
- It's perfect for all ages and physical ability.
- There is a clear path for progression.
- You perform your exercises in the comfort of your own home without expensive gym equipment or membership
- You'll have personalised professional guidance for assessment, reassessments and progressions.
- You'll be pain-free ASAP
For Clinicians & Insurers
- It's a precise measure of your functional capacity
- It allows better judgments on patient directions, e.g. returns to work
- It offers better-individualised advice and treatment
- It reduces jargon through measurable standardisation
- It's a practical measure that can be related to other outcome measures such as Oswestry Disability Score
- There is a clinically relevant correlation between subjective and objective findings
- It reduces malingering.
What Conditions Does the Back Stability Program Improve?
- Spinal Pain
- Spinal Posture
- Pelvic floor function
- Sciatica
- Spondylolisthesis
- Spondylosis
- Degenerative Disc Disease
- Poor Balance or Fall History
What Causes Back Pain?
Back pain is often the result of having weak stabilising muscles supporting your joints. Without strong support, your joints simply collapse. Your bony skeletons don't stand up by themselves. The bones are held upright by efficient, supportive muscles that work across every joint in your body.
Research has shown us that pain causes these supportive muscles (known as your "stabilisers" or "inner core stability" muscles) to stop working. Research on sufferers of lower back pain has found that these muscles stop working every time you experience back pain.
Even worse, in most cases, these muscles don't automatically start working again when your pain goes. They need to be deliberately re-started by your brain.
How Can You Reactivate Your Core Stability Muscles?
There are several ways to reactivate your core stability muscles. One of the most effective is to use a Swiss Exercise Ball. Usually, some simple Exercise Ball exercises can often automatically 'kick start' these stabilising muscles.
Your physiotherapist is an expert at the reactivation techniques of these stabilising muscles. For more advice, please contact your physiotherapist. Alternatively, you can download or eBook on Back Pain Rehabilitation using a Swiss Exercise Ball.
How Does a Swiss Exercise Ball Eliminate Pain?
Your Exercise Ball is an unstable surface. When you sit or exercise upon one of these balls, your body will automatically recruit your natural balance reactions. One of the critical most components of your balance reaction system is the activation of your stabilising muscles. With repeated use over just a few days, your stabilising muscles will automatically start working again in most cases.
Researchers have discovered that by merely activating the inner core stability muscles, you have two to three times less likelihood of recurring lower back pain.
What Can You Do?
If you want to fix your back pain, you can do something. The Exercise Ball could be just the solution you need to avoid future bouts of lower back pain.
Back, Braces & Supports, Pillows/Cushions, Posture
AllCare Deluxe Back Cushion
Back, Braces & Supports, Posture
Mueller Green Adjustable Back & Abdominal Support
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Maternity Back Support – OPP2062$60.00 – $64.00
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Maternity Support Belt – OPP4062$39.60
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Exercise Ball – 550kg Antiburst$30.00 – $48.00
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Flexall 454$24.00 – $47.00
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Core Stability Support – OPP3462$54.00
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Polar Frost – Pain Relieving Cold Gel$12.00 – $36.00
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Lockeroom Posture Pro$39.00


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Garage banned? Nope, big hole can't stop tiny venue
10 comments
Good news - love this space and so glad they will rebuild.
Tom Daly's picture is outstanding !
Old People and car keys. Never a good mix.
Grandma has to be the opener for the headliner.
Looks like she already opened to me.
Not only did she put it in drive instead of reverse, but she apparently also slammed down the accelerator. Thank goodness no one was hurt.
This situation doesn't make sense to me. The driver at fault must have--as @Lost In Space said--been accelerating rather quickly into what she thought was reverse. But more than that, she also proceeded to keep driving after she went over the concrete parking bumper (which would signal most drivers that something was not right). It sounds very reckless and like something else was a factor here. I hope she is paying to rebuild the wall.
they should keep the hole. they've doubled their audience capacity and now they can make money on the side.
People can be very upset and drive badly when leaving funeral homes.(a funeral home operates the parking lot)
Hooray for the church that will keep this great little venue going! If it weren't for several churches in town (Westminster, TJ Unitarian, etc.), some of our best venues would never have existed (The Prism, The Haven, etc).


text:
Did Kindle Gift Cards Outsell iTunes Gift Cards This Holiday?
It's possible Kindle gift cards outperformed iTunes gift cards this holiday — if what people were searching for online is any indication.
According to Experian Hitwise, the top search query the week before Christmas that included some variation of the term "gift card" was for "kindle gift card." Apple's iTunes gift card was not even close, ranking as the eighth most searched-for term. In between were several more generic combinations, including American Express or Visa, or terms like "cheap gift cards."
This holiday season, spending on gift cards was expected to hit $27.8 billion, a four-year high, according to a survey conducted by the National Retail Federation.
The plastic versions of cash were the most requested items on people's wish lists for the fifth year in a row. What was unusual was the increased number of shoppers who were willing to give them, shedding concerns about looking impersonal or lazy.
The average shopper was expected to spend $155.43 on gift cards, the highest amount since 2007.
Experian theorized that the Kindle gift card, in particular, was searched for so heavily because it made a practical companion gift to the record number of e-readers being purchased. It also said that the increase in gift card purchases drove higher traffic to retailers' Web sites on Christmas Day, with visits up 31 percent year over year.
But what if you got a gift card you don't want, or one for a restaurant or theater that doesn't exist in your hometown?
There's a secondary market for that.
Companies such as PlasticJungle.com, GiftCardRescue.com and CardPool.com will give you up to 90 percent of the voucher's value — depending on the demand for the card. Likewise, you can also purchase gift cards for below face value on these sites.
Even better, if you didn't get a Kindle gift card but wanted one, PlasticJungle and GiftCardRescue both have partnerships with Amazon that will give you an extra 5 percent on the value of the unwanted card if you swap it for an Amazon gift card instead of cash.
Whatever you do, experts suggest you don't put the cards in a drawer and forget about them. The best deals are being offered now, so spend them.


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The return of Chris Leben at UFC 155 this weekend seems like as good a reason as any to reflect on the nature of sin and forgiveness in the world's biggest mixed martial arts promotion. Because Leben? Oh yes, he hath sinned. Several times, in fact.
Each time he is forgiven, washed clean by the passage of time and the loss of money and/or career opportunities, then eagerly welcomed back into the fold once his penance is complete. His crimes aren't forgotten, exactly, but neither are they used against him. He's been bad and he knows it. He's suffered just enough to deter him from repeating the same mistake. Maybe. Hopefully. We'll see.
It seems fairly obvious that if Leben were almost anyone else, he'd have been fired by now. If he acted like Leben outside the cage but fought like just another wall-and-stall point fighter inside it, the DUIs and the failed drug tests would have gotten him bounced out of the UFC a long time ago.
The good (and the bad) news is that he's never been a part-time Leben. He's an all-in kind of dude, fighting with a reckless disregard for health and safety that seems like it can't help but bleed into his personal life. He wades into punches like a man who is incapable of considering how he's going to feel in the morning. Should we be surprised that he sometimes takes the same approach to drugs and alcohol?
When I spoke to Leben for an article that's forthcoming in the UFC 155 pullout section in USA TODAY this week, he said he knew when he popped those oxycontin before his fight with Mark Munoz last November that he was probably dooming himself to a failed drug test. He understood that he was screwing up before he did it – even while he was doing it – and then he did it anyway. As he put it, "I was sick."
Or, to put it another way, he was an addict. He was using prescription painkillers "for physical and emotional pain," he said. He could tell how well things were going in his personal life by how many pills he was popping. Right around the time of the Munoz fight, things were not so great.
It's a good thing the UFC didn't cut him then. If he'd lost his job after all that, who knows what kind of spiral of despair Leben may have fallen into. Instead, according to Leben, the UFC paid to send him to a 30-day in-patient treatment program right after it suspended him for a year. He's been doing outpatient treatment ever since, he said, and he at least appears to have a better handle on the pattern of abuse and self-destruction that's been knocking him around like a tennis ball in the spin cycle for most of his career. For the moment, anyway.
But the thing is, now he has to find a way to be a part-time Leben. He has to keep being that reckless guy in the cage, but without being the same way outside of it, which might be tougher than any of us realize. It might even be tougher than Leben realizes, because to fight the way he does you have to be willing to walk hand-in-hand with disaster. You have to risk defeat, unconsciousness, total physical and emotional destruction – all of that. Then, once it's over, you have to find a way to deal with the ensuing depression without the comfort of pills and booze. Leben just wouldn't be Leben if he played it safe in his fights. And if he wasn't Leben in his fights, no way would the UFC have tolerated all this Leben-ness between them.
That's a tough spot to be in, though at least Leben seems to appreciate it for what it is. When he first started fighting, he said, it was with a lot of anger. He wanted to prove he was "worth something," since the default assumption in his life up to that point had always leaned the other direction. It's not an uncommon story in this sport. Not surprisingly, a lot of people who choose to beat people up for a living have come from some pretty dark emotional places to get here. As Leben likes to say, "Fighters are like strippers: we're not working our way through college."
Most haven't struggled with substance abuse the way Leben has. Then again, very few fight the way he does, with that raw, wide-open aggression, gobbling up pain as if it only gives him more ammunition to fire back at the man who gave it to him. He sins big, but he also atones big. His mistakes are rarely malicious ones. It's just that he's sometimes a little too Leben for his own good, which is what makes him so fun to watch. It's what makes him special. It's also, at least in part, what convinces the UFC that he's worth all the trouble.
Finding a way to keep one Leben and get rid of the other isn't going to be easy, but it's probably not supposed to be. It is, however, completely necessary. At 32, even the best-case scenario would only allow him to keep making a living as a fighter for the next, what, seven or eight years? It's the other Leben – the one who exists outside the cage – that he'll have to live with for the rest of his life.
For more on UFC 155, stay tuned to the UFC Rumors section of the site.


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- Description
* Contemporary sectional sofa by VIG Furniture.
* Brown color.
* Leather/Leather Match Upholstery.
* Sturdy construction.
* "U" shape sectional sofa.
* Low profile and stitched cushions.
* Two decorative lights.
* Side drawer and a shelf.Dimensions & Weight
Item Dimensions Sectional W85" x D39" x H37" Sofa Left Arm Facing W84.5" x D44" x H37" Corner W51" x D51" x H37" 2 Seat Armless W54" x D44" x H37" Chaise Right Arm Facing W62" x D44" x H37"
- Additional Information
Additional Information
Color No Ship Time 5 - 10 Business days Items Included 4 PC Sectional Sofa SKU # No Manufacturer No
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